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Trigger 2 Flashcards

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1
Q

What is Ischemia

A

restriction in blood supply

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2
Q

What is an atheroma

A

degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue, and leading to restriction of the circulation and a risk of thrombosis.

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3
Q

What are the 4 stages of plaque formation

A

Endotheial Dysfunction
Stable Plaque Formation
T- Cell activation
Plaque repture & blood coagulation

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4
Q

What happens in the endothelial dysfunction stage

A

Risk factors = ROS, hyperglyceamia, hypercholesterolaemia, hypertension
Monocytes adhere to endothelium via VCAM-1 (vascular cell adhesion molecule-1) & infiltrate
Monocytes become macrophages in intima
Macrophages uptake modified (oxidised & glycated) LDL
Macrophages become foam cells
= Fatty Streak

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5
Q

What happens in the Stable Plaque Formation stage

A

Many Foam Cells in intima
Vascular Smooth muscle cells migrate from tunica media, proliferate & act like myofibroblasts to produce collagen
Fibrous cap containing collagen fibres forms

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6
Q

What happens in the T- Cell activation stage

A

Th1 & Th2 recruited & activated
Matrix metalloproteinases (MMPs - produced by foam cells
Proinflammatory cytokines released
MMPs start to break down fibrous cap

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7
Q

What happens in the Plaque repture & blood coagulation stage

A

MMPs & Proinflammatory cytokines break fibrous cap
Tissue factor released from endothelium
Start of Extrinsic Coagulation Cascade
TF Binds to Factor VIIa (serine protease) & activates (coagulation factors are inactive zymogens)
Catalyses conversion of Factor X → Factor Xa
Initiates common pathway of blood clotting Prothrombin→ thrombin & fibrinogen → fibrin
Blood vessel stenosis, occlusion or thrombi released

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8
Q

What is reperfusion?

A

Return of blood supply and oxygen

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9
Q

What is the process of reperfusion

A 
O2 returns --> ATP serca pumps restart 
ROS generated --> damage membranes 
ER breakdown, Ca2+ released 
Ca2+ uptake into the mitochondria 
Mitochondira permability tranistion pores open and Na2+/Ca2+ exchanger reversed --> Ca2+ released
Endothelial dysfunction 
Haemostasis and prothrombosis 
Pro-inflammatory cytokines released
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10
Q

What is an ishemic stroke

A

When an artery to the brain is blocked

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11
Q

What is an thrombotic stroke

A

when a cerebral artery becomes blocked with a clot that formed in the brain blood vessels
responsible for 50% of all strokes

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12
Q

What is an embolic stroke

A

when an artery becomes blocked with a clot that formed somewhere other than the brain

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13
Q

what is the ischemic cascade

A

a series of biomechanical reactions that are iniated in the brain and other aerobic tissues after seconds to minute of ischemia

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14
Q

Stages of Ischemic Cascade

A

decrease in O2 - ATP shortage
anaerobic metabolism –> Lactatic acid production
Na2+ build up in neuron –> water moves in causes cytotoxic odema
Na2+/Ca2+ pumps stop working –> excitotoxicity
Cell membrane broken down by phopholipodase
Mitochondarial breakdown
Casacde dependant cascade –> Apoptosis
Inflammatory response

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15
Q

What are stents used for

A

placed in an artery as part of percutaneous conorary intervention procedure
small mesh tube
supports narrow or weak arteries

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16
Q

What are Cardiac Markers

A

molecules that show up in your blood after you heart has been under servere stress due to low oxygen
used in combination with ECG to diagnose heart attacks

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17
Q

What happens to creatine kinase

A 
normally doubles if  youve had a heart attack 
CK-MB 
expressed by the myocardium 
appears 4-6 hours after 
peaks at 24 hours
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18
Q

What happens to troponin levels

A 
cardiac specific troponin I 
expressed by the myocardium 
increases 3-12 hours 
peak 24-48 hours 
highly sensitive and specific
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19
Q

What does the cerebellum control

A

coordination of movement, planning and execution of movement, maintenance of posture, and coordination of head and eye movements.

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20
Q

What symptoms would show if an indivdual had a stroke in the cerebellum

A

A stroke involving the cerebellum may result in a lack of coordination, clumsiness, shaking, or other muscular difficulties. These are important to diagnose early, since swelling may cause brainstem compression or hydrocephalus.

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21
Q

What does the pons control?

A

participates in balance maintenance of posture and in regulation of breathing. In addition, the pons relays information from the cerebral hemispheres to the cerebellum.

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22
Q

What does the medulla control?

A

It contains autonomic centers that regulate breathing and blood pressure, as well as the centers that coordinate swallowing, coughing, and vomiting reflexes

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23
Q

Role of the frontal lobe

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A

planning
personality
intelligenece
Brocas area

24
Q

Role of the parietal lobe

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A

interprets language
interprest signals from vision, hearing, motor, sensory and memory
sensory strip - touch and heat

