Vascular Disease Pathology I Flashcards
How to avoid blood clotting?
Laminar flow
What causes thrombosis?
Change in vessel wall
Change in bloodflow
Change in blood constituents
Causes of ischaemic heart disease?
Atherosclerosis
Myocardial hypertrophy
Small vessel disease
What is atherosclerosis?
Plaque builds up in arteries
Risk factors of atherosclerosis?
Cigarette smoking Hypertension Diabetes (poorly controlled) Hyperlipidaemia Men
Why is left ventricular hypertrophy a problem?
Part of heart is enlarged but same amount of blood reaches it = not enough blood
Where do small vessel changes occur?
What does this cause?
At arteriolar level
Inappropriate vasoconstriction:
- Reduced production of nitric oxide
- Increased destruction of nitric oxide
What does ischaemic heart disease look like?
Regional transmural MI
Subendocardial MI
Chronic ischaemia
What is regional transmural MI? What does it cause?
Patch of dead heart muscle in one area of the heart as one coronary artery is blocked
Crushing chest pain
What is subendocardial MI?
Severe coronary artery atherosclerosis in all 3 main coronary arteries
Some sudden reduction in blood flow e.g. hypotension during an operative procedure
Chronic ischaemia
Fixed atherosclerotic lesion Angina Myocardial fibrosis Hibernating myocardium Stunned myocardium
Complications of MI?
Death Arrhythmias Mitral incompetence Cardiac failure Pericarditis Cardiac rupture Mural thrombosis Ventricular aneurysm Pulmonary emboli
What is cardiac failure?
Arrhythmias
Loss of myocardium and so reduced pump function
Mitral incompetence?
Rupture or necrosis of papillary muscles
Pan systolic murmur
Cardiac rupture?
Weakening of wall due to muscle necrosis and acute inflam
3-7 days after infarction
Rupture into pericardial sac and interventricular septum
Mural thrombosis?
Thrombosis on the abnormal endothelial surface following infarction
7-14 days after infarction
Embolisation to any arterial site
Clinical importance of hypertension?
Commonest cause of heart failure
Major risk factor for atherosclerosis
Major risk factor for cerebral haemorrhage
Classification of hypertension?
Primary - no identified cause
Secondary - identifiable cause
Primary hypertension - what can cause it?
Adrenaline
Sodium control
Renin angiotensin aldosterone
Secondary hypertension causes?
Renal - Renin dependent - Salt and water overload Endocrine - Cushing's Coarctation of aorta Drug therapy - Corticosteroids, NSAIDs
Clinicopathological classification of hypertension?
Benign - Long asymptomatic period - Increased freq of complications later Malignant - Markedly raised diastolic pressure - Symtomatic - Rapidly fatal if untreated
Effects of hypertension?
Accelerated atherosclerosis Sclerosis of smaller vessels Micro-aneurysms and haemorrhages Heart and kidney failure Cerebral haemorrhages = strokes
