2.2a Pathophysiology Flashcards
(34 cards)
What is endothelial dysfunction?
- like the wearing out of Teflon on a fry pan
- condition where the endothelial layer (inner layer) of small arteries fails to perform all its important functions
What is the importance of the endothelium?
maintains proper dilation and constriction of blood vessels
protects tissues from toxic substances
regulates blood clotting mechanism
controls the fluid, electrolytes, and other substances that pass back and forth between blood and the tissues
regulates inflammation in the tissues
Is the initiation, progression, and subsequent regression and stabilization of atherosclerosis a random process?
No, it is a chaotic process
non-linear process, where the variables within the system interact in an exponential or multiplicative fashion rather than in a simple additive manner
What is the importance of nitric oxide?
plays a vital role in the maintenance of cardiovascular and endothelial homeostasis
What is oxidative stress?
the development of an imbalance between endogenous cellular ROS (during normal cellular functions) and the levels of antioxidants intended to mitigate their potentially destructive effects
ROS = reactive oxygen species
other CVD risk factors can accelerate the production of ROS within arterial walls
What is C-reactive protein?
it is being looked into as a non-direct indication that someone is likely to get heart disease
elevated levels of CRP are associated with endothelial dysfunction in patients with coronary artery disease; may predict adverse CVD events and CRP can induce the expression of vascular adhesion molecules that attract leukocytes and accelerate the atherosclerotic process
What is cardiovascular disease?
What is atherosclerosis?
the buildup of fats, cholesterol, and other substances in and on the artery walls
this buildup = plaque
plaque causes arteries to narrow, blocking blood flow
plaque can also burst and lead to a clot
What are the divisions of CVD?
macrovascular disease
microvascular disease
What are the 3 types of macrovascular disease?
Coronary artery disease
Peripheral vascular disease
Cerebral vascular disease
What are the 3 types of microvascular disease?
Retinopathy - damage to blood vessels of the eyes
Neuropathy - damage to nerves
Nephropathy - damage to kidneys
Why do we say “hardening of the arteries”?
the hardness of atherosclerotic arteries comes from the deposition of calcium within the vascular intima and media due to chronic inflammation
What likely drives chronic vascular inflammation?
oxidative stress
What causes oxidative stress?
- usually driven by the traditional CVD risk factors
- facilitates and propagates endothelial dysfunction
At what % of blockage will we typically intervene with stent or other technique?
70% or more blockage
What is a myocardial infarct?
A heart attack
occurs when a blood clot is lodged in the coronary artery
most are due to rupture of a plaque, leading to platelet activation and formation of a thrombus that blocks the artery
What are the symptoms of a myocardial infarction?
most common = chest pain or discomfort, which may travel into the shoulder, arm, back, neck, or jaw
What is ischemia?
Lack of oxygenated blood flow
What are the 3 types of angina? Explain.
Stable angina: more or less a fixed blockage/plaque; symptoms will be fairly consistent
- NO symptoms at rest
Unstable angina: plaque is not as stable; changing symptoms according to exertion, sometimes symptoms at rest
Variant angina: no overt plaque; vasospasm (smooth muscle is spasming and that is what is causing the angina)
What is hibernating myocardium?
Ischemia of longer duration that may lead to hibernation of myocardium - may last days to weeks.
Macrovascular disease involves what vessels?
Large blood vessels, including coronary arteries, aorta, large arteries of the brain and the limbs
Microvascular disease involves what vessels?
Small blood vessels, including the carotid arteries, renal arteries, and the small vessels in limbs
What are the 3 acute coronary syndromes?
Unstable angina
NSTEMI
STEMI
(these two are myocardial infarction)
What is NSTEMI?
What is seen in ECG?
non-ST elevation myocardial infarction
- an occluding thrombus that opens or has good collaterals
ST depression and/or T-wave inversion
