Week 5 (test 2) Flashcards
Name in order the three most major causes of death. Give the percentages of their contribution to the total deaths for each.
1) heart disease (28%)
2) malignancies (23%)
3) stroke (6%)
Define hypertrophy
The enlargement of an organ or tissue from the increase in size of its cells
Define hyperplasia
The enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer.
(Increase in # of cells)
Define metaplasia
Replacement of one cell type with another
E.g, smoker’s airway, cervix Barrett’s esophagus
Define dysplasia. What are some examples?
The presence of cells of an abnormal type (abnormal DNA) within a tissue, which may signify a stage preceding the development of cancer.(per neoplastic)
Disordered hyperplasia without maturation.
Examples: uterine cervix. Bowel in inflammatory bowel disease
Define atrophy. What can cause it?
Cell shrinkage or loss.
Caused by: lack of hormonal signals, loss of innervation, lack of use, loss of blood supply, starvation, individual cell death.
Define necrosis
Uncoordinated cell death. Often happens in cell clusters rather than individual cells. Cells are often swollen
Define heterolysis
The dissolution of cells by lysins or enzymes from different species
Define autolysis
The destruction of cells or tissues by their own enzymes, especially those released by lysosomes
Define apoptosis
Orderly, energy-requiring cell death. Often a normal phenomenon. No inflammation, one cell at a time.
Hypertrophy/atrophy, hyperplasia, metaplasia, and dysplasia are all types of responses to direct ____ or to changing ____.
Injury/stress
Hormonal or chemical signals
How does cardiac hypertrophy cause anoxia?
Increased cell size causes the blood vessels to be more dispersed.
This predisposes the heart to arrhythmias or failure
True or false… the dementia brain undergoes processes of necrosis.
False. It undergoes atrophy
What is cachexia? When is it fatal?
Fatty atrophy
Cachexia at ~68% of normal body weight is fatal.
What is BPH?
Benign prostatic hyperplasia
Note that hyperplasia can occur with hypertrophy
Which cells are most prone to injury?
High metabolic cells (cardiac myocytes, renal tubular cells, hepatocytes)
Rapidly proliferating cells (testicular cells, intestinal lining cells, hematopoietic cells)
What are the two degrees of cell injury?
Reversible
Irreversible
What 3 things may cause reversible cell injury? (Not enough to cause cell death)
Loss of ATP from hypoxia
Loss of Na pump (causing swelling)
Anaerobic glycolysis (severe exercise)
Examples: Toxic liver injury and mild acute tubular necrosis
Describe irreversible cell injury
More severe damage causing cell death
Examples: holes in cell membrane, long calcium influx, mitochondrial loss
What are the two types of cell death? Define them.
Necrosis - uncoordinated cell death. Often happens in clusters rather than individual cells. Incites acute inflammation from leakage of cell contents. Cells often swollen (loss of ion pumps). Cell membrane disruption, calcium signal and energy loss are early events.
Apoptosis - orderly, energy-requireing cell death. No inflammation. Normal phenomenon. Happens one cell at a time. Happens in normal embryology, normal cell turnover, viral infection
Name 5 different types of necrosis
Coagulative necrosis
Liquefactive necrosis
Caseous necrosis
Gangrenous necrosis
Fat necrosis
What is coagulative necrosis?
Heart infarct. Dead cells within the area, may have a scar that forms later on and the scar is smaller than the myocardium that it replaces.
What is liquefactive necrosis?
Brain, deteriorates and there is a space left
What is caseous necrosis?
Tuberculosis, cell death in a granuloma (if there is necrosis in a granuloma there is almost infection)
What is gangrenous necrosis?
Death of a whole body part. Frostbite or diabetes.
What is karyorrhexis?
Nuclear change in cell death. Destructive fragmentation of nucleus of a dying cell causing irregular chromatin distribution
What is nuclear pyknosis? What is karyolysis?
Nuclear changes in cell death.
