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PathoPhys > Lecture 7 - Vascular disease & Atherosclerosis > Flashcards

Lecture 7 - Vascular disease & Atherosclerosis Flashcards

1
Q

What is the leading cause of death and disability in the world?

A

Cardiovascular disease

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2
Q

One person dies to CVD every __ minutes?

A

12

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3
Q 
Which of these are not risk factors for CVD?
Hypothyroidism
Alcohol consumption
Glucose intolerance/resistance
Gender
A

Hypothyroidism

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4
Q

Is vascular disease present in all forms of CVD?

A

Yes

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5
Q

What is the earliest detectable risk factor for CVD?

A

Vascular disease

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6
Q

How can vascular disease be caused?

A

Damage, blockage or rupture of the vessel

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7
Q

Layers of Tunica Intima from superficial to deep. (blood vessel)

A

Internal elastic membrane
Lamina propria
Basement membrane
Endothelium

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8
Q

Layers of Tunica media from superficial to deep. (blood vessel)

A

External elastic membrane

Smooth muscle

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9
Q

Layers of Tunica externa from superficial to deep. (blood vessel)

A

Its literally just tunica adventitia

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10
Q

Examples of elastic arteries?

A

Aorta, major vessels

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11
Q

Which arteries/arterioles are considered pressure reservoirs?

A

Elastic arteries

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12
Q

Which arteries/arterioles expand and recoil?

A

Elastic arteries

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13
Q

Which arteries/arterioles are ‘conducting arteries’?

A

Elastic arteries

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14
Q

How many layers of muscle in muscular arteries?

A

25+ layers

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15
Q

Which arteries/arterioles are considered ‘distributing arteries’?

A

Muscular arteries

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16
Q

Which arteries/arterioles are capable of vasoconstriction/vasodilation?

A

Muscular arteries

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17
Q

Which arteries/arterioles are considered to be terminal

A

Arterioles

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18
Q

All the layers in a vein from superficial to deep

A

Tunica adventitia
Tunica media
Tunica intima (Internal elastic membrane -> Basement membrane ->endothelium)

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19
Q

What is a characteristic unique to veins and not arteries?

A

Valves

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20
Q

How many times more complaint are veins to arteries?

A

24x

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21
Q

Which vessels are considered capacitance vessels?

A

Veins

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22
Q

All vessels including the heart are lined with a singular layer of _____?

A

Endothelial cells

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23
Q

What is normal vascular function maintained by? (Chemical)

A

Nitric Oxide

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24
Q

Nitric Oxide has a quick or slow half life?

A

Quick

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25
Q

Nitric Oxide:
Reactivity?
More important in signalling or receiving messages?
Vasodilator or vasoconstrictor?

A

Free radical
Signalling
Vasodilator

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26
Q

Nitric oxide is produced endogenously by ___

A

Nitric oxide synthase enzymes

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27
Q

Which vessels undergo the most significant change, due to age?

A

Large elastic arteries

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28
Q

Changes occurring to arteries due to age:

a. ) hypo or hypertrophy? where?
b. ) smooth muscle change?
c. ) elastic change?
d. ) softening or hardening - why?
e. ) Chemical deposits?

A

– Hypertrophy of the tunica intima and tunica media
– Increase in smooth muscle and elastic tissues
– Elastic tissue forms concentric layers in the tunica intima
– becomes less elastic
– Collagen fibres start to replace smooth muscle tissue
– stiffening walls of vessel
– Calcium deposits in the tunica media
– Reduction in vessel elasticity & hardening of the vessel walls

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29
Q

Vascular dysfunction causes: Reduction in bioavailability and or bioactivity of NO (3 examples)

A

Degradation in NO
Decrease in NO activity
Decrease availability of NOs substrates and co-factors

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30
Q

Causes of vascular dysfunction due to damage of endothelium

A

– Turbulent blood flow
– Increased blood pressure
– Lifestyle factors – smoking, alcohol, excessive fats &/or sugars
– Inflammation & infection

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31
Q

Causes of alteration in epithelium

A 
Inflammation
– Increased vaso-tone
– Increased thrombotic activity
– Reduced dilation
– Damaged endothelium
32
Q

What is an aneurysm?

