Exam 5 Mon 4.18 Heart patho PP Flashcards
Info about True and false aneurysms
- Local dilation or outpouching of a vessel wall or cardiac chamber
- True aneurysms – all 3 layers of the arterial wall, weakening of the vessel
- Fusiform aneurysms
- Circumferential aneurysms
- False aneurysms – extravascular hematoma
- accular aneurysms
- Aorta most susceptible, especially abdominal
Causes include atherosclerosis, hypertension
Can lead to aortic dissection or rupture
Cardiac aneurysm
- seen after MI, when noncontracting infarcted muscle is stretched
What is Aortic dissection?
– tear in the intima, blood enters wall of artery
Info about aortic aneurysms
- Aortic aneurysm may be asymptomatic until rupture, then severe pain
- Pain between shoulder blades or in abdomen, sometimes with hypotension – emergency
- May cause difficulty swallowing or dyspnea
- Aortic – ¾ of all aneurysms here
Very basic info about how aneurysms are diagnosed and treated
- All are confirmed with ultrasonography (think she is talking about aortic?)
- If slow-growing, may be treated conservatively
- Surgical resection and graft placement, or stent
Basic explanation of Atherosclerosis
- Form of arteriosclerosis
- Thickening and hardening caused by accumulation of lipid-laden macrophages in the arterial wall
- Plaque development through all body arterioles
How the endothelium sustains Injury and inflammation in Atherosclerosis
- Endothelial cells cannot make normal amounts of antithrombic and vasodilating cytokines
- Inflamed cells express adhesion molecules that bind macrophages and immune cells (TNF-α, interferons, interleukins, C-reactive protein), further injuring vessel wall
- Macrophage migration and adherence
- Low density lipoprotein (LDL) oxidation (foam cell formation – lipid-laden macrophages)
What’s the deal with fatty streaks and Atherosclerosis?
- accumulation of foam cells, which now recruit T cells and secrete toxic oxygen “free” radicals
- Now seeing fatty streaks in vessels of children
- Lipid-lowering treatments (diet, statin drugs) may reverse this process
What’s up with the Fibrous plaque in Atherosclerosis?
- macrophages also release growth factors that stimulate smooth muscle cell proliferation, produce collagen, and migrate over the fatty streak, forming a fibrous plaque
- •Fibrous plaque may calcify, protrude into vessel lumen, obstruct blood flow to distal tissues (especially during exercise)
- Angina (cardiac) or intermittent claudication (peripheral)
What is complicated plaque in the progression of Atherosclerosis
- unstable plaques may rupture without warning due to underlying inflammation, causes bleeding within the plaque (plaque hemorrhage) –
- Clotting cascade begins, forming a thrombus
- Antithrombotic medicines are used to treat/prevent thrombi
Risk factors for Atherosclerosis and what it can lead to
Risk factors include:
- hyperlipidemia/dyslipidemia
- diabetes
- smoking
- hypertension
Result in:
- inadequate perfusion
- ischemia
- necrosis – heart attack
- stroke
- peripheral vessel occlusion (wounds and amputations)
What are Arterial bruits?
auscultation of blood flow sounds
More detailed explanation:
Most commonly, a bruit is caused by abnormal narrowing of an artery. Listening for a bruit in the neck with a stethoscope is a simple way to screen for narrowing (stenosis) of the carotid artery, which can be a result of cholesterol plaque accumulation.
What is Coronary Artery Disease?
- Any vascular disorder that narrows or occludes the coronary arteries leading to myocardial ischemia
- Atherosclerosis is the most common cause
Major risk factors for Coronary Artery Disease (3)
- Increased age
- Family history
- Male gender or female gender post menopause
- These factors cannot be modified
Modifiable risk factors of Coronary Artery Disease (6)
- Dyslipidemia
- Hypertension
- Cigarette smoking
- Diabetes mellitus
- Obesity/sedentary lifestyle
- Atherogenic diet
Pathophysiology of Dyslipidemia
- Lipids, phospholipids, cholesterol, and triglycerides all bind to carrier proteins
- Lipids are needed for manufacture and repair of plasma membranes
- Cholesterol needed for manufacture of bile acids and steroid hormones
- Most body cells manufacture cholesterol
- Chemical reactions in the liver produce
- Very low density lipoproteins (VLDLs), triglyceride and protein
- Low density lipoproteins (LDLs), cholesterol and protein
- High density lipoproteins (HDLs), phospholipids and protein
Points that were highlighted in PP about EKGs and ischemia
- During ischemia, will see ST segment depression on EKG; stress testing done to provoke symptoms
- ST segment and T wave correlate with ventricular contraction and relaxation
- EKG can also identify the coronary artery involved, as each artery has a specific area of distribution
