blood vessel pathology

Question 1

origins of atherosclerosis

Answer 1

d

Question 2

What is the most common form of arteriosclerosis

Answer 2

atherosclerosis

Question 3

what is atherosclerosis

Answer 3

a narrowing and hardening of arteries due to intimal atheromas (atherosclerotic plaque)

Question 4

What are the vessels most affected by atherosclerosis

Answer 4

abdominal aorta
coronary arteries
popliteal arteries
carotid arteries
vessels of the circle of willis

Question 5

what are the contents of an artherosclerotic plaque

Answer 5

fibrous cap
lipid core
necrotic center (cell debris, cholesterol, foam cells, and calcium)

Question 6

What are the steps of atherosclerosis development

Answer 6

1. chronic endothelial injury
2. endothelial dysfunction/monocyte adhesion and immigration
3. macrophage activation/ smooth muscle recruitment
4. leukocytes and smooth muscle engulf lipid
5. smooth muscle proliferation/ collagen and extracellular lipid deposition

Question 7

what can cause chronic endothelial injury

Answer 7

hypertension
hyperlipidemia
smoking
toxins
viruses
immune reactions

Question 8

what happens when high blood pressure damages the endothelium of blood vessels

Answer 8

it causes inflammation. mostly in areas of turbulent flow, this increases cholesterol invasion/plaque formation

Question 9

What are the risk factors for atherosclerosis

Answer 9

age
gender
genetics
lifestyle*
smoking 
diabetes
inflammation

Question 10

What are the complications caused by atherosclerosis

Answer 10

stenosis
thrombus/embolism
aneurism
calcification

Question 11

how does LDL increase atherosclerosis

Answer 11

OXIDIZED LDL causes adhesion and entry of monocytes, then the monocytes turn into macrophages, which consume the LDL and turn into a foam cell. foam cells release growth factors that encourage atherosclerosis

Question 12

what are the two types of LDL

Answer 12

type A = large less dense

type B = small more dense

Question 13

which is the worse type of LDL, type A or type B

Answer 13

type B. it is smaller so it can fit through the endothelium more easily, and it is more dense so it bounces along the endothelium more, causing it again to be more likely to penetrate the endothelium

Question 14

what determines which type of LDL you have more of

Answer 14

genetics, oral contraceptives, and diet

Question 15

what kind of diet increases type B LDL

Answer 15

low fat, high carb diets

Question 16

is LDL type B commonly measured in a blood test? if not, what is a good substitute?

Answer 16

it can be measured but usually isn’t

TG:HDL is a good surrogate

Question 17

what is a good TG:HDL level

Answer 17

less than 1.5 is good, less than 2 is recommended

Question 18

what diet decreases both LDL type B and TG:HDL levels

Answer 18

a low carb, high fat diet

Question 19

what must occur for cholesterol to be a problem in atherosclerosis

Answer 19

is must be oxidized.

Question 20

how do we prevent our LDL from being oxidized and becoming problematic

Answer 20

antioxidant therapy
exercise
keto diet

Question 21

what does the HMG CoA reducatase enzyme do

Answer 21

it causes cholesterol to be synthesized

Question 22

what actiavates, and what deactivates HMG CoA reductase

Answer 22

insulin activates, glucagon inactivates

Question 23

what drugs inhibit HMG CoA reductase

Answer 23

statins

Question 24

What are the negative side effects of statins

Answer 24

increase risk of diabetes
kidney failure
liver failure
muscle pain (myopathy )
reduces ubiquinone
reduced important cholesterols

Question 25

What are the potential problems caused by statins reducing ubiquinone (electron carrier in the ETC of the mitochondria)

Answer 25

muscle break down (rhabdomyelosis) muscle weakness and pain reduced mitochondrial function (oxidative stress) cataracts

Question 26

what is the most cost effective treatment of coronary heart disease

Answer 26

aspirin

Question 27

what are the 5 cholesterol containing things that are important that can be reduced by statins

Answer 27

``` cell membrane cholesterols steroid synthesis ubiquinone bile salts vitamin D ```

Question 28

what are the two types of hypertension

Answer 28

benign and malignant

Question 29

what are the two types of benign hyper tension

Answer 29

essential or primary and secondary

Question 30

what is essential or primary hypertension

Answer 30

idopathic hypertension that arises from a mix of genetic and environmental factors

Question 31

what is seconday hypertension

Answer 31

hypertension resulting from | structural renal, or endocrine defects

Question 32

what are the symptoms of malignant hypertension

Answer 32

``` >200/120 mm/hg lethal in 1-2 years if untreated renal failure retinal hemorrhages papilledema ```

Question 33

what is the major pathogenic defect that initiates the hypertensive process

Answer 33

insulin resistance

Question 34

what are the 5 ways insulin resistance affects hypertension

Answer 34

RAAS dysfunction (antidiuretic, increased bp) enhanced growth factor (thicker vessel walls) SNS activity increase (increased heart rate) dyslipidemia (less HDL, more LDL type B) decrease in Nitric oxide (NO is vasodilator)

Question 35

what is an aneurism

Answer 35

local abnormal vessel dilation

Question 36

what is an aneurism

Answer 36

local abnormal vessel dilation

Question 37

what causes aneurisms

Answer 37

``` atherosclerosis wall degeneration trauma conginital defects (marfan) infection ```

Question 38

what is aortic dissection

Answer 38

aneurism of the aorta

Question 39

what are the types of aortic dissection

Answer 39

``` 1 = both ascending and descending 2 = ascending only 3 = descending ```

Question 40

what are the four types of vessel tumors

Answer 40

hemangioma - common and benign glomus tumor - benign but painful kaposi sarcoma - low malignant angiosarcoma - highly malignant