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Bloc C - Exam 2 > Pathology > Flashcards

Pathology Flashcards

1
Q

Risk factors of artherosclerosis?

A
  1. : Hyperlipidemia (high LDL is bad, high HDL is good)
  2. Hypertension
  3. Smocking
  4. Homocysteine
  5. Hemodynamic factors
  6. Toxins
  7. Viruses
  8. Immune reactions
  9. Estrogen therapy or low estrogen before menopause
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2
Q

Describe the Pathogenesis of endothelial chronic injury

A
  1. Risk factors to chronic endothelial injury
  2. Endothelial dysfunction: monocyte adhesion and emigration
  3. Macrophage activation and smooth muscle recruitment
  4. Macrophages and smooth muscle engulfs lipid
  5. Smooth muscle proliferation, collagen and other ECM deposition, extracellular lipid
  6. Arherromatous Plaque: necrotic center and fibrous cap in the Intima
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3
Q

What’s the difference between stable and vulnerable atherosclerotic plaque ?

A

Stable Plaque

  1. Thickened fibrous cap
  2. Smaller lipid core
  3. Less inflammatory agents

Vulnerable Plaque

  1. Large lipid pool
  2. Thin fibrous cap
  3. Many inflammatory cells
    * ***Can cause a thrombi, rupture, aneurysm**
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4
Q

What are the infarct terrotories of the different coronary arteries?

A
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5
Q

In which order to we autopsy the heart?

A

Open in direction of blood flow: IVC → RA → RV → PA → LA → LV → aorta

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6
Q

What are the types of heart failure?

A
  1. Circulatory failure: inability to meet metabolic demands of body
  2. Cardiac or heart failure: inability to pump at sufficient rate and/or pressure too high
  3. Circulatory overload/congestion: excess in blood volume
  4. Congestive heart failure (CHF): cardiac failure + abnormal circulatory congestion
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7
Q

What are the possible Etiologies of heart failure?

A
  • ↓ contractility
  • ↓ preload
  • ↑ preload or overload
  • ↑ afterload
  • Electrophysioligical abnormalities (arrhythmias, conduction)
  • Aggravating factors (anemia, fever, hyperthyroidism)
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8
Q

What are the 2 main categories of heart failure?

A
  1. Systolic dysfunction (½ patients) FORWARD FAILURE
  2. end-diastolic volume and pressure → pulmonary congestion and edema and ischemia
  3. Diastolic dysfunction (½ patients) BACKWARD FAILURE
    Reduced ventricular compliance causes ↑ end-diastolic pressure for given volume → pulmonary edema
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9
Q

By wich mechanism the heart tries to compensate before being in heart failure?

A
  1. Frank-Starling mechanism
  2. Activation sympathetic nervous system
  3. Renin-angiotensin system, aldosterone, ADH
  4. Hypertrophy (Laplace equation)
  5. Volume overload → ↑ stress by ↑ radius → sacomeres replicate in serie → ↑ length sarcomeres → ECCENTRIC HYPERTROPHY
  6. Pressure overload → stress by pressure → sacomeres replicate in parallel ↑ diam. sarcomeres → CONCENTRIC HYPERTROPHY
  7. Dilatation
    ↑ EDV → ↑ radius → ↑ stress of myocardium → stretches → pulmonary edema
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10
Q

How doest heart failure manifests itself in the heart itself?

A
  • Left heart failure

→ Dyspnea, orthopnea, fatigue, paroxysmal nocturnal dyspnea

  • Right heart failure

→ Jugular venous distention, hepatomegaly, peripheral edema

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11
Q

What are the systemic manifestations of heart failure?

A
  1. Lungs: acute (pulmonary oedema in capillaries → interstitial → alveolar) OR chronic (brown induration), we can measure with the wedge pressure (pulmonary capillary pressure – left atrial pressure) with with a balloon
  2. Liver: ↑ hepatic venous pressure congestive hepatomegaly, centrilobular congestion ± hepatocyte necrosis → pain, altered liver function tests and portal hypertension → congestive splenomegaly
  3. Pleural, pericardial, peritoneal effusions
  4. Edema subcutaneous tissue → pedal edema
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12
Q

What are the types of cardiomyopathies?

A
  1. Dilated [dilatation + systolic dysfunction]

Most common, transplantation cause, high mortality, caused by alcohol, pregnancy, nutrition, myocarditis, fat and fibrotic heart

  1. Hypertrophic [hypertrophy + diastolic dysfunction]

Cause of sudden cardiac death, genetic, without outflow obstruction of with outflow obstruction

  1. Restrictive [restriction + diastolic dysfunction]

Genetic, familial amyloidosis

  1. Unclassified
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13
Q

What are the types of shock ?

A
  1. Hypovolemic
  2. Cardiogenic
    A. Myocardial, valvular
    B. Electrophysiological
    C. Pericardial
  3. Septic
  4. Other
    A. Neurogenic
    B. Hypo-adrenal
    C. Anaphylactic
  5. Post-traumatic
    Mixed of hypovolemic, tissue damage and septic
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14
Q

What is the pathogenesis of hypovolemic shock?

