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AU17: Gen Pathology > Cariovascular Disease > Flashcards

Cariovascular Disease Flashcards

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1
Q

What category of disease is responsible for more morbidity and mortality than any other?

A

Vascular disease

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2
Q

What are the two principal mechanisms for vascular disease?

A
  1. Narrowing or obstruction of the lumen

2. Weakening of vascular walls

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3
Q

Which level of artery controls blood pressure?

A

Arteriole

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4
Q

What type of vascular disease causes calcifications in the muscle walls and is clinically insignificant?

A

Monckeberg’s Disease

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5
Q

What are the two types of arteriolosclerosis (affects arterioles)?

A
  1. Hyaline: hypertension and diabetes

2. Hyperplastic: malignant hypertension

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6
Q

Which type of arteriosclerosis affects larger arteries?

A

Atherosclerosis

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7
Q

Which type of arteriosclerosis will have atheromas protruding into the lumen?

A

Atherosclerosis

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8
Q

What is the difference between hyaline and hyperplastic arteriolosclerosis?

A

Hyaline: thickening of basement membrane
Hyperplastic: Fibrocellular thickening

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9
Q

An enlargement of the vessel is protruding into the lumen of a large artery. The enlargement seems to have a necrotic center filled with cholesterol crystals. What vascular disease is this resulting from?

A

Atherosclerosis

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10
Q

What do people with atherosclerosis normally die from?

A

Myocardial Infarction (25%)

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11
Q

What are some non modifiable risk factors for atherosclerosis?

A
  1. Genetics: most important!
  2. Age: 40-60
  3. Gender: man
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12
Q

What are some modifiable risk factors for atherosclerosis?

A
  1. High LDL and low HDL cholesterol
  2. Diabetes
  3. Hypertension
  4. Smoking
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13
Q

What is the response-to-injury hypothesis in forming atheromas?

A
  1. Endothelial injury
  2. LDL and cholesterol accumulate in vessel wall
  3. Monocyte adhesion -> macrophages
  4. Inflammatory cytokines released -> smooth muscle cell recruitment
  5. Smooth muscle cells and macrophages engulf lipid
  6. Collagen released
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14
Q

Where are the most common sites of atheroma formation?

A

Major arteriole branches

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15
Q

What are some hallmark features of an atheromic plaque?

A

A fibrous cap (myofibroblasts and collagen) over a central core of lipid, cellular debris, and cholesterol

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16
Q

T/F: Fatty streaks are a sign of a progressing atheroma and must be treated.

A

FALSE

Seen in most children and they may regress, or progress into atheromas

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17
Q

T/F: Macrophages surrounding lipids are commonly seen in atherosclerotic plaques.

A

True

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18
Q

T/F: A plaque with a thick fibrous plaque is most vulnerable to complications.

A

FALSE

Thin fibrous cap is the most dangerous

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19
Q

What BP numbers correlate with moderate - severe hypertension?

A

160/106

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20
Q

T/F: Hypertension affects approximately 25% of the US.

A

True

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21
Q

What is the most common type of hypertension?

A

Essential hypertension

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22
Q

Left ventricular hypertrophy can be either compensated or decompensated. What is the difference?

A

Compensated: maintains normal cardiac output

Decompensated: loss of functions leads to ventricular dilation which can lead to congestive heart failure

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23
Q

Hypertension could eventually lead to ______________ which can cause ischemic heart disease, stroke, and ischemic injury to other organs.

A

Atherosclerosis

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24
Q

T/F: During concentric (compensated) hypertrophy the outside dimensions of the heart increase.

