Week 6 Cardiovascular Flashcards
What vascular diseases did we cover?
- Hypertension
- Atherosclerosis
What diseases of the heart were covered?
- Myocardial Infarction
- Cardiac Hypertrophy
- Conduction Disorders
- Myocarditis
- Carcinoid Syndrome
What Hematopathology diseases were covered?
- Anemia (Erythrocytes)
- Thombocytopenia (Platelets)
- Neutropenia (Leukocytes)
Explain the causes of Hypertension.
- Essential Hypertension–> NOT explained by another disease
- Sustained pressure increase
Systolic over 140
Diastolic over 90
- Complex multigenic disorder
Genetic predisposition
Environmental factors - Secondary Hypertension–> explained by another disease
- Renal Dysfunction
- Endocrine Dysfunction
- Cardiovascular Dysfunction
- Neurologic Dysfunction
How do diuretics treat hypertension?
They force the kidney to NOT retain as much fluid; decreases blood volume, which decreases blood pressure
What is the blood pressure formula?
Blood pressure= Cardiac output + Peripheral resistance
What is peripheral resistance?
How much the blood vessels push on the blood itself
- Anything that affects constriction or dilation of blood vessels also affects peripheral resistance
- Ex: larger blood volume = more total pressure on the cardiovascular system
2 types of Arteriosclerosis
- Hyaline
- Hyperplastic
Describe hyaline arteriosclerosis
- Protein deposits
- Narrow lumen of vessels
- Associated with benign hypertension
- Leak of plasma proteins past damaged epithelial cells
Describe hyperplastic arteriosclerosis
- Onion-skinning
Smooth muscle and basement membrane- many layers
PAS staining for basement membrane - Associated with severe hypertension
Narrows lumen and causes hypertension to be worse
What is arteriosclerosis?
Hardening of arteries
- happens over time
- damage to BVs causes sclerosis
- scar tissue forming around BVs b/c they are damaged by excessive pressure
What is Atherosclerosis?
Type of arteriosclerosis
- Characterized by formation of atheromas
Aka: atherosclerotic plaques
Lesion in tunica intima
Projects into lumen
- Core is lipids covered by fibrous cap
Body NOT handling lipids properly and they end up deposited in the walls of BVs
What is the difference b/t vulnerable atherosclerotic plaque and a stable plaque?
- Vulnerable
- larger fibrous core with smaller/thinner fibrous cap
- a lot of immune response
- more vulnerable to breaking off and traveling through the blood - Stable
- Greater/thicker fibrous cap relative to lipid core = the more stable the plaque
What are cholesterol deposits?
Cholesterol clefts–> cholesterol crystalized out–> cholesterol crystals form and when tissue is processed the crystals are not stable and they get knocked out and you end up with cholesterol clefts in tissue
What are foam cells?
Macrophages trying to digest lipids and failing to do so
- Macrophages with a foamy appearance
What are the 4 basic steps of atherosclerosis pathogenesis
- Endothelial cell dysfunction
- Formation of atherosclerosis plaque
- T cells-macrophage interaction
- Fracture of the plaque and thrombosis
Describe atherosclerosis pathogenesis step 1: endothelial cell dysfunction
- plaques initiate at sites where endothelium is intact
- result from endothelial dysfunction–> stressors affecting endothelial function
- Most important contributors are:
1. Hemodynamic disturbances- where you are getting turbulence through lumen of BV
2. Hypercholesterolemia- high cholesterol in lipoproteins can damage endothelial cells directly
Explain apoproteins and lipoproteins
- liver makes apoproteins
- apoproteins can bind to lipids
- lipids are transported by apoproteins–> when lipids travel in complex with apoproteins, they are called lipoproteins
- depending on relative amount of lipid and protein, you get different densities of lipoproteins
Lipids are LESS dense then proteins
What are common abnormalities of lipoproteins in Hypercholesterolemia?