A
  • stroke volume → ↓ cardiac output → ↓ blood pressure
  • Severe: > 40% blood loss
  • Compensation/decompensation: Se, Renin-angiotensine, hematocrit fall → ischemia, hypoxia, cell damage and death
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15
Q

What is the pathogenesis of septic shock?

A

Deregulated host response to infection, Organ dysfunction assessed by the Sequential [sepsis-related] organ failure assessment (A SOFA score of 2 = mortality risk of ~10%)

Primary cause of death from infection, may be occult but may be the cause of new-onset organ dysfunction

Effects include:

  1. Systemic necrosis (circumferential subendocardial infarct in the heart, tubular and cortical in kidney and adrenal necrosis and hemorrhage)
  2. Acute respiratory distress syndrome: diffuse alveolar damage + acute exudative phase of ARDS → edema and hyaline membranes: that resolves in (1) resolution, (2) proliferative phase or (3) fibrotic phase
  3. GI tract: gastric erosions, acute ulcers and severe ischemic necrosis in intestine
  4. Liver: abnormal liver function
  5. Brain: micro-infarcts
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16
Q

Systolic 120-139

Diastolic 85-89

A

Pre-hypertension

17
Q

Stage 1 hypertension?

A

S: 140-159

D: 90-99

18
Q

Stage 2 hypertension?

A

S: ≥ 160

D: ≥ 100

19
Q

What organs are affected by Systemic hypertension?

A
  1. Vascular
  2. Renal
  3. Cerebral
  4. Retinal
20
Q

What are the vascular effects of systemic hypertension?

A
  • Arteriolar lesions (hyaline and hyperplastic arteriolosclerosis)
  • Large arterial lesions (atherosclerosis)
21
Q

What are the renal effects of systemic hypertension?

A
  • Benign nephrosclerosis (scleroses glomerulus)
  • Malignant” nephrosclerosis = benign nephrosclerosis plus
22
Q

What are the cerebral effects of systemic hypertension?

A
  • Large hypertensive hemorrhages related to rupture of “Charcot-Bouchard” microaneurysms
  • Lacunar infarcts 2o to occlusion of small arteries
  • Hypertensive encephalopathy: edema, petechial hemorrhages, necrotizing arteritis (with severe or very severe hypertension)
  • Multi-infarct dementia
23
Q

What are the retinal effects of systemic hypertension?

A

retinopathy

24
Q

What are the normal pressures in the lungs?

A
  1. Normal pulmonary artery pressure (Ppa): 15-30/4-12, mean ≈ 15 mmHg
  2. Normal (pulmonary capillary) wedge pressure (Pw) 2-10 (5) mm Hg
25
Q

What is pulmonary hypertenison?

A

Mean Ppa ≥ 25, systolic > 30 mmHg.

26
Q

What is the mechanism of pulmonary hypertension?

A

Increased pressure, blood flow: “hyperkinetic” –> Active vasoconstriction –> Passive, due to elevated pulmonary venous pressure –> Vascular lesions or remodeling or destruction of the vasculature –> Obstruction of lumen –> Elevated blood viscosity (contributing factor)

27
Q

What are the 5 types or pulmonary hypertenion and on what are they based?

A

The classification is based on the etiology of the PH.

  1. Pulmonary arterial hypertension: high Ppa, normal Pw (< 15 mmHg) a.k.a. “pre-capillary”
  2. Pulmonary hypertension owing to left heart disease: moderate ↑ Ppa and ↑ Pw (abnormality is on venous end of pulmonary circulation)
  3. Pulmonary hypertension owing to lung diseases/hypoxia: moderate ↓ PO2, ↑ Ppa
  4. Chronic thromboembolic pulmonary hypertension (CTEPH): obstruction > 3 mo
  5. Pulmonary hypertension with unclear or multifactorial mechanisms (idiopathic)
28
Q

What are the characteristics of Pulmonary arterial hypertension?

A
  • Associated with connective tissue diseases, HIV infection, portal hypertension or congenital (ex. Eisenmenger syndrome)
  • Therapy includes vasodilators, Endothelin receptor antagonists (bosentan…) or transplantation
29
Q

What are the characteristics of Pulmonary hypertension owing to left heart disease: ?

A
  • Second to left-sided cardiac failure, mitral valvular lesions
  • Leads to Arterialization of veins
30
Q

What are the characteristics of Pulmonary hypertension owing to lung diseases/hypoxia?

A
  • Due to hypoxia or vascular destruction by the disease
  • Atherosclerosis large elastic arteries and peripheral muscularization arteries and pulmonary fibrosis
31
Q

What are the characteristics of Chronic thromboembolic pulmonary hypertension (CTEPH)?

A
  • Important diagnostic clue:abnormal ventilation/perfusion (V/Q) scan
  • Two main forms:
    1. In proximal arteries (require surgical treatment)
    2. In small distal arteries (require medical therapy)

Bloc C - Exam 2 (7 decks)

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