Nuclear pyknosis - Nucleus is shriveled and dark
Karyolysis - digested pale nucleus
Describe some abnormal storage products of fats.
Fatty change of liver associated with alcoholism and obesity
Glycogen accumulation - liver in diabetes
Lipid storage can accumulate in vessels in atherosclerosis. Lipid storage disease - Fabry’s- gaucher’s
What is gaucher disease?
Lysosomal accumulation of lipid
What is lipofuscin?
Degraded lipid in lysosomes
Increases with age, free radical damage
Brown storage product
What is bilirubin?
Hemoglobin breakdown product
Normally present in bile
Increased with biliary obstruction and hepatocyte disorders
Too much causes jaundice/icterus (yellow-brown color seen with hyperbilirubinemia)
Brown storage product
What is hemosiderin?
Iron containing pigment
Increased with excessive iron absorption, bleeding into tissues
Brown storage product
Large deposits of proteins (immunoglobulin) can be stored intracellularly in plasma cells in __ bodies
Russell
What is alpha-1-antitrypsin?
Involved in intracellular protein storage deficiency ?
True or false.. amyloid is only found in the brain
False. It is an extracellular protein storage product that can be found throughout the body, namely the lung
What is antracosis?
Carbon pigment found mostly in the lung (coal worker’s lung)
It in of itself is harmless, but other harmful materials can be deposited with it (silica, asbestos)
What is the difference between dystrophic calcification and metastatic calcification?
Dystrophic calcification - into damaged tissue (causes a dark purple lesion in stain)
Metastatic calcification - into normal tissue
Disorder of calcium metabolism (renal failure, hyperparathyroidism, malignancy)
Define edema
Too much extravascular fluid in tissues
Pulmonary edema interferes with gas exchange
What is effusion? Describe three types of effusion.
Effusion - too much fluid in body cavity
Ascites - excess fluid in peritoneal space
Pleural effusion - excess fluid in pleural space
Hydrocephalus - excess fluid in cerebralspinal fluid
What are thrombi or emboli?
Thrombus - a blood clot that blocks flow
Embolus - any material that circulates through the blood stream and can block flow once it reaches a vessel that is too small to allow it to pass
What is hypotension and what causes it?
Hypotension (shock) is too low blood pressure.
It can be caused from low cardiac output or low vascular resistance
Hypovolemic - blood
Cardiogenic - arrhythmic
Septic shock - due to generalized infection and endotoxin release. It is associated with vasodilation (the body’s response to compensate)
What is hypertension? What causes it?
High blood pressure
Caused by high cardiac output or high vascular resistance
Define ascites. What may cause it?
Massive amounts of fluid in the peritoneal space.
Caused by liver failure, heart failure, compromised heart function, or kidney disease
What is dependent edema?
Edema in the lower extremities.
Finger pressure temporarily pushes fluid away - pitting edema
Can be caused by hormonal fluid retention, heart failure, and inflammation
True or false…. foreign material, amniotic fluid, and even air can embolize, causing infarcts by blocking blood flow. Tumors however, rarely grow into veins and embolize
True
Which cause of shock, hypovolemia or septic shock has a better prognosis?
Hypovolemia.
Hypovolemia is low blood volume from bleeding or dehydration
Septic shock is from an overwhelming infection. Vasodilation and high permeability, poor cardiac pumping, and increased metabolism occur
Define congestive heart failure
Cardiac output is insufficient for metabolic needs of the body
What is the difference between systolic dysfunction and diastolic dysfunction?
Systolic dysfunction - decreased myocardial contractiliy (heart pumps weakly)
Diastolic dysfunction - insufficient expansion (heart does not fill with blood between beats)
What are some ways the body compensates for congestive heart failure?
Tachycardia
Myocardial hypertrophy
Increased stroke volume. Frank starling - increased end diastolic volume results in increased stroke volume
Increase of catecholamine activity leading to positive ionotropic effect
Redistribution of blood flow (kidneys)
Increased oxygen extraction from hemoglobin
Renin-angiotensin-aldosterone system
What may cause left-sided heart failure?
