week 3: diseases of arteries Flashcards
an ____ is a localized dilation or outpouching of a vessel wall or cardiac chamber
aneurysm
_____ aneurysm involves all 3 layers of arterial wall and are described as a weakening of the vessel wall (fusiform or circumferential)
true aneurysm
outpouches on both sides
____ aneurysm is an extravascular hematoma that communicated with the intravascular space
false aneurysm
break in vessel wall (usually by trauma)
the 2 conditions that are found in more than half of all individuals with aneurysms
arteriosclerosis and htn
(htn - shear forces that remodel/weaken vessel walls
atherosclerosis - plaque formation erodes the vessel wall)
where do aneurysms most commonly occur?
thoracic or abdominal aorta
____ _____ is a devastating complication that can involve any part of the aorta and can disrupt flow through arterial branches, thus creating surgical emergency
aortic dissection
symptoms of aortic dissection :
sudden severe sharp pain in chest of upper back, described as a tearing, stabbing or ripping feeling, SOB, fainting, dizziness, low blood pressure, high suspicion when there’s 20mmHg pressure difference bw the arms
____ occurs when there’s a tear in the intima and blood enters the wall of the artery
(occurs from trauma or ischemia from plaque weakening the intima, chronic htn and inflammation contribute to degradation of vessel wall)
(aortic) dissection
____ ___ ____ occurs when intraventricular tension stretches the noncontracting infarcted muscle
usually after a heart attack !!
ventricular wall aneurysm
with time the aneurysm becomes fibrotic but continues to bulge with each systole, acting as a reservoir for some of the stroke volume
__ ___ is an outpouching of a weakened arterial wall
occurs in 2-4% of population
it is usually silent over a lifetime, but can be complicated by subarachnoid hemorrhage
intracranial aneurysm
goals of medical treatment on aneurysms are:
maintain low blood volume and low blood pressure to decrease mechanical forces thought to contribute to vessel wall dilation
for aortic aneurysms: smoking cessation, reducing blood pressure/volume and beta blockers. surgery is done when the anuerysm reaches 5cm in diameter
(If aneurysms are dilating rapidly, surgery indicated. Surgical repair is done when aortic aneurysms reach 5cm in diameter )
varicose veins are caused by:
trauma to the saphenous
Clinical manifestations of aneurysms in heart:
Dysrhythmias, heart failure, embolism of clots to the brain or other vital organs
Clinical manifestations of aortic aneurysms:
Often asymptomatic until they rupture, when they become painful. Sxs of dysphagia, dyspnea caused by pressure of a thoracic aneurysm on surrounding organs
Clinical manifestations of abdominal aneurysms:
Impair flow to an extremity and cause sxs of ischemia
___ ____ are a common condition, affecting women nearly twice as often as men
Varicose veins
__ ___ is a superficial vein in which blood has pooled, typically involving the saphenous veins of the legs and are distended, tortuous, and palpable
Varicose veins
2 causes of varicose veins
- Traumas to the saphenous veins that damages one or more valves
- Gradual venous distention caused by the action of gravity on blood in legs
(Gravity and valves)
Valve damage causing varicose veins
Pressure in the vein builds and damages the valves
From standing long periods, wearing constricting garments, crossing legs
Damaged valves can’t maintain normal venous pressure, which causes hydrostatic pressure in the vein to increase — distending the vein and it becomes tortuous and edema develops in extremity
Virtually everyone who is hospitalized is at risk for ___
deep vein thrombosis (DVT)
Especially after hip surgery
S/sxs of ___ entail:
Potentially no s/sxs
Throbbing or cramping in 1 leg, usually the calf, swelling in 1 leg
Warm/red/darkened skin around painful area
Swollen veins that are hard or sore to the touch
calf cramping
DVT
Diagnoses of a DVT
- D dimer = blood test that measures the presence of thrombosis
if positive, diagnosis must be confirmed with ultrasound - Ultrasound
What is a thrombus?
A blood clot that remains attached to a vessel wall
What is d-dimer?
A protein fragment made when a blood clot dissolves in your body
Only detectable when body is forming or breaking down significant blood clots
D-dimer detectable in patients w DVT as it is a marker of endogenous fibrinolysis
Risk of an untreated DVT
High risk of thromboembolization of a part of the clot from the leg to the lung (pulmonary embolism)
What activates the coagulation cascade in arteries?
The roughening of tunica intima by atherosclerosis
Where do arterial thrombi have a tendency to develop?
Wherever intravascular conditions promote activation of coagulation/the clotting cascade
(Roughening of endothelium, atherosclerosis)
Arterial thrombi diagnosis and treatment:
Diagnosed through Doppler ultrasound and angiography
Treatment: heparin, warfarin, thrombin inhibitors, thrombolytics, balloon tipped catheter
Severity of embolism?