A

FALSE

Cardiac muscle fibers grow into the ventricle

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25
Several different diseases may cause _________ hypertension.
Secondary
26
Cerebral edema and hemorrhage as well as encephalopathy are complications of which type of hypertension?
Malignant: rapid onset
27
Define congestive heart failure.
Failure of the heart to pump an adequate amount of blood to the organs
28
What are some mechanisms that can compensate for a failing heart?
1. Neurohormonal systems: NE increases heart rate; renin-angiotensin system increases blood volume 2. Frank-Starling: fibers contract more forcefully 3. Myocardial hypertrophy: increased thickness into the lumen
29
What often causes compensatory mechanisms of CHF to fail?
Increased oxygen requirements
30
T/F: Left sided heart failure is much more common.
TRUE
31
What is the most common cause of right sided heart failure?
Left sided failure
32
What are the causes of left sided heart failure?
1. Ischemic heart disease 2. Hypertension 3. Myocarditis 4. Cardiomyopathy 5. Valvular disease
33
A septal defect with a left-to-right shunt would cause CHF of which side?
Right
34
What is the most common clinical manifestation of left ventricular failure?
Pulmonary edema and congestion
35
Cerebral hypoxia can be a result of CHF on which side?
Right and/or left
36
Respiratory symptoms come from _____ sided failure, while edema in the periphery comes from ______ sided failure.
Left; right
37
T/F: 90% of congenital heart disease has unknown causes.
True
38
What is the difference between cyanotic and non-cyanotic heart disease?
Cyanotic: shunting of poorly oxygenated blood to systemic arteriole circulation bypassing the lungs
39
What is the most common non-cyanotic heart disease?
Ventricular septal defect
40
What is a patent ductus arteriousus? Cyanotic or non-cyanotic?
Connects aorta and pulmonary artery Non-cyanotic
41
What are the four anomalies that lead to the Tetralogy of Fallot?
1. VSD 2. Narrowed right ventricular outflow 3. Overriding of the VSD by aorta 4. Right ventricular hypertrophy
42
What is a transposition of the great arteries?
A cyanotic heart defect where the ventricles empty into the wrong great artery
43
What causes over 90% of ischemic heart disease?
Coronary artery atherosclerosis
44
T/F: Ischemic heart disease is the leading cause of death in the U.S.
True
45
A fissure in the fibrous cap of an atherosclerotic plaque in the coronary artery would lead to what?
Thrombosis in the coronary artery leading to ischemic heart disease
46
Other than coronary artery issues, what are some other factors that can lead to IHD?
1. Hypertension 2. Shock/hypotension 3. Pneumonia 4. Anemia
47
What are four clinical manifestations of IHD?
1. Angina 2. Myocardial infarction 3. Chronic IHD with CHF 4. Sudden cardiac death
48
A patient comes in complaining of severe chest pain while exercising that gets better with rest. What is the diagnosis?
Stable angina
49
The necrosis of cardiac muscle caused by ischemia is called __________.
Acute myocardial infarction
50
How long does it take for an ischemic episode to cause irreversible myocyte injury and cell death?
20-40 minutes
51
What is a secondary way that myocardial ischemia can lead to death?
Arythmia
52
What molecules can be tested for as a potential warning for a heart attack?
CK-MB and troponin
53
What is a possible complication in the treatment of myocardial infarction?
Reperfusion injury: muscle damage due to ROS
54
In ________ cardiomyopathy the disease is confined to the heart muscle; in _________ cardiomyopathy there is a systemic disorder causing problems.
Primary; secondary
55
What are the three types of cardiomyopathies?
1. Dilated (most common) 2. Hypertrophic 3. Restrictive
56
T/F: In dilated cardiomyopathy all four chambers are dilated.
True
57
T/F: Genetics often plays a large role in dilated cardiomyopathy.
True
58
T/F: Dilated cardiomyopathy involves poor atrial contractility.
FALSE Ventricular
59
Which type of cardiomyopathy prevents adequate filling of the ventricles (diastolic dysfunction)?
Hypertrophic cardiomyopathy (and restrictive)
60
What virus is the most common cause for myocarditis in the U.S.?
Coxsackie A and B
61
Recurrent bouts of acute rheumatic fever can lead to fibrosis and _________.
Mitral valve stenosis
62
What is a stenosis?
Failure of valve to fully open
63
Aschoff bodies are seen in which cardiac disorder?
Rheumatic carditis
64
What is valve regurgitation?
Valve does not close completely
65
What two cardiac disorders can cause mitral valve regurgitation?
IHD and endocarditis
66
Myxomatous degeneration is a feature of _________.
Mitral valve regurgitation
67
What are the common causes of aortic valve stenosis?
Fibrosis and calcification of valve from either: 1. Chronic rheumatic valvular disease 2. Advanced age 3. Congenitive malformation
68
What are the three mechanisms for aortic valve regurgitation?
1. Valve cusp destruction (endocarditis) 2. Myxomatous degeneration (weakened valve cusps) 3. Dilation of aortic root
69
What is the most common cause of infective endocarditis?
Bacterial infection in the heart valve
70
What are the three important factors in the pathogenesis of infective endocarditis?
1. Endocardial/endothelial injury due to abnormal blood flow 2. Fibrin thrombi 3. Organisms in the blood
71
What is the difference between acute and subacute endocarditis?
Acute: short, prominent tissue destruction, previously normal valve Subacute: long, less tissue destruction, previously abnormal valve
72
What are some complications of infective endocarditis?
1. Valvular regurgitation 2. Rupture of chordate tendineae 3. Spread of infection 4. Thromboembolism
73
What are the two forms of large vessel vasculitis?
1. Giant cell (temporal) arteritis | 2. Takayasu arteritis
74
T/F: Both types of large cell vasculitis will have granulomatous inflammation.
True
75
What type of vasculitis is typically referred to as the "pulseless disease"?
Takayasu arteritis
76
A 30 year old comes in with granulomatous inflammation in the aortic arch. What is the diagnosis?
Takayasu arteritis
77
Which type of vasculitis is often associated with renal failure?
Polyarteritis nodosa
78
Which type of vasculitis often effects infants and young children?
Kawasaki disease
79
________________ is associated with neutrophil-related endothelial damage mediated by PR3-ANCA.
Wegener granulomatosis
80
Which type of vasculitis is specifically associated with cigarette smoke?
Thromoangiitis obliterans (Buerger Disease)
81
Which forms of vasculitis are ANCA-positive?
Wegener's granulomatosis and microscopic polyarteritis Small vessel vasculitis
82
What are the complications with a dissecting aortic hematoma?
1. Hemorrhage | 2. Branch obstruction
83
What is a dissecting aortic hematoma?
A split between the mid and outer third of the tunica media
84
Which type of aortic dissection causes the most complications?
Type A: involves ascending aorta

AU17: Gen Pathology (22 decks)

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