Patho Exam 1 Flashcards
What are varicose veins?
They are veins in which the blood has pooled
What causes varicose veins to develop?
Trauma or gradual venous distension render the valves incompetent and decrease their capacity to push blood back toward the heart
What’s the difference between primary varicose veins and secondary varicose veins?
Primary varicose veins originate in superficial saphenous muscle while secondary varicose veins result from impaired blood flow in deep venous channels, such as DVTs
What is mycoardial ischemia?
When the coronary blood supply can’t meet the oxygen and nutrient demands of the myocardium
What are nonmodifiable risk factors for developing CAD? (2)
- age
2. fam history
What are modifiable risk factors for developing CAD? (7)
- dyslipidemia
- HTN
- smoking
- DM/insulin resistance
- obesity
- sedentary lifestyle
- atherogenic diet
What are nontraditional risk factors for developing CAD? (4)
- CRP - a serum marker for inflammation
- serum homocysteine - derived from the metab of an amino acid that is abundent in animal protein
- serum lipoprotein - similar in composition to LDL
- infectious agents
How does Nicotine increase risk for atherosclerosis? (4)
1) causes vasoconstriction
2) causes endothelial damage
3) causes an increase in LDL
4) causes a decrease in HDL
What comprise LDLs?
What role does LDL play?
LDLs are comprised of cholesterol and a carrier protein
LDLs deliver cholesterol to tissues
What comprise HDLs?
What role does HDL play?
HDLs are comprised of a phosholipid and a carrier protein
HDLs are responsible for reverse cholesterol transport – return excess cholesterol from tissues to the liver where it is eliminated as bile or converted into steroids.
What’s the relationship between HDLs and atherosclerosis
HDLs helps combat atherosclerosis by removing cholesterol from arterial walls
What is prinzmetal angina?
How does it present?
Why is it dangerous?
Prinzmetal angina is a kind of angina that causes unpredictable chest pain
It usually occurs at rest or with minimal exercise. It often occurs nocturnally.
It’s dangerous because it’s known cause serious arrythmias and ECG changes during episodes
What is the difference between MI and unstable angina?
During an MI, ischemia is severe enough to cause myocardial damage and tissue necrosis that results in the release of detectable levels of troponin and CKMB. In unstable angina, ischemia is transient enough that reperfusio occurs before tissue necrosis takes place. You therefore won’t see serum troponin and CKMB.
Describe the pathophysiology of what happens after an MI:
- -4 hours after?
- -12-24 hours after?
- -1-3 days after?
- -4-7 days after?
- -7-10 days after?
4 hours after infarct: myocytes without adequate blood supply arent able get rid of toxic waste. They become very leaky/self destruct. this causes release of enzymes like troponin
12-24 hours: neutrophils enter infarcted area and start clean up
1-3 days: LOTS of neuts lysing all the old myocytes
4-7 days: neuts die and macrophages come in to remove necrotic tissue and cellular debris. This is when the myocardial wall is weakest and at highest risk for rupture
7-10 days: small blood vessels start to grow into infarcted area, allowing for fibroblasts to lay down structural collagen proteins. We call this granulation tissue
1-1.5 months: collagen tissue is replaced by Type 1 collagen, which is noncontractile scar tissue
What is cardiac remodeling?
After an MI the myocardial wall changes in size, shape and thickness. Nonfunctioning muscle in infarcted area becomes thinner and dilated. The muscle around it becomes thicker as it compensates for the infarcted area.
What serum biomarkers do we see elevated after an MI? (3)
How long after an MI do we see each?
For how long does each remain elevated?
Troponin 1, Troponin T, and CKMB
Trop 1 and Trop 2 rise within 3 hours of onset and remain elevated for 7-10 days.
CKMB rise within 4-8 hours and decline to normal within 2-3 days
Which cardiac biomarker is more reliable in indicating an MI?
Troponins
What EKG changes are associated with myocardial ischemia? (3)
- ST segment depression
- T wave inversion
- ST segment elevation
What role does angiotensin II play systemically after a MI?
An MI triggers the SNS, which triggers the RAAS. The RAAS activates angiotensin II, which causes peripheral vasoconstriction and fluid retention. This increased peripheral vascular resistance and increased blood volume increases the workload of the heart and exacerbates the loss of myocardial contractility
What are the effects of angiotensin II locally on the myocardium during and immediately after a MI?
- -1 good thing
- -1 good and bad thing
- -1 bad thing
Good thing: it’s a growth factor for smooth muscle cells, myocytes, and fibroblasts
good and bad thing: promotes release of catecholamines (epi and norepi)
bad thing: causes coronary artery spasms
How is Ang II contribute to cardiac remodeling
–2 things
- it’s a growth factor for myocites, so contributes to hypertrophy of myocardium around infarcted area
- growth factor for fibroblasts, so contributes to development of noncontractile scar tissue
What is right sided HF
Manifestations of R sided heart failure:
- what’s the hallmark sign?
- blood might also back up into what important organ system?
