Exam2, Blood vessels gomez Flashcards
1
Q
give examples of elastic arteries
A
large like aorta & large branches, pulmonary aa
2
Q
give examples of muscular aa
A
medium sized branches from aorta
3
Q
what are the vasa vasorum aa
A
feed medium and large arteries, found in the inter 1/2-2/3 media
4
Q
what layer of arterioles change the lumen diamter
A
medial smooth muscle
5
Q
what happens to resistance if you half the diameter in arteriole
A
resistance increases 16 fold
6
Q
what aa have greets regulation affect on blood pressure
A
small muscular aa- arterioles
7
Q
where dose leukocyte exudation and vascular leakage occur
A
in postcapillary venules
8
Q
describe size and cell lining of a capillary
A
diameter of a RBC 7-8 um endothelial cell lining without media, has pericytes around it
9
Q
describe the structure and function of lymphatics
A
endothelial, no media valves in larger lymph vessels return interstitial fluid and inflammarotyr cells to blood important pathway in disease dissemination
10
Q
Where are weibel palade bodies found and what are they
A
found in endothelial cells they are membrae bound storage organelles with vWF
11
Q
what are the 3 types of endothelial cells
A
fenestrated, discontinuous (sinusoidal) and continuous
12
Q
what factors are expressed on endothelial cells
A
vWF, FVIII, CD34 and CD31(PECAM-1)
13
Q
what are the anti-coagulant natural regulators
A
prostacyclin thrombomodulin heparin like molecules plasminogen activator
14
Q
what are the natura prothrombotic regulators
A
vWF tisue factor plasminogen activator inhibitor
15
Q
What are the ECM molecules that vasoconstrict and vasodilate
A
vasoconstrict: endothelin and ACE vasodilate: NO, prostacyclin
16
Q
What are the natura regulators of inflammation and immunity in endothlium
A
IL1 IL6 chemokines adhesion: VCAM-1, ICAM, E-selectin, P-selectin histocompatability Ag
17
Q
What molecules from endothelium stimulate growth? inhibit?
A
stimulators: PDGF, CSF, FGF inhibitors: heparin, TGF-beta
18
Q
what are arteriovenous fistulas
A
rar abnormal communications between aa and vv most are congenital
19
Q
What is fibromuscular dysplasia
A
focal irregular medial and intimal hyperplasia with thickening of walls of medium and large muscular aa most common in young women
20
Q
What is HTN in adults >60
A
> 150/90
21
Q
what are additional risks with HTN
A
coronary artery disease, cerebral vascular accidents, hypertensive heart disease aortic dissection, renal failure
22
Q
What are the major factors that determine BP
A
age gender, BMI and diet genetic variation in genes of RAAS that increase Na retention
23
Q
what is a hypertensive urgency
A
>220 / >120 with NO evidence of target organ damage
24
Q
what is accelerated HTN
A
hypertensive emergency of significan increase in BP with organ damage
25
What is malignant HTN
target organ damage with papilledema
26
What are renal causes of secondary HTN
acute glomerulonephritis chronic renal disease polycystic disease renal artery stenosis renal vasculitis renin-producing tumors
27
What are the endocrine causes of secondary HTN
adrenocortical hyper function (cushing, primary aldosteronism, licorice ingestion) exogenous hormones pheochromocytoma acromegaly hypothyroidism hyperthyroidism pregnangyc induced
28
what are the cardiovascular causes of secondary HTN
coarctation of aorta polyarteritis nodosa increased intravascular volume increased CO rigidity of the aorta
29
what are the neurologic causes of secondary HTN
psychogenic increased intracranial pressure sleep apnea acute stress, including surgery
30
how does licorice ingestion cause HTN
molecule is similar structure to cortisol and aldosterone
31
what occurs in RAAS system with 11B-hydroxylase deficiency
increase mineralocorticoids
32
What is liddle syndrome
moderately severe salt sensitive HTN due to increased distal tubular reabsorption of Na with aldosterone stimulation
33
what are the 3 patterns of arteriosclerosis
monckeberg medial calcific sclerosis arterolosclerosis atherosclerosis
34
what is monckeberg medial calcific sclerosis
in muscular aa \>50 y/o with no vessel umen narrowing
35
what is arterolosclerosis
in small arteries and arterioles
36
what is atherosclerosis
atheromas= atheromatous plaques develop in elastic aa and muscular aa
37
what systemid diseases is hyaline arterolosclerosis seen in
