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Pathology I > Blood Vessels and Cardiovascular System > Flashcards

Blood Vessels and Cardiovascular System Flashcards

1
Q

describe blood vessel composition

A
  • vessels composed of smooth muscle cells and ECM
  • inner lumen: endothelial cells
  • proportion varies throughout vasculature
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1
Q

describe arterial walls and the layers

A
  • thicker layers to accomodate pulsatile flow and BP
  • tunica intima, tunica media, adventitia
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2
Q

describe veins and the layers

A

thin walled due to reduced pressure
- tunica intima, media, adventitia

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3
Q

describe capillaries and the layers

A
  • smallest vessel for exchange of material between blood and tissue
  • basement membrane, tunica intima
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4
Q

what is the blood flow of heart

A

IVC -> RA -> RV -> pulmonary artery -> lungs -> pulmonary vein -> LA -> LV -> aorta

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5
Q

describe hypertensive vascular disease

A
  • often asymptomatic for years
  • over 25% of individuals in general population are hypertensive
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6
Q

what qualifies as stage 1 hypertension

A

greater than or equal to 130/80 mmHg

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7
Q

what qualifies as stage 2 hypertension

A

greater than or equal to 140/90mmHg

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8
Q

what is primary hypertension

A
  • idiopathic
  • 95% of cases
  • favorable prognosis unless complication such as MI or stroke
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9
Q

what is secondary hypertension

A
  • related to an underlying condition
  • prognosis dependent on tx of underlying disease
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10
Q

what is the most common cause of secondary HTN

A

renal disease

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11
Q

what are the other causes of secondary HTN

A
  • renal
  • endocrine
  • cardiovascular
  • neurologic
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12
Q

what is the mechanism of essential HTN

A
  • reduced renal/sodium excretion results fluid volume increase
  • vasoconstriction or structural changes in vessel wall
  • genetic factors
  • environmental factors - stress, smoking, obesity, diet
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13
Q

describe atherosclerosis

A
  • chronic arterial disease, consists of cholesterol plaques that lead to hardening and narrowing
  • in the US, diseases linked to atherosclerosis are the #1 leading cause of death
  • risk factors include nonmodifiable and modifiable factors
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14
Q

what are the nonmodifiable factors of atherosclerosis

A
  • genetic abnormalities
  • family history
  • increasing age
  • male gender
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15
Q

what are the modifable risk factors for atherosclerosis

A
  • hyperlipidemia
  • hypertension
  • cigarette smoking
  • diabetes
  • inflammation
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16
Q

what is atherosclerosis characterized by

A

atheromas that impinge on vascular lumen
- can rupture and cause occlusion

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17
Q

what is atherosclerosis composed of

A

soft, friable lipid cores (cholesterol) , necrotic debris and a fibrous cap

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18
Q

what do atherosclerotic plaques do

A
  • obstruct vascular lumen leading to stenosis
  • prone to rupture -> thrombosis -> occlusion
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19
Q

what is in the fibrous cap

A

smooth muscle cells
- macrophages
- foam cells
- lymphocytes
- collagen
- elastin
- proteoglycans
- neovascularization

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20
Q

what is in the necrotic center

A
  • cell debris
  • cholesterol crystals
  • foam cells
  • calcium
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21
Q

what is the pathogenesis of atherosclerosis

A
  • chronic inflammatory response of the arterial wall to endothelial injury
  • endothelial injury -> accumulation of lipoproteins -> platelet adhesion -> macrophage migration -> lipid accumulation within macrophages -> smooth muscle cell recruitment and proliferation
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22
Q

what type of arteries are most commonly involved in athersclerosis

A
  • large elastic arteries: aorta, carotid, iliac artery
  • medium sized arteries: coronary, renal, popliteal
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23
Q

ischemia to what areas are most common in atherosclerosis

A
  • heart
  • brain
  • kidney
  • lower extremities
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24
Q

what are major clinical consequences of atherosclerosis

A
  • myocardial infarction
  • stroke
  • aortic aneurysm
  • peripheral vascular disease- gangrene of extremities
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25
Q

what is ischemic heart disease

A
  • broad category caused by myocardial ischemia
  • 90% of cases are a result of reduced coronary blood flow secondary to atherosclerosis
  • remaining cases may be a result of increased demand, diminished blood volume, diminished oxygenation or diminished oxygen carrying capacity
26
Q

ischemic heart disease is a direct consequence of:

A

insufficient blood supply to the heart

27
Q

what is the clinical presentation of ischemic heart disease

A
  • angina pectoris- intermittent chest pain caused by reversible myocardial ischemia
  • myocardial infarction
  • chronic IHD with congestive heart failure
  • sudden cardiac death
28
Q

what is a myocardial infarction

A
  • necrosis of the heart muscle due to ischemia
  • major underlying cause is atherosclerosis
  • more common in males
29
Q

what is MI pathogenesis

A
  • most are caused by acute thrombosis within coronary arteries: form from preexisting atherosclerotic plaque and results in infarction of the myocardium
  • 10% of cases MI occurs in absence of occlusive atherosclerotic vascular disease: coronary artery vasospasm, mural thrombi emboli, valve vegetations
30
Q

what happens in MI within seconds of vascular obstruction ( reversible and irreversible changes)

