CV lecture 1- Arteriosclerosis and Hypertension Flashcards Preview

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Flashcards in CV lecture 1- Arteriosclerosis and Hypertension Deck (44):
1

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

vascular disease

2

name the 2 principal mechanisms of vascular disease

1) Narrowing or obstruction of vascular lumina

2) Weakening of vascular walls, leading to dilation and/or rupture

3

atherosclerosis is characterized by _________, which are A fatty deposit in the inner lining (intima) of an artery

atheromas

4

ahterosclerosis effects the _________ and _________ arteriolies

medium and large

5

what condition is classified by: medial calcification without luminal narrowing or intimal disruption

Mönckeberg's medial calcific sclerosis

6

what are the 2 types of atherosclerosis? (describe both types)

1) hyaline type: thickening of basement membrane

2) hyperplastic (proliferative) type: fibrocellular intimal thickening

7

malignant hypertension and scleroderma both cause what type of atherosclerotic formation?

hyperplastic

8

hyaline type athrosclorosis is caused by _________ and ________

hypertension and diabetes mellitus

9

Atheromas protrude into the ______ of the vessel

lumen

10

how can atheromas cause injury to the body?

1) can enlarge and obstruct blood flow

2) May weaken the underlying media of the artery (aneurysm)

3) Plaques can rupture, resulting in catastrophic vessel thrombosis

11

what regions of the world have a high prevalence for atherosclerosis? which regions have a low prevalence?

High Prevelance – United States, Western Europe


Low Prevelance – Africa, Far East

12

name the Non-modifiable (“constitutional”) modifiers for risk of atherosclerosis

Genetics (family history) – most important in this group

Increasing age

Male gender

13

what are the major modifiable risk factors for atherosclerosis?

Hypercholesterolemia – high LDL, low HDL

Diabetes Mellitus

Hypertension

Cigarette smoking

14

what modifiable risk factor will increase your risk for Atherosclerosis by 200%?

smoking one pack of cigarettes a day

15

what are the steps involved in the "Response-to-injury" hypothesis for atherosclerosis?

1) endothelial cell injury

2) accumulation of lipoproteins

3) monocyte adhesion

16

what are the common sites for atheroma formations?

1. Major arterial branch points
2. Abdominal aorta
3. Coronary arteries
4. Popliteal arteries
5. Carotid arteries
6. Cerebral arteries

17

atheroma plaques contain what substances?

plaques contain collagen, lipid, myofibroblasts, macrophages, neovascularization.

18

during atheroma formation, a fibrous cap, composed of __________ and ________, develops over a central core of lipid/cellular debris with cholesterol

smooth muscle cells (myofibroblasts) and collagen

19

Progressive changes in atheroma plaques include:


(hint: theres 6 of them)

1) ulceration
2) fissure formation
3) thrombosis
4) embolization (thrombus or debris from the central core)
5) calcification
6) hemorrhage into the plaque from neovascularization

20

Fatty streaks appear in atherosclerosis involving __________, and is independent of geography, gender, race and environment

children

21

T/F: Fatty streaks will form in almost any location, regardless of if that location is prone to atheroma formation

True

22

T/F: fatty streaks signal the start of atheromas formation

False

not all atheroma formations will start as fatty streaks
- its a possible step in formation, but not always present

23

what complications are associated with atherosclerosis?

(theres 5)

Ischemic heart disease (MI)
Cerebral infarct (stroke)
Gangrene
Renal artery stenosis (narrowing)
Aortic aneurysm (dilation/bulge)

24

what is mild hypertension?

what is mild to severe hypertension?

Mild: BP between 140/90 - 159/104 mmHg

Moderate – severe: BP greater than 160/106 mmHg

25

Hypertension affects approximately _____% of the US population

25%

26

the "peak death rate" for Myocardial infarctions (heart attacks) was ______% in the 1960s

54%

27

what is the current death rate for all atherosclerosis-related complications ?

50%

28

___________ hypertension Accounts for 90% or more of all hypertension

essential hypertension

29

Contributing factors for hypertension include:

genetics
stress
obesity
increased salt intake
inactivity
cigarette smoking

30

what are the symptoms of low, and moderate, hypertension?

NO SYMPTOMS

31

name the symptoms of severe hypertension:

Headache
Fatigue
Dizziness
Palpitations

32

what is "essential hypertension"

hypertension that has no identifiable cause

33

what are the FOUR factors involved in the pathogenesis of ESSENTIAL hypertension?

a) Peripheral vascular resistance (vasoconstriction)

b) hereditary factors

c) Reduced sodium excretion → salt and water retention→ increased plasma volume and cardiac output

d) environmental factors

34

what are the COMPLICATIONS of hypertension?

(theres 6 of them)

1) Concentric left ventricular hypertrophy (LVH)

2) LVH + ventricular dilation

3) Atherosclerosis and arteriolosclerosis

4) Retinal injury

5) Nephrosclerosis

6) Dissecting hematoma of the aorta

35

which complication of hypertension, if "decompensated", can lead to coronary heart failure (CHF)?

LVH + ventricular dilation



(LVH = left ventricular hypertrophy)

36

what occurs during decompensated hypertensive heart disease?

- hypertrophy no longer adequate to provide normal cardiac output due to decreased myocardial contractility

- results in left ventricle dilation and gradual onset of CHF

37

what are the characteristics of "Concentric Hypertrophy"?

- Thickening of the left ventricular wall at the expense of the left ventricular chamber

- little or no increase in the outside cardiac dimensions.


(heart increases muscle mass at the expense of chamber volume)

38

name the characteristics of Accelerated (Malignant) Hypertension:

- Relatively rapid onset
- Often superimposed on previous hypertension
- Very high systolic and diastolic pressures

39

the complications of accelerated (malignant) hypertension include:

cerebral edema
papilledema
encephalopathy
renal failure
cerebral hemorrhage

40

the thickness of what structure will determine if it is a vulnerable plaque or a stable plaque?

the fibrous cap

- it surrounds the lipid core of the plaque

thick cap = stable
thin cap = vulnerable

41

what are the PRE-clinical phases of plaque formation?

1) normal artery

2) fatty streak (may not be part of progression)

3) Fibrofatty plaque

4) Advanced/vulnerable plaque

42

what differentiates a foam cell from a macrophage?

foam cells are macrophages that have become engorged with lipoproteins (cholesterol)

43

during atherosclerosis progression, what happens once monocytes adhere to the lipoprotein deposits?

- migration into intima

- differentiation into macrophages and “foam cells” (macrophages that have ingested lipid)

44

what are the lipoproteins that adhere to the vessel walls following endothelial injury?

LDL and cholesterol