- increased LDL levels–> more lipid than protein
- decreased HDL levels–> more protein than lipid
- presence of abnormal lipoproteins–> may be modified in some way due to other disease processes affecting lipoproteins
What is chronic hyperlipidemia (in reference to hypercholesterolemia)
- Increased LDL, Decreased HDL
- Damage the intima by LDL accumulation
–> macrophages attempt to remove - Directly affect endothelial cell function
–> endothelial cells are sensitive to amount of lipid being transported in blood
What are oxidized LDLs and what do they do?
- LDLs are oxidized by excess ROS
- Directly damage endothelial cells by attaching to them
- Ingested by macrophages through specific receptor (NOT LDL receptor)
- Accumulates in phagocytes, which then appear foamy
- Stimulate cytokine, growth factor, and chemokine secretion–> innate immune response to help the body cope with stress
–> monocyte recruitment - Macrophages release ROS
–> injure tissue and deplete NO–> removing a dilator, so more likely to have constriction (secondary hypertension b/c caused by hyperlipidemia)
What is a fatty streak?
Area of fat accumulation in tunica intima with macrophages including foam cells
- NO fibrous cap yet
Describe atherosclerosis path. step 2: Fibrous Cap
- Cytokines released during inflammatory rxn induce smooth muscle cell proliferation and ECM production
- Smooth muscle cells migrate to endothelium
- Fibrous cap forms
–> Conversion of fatty streak into mature atheroma - ROS and cytokines continue to produce oxidized LDLs
What is the difference between fatty streak and mature atheroma?
fibrous cap in mature atheroma
Describe atherosclerosis path. step 3: Cell Migration
- Normally leukocytes do not bind to endothelium
- Dysfunctional endothelial cells express adhesion molecules
- Bound leukocytes migrate into intima due to chemokines being produced by macrophages
- T lymphocytes induce chronic inflammation
–> release of inflammatory cytokines - Now you are going from macrophages trying to clean up some damage to a chronic inflammatory response in the atheroma
Describe atherosclerosis path. step 4: Thrombus Formation
- Damaged endothelium provides focal point for platelet binding and activation
- Accumulation of platelets produces blood clot
–> inflammatory mediators contribute - Clot breaks free–> will travel and eventually block a smaller vessel
Pre-clinical phase of atherosclerosis progression
Normal artery–> fatty streak–> fibrofatty plaque–> advanced/vulnerable plaque
Clinical phase of atherosclerosis progression
- Aneurysm and Rupture
- Mural thrombosis
- embolization
- wall weakening
- potential life-threatening hemorrhage
- clot damages more of the wall–> damages tunica media and adventitia
Clinical phase of atherosclerosis progression
- Occlusion by Thrombus
- Plaque rupture
- plaque erosion
- plaque hemorrhage
- mural thrombosis
- embolization
- clot forming that completely occludes BV
Clinical phase of atherosclerosis progression
- Critical Stenosis
- progressive plaque growth
- NOT blood clot forming
- plaque growing to a point that it blocks BV sufficiently enough to be noticed
- lumen of BV too small for normal function b/c atheroma has gotten so large
What are the consequences of atherosclerosis?
- Obstruct blood flow
- Rupture of plaque–> thrombosis
- Weaken underlying tunica media
–> aneurysm formation
Coronary Artery Disease - Myocardial infarction responsible for 1/4 of deaths in US
- If it happens in an artery assoc. with blood supply to the heart itself, you can get myocardial infarct (heart attack)
What are the clinical complications of atherosclerosis?
Location is critical
- Occlusion results in infarct
–>myocardial infarction- coronary arteries
–>cerebral infarction (stroke)- brain
–> peripheral vascular disease- smaller vessel in peripheral system
- Rupture results in hemorrhage
–>formation of thrombus
–> aortic aneurism- if happens in BV like the aorta, you can bleed out quickly
What can thrombosis (mobile plaque) cause?
Can produce distal occlusions and additional plaques
- can attach to the wall or get stuck somewhere and actually cause a new plaque to form in that area
Trace the blood flow through the heart.
From body–> vena cava–> Right atrium–> valve to Right ventricle–> pulmonary artery–> lungs–> pulmonary veins–> Left atrium–> valve to Left ventricle–> aorta–> rest of body