Introduction to vascular pathology + coronary artery disease

Question 1

Define infarction.

Answer 1

Tissue death due to inadequate blood supply

Question 2

What are the 3 factors of Virchow’s triad?

Answer 2

Endothelial injury

Abnormal blood flow (stasis or turbulence)

Hypercoagulability

Question 3

What 2 things comprise endothelial injury?

Answer 3

Physical endothelial damage

Endothelial dysfunction

Question 4

What type of endothelial injury does stasis cause?

Answer 4

Endothelial dysfunction

Question 5

What type of endothelial injury does turbulence cause?

Answer 5

Physical endothelial damage

Question 6

List 3 inherited disorders which cause hypercoagulability.

Answer 6

Antithrombin III deficiency
Protein C deficiency
Protein S deficiency

Question 7

Give 2 consequences of venous thrombi.

Answer 7

Deep vein thrombosis

Pulmonary embolism

Question 8

What kind of blood flow is DVT associated with?

Answer 8

Stasis

Question 9

In what percentage of cases is DVT asymptomatic?

Answer 9

50%

Question 10

What are vegetations?

Answer 10

Thrombi which develop on heart valves

Question 11

What is the most common cause of vegetations?

Answer 11

Bacterial or fungal infections (infective endocarditis)

Question 12

What are the 4 main fates of thrombi?

Answer 12

Resolution
Organisation
Recanalisation
Embolism

Question 13

In the fate of thrombi, what is meant by organisation?

Answer 13

Thrombus is replaced by scar tissue - can narrow the vessel

Question 14

In the fate of thrombi, what is meant by recanalisation?

Answer 14

New channels restore some blood flow

Question 15

What type of emboli could result from medical / surgical procedures?

Answer 15

Air (gas) emboli

Question 16

What type of emboli occur in decompression sickness?

Answer 16

Air (gas) emboli

Question 17

What are the main 8 types of emboli?

Answer 17

Thromboemboli

Air (gas) emboli

Fat emboli

Cholesterol emboli

Amniotic fluid emboli

Tumour embolism

Foreign body embolism

Septic emboli

Question 18

What is a paradoxical embolism?

Answer 18

When a venous embolus ends up in arterial circulation due to an intracardiac defect

Question 19

Which specific type of pulmonary embolus can cause sudden death?

Answer 19

Saddle embolus

Question 20

What kind of blood flow does atrial fibrillation cause?

Answer 20

Stasis

Question 21

Atherosclerotic plaques are most common in which area of vessels?

Answer 21

Branching points

Question 22

When LDLs enter the tunica intima, what happens to them?

Answer 22

Oxidised by ROS

Question 23

Oxidised LDLs in the tunica intima are taken up by what?

What does this produce?

Answer 23

Macrophages

Foam cells

Question 24

Other than macrophages, which 2 other types of cells migrate into the tunica intima in atherosclerosis?

Answer 24

T lymphocytes

Smooth muscle cells

Question 25

What are the 2 layers of an advanced atherosclerotic plaque?

Answer 25

Fibrous cap Necrotic core

Question 26

What are the 4 components of the fibrous cap of advanced atherosclerotic plaques?

Answer 26

Collagen Smooth muscle cells Macrophages T lymphocytes

Question 27

What are the 4 components of the necrotic core of advanced atherosclerotic plaques?

Answer 27

Free lipid Foam cells Cellular debris Calcium

Question 28

What is the underlying pathology of aneurysm formation?

Answer 28

Ischaemic atrophy of tunica media and extracellular matrix degradation from action of proteolytic enzymes

Question 29

What are the 2 kinds of aneurysm?

Answer 29

Saccular Fusiform

Question 30

Which 3 factors make a plaque vulnerable to rupture?

Answer 30

Thin fibrous cap Large lipid core Inflammation

Question 31

Define the term critical stenosis.

Answer 31

The point at which blood flow is limited to a degree that tissue demand for oxygen exceeds supply (often reduction in the luminal cross-sectional area of 70%, or 50% in left main coronary artery)

Question 32

What is a subendocardial infarct?

Answer 32

Infarct limited to the inner third of the myocardium

Question 33

What are the 2 types of subendocardial infarct?

Answer 33

Regional subendocardial infarct Circumferential subendocardial infarct

Question 34

What are the 4 stages of myocardial infarction?

Answer 34

Coagulative necrosis Acute inflammation Chronic inflammation Fibrosis + scarring