A
  • aerobic metabolism ceases
  • reversible changes: drop in ATP, accumulation of noxious metabolites, glycogen depletion, cellular swelling -> rapid loss in contractility
  • irreversible: prolonged ischemia lasting 20-40 minutes -> coagulative necrosis of myocytes
31
Q

what are the clinical features of MI

A
  • severe, crushing chest pain- may radiate to neck, jaw, epigastrium or left arm
  • 10-15% patients present with atypical symptoms
  • some are asymptomatic
  • electrocardiographic abnormalities
  • elevated serum biomarkers
32
Q

what are the elevated serum biomarkers in MI

A
  • myoglobin
  • troponin
  • creatine kinase
33
Q

what are the complications after MI

A
  • contractile dysfunction
  • arrythmias
  • myocardial rupture
  • mural thrombus
  • heart failure
34
Q

describe congestive heart failure

A
  • the heart cannot generate sufficient output to meet metabolic demands of tissue
  • usually develops gradually due to cumulative effects of chronic work overload or progressive loss of myocardium
35
Q

CHF may result from:

A

systolic or diastolic dysfunction

36
Q

what is systolic dysfunction in CHF

A
  • inadequate myocardial contractile function
  • ischemic heart disease, HTN
37
Q

what is diastolic dysfunction in CHF

A
  • inabiltiy of herat to adequately relax and fill
  • left ventricular hypertrophy
38
Q

describe left sided heart failure

A
  • most common causes: ischemic heart disease, systemic hypertension
  • systolic: LV pumps blood with reduved ejection volume
  • diastolic: LV does not relax and fill
39
Q

what are the clinical features of left sided heart failure

A
  • dyspnea- earliest and most significant symptom
  • cough
  • tachycardia
  • cardiomegaly
40
Q

describe right sided heart failure

A
  • inefficient pumpling of blood to the lungs
  • usually a consequence of left sided heart failure
  • same etiology as left sided
41
Q

what is cor pulmonale

A

isolated right heart failure

42
Q

what is cor pulmonale caused by and what is it

A
  • respiratory disease
  • myocardial hypertrophy and dilation
43
Q

what are the clinical features of right sided heart failure

A
  • systemic and portal venous congestion
  • hepatic and splenic enlargement
  • peripheral edema
  • pleural effusion
  • ascites
44
Q

describe congenital heart disease

A
  • abnormalities of the heart or major vessels that are present at birth
  • accounts for 20-30% of all birth defects
  • most commonly arises from faulty embryogenesis
  • etiology unkown in 90% of cases
  • environmental factors
  • genetic factors
45
Q

what are the environmental factors involved in congenital heart disease

A
  • rubella infection
  • teratogens
  • maternal diabetes
46
Q

what are the 3 categories of congenital heart disease

A
  • left to right shunt malformations
  • right to left shunt malformations
  • malformations causing obstruction
47
Q

what is a shunt

A

abnormal communication between blood vessels

48
Q

describe right to left shunt malformations

A
  • pulmonary circulation is bypassed
  • clinical sign: cyanosis
49
Q

describe right to left shunt malformations

A
  • tetralogy of Fallot: 4 heart abnormalities
  • ventricular septal defect: shunt between ventricles
  • overriding of VSD by the aorta
  • stenosis - narrowing of R ventricular outflow tract
  • right ventricular hypertrophy
50
Q

describe left to right shunt malformations

A
  • increase blood flow into pulmonary circulation
  • right ventricular hypertrophy
  • may lead to right side failure
51
Q

what are malformations causing obstriction

A
  • narrowing of chambers, blood vessels, and valves
  • aortic coarctation
  • atresia
52
Q

what is atresia

A

complete obstruction

53
Q

what is aortic coarctation

A

narrowing of the aorta

54
Q

describe aortic coarctation

A
  • more common in males
  • clinically associated with systolic murmurs and palpable thrills
55
Q

describe valvular heart disease

A
  • group of diseases that affect the heart valves: tricuspid, pulmonary, mitral and aortic
  • may result in stenosis, insufficiency or both
56
Q

what is insufficiency

A
  • failure of valve to close completely, allowing backflow of blood
    -regurgitation or incompetence
57
Q

what is stenosis

A

failure of valve to open completely, obstructing forward flow

58
Q

what is rheumatic heart disease/ fever

A
  • acute, immunologic mediated, multi system inflammatory disease after group A Beta- hemolytic streptococcal infection
59
Q

what does rheumatic heart disease involve

A

valve inflammation and scarring
- results in mitral valve stenosis

60
Q

what is rheumatic heart disease pathogenesis

A
  • hypersensitivity type II-antibodies directed against streptococcal antigen cross reacts with a myocardial antigen
  • binds to proteins in the myocardium and cardiac valves
  • fibrotic lesions are a consequence of healing and scarring associated with resolution of acute inflammation
61
Q

what histological charactersitic is characteristic of rheumatic disease

A

aschoff bodies

62
Q
A

Pathology I (24 decks)

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