Hypertension
Ischemic heart disease
Pulmonary edema and breathing problems
Orthopenia (dyspnea lying down)
Reduced blood perfusion to organs such as kidneys
Aortic and mitral valve disease
Myocardial disease such as cardiomyopathy or myocarditis
Define paroxysmal nocturnal dyspnea
Extreme dyspnea (breathlessness), develops over a few hours. Due to pulmonary edema from heart failure while lying down.
What may cause right-sided heart failure?
Lung disease (cor pulmonale - abnormal enlargement of right side of heart)
Hepatomegaly; pools in liver
Hyperemia (in the liver)
Myocardial - myocarditis, cardiomyopathy, constrictive pericarditis
Consequence of left-sided failure
True or false… right-sided failure is more common than left sided failure and causes left sided failure
False. Right sided failure is uncommon to be isolated, usually associated with left sided failure. It can cause swollen ankles/peripheral edema
What are some systemic effects of right-sided failure?
Liver - chronic passive congestion
Spleen - congestive splenomegaly
Kidneys - congestion and hypoxia
Subcutaneous - peripheral edema and anasarca
Pleural space - effusions
Brain - venous congestion and hypoxia
Portal - ascites
What is the normal blood pressure in adults?
Normal is = 120/80
Lower in children
What is a hypertensive emergency?
Direct acute organ damage when BP is over 180/110
What are some potential causes for essential hypertension?
No obvious cause..
Increased sodium retention and intravascular volume.
Narrowing of arteries and arteries (espicially in kidney)
High vascular resistance lowers effective blood pressure in kidneys. Kidneys sense lowere pressure, signal to retain sodium/fluid and increase blood pressure. (Renin/angiotensin/aldosterone)
Increased pressure causes further vessel damage.
What is secondary hypertension? What are some causes?
Uncommon, 5-10% of all hypertensive pateints. Known cause..
Endocrine (steroid, thyroid, pheochromocytoma)
Drugs
Pregnancy
Renal failure
Sleep apnea
Renal artery stenosis
Pain/stress causes temporary increase in BP
What are some risk factors for getting essential hypertension?
Increasing age
Black (family history of hypertension)
Obesity and metabolic syndrome
High salt diet
Lack of physical activity
What causes a transmural infarct?
Aneurysm in heart wall
What are some hypertension-induced problems?
Accelerated atherosclerosis due to endothelial injury such as… myocardial infarcts, stroke, peripheral vascular disease, aneurysms
Heart failure (seen with chronic hyperorphy)
Renal failure
Retinal and brain damage, including hemorrhages
What is the main cause of ventricular hypertrophy?
Hypertension
What is arterionephrosclerosis? What causes it?
Kidney becomes smaller and have finely pitted surface.
Caused by hypertension
This is an extremely common cause of renal failure, especially in black pateints
Brain hemorrhages due to HTN is most common in what population?
Asians
___% of U.S adults have hypercholesterolemia above 240.
13%. (Under 200 is ideal)
50% have hypercholesterolemia above 200
Which is the more common cause for hyperlipidemia, familial causes or secondary causes (diabetes, sedentary lifestyle, poor diet, heavy alcohol use)
Secondary causes are far more common than familial
What are the roles of…
HDL
LDL
VLDL
Chylomicrons
HDL - delivers lipids from periphery to liver
LDL and VLDLs - delivers lipids from liver to periphery
Chylomicrons - delivers lipids from gut to liver
True or false… ideal HDL levels are greater than 40 in men and greater than 50 in females
True
Atherosclerosis is the leading cause of death. It causes ___% of heart disease, and is the main cause of stroke and peripheral vascular disease. It accounts for about ___% of all deaths
80%
30%
What is the difference between arteriosclerosis and atherosclerosis?
