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SP15 Pathology > Exam 2; Arteriosclerosis and Hypertension > Flashcards

Exam 2; Arteriosclerosis and Hypertension Flashcards

1
Q

This is responsible for more morbidity and mortality than any other category of disease

A

vascular disease

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2
Q

What are the two principal mechanism of vascular disease

A

narrowing of obstruction of vascular lumina

weakening of vascular walls, leading to dilation and/or rupture

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3
Q

This is medial calcification without luminal narrowing or intimal disruption; clinically insignificant

A

Monkeberg’s; medial calcific sclerosis

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4
Q

This type of arteriolosclerosis is the thickening of the basement membrane involving the arterioles

A

hyaline arteriolosclerosis

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5
Q

This type of arteriolosclerosis is the fibrocellular intimal thickening malignant hypertension and scleroderma

A

hyperplastic (proliferative) arteriolosclerosis

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6
Q

atherosclerosis is associated with the formation of what and where

A

atherosclerotic plaques or atheroma in the large and medium arteries

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7
Q

True or False

atherosclerosis does not protrude int the lumen of the vessel

A

False; it does

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8
Q

Atheromas can obstruct this

A

blood flow

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9
Q

Atheroma can weaken what

A

the underlying media of the artery

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10
Q

Plaques can rupture and result in this

A

catastrophic vessel thrombosis

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11
Q

Where is the highest and lowest prevalence of atherosclerosis

A

Highest; US and Western Europe

Lowest; Africa and the Far East

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12
Q

When and what was the peak death rate from MI

A

54% in the late 1960’s

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13
Q

What is the current death rate from MI

A

about 50% for all atherosclerosis-related complications

25% due to MI

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14
Q

What are three non-modifiable risk factors for atherosclerosis

A

age
gender
genetics

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15
Q

What is it about age that makes someone more susceptible to atherosclerosis

A

risk of MI increases 5x in men between 40 and 60 years

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16
Q

Which gender has the highest risk of atherosclerosis

A

men > premenopausal women

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17
Q

This is the most important non-modifiable risk factor of atherosclerosis

A

genetics; family history of MI

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18
Q

What are four modifiable risk factors for atherosclerosis

A

cigarette smoking
diabetes
hypertension
hypercholesterolemia

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19
Q

1 pack smoker/day increased death rate by what

A

200%

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20
Q

True or False

There is no specific level of hypertension which identifies an increased risk

A

True

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21
Q

what components of hypercholesterolemia are associated with atherosclerosis

A 
low HDL (high HDL is inversely associated)
high LDL (especially above 160mg/dl)
22
Q

What are seven additional risk factors associated with atherosclerosis

A 
lack of exercise
obesity
type A personality (stress)
inflammation
c-reactive protein
lipoprotein A
hyperhomocysteinemia
23
Q

What are the seven steps of the atherosclerosis response-to-injury hypothesis

A

endothelial injury
accumulation of lipoproteins
monocyte adhesion
lipid accumulation
smooth muscle cell recruitment due to factors released
smooth muscle cell proliferation and ECM production
fully developed plaque

24
Q

This step of the atherosclerosis response-to-injury hypothesis results in endothelial dysfunction

A

endothelial injury

25
Q

Accumulation of lipoproteins in the atherosclerosis response-to-injury hypothesis results in what

A

LDL and cholesterol in the vessel wall

26
Q

What is meant by monocyte adhesion in the atherosclerosis response-to-injury hypothesis

A

migration into intima with differentiation into macrophages and “foam cells” aka macrophages that have ingested lipids

27
Q

There is lipid accumulation in the macrophages which leads to what involving the atherosclerosis response-to-injury hypothesis

A

the release of inflammatory cytokines

28
Q

What type of molecules recruit the smooth muscle cells in the atherosclerosis response-to-injury hypothesis

A

activated platelets
macrophages
vascular wall cells

29
Q

The fully developed plaque with the atherosclerosis response-to-injury hypothesis is composed of what

A

collagen and smooth muscle cells (myofibroblasts) form a fibrous cap and a central lipid/cellular debris core with cholesterol

30
Q

What are six common sites of atheroma problems

A 
major arterial branch points
abdominal aorta
coronary arteries
popliteal arteries
carotid arteries
cerebral arteries
31
Q

Plaques contain these five things

A 
collagen
lipid
myofibroblasts
macrophages
neovascularization
32
Q

What are six progressive changes to atherosclerotic plaques

A 
calcification
ulceration
fissure formation
thromobosis
embolization
hemorrhage into the plaque
medial weakenig
33
Q

This appears in most children, independent of geography, gender, race and environment occurring at sites both prone and not prone to develop atherosclerosis although some may progress into atheromas

A

fatty streaks

34
Q

What are five complications of atherosclerosis

A 
ischemic heart disease
cerebral infarct
gangrene
renal artery stenosis
aortic aneurysm
35
Q

What is the prevalence of hypertension in the US

A

25% of adults

36
Q

What is considered mild hypertension

A

140/90 to 159/104

37
Q

What is considered moderate to severe hypertension

A

160/106+

38
Q

What are five symptoms of hypertension

A 
none at the early/moderate stages
headache
fatigue
dizziness
palpitations
39
Q

Essential hypertension accounts for what percentage of patients with hypertension

A

90-95%

40
Q

What are six contributing factors to essential hypertension

A 
genetics
obesity
inactivity
stress
high salt intake
smoking
41
Q

What are the four pathogenesis of essential hypertension

A

heredity factors
reduced renal sodium excretion leading to an increased plasma volume leading to increased CO
increased peripheral vascular resistance
environmental factors

42
Q

What is compensated hypertensive heart disease

A

left ventricular concentric hypertrophy provides normal cardiac output

43
Q

What is decompensated hypertensive heart disease

A

hypertrophy is no longer adequate to provide normal cardiac output due to decreased myocardial contractility, resulting in LV dilation and gradual one of CHF

44
Q

Atherosclerosis caused by hypertension can lead to what

A

ischemic heart disease, stroke, and ischemic injury to other organs

45
Q

Arteriolosclerosis caused by hypertension can lead to what

A

retinal injury and kidney damage or nephrosclerosis (kidney failure)

46
Q

Hypertension can cause this of the aorta

A

dissecting hematoma (longitudinal tear)

47
Q

What is secondary hypertension

A

A disease that produced hypertension; hypertension is controlled when the underlying disease is treated

48
Q

What is concentric hypertrophy

A

thickening of the left ventricular wall at the expense of the left ventricular chamber with little or no increase in the outside cardiac dimensions

49
Q

What are two characteristics of malignant hypertension

A

relatively rapid onset

often superimposed on previous hypertension

50
Q

What are five complications of malignant hypertension

A 
cerebral edema
papilledema
encephalopathy
renal failure
cerebral hemorrhage
5+/- years to live

SP15 Pathology (17 decks)

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