Flashcards in Arteriosclerosis and Hypertension #8 (2/1/16) Deck (23):
____ is responsible for more morbidity and mortality than any other disease.
What are the 2 principle mechanisms of vascular disease?
1. Narrowing or obstruction of vascular lumina
2. Weakening of vascular walls, leading to dilation and or rupture.
Describe medial calcific sclerosis....
Calcification in the muscular walls (No encroachment on the lumen, therefore usually clinically insignificant)
Affects arterioles and associated with diabetes and hypertension.
*Two types: Hyaline and Hyper plastic
_______ affects larger arteries.
Atherosclerosis is associated with lesions called _____.
Atheromas, which protrude into the lumen and create a speed bump that will activate epithelial cells and cause a prothrombotic situation.
- Atheromas can grow to obstruct blood
- May weaken the underlying media of the artery
- plaques can rupture, resulting in catastrophic vessel thrombosis.
What are the major non-modifiable risk factors for atherosclerosis?
- Genetics (most important)
- Increasing age
- Male gender
What are the major Modifiable risk factors for atherosclerosis?
- Hyperchloesterolemia - high LDL, low HDL
- Diabetes Mellitus
- Cigarette smoking
What are some additional risk factors for Atherosclerosis?
- Lipoprotein (A) levels
- Metabolic syndrome (obesity)
- Type A personality (stress)
- Lack of Exercise
Atherosclerosis can occur in response to injury, how does this happen supposedly?
1. Endothelial injury results in endotheilal dysfunction.
2. Accumulation of lipoproteins - LDL and Cholesterol in the vessel wall.
3. Monocyte adhesion - migration into intimate with differentiation into macrophages and "foam cells"
4. Lipid accumulation in macrophages with release of inflammatory cytokines.
5. Smooth muscle cell recruitment due to factors released form activated platelets.
6. Smooth muscle proliferation and ECM collagen production.
7. Fully developed plaque with collagen (fibers cap) and central lipid core.
What are fatty streaks?
Appear in children independent of geography, gender, race and environment.
Occur at sites both prone and not prone to develop atherosclerosis, but some may progress to atheromas.
What are some potential changes that can occur in atherosclerotic plaques?
- Fissure formation
- Hemorrhage into the plaque
- Medial weakening
What are some clinical complications of atherosclerosis?
- Ischemic heart disease (MI)
- Cerebral Infarct (stroke)
- Renal Artery stenosis
- Aortic aneurysm
What is normal BP?
Less than 140/90
What is mild hypertension?
140/90 - 159/104
What is moderate to severe hypertension?
Hypertension affects ____% of the US population.
What are the symptoms of Hypertension?
- None (If low to moderate)
________% of all patients with hypertension have contributing factors.
What are some complications that occur with hypertension?
Concentric left ventricular hypertrophy
- :VH + ventricular dilation
- Atherosclerosis and arteriosclerosis
- retinal injury
- Dissecting hematoma of the aorta
What are the 2 types of Hypertensive Heart Disease?
Compensated = left ventricular concentric hypertrophy provides normal cardiac output.
Decompensated = hypertrophy no longer adequate to provide normal cardiac output due to decreased myocardial contractility, resulting in LV dilation and gradual onset of CHF.
What is Concentric hypertrophy?
Thickening of the left ventricular wall at the expense of the left ventricular chamber with little or no increase in the outside cardiac dimensions.