aging, DM, benign nephrosclerosis
38
what is hyperplastic arteriolosclerosis and what disease has this manifestation
cell death (onion skinning) sometimes necrotizing arteriolitis seen in malignant HTN
39
what type of flow dynamics are prone to atherosclerosis
turbulent flow and low shear stress
40
how does laminar flow protect you from atherosclerosis
induces endothelial genes for products that protect against atherosclerosis (superoxide dismutase)
41
what are the nonmodifiable risks for atherosclerosis
genetic abnormalities, family history, increasing age, male gender
42
what are the modifiable risks for atherosclerosis
hyperlipidemia hypertension cigarette smoking diabetes inflammation
43
If you have 3 of the risk factors for atherosclerosis what is your risk
ischemic heart disease
44
obesity increases risk for what syndromes
diabetes, HTN, hypertriglyceridemia
45
what metabolic syndromes are at increased risk from obesity
obesity, dyslipidemia, HTN, insulin resistance
46
What are the 2 major pathways for cholesterol metabolism
2/3 LDL receptor pathway 1/3 Scavenger R pathway
47
what apolipoproteins does LDL bind to
B-100 and E
48
cholesterol released from LDL suppresses cholesterol synthesis how
inhibits 2HMG coenzyme A reductase
activates cholesterol acyltransferase (storage of excess cholesterol)
down regulates synthesis of cell surface LDL R
49
oversupply of cholesterol inhibits what processes in the metabolism pathway
HMG CoA reductase
synthesis of LDL receptors
50
what decreases risk of hyperlipidemia
exercise and alcohol
increased HDL
51
what type of fats are okay
omega 3 beneficial
52
what are the effects of estrogen on HDL and LDL
increase HDL and LDL
however replacement therapy does not decrease risk of MI in post menopausal women
53
What causes familial hypercholesterolemia
mutations in LDL R gene
impair the intracell transport and catabolism of LDL
impair transport of IDL
cause elevated LDL cholesterol in the plasma
54
What is the scavenger R pathway for LDL
oxidized LDL R
found on macrophages, monocytes, smooth m and endothelial cells
55
amount catabolized by scavenger R pathway is directly related to what plasma level
cholesterol
56
how does oxidized cholesterol affect cells in body
in macrophages it contributes to atherosclerosis and xanthoma formation
endothelial and smooth muscle cells
57
What is the most common mutation in cholesterol metabolism
class II R protein transport from ER to golgi apparatus is impaired from abnormal protein folding
58
What are the genetics behind familial hypercholesterolemia
Autosomal dominant
heterozygotes 2-3x elevation of plasma cholesterol levels
homozygotes 5x elevation of plasma cholesterol levels
59
what are symptoms and signs of homozygous familial hypercholesterolemia
develop severe atherosclerosis, mitral valve stenosis, corneal arcus, xanthomas
60
elevated plasminogen activator inhibitor 1 is a strong predictor of what
major atherosclerotic events
sedentary life style
stress
61
what is the role of C reactive protein
roles in opsonizing bacteria and activating complement
62
how does CRP contribute to atherosclerosis
involved in endothelial adhesion of WBCs and thrombosis
63
what is elevated CRP a strong independent predictor for
risk of MI, stroke, PAD, and sudden cardiac death
64
will lowering of CRP reduce cardiovascular risk
no
65
what is the pathogensis of arterial wall changes in response to injury hypothesis
chronic endothelial injury
accumulation lipoproteins with subsequent oxidation
adhesion of monocytes with migration into intima
adhesion and activation of platelets
migration os smooth muscle cells becoming neointimal smooth muscle cells
accumulation of lipids in macrophages (foam cells) smooth muscle cells and extracellular spaces
66
what infections can lead to atherosclerosis
chlaymydia pneumonia, herpesvirus and cytomegalovirus
67
what cellular process leads to aneurysms and rupture
macrophage matix metalloproteinases and inflammation induced smooth muscle apoptosis
68
What is celebrex or celexoib and what does in inhibit
Cox inhibitor, preferentially Cox 2 so prostacyclin, leads to prothormbotic state because COX2 not inhibited
69
What are the most important causes of abdominal aortas
atherosclerosis (aortic)
HTN via medial cystic degeneration (thoracic)
70
What are some syndromes that are associated with AAA
