Blood vessels and ischeic heart disease

Question 1

what is morbidity and mortality assoc with atherosclerosis

Answer 1

VIRCHOWS’
1) narrowing of vessels

2) damaged endothelial lining
3) weakened vessel walls

Question 2

why is narrowing of vessels dangerous?

Answer 2

ischemia of tissue perfused by vessels

Question 3

why is endothelial lining damage dangerous?

Answer 3

promotes intravascular thrombosis

Question 4

why is weakened vessel walls

dangerous?

Answer 4

predispose to dilation/rupture

Question 5

Virchow’s triad

Answer 5

1) abnormal blood flow = turbulence
2) hypercoagulability
3) endothelial injury

Question 6

differentiate elastic vs muscular artery

Answer 6

elastic = accomodate/dampen pulsatile flow

muscular = regulate flow (vasconstrict/dilate)

Question 7

ex of elastic artery

Answer 7

aorta

Question 8

ex of muscular artery

Answer 8

renal artery

Question 9

atherosclerosis is ____ to injury

Answer 9

response

Question 10

____ is response to injury

Answer 10

atherosclerosis

Question 11

why is atherosclerosis considered a normal response to injury

Answer 11

reconstituting damaged vessels

if intimal thickening increased can cause stenosis of vessels/grafts

Question 12

examples of responses to vessel stenosis

Answer 12

1) angioplasty re-stenosis (mech)
2) transplant arteriosclerosis (immun)
3) atherosclerosis

Question 13

subtypes of arterosclerosis

Answer 13

1) arteriolosclerosis
2) monckeberg’s
3) atherosclerosis

Question 14

what is pathology of atherosclerosis

Answer 14

fibrofatty plaques on intima

Question 15

define monckeberg’s medial calcific stenosis

Answer 15

calcification of MEDIA of muscular arteries

NOT AFFECT VESSEL LUMEN

Question 16

what is disease assoc with calcification of media of muscular arteries

Answer 16

monckeberg’s medial calcific stenosis

Question 17

where do you see arteriosclerosis

Answer 17

small arteries/arterioles

Question 18

what is arteriolosclerosis assoc with

Answer 18

HTN

Diabetes

Question 19

what are 3 major targets of atherosclerosis

Answer 19

1) coronary arteries –> ischemic disease
(with thrombosis –> MI)

2) cerebral arteries –> stroke, infarct, neuro
3) aorta –> AAA
4) ischemic bowel (mesenteric)

Question 20

Pathogenesis of atherosclerosis

Answer 20

1) focal chronic endo injury
2) insudation of lipoproteins into vessel wall
3) interactions with macs and lymphs
4) incr smooth muscle prolif –> atheroma

Question 21

what is a foam cell

Answer 21

macrophages taking up

fat globules

Question 22

what is aneurysm

Answer 22

weakening of wall

Question 23

where do you find aneurysms

Answer 23

1) trauma
2) local infection (mycotic aneurysm)
3) congenital defect (berry aneurysm)
4) arteriovenous aneurysm

Question 24

what are major causes of aortic aneurysms (3)

Answer 24

1) atherosclerosis
2) cystic medial degeneration (Marfan/age)
3) syphilis

Question 25

where do aortic aneurysms most commonly present

Answer 25

abdominal aorta, below renal

Question 26

mechanism causing aortic aneurysm

Answer 26

1) atherosclerosis weaknes wall | 2) mass effect stim tumors (compression/erosion)

Question 27

what is most common co-occurrence with aortic dissection

Answer 27

HTN (90%) abnormality of connective tissue

Question 28

what is mechanism of aortic dissection

Answer 28

1) intima tear toward heart or distal | 2) 2nd intimal tear, blood into lumen --> double barreled aorta

Question 29

what is a double barreled aorta

Answer 29

2nd intimal tear when blood returns into lumen

Question 30

symptoms of aortic dissection

Answer 30

SUDDEN EXCRUCIATING PAIN RADIATE TO BACK

Question 31

Type A aortic dissection Type B aortic dissection

Answer 31

Type A = ascending aorta Type B = off great vessels

Question 32

what are ascending aorta aortic dissections classified as?

Answer 32

type A

Question 33

which is worse type A or B aortic dissections

Answer 33

type A because could continue into coronary arteries --> ischemia

Question 34

define false aneurysm

Answer 34

small area in vessel wall with hematoma forming outside

Question 35

Features of vasculitis in pathology

Answer 35

1) vessel wall inflammation 2) vessel wall damage 3) fibrinoid necrosis

Question 36

what are underlying causes of vasculitis

Answer 36

1) localized infection (viruses) 2) radiation 3) trauma 4) arthrus rxn 5) viruses in lesion 6) SLE

Question 37

which arteries do you see polyarteritis nodosa

Answer 37

medium to small arteries | all stages coexist

Question 38

what vasculitis do you see in medium to small arteries

Answer 38

polyarteritis nodosa

Question 39

what vessels do you see microscopic polyarteritis

Answer 39

arterioles capillaries venules (all at same stage)

Question 40

which vessels do you see temporal arteritis (giant cell arteritis)

Answer 40

1) temporal arteries | 2) ophthalmic branches --> blindness

Question 41

features of temporal arteritis

Answer 41

granulomatous inflammation due to macrophages coalescing

Question 42

what patient population do you see temporal arteritis

Answer 42

elderly (>50)

Question 43

where do you find Wegener's granulomatosis

Answer 43

lungs + kidneys

Question 44

features of Wegener's granulomatosis

Answer 44

vasculitis | granulomas

Question 45

what if you don't treat Wegener's granulomatosis

Answer 45

>90% die in 2 yrs

Question 46

where do you find Takayasu's arteritis (pulseless disease)