Arteriosclerosis - hardening of the arteries
Atherosclerosis - lipid deposits/plaques (called atheromas) in arteries. Most common kind of arteriosclerosis
In regards to transmural infarct, mural thrombus often forms from __ or ___
MI or atrial fibrillation
What are the symptoms of a MI?
Retrosternal chest pain, dyspnea (shortness of breath), diaphoresis (sweating), nausea/vomiting, palpitations, anxiety.
Patient may also be asymptomatic or present as sudden death
What is the differential for an MI?
Pulmonary emboli
Aortic dissection
Pericardial tamponade (blood around heart)
Tension pneumothorax (patient has tear in lung so air leaks into pleural space)
Esophageal reflux
Chest wall pain
What is the diagnostic criteria for MI?
At least 2 of the following…
Ischemic type chest pain > 20 minutes
Acute EKG changes
Rising/falling of serum cardiac biomarkers
Pathologic documentation of an infarct at autopsy
MIs are asymptomatic in __% of cases
10-20%
What are some elevated cardiac enzymes associated with MI?
CK-MB
Troponin T (particularly common test for heart damage)
Myoglobin (often the first marker to increase)
Creatinine phosphate
What complication of MI causes most of the deaths?
Arrhythmias
What is the difference between stenosis and regurgitation?
Stenosis - valve wont open
Regurgitation - valve cant close complexity
What is a transmural infarct?
Full thickness infarct - from endocardium to epicardium
Usually involves LV anterior and posterior free wall or septum with extension into RV wall in 15-30% of cases.
Correlates with STEMI (ST segment elevation MI)
More severe
What is a sub endo cardinal infarct? What causes it?
Due to hypotension, global ischemia
Multifocal or diffuse areas of necrosis confined to inner 1/3-1/2 of LV wall
Infarct is not necessarily in distribution of one coronary artery.
Correlates with NSTEMI (non ST segment elevation MI)
Less severe but still potential lethal
What are the types of endocarditis complications? (3)
Libman-sacks - endocarditis is not associated with bacterial infection but associated with autoimmune disorders such as lupus erythematosus
Infective form can be caused by intresnic oral bacteria
Rheumatic form often involves mitral valve which becomes calcified at time of infection
What are splinter hemorrhages?
From tiny blood clots that migrate from the inflamed heart to under the nails or other body parts.
What is an aneurism?
Blood forces a separation of wall layers of aorta and may result in a rupture. Often associated with increased BP
What is cardiac tamponade?
Cardiac tompanade includes compression of the heart from fluid accumulation which can reduce cardiac output and cause death
What are some complications of artificial valves?
Can cause thrombi
Increased risk of infective endocarditis
Wears out valves and leaks (develops murmurs)
Briefly describe the atherosclerosis mechanisms
Endothelial dysfunction (smoking, hypertension, diabetes, lipids, inflammation)
Leads to lipid deposit in vessel wall
Leads to inflammation/foamy macrofages
Leads to intimal smooth muscle fibrosis which causes leads to fibroatheroma with stenosis
Or leads to plaque ulcer or rupture, which leads to thrombosis and can cause infarcts
What are some different forms of aortic stenosis?
Postinflammatory scarring - rheumatic heart disease
Senile calcific aortic stenosis (heart valves become more firm with age. Can occur with younger aortic valve if it is a bicuspid valve)
Calcific aortic valve stenosis is likely to occur after….
Post infective endocarditis or rheumatic fever
It is common in congentical biscuspid valves or normal valves of elderly people
Which is more common aortic stenosis or aortic regurgitation?
Aortic stenosis
T or F… premature heart beats are deadly
False.. they are usually not dangerous
Tacharrythmias are ___ common and ___ serious - such as fibrillation
Less
More
What are some symptoms of arrhythmias?
Palpitations; syncope (fainting), sudden cardiac death
What are some causes of conduction disturbance resulting in arrhythmias?
Ischemic heart disease – scarring
Degenerative changes
Antiarrhythmic drucs
MI
Trauma
Congenital
Which valve is infective endocarditis most likely to affect?