Right sided HF is an inability of the heart to move deoxygenated blood coming in from systemic circulation into pulmonary circulation
RHF manifests as an accumulation of blood in systemic circulation,
- hallmark sign: peripheral edema
- may also see backup of blood into the hepatic veins, causing hepatomegaly and potentially RUQ pain.
What are 2 causes of R sided HF?
- left ventricular dysfunction
2. pulmonary HTN
What is cor pulmonale?
When R HF occurs in response to chronic pulmonary disease.
What is preload?
Preload is the volume of blood entering the heart and stretching the ventricles when theyre full at the end of diastole
What can increase preload? (2)
1) decreased contractility or 2) increased blood volume
What is systolic dysfunction?
Systolic dysfunction represents a decrease in myocardial contractility and an impaired ability to eject blood from the L vent
Define systolic HF in terms of EF
When you have an EF of less than 40%
Describe how the SNS responds to a decrease in CO associated with systolic HF
- -which hormones are involved? (2)
- -what are the effects? (4)
A decrease in CO triggers SNS response.
The SNS releases catecholamines like
1) epi and 2) norepi
Epi and norepi:
1) increase HR
2) increase contractility
3) increase vascular tone
4) trigger RAAS, which enhances renal Na and water retention
Describe how systolic HF triggers the RAAS (2 ways)
What effects does Ang II have during acute of systolic HF (2)
- epi and norepi trigger the RAS
- decreased blood flow to the kidneys triggers the release of renin from the kidneys, which starts the chain reaction and production of Ang II
Effects of Ang II:
1) Ang II causes retention of Na and H20, increasing blood volume and thus increasing preload
2) Ang II inhibits reuptake of norepi by SNS, further increasing its presence in circulation
Describe why you see higher levels of circulating aldosterone in patients with systolic HF
Aldosterone is typically broken down by the liver. If you have liver congestion from 2/2 systolic HF, then it may not be broken down properly.
What are ANP and BNP and when are they released?
ANP is a peptide released by the atria in response to stretch, so often in response to increased preload/fluid overload
BNP is a peptide released by the vents in response to increased pressure or fluid overload.
So you see higher levels of ANP and BNP in patients w heart failure as the chambers become distended with too much volume.
What are the systemic effects of BNP specifically?
What are the systemic effects of ANP and BNP?
BNP promotes rapid dieuresis by increasing glomerular filtration - helps to combat fluid overload
Both ANP and BNP inhibit the SNS and RAAS – so assist in reducing the workload on the heart and decreasing blood volume
What is angina pectoris?
Precordial or substernal chest pain that is caused when blood/oxygen supply to coronary arteries doesn’t meet the oxygen demands of the myocardium.
What commonly triggers angina pectoris? (3)
- Physical exertion
- cold
- emotional stress
What is acyanotic CHF?
An inability of the heart to supply body with blood borne nutrients despite adequate blood volume and normal or elevated myocardial contractility
What are common causes of acyanotic CHF? (4)
- anemia
- septicemia
- hyperthyroidism
- beri beri
What congenital chromosomal disorders are associated with acyanotic CHF? (3)
- trisomy 13
- trisomy 18
- trisomy 21 (down’s syndrome)
Tell me about the pathophysioogy of VSD
Ventricular septal defect is a congenital defect in which there is an opening between the R and L ventricles. Oxygenated blood in the high pressure left ventricle gets shunted into the low pressure R ventricle.
Is VSD usually symptomatic?
Nah.
Under what circumstances is VSD symptomatic?
How does this develop?
How does sympatomatic VSD present? (3)
VSD may become symptomatic in a very large L –> R shunt.
Typically develops a few weeks after birth when pulmonary vascular resistance starts to fall.
Presentation: tachypnea, diaphoresis (esp when eating), failure to thrive
What two factors can cause or contribute to HTN?
- increased cardiac output
2. increased systemic vascular resistance
Tell me about the pathophysiology of primary HTN
- -which hormonal systems are involved? (2)
- -what are the physiologic effects?
- overactive SNS
- overactive RAAS
Physiologic effects:
SNS: increased HR and increased contractility, so increased CO
RAAS: vasoconstriction, salt/fluid retention,
The presence of Virchow’s Triad increases the risk for what CV disorder?
DVTs!
What 3 things comprise Virchow’s Triad?
1 ) stasis of venous flow due to inactivity of skeletal muscle pumps
2) hypercoaguable state resulting from a decrease in vascular volume , increase in blood viscosity, and increase in blood coagulation factors
3) vessel injury to the endothelium resulting from external pressure from the veins
What is aortic stenosis?
When the aortic valve becomes stiff or narrowed, therefore increasing the amount of pressure the left ventricle must generate to push blood through it and into systemic circulation.
At what point does aortic stenosis become symptomatic?
When the valve area is reduced to 1/4 of it’s normal size
Once symptomatic, how does aortic stenosis present? (5)
- loud systolic ejection murmur
- split second heart sound as the aortic valve closes more slowly than the pulmonic valve
- angina
- syncope
- exertional dyspnea
What are the 3 causes of pulmonary emboli?
1) venous stasis
2) vessel injury
3) hypercoagulability