Embolism to a coronary or cerebral artery is an immediate threat to life if the embolus severely obstructs a major vessel
Occlusion of a coronary artery causes an MI whereas occlusion of a cerebral artery causes a stroke
!!!
What is the leading cause of CAD and cerebrovascular disease?
Atherosclerosis
What is a thickening and hardening of the vessel caused by accumulation of lipid laden macrophages (aka macrophages that eat fat) within the arterial wall, which leads to a lesion called a plaque
Atherosclerosis
Not a disease but a pathological process that can affect vascular systems in the body, resulting in ischemic syndromes
____ is an inflammatory dz that develops and proceeds the presence of elevated plasma cholesterol levels
Atherosclerosis
development of atherosclerosis (5 steps)
*lesions progress from endothelial injury and dysfunction to fatty streak to fibrotic plaque to complicated lesion
- begins w injury to endothelial cells that line artery walls and therefore cannot make normal amounts of antithrombotic and vasodilating cytokines
- many inflammatory cytokines are released (cytokines = signal for macrophages)
- macrophages adhere to injured endothelium
- macrophages release enzymes and toxic oxygen radicals that create oxidative stress, oxidize LDL, and further injure vessel wall.
- growth factors are released which stimulate smooth muscle cell proliferation in the affected vessel (aka vessel gets smaller with more muscle cells)
***LDL and oxidized LDL
LDL (esp small density LDL penetrate into subintima of arterial walls where it is trapped by proteoglycans.
inflammation, oxidative stress, and activation of macrophages as well as diabetes, smoking, and hypertension (w increased angiotensin II) cause the aggregated LDL to become oxidized
oxidized LDL is toxic to endothelial cells and cause smooth muscle proliferation
macrophages filled with oxidized LDL are called foam cells
foam cells (lipid laden) accumulate and form a lesion called a fatty streak in the walls of arteries of most people (even children). smooth muscles produce collagen which migrate over the fatty streak and form a fibrous plaque
which type of plaque is clinically silent until they rupture? also they are prone to rupture before they affect blood flow
unstable plaques
what are plaques that have already ruptured called?
complicated plaques
what is THE major cause of myocardial ischemia?
CAD caused by atherosclerosis
true or false:
atherosclerotic obstruction of vessels supplying the brain is a major cause of stroke?
true
screening for athersclerosis:
chest pain, cold sweats, dizziness, extreme tiredness, heart palps, SOB, nausea, weakness
physical exam: arterial bruits and evidence of decreased blood flow to tissues
treatment of athersclerosis:
exercise, smoking cessation, control of hypertension and diabetes when appropriate while reducing LDL cholesterol by diet and/or medications
what is it called when arteries perfuse to the limbs, especially lower extremeties?
peripheral artery disease (PAD)
PAD is especially prevalent in those who ____
smoke and have diabetes
what is lower extremity ischemia resulting from arterial obstruction in PAD? can be gradual or acute.
results in pain with ambulation (movement)
can also see loss of pulses, skin color changes in affected extremity.
intermittent claudication
what is the most common cause of coronary artery obstruction?
atherosclerosis
when the heart is deprived of oxygen and nutrients, the earliest lesions of the continuum are those of ____ which occludes the coronary arteries
CAD
persistent ischemia or complete occlusion of a coronary artery cause ______
acute coronary syndrome
______ refers to abnormal concentrations of serum lipoproteins
dyslipidemia
an (increase or decrease) of serum concentration of LDL is a strong indicator of coronary risk?
increase
(LDL delivers cholesterol to the tissues)
(low or high) levels of HDL cholesterol are a strong indicator of coronary risk
low
(HDL is for “reverse cholesterol transport” which returns excess cholesterol from tissues to liver)
(LDL or HDL)
can remove excess cholesterol from the arterial wall?
HDL
are elevated triglycerides assoc with increased risk of CAD?
yes
Lipoprotein a (LP(a)) has been shown to be an important risk factor for ____________, esp in women
coronary atherosclerosis
risk factors for CAD:
htn
smoking
diabetes mellitus / insulin resistance
obesity
hsCRP is a nonspecific serum marker for inflammation
indirectly measures atherosclerotic plaque related inflammation
vitamins needed to prevent hyperhomocysteinemia
folate
b12
b6
a ____ diet may have higher levels of homocysteine
vegetarian/vegan
the two adipokines are:
leptin and adiponectin
adipokines are a group of hormones released from adipose cells
what is leptin?
an adipokine
implicated in obesity, htn, diabetes, autoimmune responses affecting blood vessels
pro-inflammatory
what is adiponectin?
an adipokine (hormone released from adipose cells)
anti-inflammatory
