mod 5 Flashcards
hardening of large and medium arteries
atherosclerosis
hardening of small arteries
arteriolosclerosis
hardening of any artery
arteriosclerosis
inflammation of any artery
arteritis
a progressive chronic inflammation of arteries are characterized by:
1.Inflammation (Macrophages engulf LDLs > Foam Cells
2. Fibrosis( Conn. tissue/Collagen/Elastin
3.Liquid deposition(Cholesterol esters & cholesterol in cells
Etiology of Atherosclerosis
-BEGINS with Endothelial Injury
-Big Inflammatory Component
-Risk Factors:
Non-Modifiable
Age (40-60), Male, FamHx, Indigenous
Modifiable
cholesterol, HTN, Smoking, Diabetes, Obesity, Metabolic Syndrome
Gruel/Porridge (ie. The fat in the blood)
Athero
Hardening
Sclerosis
Proliferation & Fibrosis
Conversion of Fatty Streak into a Mature Atheroma
Complicated plaque formation
Thin Fibrous Cap > Rupture > Thrombus > ACS
a.Heart > IHD (Angina, MI).
b.Brain > Cerebral Infarction (Stroke)
c.Kidneys > Renal Infarction
d.GIT > GI-Ischemia/Infarction
e.Lower Extremities > PVD (Eg. Claudication, Gangrene of Legs, Arterial Leg Ulcers)
Multi-Organ Disease:
Characterized By Accumulation
1.Lipids
2.Fibrous Elements
3.Local Inflammatory Response (Macrophages engulf LDLs > “Foam Cells”)
-Cause of 90% Myocardial Ischemia, Due to Occlusion of Coronary Circulation
-Cause ≈50% of deaths in Western Society.
Principal cause of Heart Disease & Stroke
3 Types of Lipids in Plasma:
1.Cholesterol + Ch. Esters
2.Phospholipids
3.Triglycerides (Fatty Acids + Glycerol)
-Insoluble In Water > Must be Packaged to be suspended in plasma.
Lipid Transport:
attribute to atherosclerosis
LDLs
help prevent atherosclerosis
HDLs
Vessel Injury – Endothelial Damage:
a. Risk Factors:
i.High Cholesterol
ii.Hypertension
iii.Smoking
iv.Toxins/Poisons
v.Virus
vi.Bacteria
vii.Immune Reaction
viii.Diabetes
a. fat deposition under the tunica-intima vessel-layer.
b. the typical early atherosclerotic lesion.
i. majority are clinically silent
ii. are reversible – eg. if diet changes
c. yellow color reflects:
i. oxidized lipids
ii. presence of ‘foam cells
Fatty Streak Formation
a. fatty streak gets more profound
b. foam cells unable to digest lipid contents → die
c. oxidized ldls – attract immune cells, cytokines, platelets, smooth muscle, connective tissue
Lipid Plaque
fat deposition under the
tunica-intima vessel-layer
the typical early atherosclerotic lesion.
i. majority are clinically silent
ii. are reversible – eg. if diet changes
yellow color Fatty Streak Formation reflects
i. oxidized lipids
ii. presence of ‘foam cells
a. fatty streak gets more profound
b. foam cells unable to digest lipid contents → die
c. oxidized ldls – attract immune cells, cytokines, platelets, smooth muscle, connective tissue
Lipid Plaque:
-Consistent Systolic of +130mmHg.
AND/OR
-Consistent Diastolic of +80mmHg
HYPERTENSION
Primary “Essential” Idiopathic Hypertension
95%
Idiopathic ʹ Likely multifactorial
not curable
▪Genetics/Family Hx
▪High Cholesterol/Salt Diet
▪Diabetes/Obesity
▪Smoking/Alcohol
▪Stress
▪Age
risk factors of HTN
Isolated Diastolic HTN
typically in older men
Due to Overactive Sympathetic NS > inc CO
Isolated Systolic HTN - in young adults
Due to dec Arterial Compliance- Calcification/Fibrosis
Isolated Systolic HTN - in older adults
-rapid inc in BP (>200/120mmhg) sufficient to cause vascular damage
Malignant Hypertension
Rupture of Artery/Arterioles in brain
Intracerebral Hemorrhage
hardening of kidney blood vessels) > Renal Failure
Nephrosclerosis
a “flow” limitation, typically due to coronary artery stenosis (narrowing)
ischemia
an oxygen limitation, typically due to high-altitude/respiratory insufficiency/etc.