Answer 46

aorta aortic branches pulmonary arteries

Question 47

why is Takayasu's arteritis also known as pulseless disease

Answer 47

because it narrows openings of great vessels

Question 48

what are symptoms of Takayasu's arteritis

Answer 48

coldness | numbness of fingers and legs

Question 49

what patient population do you see takayasu's arteritis

Answer 49

young <40 y/o | more females

Question 50

where do you find Kawasaki's disease

Answer 50

coronary arteries

Question 51

what patient population do you find Kawasaki's disease

Answer 51

infancy | early childhood

Question 52

symptoms of kawasaki's disease

Answer 52

fever erythema palms and soles rash

Question 53

where do you find Buerger's disease

Answer 53

male cigarette smokers | also female incidence incr with smoking

Question 54

where do you find Buerger's disease

Answer 54

thrombosis of medium vessels, tibial and radial

Question 55

complications of Buerger's disease

Answer 55

1) gangrene | 2) pain at rest (due to nerves)

Question 56

where do you find thrombophlebitis

Answer 56

clot in deep leg veins

Question 57

dangers of thrombophlebitis

Answer 57

death from PE (saddle embolus)

Question 58

predisposing factors to thrombophlebitis

Answer 58

1) immobilization/bed rest 2) cancer (hypercoag) 3) trousseau's sign

Question 59

what is trousseau's sign

Answer 59

clots come and go due to malignancy

Question 60

2 MAJOR dangers with ischemic heart disease

Answer 60

1) decr blood supply due to atherosclerosis of coronary arteries 2) demand ischemia caused by hypotension from infection

Question 61

when is ischemic heart disease symptomatic

Answer 61

>75% stenosis vasodilation not sufficient for O2

Question 62

define angina pectoris

Answer 62

intermittent chest pain from reversible myocardial ischemia

Question 63

define stable angina pectoris

Answer 63

episodic chest pain with exertion

Question 64

disease assoc with episodic chest pain with exertion

Answer 64

stable angina pectoris

Question 65

define unstable angina pectoris

Answer 65

incr freq and intensity with LESS EXERTION can trigger irreversible myocardial ischemia

Question 66

if you have incr freq and intensity of chest pain with less exertion

Answer 66

unstable angina pectoris

Question 67

define prinzmetal's angina

Answer 67

chest pain at rest (sleep)

Question 68

what is prinzmetal's angina due to?

Answer 68

vasospasm

Question 69

chest pain at rest disease?

Answer 69

prinzmetal's angina

Question 70

define myocardial infarction

Answer 70

myocardial necrosis from ischemia (many hrs, not relieved by nitro)

Question 71

myocardial infarction not relieved by ___

Answer 71

nitro

Question 72

what are most myocardial infarcts caused by

Answer 72

clots on plaques

Question 73

when does necrosis begin after MI

Answer 73

20-30 min after occlusion

Question 74

progression of myocardial infarction

Answer 74

1) necrosis begin in subendocardial (under endothelial lining) 2) migrates outward

Question 75

what is a full thickness necrosis known as

Answer 75

transmural infarction

Question 76

if MI affects right dominant circulation (more common) which vessels involved

Answer 76

Right coronary artery | supplying posterior LV

Question 77

if MI affects left dominant circulation, which vessels involved

Answer 77

Left circumflex coronary artery | supplying posterior LV

Question 78

____ occlusion produces larger infarcts

Answer 78

more proximal

Question 79

more proximal occlusion produces ____

Answer 79

larger infarcts

Question 80

what happens when main vessel 100% occluded?

Answer 80

chronic ischemia recruits additional vessels

Question 81

Gross appearance and microscopic appearance of MI at 4 hrs

Answer 81

gross = no change microscopic = coagulation necrosis

Question 82

what time point in MI? gross = no change microscopic = coagulation necrosis

Answer 82

4 hrs

Question 83

Gross appearance and microscopic appearance of MI at 1 day

Answer 83

gross = pallor micro = neutrophils no nuclei in most myofibers

Question 84

what time point in MI? gross = pallor micro = neutrophils

Answer 84

1 day

Question 85

Gross appearance and microscopic appearance of MI at 1 week

Answer 85

gross = pallor micro = macrophages loss nuclei hypereosinophilia contraction bands

Question 86

what time point in MI? gross = pallor micro = macrophages

Answer 86

1 week

Question 87

Gross appearance and microscopic appearance of MI at 10 days

Answer 87

gross = yellow, soft, sunken micro = granulation tissue

Question 88

what time point in MI? gross = yellow, soft, sunken micro = granulation tissue

Answer 88

10 days

Question 89

Gross appearance and microscopic appearance of MI at 2 months

Answer 89

gross = firm, grey scar micro = fibrosis

Question 90

what time point in MI? gross = firm, grey scar micro = fibrosis

Answer 90

2 months

Question 91

complications of MI < 2 weeks after?

Answer 91

risk of rupture when mostly neutrophils and dead cells

Question 92

complications of MI?

Answer 92

ventricular aneurysms- damaged wall | mural thrombus - damage and pooling of blood

Question 93

what is sudden cardiac death most common due to?

Answer 93

marked atheroslcerosis

Question 94

mechanism of sudden cardiac death due to atherosclerosis?

Answer 94

1) plaque rupture 2) clot, vasospasm 3) fatal arrhythmia or Hypertrophy

Question 95

Stable vs Unstable plaque

Answer 95

stable angina = fixed obstruction so need more O2 delivery --> reversible ischemia hemorrhage in clot --> may occlude remaining vessel