Lecture 13 (Quiz 3) Flashcards
What is normal blood pressure? Different in children? What is considered a Hypertensive Emergency/Crisis and is considered direct acute organ damage?
- Less than or equal to 120/80
- Lower in children
- > 180/110
What has no obvious cause, is very common (90-95% of all hypertensive patients), is caused by sodium retention and intravascular volume, the narrowing of arteries/arterioles (especially in the kidneys), high vascular resistance, which lowers the effective blood pressure in kidneys? What increases your odds of having this?
- Essential Hypertension
- Increasing age, Black, Family history, Obesity/Metabolic syndrome, High salt diet and Lack of physical activity.
What is uncommon (5-10% of all hypertensive patients), is caused by endocrine levels, drugs, pregnancy, renal failure, sleep apnea, and renal artery stenosis, and pain/stress cause a temporary increase in blood pressure?
- Secondary Hypertension
What are some problems that Hypertension can induce?
- Accelerated atherosclerosis
- Myocardial infarcts
- Stroke
- Peripheral vascular disease
- Aneurysms
- Heart failure
- Retinal and brain damage (hemorrhages)
Large myocytes nucleus and loss of myofibrils, Hyaline arteriolar, Fibrinoid necrosis, are all seen in what organ in patients with _________? Where is Arterionephrosclerosis seen? What happens in the brain in patients with hypertension and what ethnicity is this most predominantly seen in? What occurs in the eye?
- Heart
- Hypertension
- In Kidneys with hypertension **(Smaller kidneys and have a pitted surface. Is a common cause of renal failure, especially in black patients)
- Hemorrhage (escape of blood from a ruptured blood vessel) and is more common in Asians.
- Hypertensive Retinopathy
What is a risk factor for many atherosclerotic (The build-up of fats, cholesterol, and other substances in and on the artery walls) diseases? What is considered an elevated level of cholesterol and what is this called? What can these be attributed to?
- Hyperlipidemia
- Hypercholesterolemia (>200 mg/dL ~50% of US adults)
- Diabetes (esp. type 2), sedentary lifestyle, poor diet, obesity, heavy alcohol use.
There are 4 major lipoprotein classes, what are they and which are good for you?
- High Density Lipoprotein (HDL): Good for you, metabolized in the Liver. (Cholesteryl Ester)
- Low Density Cholesterol: Bad for you. (Cholesteryl Ester)
- Very Low Density: Bad for you. (Triglycerides)
- Chylomicrons: Bad for you. (Triglycerides)
What induces Atherosclerosis? How does this happen? This is an increase in ____ particles?
- Lipids
- Lipids leak into vessel intima,
induce macrophage response /
inflammation. Inflammatory response
induces smooth muscle cells in
intima, fibrosis, calcification. Atheroma (degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue) can rupture into
lumen, cause Thrombus (a blood clot that forms in a vessel and remains there). - Apo-B particles
What are the goal levels for total cholesterol, LDL, and HDL?
- Cholesterol: > or equal to 40 md/dL in men, > or equal to 50 mg/dL in women.
What causes 80% of heart disease cases? It is also the main cause for what other two problems? How many deaths does Atherosclerosis account for? What is the number 1 cause of death?
- Atherosclerosis (The build-up of fats, cholesterol, and other substances in and on the artery walls.)
- Strokes and Peripheral Vascular Disease
- 30% of all deaths
- Heart Disease
What is the hardening of the arteries? What are lipid deposits / plaques (called atheromas) in arteries and is the Most common kind of Arteriosclerosis?
- Arteriosclerosis
- Atherosclerosis
Atherosclerosis begins with Endothelial Dysfunction which leads to Lipid Deposits that causes Inflammation of macrophages which leads to either smooth muscle fibrosis or plaque ulcers/ruptures, what are the names for these two endings?
- Fibroatheroma with Stenosis (Fibrosis of smooth muscle that causes Angina)
- Thrombosis (Rupture or ulcerated plaques that causes Infarcts [dead tissue resulting from failure of blood supply], and possibly sudden death)
How much Stenosis (A narrowing of the open spaces) is required to clinically impede flow? What can a Slow Stenosis cause? What can an Abrupt Stenosis/Occlusion cause?
- 75% Stenosis (causes 16X increase in resistance).
- Slow Stenosis: Stable Angina (A type of chest pain caused by reduced blood flow to the heart)
- Abrupt Stenosis/Occlusion: Thrombus (clot that stays still) or Embolus (clot that moves), and can often cause an Infarct or Sudden Death.
Where does Arteriosclerosis usually occur and what are the consequences for these areas? (6)
(AAA, Heart disease, Diabetes, Hyaline and Proliferative, Fatty Streaks)
- Aorta Arteriosclerosis: Is never occluded (too much flow), but damage can cause an Abdominal Aortic Aneurysm (AAA: Enlargement due to weakening of the wall, usually caused by smoking).
- Coronary Artery Atherosclerosis: Causes ~80% of heart disease. Stenotic (narrowing of blood vessels): Cause angina. Lesions: Cause thrombosis and occlusion.
- Peripheral Arteries: Usually caused by diabetes, causes claudication (ache, pain, fatigue), ulcers and gangrene. Often also have Cardiac Artery Disease.
- Carotid/Circle of Willis: Is closely associated with hypertension.
- Kidneys: Is known as Hyaline arteriolosclerosis (Hyaline in the arterioles), and Proliferative Arteriolosclerosis (Fibrinoid necrosis or “onion skin” proliferative change and are concentric layers of smooth muscle in the intima).
- Lungs: Fatty streaks that are asymptomatic, but can cause pulmonary artery thickening and fibrosis.
What is an abrupt onset of focal or global neurological symptoms caused by ischemia or hemorrhage, where symptoms must continue for >24 hours and is usually associated with permanent damage to brain tissue? It symptoms resolve within 24 hours what is it called? What is the most common stroke subtype?
- Stroke
- Transient Ischemic Attack
- Cerebral Infarct (60-80%)