Mitral valve
Right sided valves are less common
What is the differential diagnosis of syncope?
Dizziness
Seizure. Can resemble syncope. Look for postictal changes
Bradycardia is a BPM of ___
Tachycardia is a BPM of ___
<60
> 100
What is a conduction block?
Abnormal impulse propagation (causes bradycardia)
Can occur at the level of the SA node, AV node, His-purkinje system, branches of the His bundle, or myocardium itself
What are some causes of conduction disturbances?
Ischemic heart disease and cardiomyopathy scarring
Degenerative changes in the conduction system
Aniarrhythmic drugs
Hyperkalemia
Myocardial infection (Lyme disease), infiltration (amyloid or a tumor)
Trauma (including cardiac surgery)
Congenital abnormally
What is a first degree heart block?
Slow but reliable impulse propagation to ventricles
Generally not symptomatic. No treatment needed.
P wave and QRS wave are further apart
What is a second degree heart block?
Impulse propagation to ventricles sometimes fails.
Irregular ventricular contraction.
Sometimes causes syncope
Pacemaker sometimes needed
What is a third degree AV block?
Complete block. No conduction of any atrial electrical impulses to the ventricles.
Ventricles resort to latent pacemakers
result is more p waves than QRS, QRS are regular and determined by latent pacemaker. No relationship between p waves and QRS. Risk for sudden cardiac death
What are ectopic beats?
Increased rate of depolarization at any site, to a rate faster than the sinus node results in a premature depolarization
Since it originates from a site other than the sinus node its called ectopic.
Latent pacemakers (such as the AV node) are often sites of origin of ectopic beats, however other sites may be responsible as well
Where can ectopic beats originate from?
The atria
Specialized conduction system
The ventricles (area where its the most serious)
What can cause tachycardia?
An ectopic focus that is firing rapidly
Multiple ectopic foci collectively causing a fast rhythm
Re-entrant circuits
What is the most common ineffective contraction (arrhythmia)?
Atrial fibrillation
What causes ~25% of strokes?
Thrombi formation in atria and emboli formation
Atrial fibrillation increases with age. More than __% of Americans older than 65 have AF
10%
What accounts for the majority of cardiovascular related deaths in the US?
Sudden cardiac death (often caused by ventricular fibrillation which leads to abrupt cessation)
What are some patients that have an inherited risk for ventricular arrhythmias due to channelopatheis?
Congenital long QT syndrome
Brugada syndrome
Catecholaminergic polymorphic ventricular tachycardia
Arrhythmogenic right ventricular cardiomyopathy
Short QT syndrome
Brain damage and brain death occurs within ___ minutes of sudden cardiac arrest. Survival rate reduces ___% per minute without CPR or defibrillator
4-6 minutes
10%
What is preclampsia?
Secondary hypertension associated with pregnancy often connected with diabetes. Can lead to eclampsia and seizures
What is malignant hypertension?
Sudden increase in BP, most common in African Americans
What are some risk factors for atherosclerosis?
Smoking HTN Diabetes Nephosclerosis Post menopause
Stenosis impedes blood flow at __% blockage
75%
Which is more dangerous, abrupt stenosis or chronic?
Abrupt
Strokes cause numbness/paralysis on the ___ side
Contralateral
What is the difference between stable angina, variant angina, and unstable angina?
Stable angina - caused by exertion, most common type and the easiest to manage. Subendocardial ischemia. Relieved by vasodilators. ST depesssion
Variant angina - brief like stable angina. Classically occurs at rest. Reversible spasm. ST segment elevation, sometimes depression
Unstable angina - new or worsening angina. Prolonged pain or pain at rest. ST depression. Often due to acute plaque change (dangerous)
What is ludwig’s angina?
Neck infection sometimes from mandibular molar and can block airway
What is pericarditis? What are some causes?
Swelling and irritation of the pericardium
Associated with stabbing sharp pain usually acute in chest but may be chronic
Causes: infection and inflammatory disorders