A

Excessive localised swelling in the wall of an artery

33
Q

3 Consequences of vascular disease

A

Angina
Myocardial infarction
Heart failure

34
Q

Definition of hypertension

A

Hypertension or elevated blood pressure is a sustained increase in the pressure exerted on vessel walls during the heart’s normal contraction and relaxation

35
Q

What blood pressure would be considered hypertension?

A

> 140/90mmHg

36
Q

What is Essential hypertension?

A

No specific medical cause to explain hypertension (90% of cases)

37
Q

What is secondary hypertension?

A

Result from a specific underlying condition with a well-known mechanism

38
Q

What is malignant hypertension

A

extremely high and uncontrolled hypertension

39
Q

What is white-coat hypertension

A

Elevation in blood pressure due to seeing your GP

40
Q

5 Causes of hypertension

A
  1. Single gene mutations – altered renal salt handling
  2. Autonomic nervous system – effect pressure, volume and chemoreceptor signals
  3. Renin-angiotensin-aldosterone system – Ang II, ADH and Aldosterone production which can affect Na+ & water reabsorption/secretion
  4. Vascular dysfunction – reduction in NO, thickening of vessel wall & impaired vessel response
  5. Lifestyle factors – overweight, excessive alcohol consumption, elevated glucose levels, high potassium and/or calcium levels
41
Q

Symptoms of hypertension?

A

Very few symptoms, if pressure is very high headache and vision problems may occur

42
Q

What long term damage and complications can occur due to hypertension?

A

– Increased work load on heart can lead to hypertrophy & heart failure
– Increase in blood flow & pressure can damage walls of vessels, leading to thrombus formation and/or ruptured vessel walls
– Increased blood flow to kidney affects workload & volume control

43
Q

What are lifestyle treatments to hypertension?

A

Reducing weight, improving diet, increasing physical activity, quitting smoking

44
Q

What are the categories of drug therapies for hypertension and what do they do?

A
  1. ACE inhibitors – prevent conversion of Ang I to Ang II
  2. Ang II receptor blockers – block the actions of Ang II
  3. Ca+2 channel blockers – block intracellular Ca+2 concentration increases
  4. Beta blockers – block stimulation of adrenergic receptors responsible for cardiac activity
  5. Diuretics – promote water loss
45
Q

What are peripheral vascular diseases?

A

Circulation disorders that affect vessels outside the heart or brain.

46
Q

Cause of peripheral vascular disease

A

Arteries or veins narrowing, blocking or spasming

47
Q

What is claudication?

A

Pain in the body, most commonly the legs due to lack f blood supply, typically indicative of peripheral vascular disease.

48
Q

What is the most common form of peripheral vascular disease?

A

Peripheral artery disease

49
Q

Symptoms of peripheral vascular disease?

A
  • Legs cramps and/or pain - exercise
  • Numbness, tingling, coldness and/or ”pins & needles” – at rest
  • Cuts or sores on lower legs or feet that don’t heal
  • Necrosis of tissue
50
Q

If peripheral vascular disease is left untreated, what can occur?

A

If left untreated, the damaged & hardened vessel wall can lead to a build
up of plaque and narrowing/complete occlusion of vessels

51
Q

How is peripheral vascular disease diagnosed?

A

Diagnosis by ankle-brachial index = compares BP in your arm to the BP in your ankle

52
Q

Treatment to peripheral vascular disease?

A

Lifestyle stuff: the classics, ya know, quit smoking, lose weight
Drug Therapy: BP drugs, Antiplatelet drugs, other blood thinners, monitor diabetes and/or cholesterol drug treatments
Serious case: balloon angioplasty, arterial bypass

53
Q

What is arteriosclerosis?

A

Degenerative thickening of the arteries, making them less elastic

54
Q

What is atherosclerosis?

A

Deposition of material in the vessel wall leading to plaque formation

55
Q

Accumulation of lipid in the intima of the blood vessel =

56
Q

What does the formation of an atheroma in the bv lead to?