marfan syndrome
loeys dietz syndrome
ehlers danlos syndrome
scurvy
trauma
congenital defects
syphilis and vasculitides
71
what are mycotic aneurysms caused by
septic embolus (infective endocarditis)
extension of an adjacent suppurative process
circulating organisms infecting the arterial wall
72
what are the types of true aneurysms
saccular aneurysm-apears rounded
fusiform aneurysm- involves long segment of artery and is not rounded
73
what is a pseudoaneurysm
false aneurysm
hematoma secondary to transmural rupture
74
what is the demographic distribution of AAA
M\>F
smokers and age\>50
75
What are inflammatory AAA
rich in lymphocytes, plasma cells and macrophages
often giant cells
cause uncertain
occur at younger age
76
What infects mycotic AAA
salmonella gastroenteritis
77
at what size are AAA surgically repaired
5 cm
78
what are they types of syphilitic (Luetic) aneurysms
obliterative endarteritis-- tertiarty stage syphilis with the arterioles of thoracic aorta
syphilitic aortitis-- obliterative endarteritis of vasa causing ischemic injury of media causing loss of the medial elastic fibers and muscle cells
79
how does syphilitic aortitis lead to aortic valve incompetence
can lead to aneurysmal dilation that can include aortic annulus
can involve coronary ostia
80
What is an aortic dissection
dissection of blood between planes of the media
81
What population are aortic dissections most common in
\>90% in men 40-60 with HTN
82
what procedure can cause iatrogenic aortic dissection
arterial cannulation
83
How do you Tx an aortic dissection
antiHTN therapy and aortic plication
84
what is characteristic symptoms onset of aortic dissection
sudden onset of excrutiatin pain, usually involves anterior chest, radiating to the back, and moving downard as the dissection progressesl
85
where do aortic dissections usually occur
within 10 cm aortic valve
86
what is the genetic basis of marfan syndrome
loss of function mutation of fibrillin
\>500 mutations of FBN1 gene for fibrillin 1
prevents normal assemly of microfibrils
87
what is the genetic inheritance of marfan syndrome usually
autosomal dominant. familial
88
why does loeys dietz syndrome have similar signs to marfan
because fibrillin decrease leads to increase TGF beta
Loeys Dietz syndrome involves mutations in TGF beta R
89
What are the skeletal manifestations of marfan syndrome
slender with abnormally long legs, arms and fingers. high arched palate, hyperextensibility of joints, spinal deformities
pectus excavatum or pigeon breast
90
what are they eye manifestations of marfan syndrome
bilateral dislocation of lens from wekaness suspensory ligaments
91
what are the CV manifestations of marfan syndrome
aneurysmal dilation and aortic dissection, dilation of the aortic valve ring (aortic incompetence)
mitral and tricuspid valve floppy calce syndrome giving rise to congestive cardiac failure
92
What does marfan look like on cross section of aortic media
areas devoid of elastin that resemble cystic spaces that are filled with proteoglycans
93
What are types of ANCA mediated vasculitis
wegener granulomatosis (PR3-ANCA/c-ANCA)
Microscopic polyangiitis/polyarteritis (MPO-ANCA/p-ANCA)
Churg-Strauss syndrome (MPO-ANCA/p-ANCA)
94
What are the direct Ab mediated vasculitis
Goodpastures syndrome (anti-glomerular basement membrane Ab)
Kawasaki disease (anti-endothelial Ab and also anti smooth muscle cell Ab)
95
What are the immune complex mediated causes of vasculitis
infection induced (Hep B or C)
Henoch-Schonlein purpura
SLE and RA
polyarteritis nodosa
Drug induced HS reactions
cryoglobulinemia
serum sickness
96
what are the nonspcific Sx with vasculitis
fever
weight loss
myalgia
arthralgia
malaise
fatigue
97
what are the types of large vessel vasculitis
giant cell (temporal ) arteritis: polymyalgia, usually patients older than 50
takayasus arteritis: grnaulomatous inflammation in patients younger than age 50
98
What are types of medium vessel vasculitis
polyarteritis nodosa: necrotizing inflammation typically involving renal aa but sparing pulmonary vessels
kawasaki disease: arteritis with mucocutaneous lymph nodes. occurs in children
99
what are types of small vessel vasculitis
wegener granulomatosis- PR3 ANCA
churg strauss syndrome- MPO ANCA, eos rich granulomatous inflammation
microscopic polyangiitis- MPO ANCA, necrotizing
