Week 3

Question 1

Correlate hyperlipidemia with the development of atherosclerotic plaques in blood vessels.

Answer 1

• endothelial injury (cholesterol can increase oxygen radicals) -> endothelial dysfunction -> increased permeability -> Accumulation of lipoproteins in the vessel wall -> Platelet adhesion to the site -> Monocyte adhesion to the endothelium -> migration into the intima -> differentiation into macrophages -> LDL is oxidized and eaten by macrophages and cyotkines are released -> (foam cells) accumulate in the intimal layer -> formation of fatty streak
  d. Plaque progression occurs as smooth muscle cells migrate into the intima in response to PDGF released form activated platelets
  e. Smooth muscle cells differentiate into fibroblasts and proliferate causing altered matrix synthesis and degradation
  f. Calcification takes place via the abnormal deposition of calcium salts, iron, magnesium and other minerals takes place via Dystrophic calcification (deposition of calcium in injured or dead tissue, such as the arterial lesions of advanced atherosclerosis)

Question 2

How do plaques form?

Answer 2

fatty plaque -> smooth muscle cells migrate into the intima in response to PDGF released form activated platelets -> Smooth muscle cells differentiate into fibroblasts and proliferate causing altered matrix synthesis and degradation -> calcium is deposited into the injured tissu

Question 3

Clinical presentation of atherosclerosis

Answer 3

• depends on severity of ischemia -> the degree of luminal occlusion, and the location of involvement

Question 4

What happens to flow when….

• there is decrease in radius
• increased pressure

Answer 4

• flow rate will decrease

- increase flow rate

Question 5

Describe the alterations in vascular reactivity that result from endothelial damage

Answer 5

• progressive hardening of the artery, loss of elasticity, and plaque formation

Question 6

role of ankle brachial index (ABI)

Answer 6

• ratio of systolic blood pressure in the ankle to the systolic pressure in the arm
• less than 0.5, it suggests severe PAD.

Question 7

role of magnetic resonance angiography (MRA) in the diagnosis of atherosclerotic disease of the arteries

Answer 7

used to identify which blood vessels are blocked and to what severity they are blocked

Question 8

significance of bruits.

Answer 8

Bruits are an audible vascular sound associated with turbulent blood flow

Question 9

Describe the significance of lipid, lipoprotein levels, and inflammatory markers in the process of atherogenesis.

Answer 9

• Increased LDL -> LDL distributes cholesterol to peripheral tissues
• Inflammation contributes to initiation, progression and complications of atherosclerotic lesions

Question 10

mechanism of action of cilostazol

Answer 10

inhibits phosphodiesterase (PDE) III -> increased cAMP levels -> In vascular smooth muscle, leads to myosin light-chain kinase phosphorylation and inactivation -> myosin light-chain dephosphorylation -> smooth muscle relaxation -> arteriolar and venous vasodilation

Question 11

cardiovascular (CV) benefits of the Mediterranean diet.

Answer 11

• decrease BP
• Decrease LDL
• Endothelium vasodilation
• antioxidant

Question 12

cardiovascular (CV) benefits of cocoa

Answer 12

Shown to decrease HTN prevalence via NO vasodilation

Question 13

Red Wine

Answer 13

olyphenols = may act via NO to dilate vascular endothelium

Question 14

TTP

• cause
• forms

Answer 14

• lack ADAMTS13 which is responsible for breaking down VWF

- acquired and genetic

Question 15

Clinical presentation of TTP

Answer 15

○ Microangiopathic hemolytic anemia
○ Thrombocytopenic purpura
○ Neurologic abnormalities
○ Fever
Renal disease

Question 16

role of ADAMSTS13 and effect with TTP

Answer 16

• ADAMTS13 cleaves the large multimers of von Willebrand factor when they are secreted from endothelial cells.
• Without it the VWF multimers can bind to platelets in the absence of physiologic stimulus

Question 17

risk factors associated with TTP

Answer 17

• genetic
• women/black
• autoimmune diseases (lupus)

Question 18

Describe the process that leads to microangiopathic hemolytic anemia

Answer 18

formation of a fibrinmesh due to increased activation of the system of coagulation. The red blood cells are physically cut by these protein networks. The resulting fragments are the schistocytes observed in light microscopy.

Question 19

Explain why??

• decreased haptoglobin,
• increased LDH,
• increased indirect bilirubin.

Answer 19

• haptoglobin binds to the hemoglobin being released from lysing of RBC
• LDH is released from rupture of the RBC
• bili is released into blood stream

Question 20

Describe the process of plasmapheresis

Answer 20

Plasmapheresis or plasma exchange, is a procedure which involves the removal, treatment, and return of blood to the body to remove antibodies, thereby preventing them from attacking their targets. This blood purification procedure is used to treat several autoimmune diseases.