hypoxia
- irreversible cell-death, typically due to sustained ischemia.
infarction
Regional Ischemia
local
Global Ischemia
entire heart
-Initially Subendocardial Ischemia /Infarction (ST-Depression & T-Wave Inversion)
-Progresses to Transmural͛-Ischemia/Infarction (ST-Elevation & Pathological Q-Waves)
myocardial ischemia
Metabolic Changes - (Aerobic → Anaerobic)
Inc. Lactate, (Anaerobic Metabolism) dec. pH
-Decreased Myocardial Perfusion (relative to demand) due to Coronary Insufficiency.
Angina pectoris
- Stable Atherosclerotic Coronary Obstruction (No Plaque Disruption)
-Presentation: Chest Pain on Physical Exertion, which fades quickly with Rest (minutes)
Stable Angina
-Due to: Coronary Vasospasm (May not be Atheroma).
-Presentation: Angina Unrelated to Activity (Ie. At Rest)
Variant/Prinzmetal Angina
-Unstable Atherosclerotic Plaque (+/- Plaque Disruption & Thrombus).
-Presentation: Prolonged Angina @ Rest (Either New Onset /inc Severity/inc Frequency).
-Red Flag that MI may be Imminent
Unstable Angina “Preinfarction Angina”
-Due to: Ischemia masked by neuropathy (eg. Diabetes/dec. B12/etc)
-Presentation: Painless, but may have Nausea, Vomiting, Diaphoresis + Abnormal ECG
silent ischemia
-Smoking
-Hypertension
-Hyperlipidaemia
-Diabetes
-Obesity
Prevention/Management of CV Risk Factors
Anti-Anginal Therapy
a.Nitrates (GTN)
b.B-Blockers (Metoprolol)
c.Ca-Channel Blockers
Antiplatelet Therapy
Aspirin / Clopidogrel
Lipid-Lowering Therapy
Atorvastatin/Simvastatin
Delayed Autoimmune Complication of a GROUP A BETA HEMOLYTIC STREPTOCOCCI Tonsillo - Pharyngitis.
Rheumatic Fever (RF
Acute Phase of Rheumatic Fever
Acute Rheumatic Fever / Carditis
Typically > Mitral Stenosis
Chronic Rheumatic Heart Disease (RHD)
Licks joints but bites heart! (Temporary Arthritis, but Permanent Valvular Damage)
Rheumatic Fever (RF)
Licks heart but bites joints! (Mild Myocarditis, but permanent Severe Arthritis
Rheumatoid Arthritis (RA)
Jones Criteria Rules - Must Have:
a.Evidence of Previous GABH-Strep (Strep. Pyogenes) Infection
b.(2x Major Criteria) OR (1 Major + 2 Minor)
(Evidence of Previous Strep Infection):
a.Anti-Streptolysin-O Titre
b.Anti-DNaseB Antibodies
c.Positive Throat Swab Culture
a.Joints (Migratory Polyarthritis ʹ Not necessarily arthralgia)
b.Carditis (Incl. Pericarditis - Friction Rub, Quiet Heart Sounds, Tachy)
c.Nodules (Subcutaneous, painless, on extensor surfaces)
d.Erythema Marginatum (Non-Pruritic, Tinea-like Rings on Trunk & Limbs)
Sydenham’s Chorea (Rapid, Involuntary Movements)
(Major Criteria) – the JONES Criteria
-(Fever)
-(Arthralgia)
-(Elevated ESR)
-(Prolonged PR-Segment)
(Minor Criteria)
also called a defect, refers to one or more problems with the heart structure that are present at birth.
CONGENITAL HEART DISEASE
where problems with the heart mean there isn’t enough oxygen present in the blood. Babies born with cyanotic heart disease generally have a blue-coloured tinge to areas such as their fingers, toes and lips because of a lack of oxygen. They may also experience symptoms of: breathlessness. chest pain.
Cyanotic
where the blood contains enough oxygen but it’s pumped abnormally around the body. Babies born with acyanotic heart disease may not have any apparent symptoms but, over time, the condition can cause health problems.
Acyanotic
yellow color reflects
i. oxidized lipids
ii. presence of ‘foam cells
Rupture of Artery/Arterioles in brain
Intracerebral Hemorrhage
hardening of kidney blood vessels
Nephrosclerosis