Blood Vessels III Flashcards

1
Q

obesity

A

accumulation of adipose tissue sufficient to impair health

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2
Q

BMI

A

weight in kg / height in m-2

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3
Q

BMI increases risk for

A

DM, HTN, hypertriglyceridemia and low HDL

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4
Q

metabolic syndrome**

A

obesity
dyslipidemia
HTN
insulin resistance (pre-diabetic)

predisposition to CV disease and DM type II

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5
Q

vasoconstriction

A

can occur at sites of plaques

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6
Q

2/3 cholesterol metabolism

A

LDL receptor pathway
-apo B100 and E

75% LDL receptors on hepatocytes

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7
Q

cholesterol released from LDL

A

1 suppresses cholesterol synthesis
-inhibits HMG CoA reductase (like statins)

2 activates ACAT - ester and storage of cholesterol

3 down regulates synthesis of LDL receptors

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8
Q

statins

A

inhibit HMG CoA reductase

promote synthesis of LDL receptors

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9
Q

1/3 cholesterol metabolism

A

oxidized LDL - to scavenger receptor pathway

to macrophages - foam cells

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10
Q

lipoprotein lipase

A

lipolysis of VLDL - in capillaries

-release triglycerides - stored in fat cells or used as energy in skeletal m.

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11
Q

IDL

A

after capillary lipolysis of VLDL

-to liver OR converted to LDL

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12
Q

cholesterol acyltransferase

A

storage of cholesterol esters

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13
Q

highest risk factor for atherosclerosis

A

LDL-C > 190

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14
Q

decreased risk for atherosclerosis

A

increased HDL

  • increases with exercise and alcohol
  • decreases with obesity and smoking
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15
Q

estrogen

A

does not decrease risk for heart attacks in post-menopausal women***

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16
Q

omega 3

A

beneficial

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17
Q

trans-unsaturated fats

A

margarine

-BAD

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18
Q

increased risk of CAD with oral contraceptives

A

women > 35 yo who also smoke

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19
Q

familial hypercholesterolemia

A

autosomal dominant

  • mutations in LDL receptor
  • elevated LDL cholesterol in plasma

leads to oxidized LDL - scavenger receptor pathway
-cytotoxic

monocytes, macrophages, smooth m, endo cells - receptors for oxidized LDL

atherosclerosis, xanthomas, and cytotoxicity occur

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20
Q

class 2 familial hypercholesterolemia

A

disrupted transport to golgi

  • most prevalent
  • abnormal protein folding
  • cannot transport from ER to golgi
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21
Q

familial hypercholesterolemia mutation classes

A
1 - synthesis
2** - transport to golgi
3 - binding apoprotein ligands
4 - clustering in coated pits
5 - recycling in endosomes
22
Q

heterozygote familial hypercholesterolemia

A

2-3x increase in plasma cholesterol

no xanthomas

23
Q

homozygote familial hypercholesterolemia

A

5x increase in plasma cholesterol
-severe atherosclerosis, corneal arcus, xanthomas, mitral valve stenosis

die from complications as child or young adult

24
Q

arcus

A

ring around outside of iris

25
Q

strong predictor for major atherosclerotic event

A

elevated plasminogen activator inhibitor 1

26
Q

lipoprotein a

A

higher risk of coronary and cerebrovascular disease

27
Q

premature vascular disease

A

elevated homocystine
-low folate or vit B - homocystinuria

therapeutic homocystine elevation - no atherosclerosis

28
Q

C-reactive protein

A

acute phase reactant - from liver

-strong and independent predictor for risk of MI, stroke, PAD, and sudden cardiac death

29
Q

to reduce CRP

A

smoking cessation
weight loss
statins
exercise

30
Q

best marker for degree of atherosclerosis

A

C-reactive protein**

31
Q

pathogenesis of endo injury

A

accumulation of lipoproteins (LDL) - oxidized
adhesion of monocytes and migration into intima
adhesion/activation of platelets
migration of smooth m cells - become neointimal
proliferate and deposit ECM/collagen
foam cell accumulation
over time lay down collagen - fibrous cap

32
Q

infections and atherosclerosis

A

chlamydia pneumoniae
herpesvirus
cytomegalovirus

33
Q

cholesterol efflux from plaques**

A

HDL helps clear cholesterol from accumulations

34
Q

celecoxib

A

COX2 inhibitor

  • no prostacyclin formation
  • prothrombotic state
35
Q

aspirin

A

COX1 inhibitor

  • no thromboxane formation
  • anti-thrombotic state
36
Q

prostacyclin

A

formed during COX2 pathway

-inhibited vy celecoxib

37
Q

thromboxane

A

formed during COX1 pathway

-inhibited by asprin

38
Q

aneurysm

A

localized dilation of blood vessel or wall of heart

39
Q

abdominal aortic aneurysm

A

atherosclerosis

40
Q

thoracic aortic aneurysm

A

HTN - medial cystic degeneration

vaso vasorum arteriolosclerosis - not enough nutrients to media - degeneration of wall occurs

41
Q

mycotic aneurysms

A

with infection

  • embolization of septic embolus
  • extension of adjacent suppurative process
  • circulating organisms
42
Q

marfan syndreom

A

inadequate fibrillin
-aberrant TGF-beta activation - loss of elastic tissue matrix

likely to aneurysm

43
Q

loeys-dietz

A

TGF-beta receptor mutations - elastic tissue loss

likely to aneurysm

44
Q

ehlers-danlos syndrome

A

defective collagen III synthesis

likely to aneurysm

45
Q

scurvy

A

Vit C deficiency
-defective collagen cross-linking

likely to aneurysm

46
Q

increased MMP activity

A

by inflammatory cells - cause net loss of medial ECM - aneurysm

47
Q

true aneurysm

A

bound by aterial wall component or myocardium

48
Q

saccular aneurysm

A

rounded - localized one area out-pouching

49
Q

fusiform aneurysm

A

entire vessel wall circumferentially

50
Q

false aneurysm

A

hematoma secondary to transmural rupture

aka pseudoaneurysm

51
Q

X-ray of abdomen

A

see aneurysms - cannot tell if false vs. true