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Flashcards in Blood Vessels II Deck (52):
1

benign HTN

essential
-controlled with no short term problems

2

HTN urgency

systolic > 220
diastolic > 120

no evidence target organ damage

3

accelerated HTN

increase in BP with target organ damage

4

malignant HTN

increased in BP with target organ damage

ALSO papilledema

5

secondary causes of HTN

renal
endocrine
caardiovascular
neurological

6

licorice

glycrrhizin
-similar to cortisol and aldosterone

can go to aldosterone receptors

result is secondary HTN

7

high cortisol

binds aldosterone receptors

8

vasoconstriction

ANG II
catecholamines
thromboxane
endothelin
alpha-adrenergic

9

vasodilation

NO
prostacyclin
kinins
ANP
beta-adrenergic

10

renovascular HTN

stenosis - decreased glomeruli pressure

> renin release
> RAAS activation
> vasoconstriction
> increased blood volume

leads to HTN

11

RAAS control

only 2% of sodium reabsorption


98% reabsorbed rest of kidney

12

hydroxylase deficiency

results in HTN


congenital adrenal hyperplasia

associated with androgen and mineralocorticoid excess
-masculinization and HTN

13

liddle syndrome

mutations in ENaC
-overresponseive to aldosterone
-large Na reabsorption
-more blood volume

> HTN

14

arteriosclerosis

hardening of artery

3 patterns:
-monckeberg
-arteriolosclerosis
-atherosclerosis

15

monckeberg

medial calcific sclerosis
-muscular arteries of patients > 50yo with no vessel lumen narrowing**

**not clinically significant

may be seen in mammogram as calcified vessels

16

arteriolosclerosis

small arteries and arterioles

two subtypes
-hyperplastic
-hyaline

result in small lumen - clinically significant

17

hyaline arteriolosclerosis

plasma proteins leak across endo cells - cell matrix synthesis

hyaline thickening with luminal narrowing

more severe in those with HTN

in aging, diabetic microangiography and nephrosclerosis

18

hyperplastic arteriolosclerosis

with severe malignant HTN
-onion-skinning lesion**

concentric laminated thickening of walls with luminal narrowing

in malignant HTN - accompanied by fibrinoid deposits and vessel wall necrosis - necrotizing arteriolitis (kidney)

19

atherosclerosis

intimal lesions - atheromas (atheromatous plaques)

raised soft, yellow, grumous core of lipid

can rupture and weaken underlying media

20

50% of deaths and serious morbidity in US

atherosclerosis

21

primary intervention

prevent onset of disease

22

secondary intervention

patient already has problem - lets help them out

asymptomatic patient

23

tertiary prevention

prevent recurrences with disease
-symptomatic patient

24

atherosclerotic plaque

atheromas or atheromatous plaques

-obstruction
-thrombi
-weaken media

25

prone to atherosclerosis

turbulent flow and low shear stress

26

laminar flow

endothelial genes for agents against atherosclerosis - superoxide dismutase

27

turbulent flow

increased blood hitting vessel wall
> endo cell takes beating
> endo dysfunction
> increased risk of plaque formation

-also inflammation causes endo dysfunction

28

type I atherosclerotic lesion

fatty dot

29

superoxide dismutase

expressed by endo cells with laminar flow
-protects against atherosclerosis

30

problems with atherosclerosis

obstruction

plaque rupture

weaken vessel wall - aneurysm

31

constitutional risk factors for ischemic heart disease

non-modifiable
age
gender
genetics

32

modifiable risk factors for ischemic heart disease

hypercholesterol
HTN
smoking
DM

33

additional risk factors for ischemic heart disease

inflammation
hyperhomocystinemia
metabolic syndrome
lipoprotein a
hemostatic factors

34

endo injury response

intimal thickening
-presence of lipids - atheroma forms

35

atheromas more common

branch points - high turbulence

36

oxidized LDL

taken up by macrophages - form foam cells
-scavenger receptors

pro-inflammatory response

37

fatty dot

stage I
-to fatty streak

38

stage 6 plaque

complicated - when endo denuded
-sets off thrombi**

39

dark spots on atherosclerotic lesion?

thrombi
-means it is complicated -stage 6

40

trichrome stain

for collagen
-collagen in atheroma - means its been there long time

41

atheroma structure

fibrous cap
-necrotic center
-media destroyed

42

plaque stenosis

at 70% occlusion

43

new plaque

thinner fibrous cap
-more likely to break apart

aka vulnerable plaque

44

stable plaque

thicker fibrous cap
-older
-more stable

45

MI risk at 60

5x risk at 40

46

genetics of atherosclerosis

familial hypercholesterolemia

47

male

more likely to get atherosclerosis

48

2 risk factors together

4x risk

49

3 risk factors together

7x risk

50

BP > 169/95

60% increased risk of IHD

51

cigarette smoking

death rate from HID increased > 200%

52

inflammation measure

C-reactive protein
-increased risk of atherosclerosis