25
Role of the occipital lobe
processes and interprets colour, light and movement to vision
26
Role of the temporal lobe
memory hearing wernicks areas
27
Role of the ryhmicity centre
controls the rate of breathing | contains the Dorsal and ventral respiratory group
28
Appneustic area
prolongs and slow the rate of breathing stimulates inspiratory neurons of VRG and DRG overridden by the pneumotaxic
29
Pneumotaxic area
inhibirtory impluse, limits breath duration | speeds up breathing
30
peripheral Chemoreceptors
``` respond to pH - decrease fall in O2 below 60mmHg increase in H+ inside the cell blocks K+ channels causes a build up of positive charge Ca2+ rushes in causes the release of dopamine vesicles dopamine binds to nerve cells, signal via the vagus nerve to brain, increase breathing ```
31
Central chemoreceptors
Increase in CO2 H+ can’t pass through the blood brain barrier, CO2 moves into the CSF Binds with water via carbonic anhandrayse to form carbonic acid H2CO3 dissociates into HCO3- and H+ Decrease in pH is detected by chemoreceptors
32
What does Arterial Blood Analysis measure
The acidity and PO2 and PCO2 in the arteries | how well your lungs are able to move O2 into the blood and remove CO2
33
What are the normal values for AGB
``` pH 7.34-7.45 pO2 10-14kPa pCO2 4.5-6 kPa base excess -2 - 2 mmol/L HCO3 22-26 mmol/L ```
34
What is the acid base balance
the concentration to hydrogen ions in the body fluids
35
How is the acid base balance achieved
utiliastion of buffers in extracellular fluid respiratory mechainsms renal mechanisms
36
What is respiratory acidosis
Increased pCO2 decresed pH hypoventilation (abnormally slow)
37
What is respiratoty alkalosis
decrease pCO2 increased pH hyperventilation (fast)
38
Outline Bicarb reabsorption in the kidenys
Na+/H+ exchanger in luminal membrane, Na+ in, H+ out H+ combines with HCO3- to form H2CO3 H2CO3 decomposes into CO2 and H2O, catalysed by brush border carbonic anhydrase CO2 and H2O enter the cell reaction reversed, H2CO3 formed Convereted to H+ and HCO3- HCO3- transported across basolateral membrane via Na+/HCO3- and Cl-/HCO3- transporters H+ restarts in the cycle
39
Describe the HIF pathway in Normoxia conditions
PHD1,2,3 are oxygen sensors hydroxlate HIFa HIFa is ubiquinated sends it to the proteasome where is it degraded
40
Describe the HIF pathway in hypoxic conditions
Low O2, HIFa cant be hydroxlated HIFa translocates to the nucleus where it combines with HIFb and HRE Transcribes gene The genes are involved in - metastasis, cell surival, metabolism, immune response, angiogensis e.g EPO, VEGF, iNOS
41
What is the circle of willis
a circle of communincating arteries made up from the cartoid and vertebrobilsilar arteries
42
Where does the anterior cerebral artery supply and what would be affected in a stroke
Supplies the frontal lobe stroke results in opposite leg weakness profound mental symptoms
43
Where does the middle cerebral artery supply and what would be affected in a stroke
Largest branch on the carotid supplying the frontal, temporal and partieal most often occluded in stroke symptoms could be severe, even fatal depending where along the artery it occurs affects speech, motor and senosry fucntion of the face, hands and arms
44
Where does the posterior cerebral artery supply and what would be affected in a stroke
stems from the basilar artery, supplying the temporal and occipital lobes stroke damage is usually secondray to embolsim from lower segments of vertebral basilar system or heart
45
what are lenticulstriates?
small deep penetrating arteries branching from the middle cerebral artery
46
How is the intrinsic coagulation pathway activated?
activated when blood comes into contact with sub-endothelial connective tissues or negatively charged surfaces
47
Outline the steps of the intrinsic pathway
``` Hageman factor --> factor XII, binds to subendothlial surafce prekallikrein and HMWk also interact Factor XII actiavated --> factor XIIa prekallikrein --> Kallikrein Factor XIIa and Ca2+ activate Factor XI Factor IX activated Factor X activated by IXa and VIIIa Factor Xa is the first molecule of the common pathway ```
48
Outline the steps of the extrinsic pathway
Tissue Factor activated Binds to Factor VII Factor VIIa, TF, Ca2+ and a phosophlipid activate factor X
49
outline the steps of the common pathway
Factor Xa combines with Va, Ca2+ and a phospholipid to activate Thrombin from Prothrombin Fibrogen activated by Thrombin to form Fibrin and XIIIa Cross linked fibrin clot formed
50
What is Fibrinolysis
removal of clot of thrombus
51
outline the steps of fibrinolysis
Plasminogen --> Plasmin via plasminogen activators e.g tPa Plamsin digest fibriogen, fibrin and Factors II, V and VIII plasmin attacks fibrinin at least 50 different sites, reducing its size so it no longer has Hameostatic activity
52
what is excitotoixcity
pathological process by which neurons are damaged and killed by the overactivations of receptors for the excitatory neurotransmitter glutamate
53
why does excitotoixity occur
Low O2 --> reduced ATP and H+ gradient not maintained = ROS and Ca2+ generation High Ca2+ activates nNOS, increased ROS ROS damage dna and membrane proteins leading to activation of caspases (apoptosis)
54
what happens when Glutamine is present
Glu binds to AMPA in pre synaptic membrane NA2+ floods in depolarises membrane NMPA Mg2+ block is relased allowing Ca2+ to flood in. low O2, so mitochondria relase Ca2+ VOCC L-type channels opwn so Ca2+ increases no ATP generated so SERCA and PMCA pumps stop IP3 binds to IP3R so Ca2+ released from Smooth ER
55
where is brocas area located and what does it allow
located in the frontal lobe | allows the movements required to speak
56
where is wernicks area located and what does it allow
in the pareital and temporal lobe | understanding of written and spoken language
57
Which artery is most frequently occluded in patients with stroke?
Middle Cerebral artery

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