A

Formation of a plaque

57
Q

What is a plaque comprised of?

A

Lesion comprised of lipid, connective and fibrotic tissue and cells including inflammatory cells.

58
Q

What is the oxidative modification hypothesis?

A

The current oxidative modification or stress hypothesis of atherosclerosis predicts that LDL oxidation is an early, essential event in atherosclerosis and that Ox-LDL does contribute to both initiation and progression of atherosclerosis.

59
Q

Progression of atherosclerosis? (6 steps)

A

Fatty Streak-> Foam cells -> Intermediate Lesion -> Atheroma -> Fibrous plaque -> Complicated lesion or rupture

60
Q

In which layer of a blood vessel does atherosclerosis occur?

A

Deep to endothelial cells

61
Q

A CANTOS study on atherosclerosis being an inflammatory disease showed selective targeting of inflammation through inhibition of ___ improves cardiovascular outcomes

62
Q

What two tests can be used to determine presence of atherosclerosis in blood vessels?

A

Ultrasound and angiography

63
Q

Treatments of atherosclerosis?

A

– Angioplasty – insertion of a balloon to widen vessel walls
– Stents – plastic “vessel” to maintain vessel width
– Coronary artery bypass graft (CABG) – vessels are re-routed around the blockage
– Drugs to lower BP and cholesterol
– Nitroglycerin – dilates vessels
– Blood thinners, aspirin & anticoagulants

64
Q

What is unstable angina?

A

Chest pain due to poor blood flow and oxygen to the heart. Without treatment can lead to heart attack

65
Q

What causes angina?

A

Most cases = narrowing of the blood vessels supplying the heart

66
Q

Is angina a disease or symptom?

A

Symptom of underlying heart problem

67
Q

What is stable angina?

A

Pain in the chest due to increased workload of the heart. Usually disappears with rest (due to exercise)

68
Q

Wha is an acute myocardial infarction?

A

Occurs when blood flow stops to a part of the heart and causes damage (infarction) o the heart muscle.

69
Q

Where do myocardial infarctions occur?

A

Coronary arteries?

70
Q

How are myocardial infarctions diagnosed?

A

ECG, Blood tests, chest X-rays, angiograms

71
Q

What is cerebrovascular disease?

A

Vascular disease involving vessels of the brain

72
Q

Difference between embolic stroke and thrombotic stroke? (Both types of ischaemic stroke)

A 
Embolic = Clot forms elsewhere and lodges in the brain vessels
Thrombotic = Clot forms in vessel within brain.
73
Q

Difference between ischaemic stroke and haemorrhagic stroke?

A 
Ischaemic = blockage in vessel
Haemorrhagic = rupture of blood vessel or brain membrane
74
Q

Causes of cerebrovascular disease

A

Ischaemic stroke caused by plaque build-up in vessel, narrowing or occluding the vessel and preventing blood flow. Plaque may rupture elsewhere and travel to brain. Haemorrhage stroke caused by high BP, weakening vessel wall -> rupture. Dementia and alzheirmers caused by protein build up in walls.

75
Q

Symptoms of cardiovascular disease

A
  • Difficulty walking
  • Dizziness
  • Loss of balance and coordination
  • Difficulty speaking or understanding basic questions
  • Numbness or paralysis in face, leg or arm – usually on one side of the body
  • Blurred or darkened vision
  • Sudden headache accompanied by nausea, vomiting or dizziness
76
Q

Diagnosis of cerebrovascular disease

A

– Blood tests – clotting time, sugar levels or infection
– Angiogram – contrast dye x-ray of blood vessels
– Carotid ultrasound – determine blood flow to the brain
– CT scan or MRI
– Echocardiagram or electrocardiogram – imaging of heart and electrical signals of heart

77
Q

Treatment of cerebrovascular disease

A

– Ischaemic stroke – remove the blockage via drugs or surgery
– Hemorrhagic stroke – drug to lower BP and possible surgery to repair the vessel

PathoPhys (25 decks)

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