Vascular Disease Flashcards by Jeanette McLaren

Define arteriosclerosis.

A broader term for a condition in which the arteries narrow and harden

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Define atherosclerosis.

A specific kind of arteriosclerosis but it affects the intima of the large and medium sized arteries.

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Name the three main forms of Arteriosclerosis

Monckenberg medial calcification
Arteriolosclerosis
Atherosclerosis

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What is an aneurysm?

An abnormal, permanent dilation of a blood vessel

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Name the types aneurysms.

Fusiform
Saccular
Rupturing/ Dissecting

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Most common causes of aneurysms?

Atherosclerosis

Systemic hyperstension

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What are the consequences of the formation of an embolism?

Rupture into peritoneal cavity or retroperitoneal tissue.
Obstruction of a vessel.
Ischemia .
Embolism from atheroma or thrombus.
Impinge adjacent structures.
Erosion of vertebrae.

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Define thrombosis.

Formation of a blood clot (thrombus) in a blood vessel, prevents blood from flowing normally.

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What is a thrombus?

A blood clot that forms in a vessel and remains there.

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What is an embolism?

A clot that travels form the site where it is formed to another location.

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What are the two types of thrombosis?

Venous thrombosis

Arterial thrombosis

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Characteristics of atherosclerosis?

Athermatous/atherosclerotic plaque deposits on the walls causing narrowing of the lumen.

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What is atheroma/atheromatous plaque?

A localized collection of lipid and cholesterol with a fibrous cap.

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How does the collection of atheromatous plaque become complicated?

Through rupturing and superadded thrombus.

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Consequences of atherosclerosis?

Atheromatous plaques cause mechanical obstruction of blood flow and luminal narrowing.
A decreased flow and ischemia follows.
Decrease in tissue perfusion (distal tissues)
If the blood vessels are occluded, there is no blood flow and the result is infarction (coagulative tissue necrosis).

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Non-modifiable risk factors of atherosclerosis?

Genetic abnormalities (Familial hyperchlesterolaemia)
Family history
Increasing age
Male gender

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Modifiable risk factors of atherosclerosis?

Hyperlipidemia
Hypertension
Cigarette smoking & tobacco chewing
Diabetes mellitus
Vasculitis 
Diet
Sedentary life style

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Consequences of atherosclerosis?

Myocardial ischemia and infarction.
Stroke/CVA.
Peripheral vascular disease, gangrene.
Aneurysms, Gastrointestinal tract ischaemia.

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Define Diabetes.

An abnormality in glucose metabolism due to either absent or improper utilization of insulin.

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The microvascular consequences of retinopathy and nephropathy includes what?

Blindness and renal failure.

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Which characteristics of diabetes provoke molecular mechanisms that alter the function and structure blood vessels?

Metabolic abnormalities->hyperglycaemia, free fatty acids, insulin resistance.

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Describe the macrovasular pathology of diabetes.

Accelerated atherosclerosis (earlier onset, more severe, myocardial ischemia and infarction, stroke, peripheral vascular disease)
Systemic hypertension (renal artery stenosis, diabetic nephropathy)

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Describe the microvascular pathology of diabetes.

Diabetic nephropathy (nodular glomerulosclerosis, pyelonephritis, papillary necrosis, diffuse mesangial sclerosis)
Peripheral neuropathy (glove and stocking distribution)
Diabetic ocular pathology (cataracts, diabetic retinopathy, glaucoma, retinal detachment)
Autononic neuropathy (delayed gastric enoptying, constipation)

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Diabetic neuropathy: example of proprioception loss

Charcot joint deformity.

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Diabetic neuropathy: motor loss causes...

Hammer toes and contracture

Define ischemia

Restriction of blood supply to tissue, causing a shortage of oxygen that is needed for cellular metabolism.

Define infarction

Tissue death (necrosis) due to inadequate blood supply to the affected areas. The resulting lesion is called an infarct.

Define cardiac output.

The amount of blood the heart pumps through the circulatory system in a minute.

Possible pathology of heart failure.

Leaks in the system. Cardiac muscle weakness and failure. Valve problems, obstruction or incompetence. Electrical conduction, irregular rhythm.

Name the two pathological setting for myocardial ischaemia and infarction

Blockage of coronary artery/arteries (localised region of ischaemia and infarction; results in TRANSMURAL INFARCTION) Global decrease inn blood flow (shock, results in subendocardial ischaemia and infarction in watershed zone)

What is the main risk factor for ischaemic heart disease?

Atherosclerosis.

Risk factors for myocardial ischaemia and infarction.

Tobacco smoking Alcohol Hypertension Obesity

Explanation of why demand increases?

Ventricular hypertrophy Pregnancy Exercise High altitude

Explanation of low supply?

Global ischaemia-cardiac failure, shock | Coronary artery occlusion

What is the function of cardiac valves?

Prevents retrograde flow of blood.

Complications of myocardial infarction?

``` Death Arrhythmias Contractile dysfunction and cardiogenic shock Myocardial rupture Vulvar dysfunction Ventricular aneurysm Pericarditis Rupture and tamponade Progressive heart failure ```

Clinical presentation of myocardial ischaemia and infarction

Stable angina pectoris Unstable angina pectoris Myocardial infarction

Management of myocardial ischaemia

``` Prevention Nitroglycerin under tongue Aspirin Other drugs Surgical treatment->stents, angioplasty, arthrectomy bypass ```

What is rheumatic fever?

An acute, immunological mediated multisystem inflammatory disease following an infection with Group A B (beta) haemdytic streptococcal infection.

What process does rheumatic fever involve?

The immunological process of the unmasking of antigens and an antibody-antigen cross reactivity

Which bodily structures does rheumatic fever affect?

Involves the heart, skin and joints.

During phase of rheumatic fever is acute rheumatic carditis a frequent manifestation?

The active phase of rheumatic fever.

What are the two cardiac manifestation following rheumatic fever?

Acute rheumatic pancarditis | Chronic rheumatic heart disease.

What are the risk factors involved in Rheumatic heart disease?

Low socio-economic status Overcrowded living conditions Poor nutrition Delays in seeking medical attention High prevalence of Group A B (beta) haemolytic streptococci in the community Possible predisposing genetic influence in some persons.

What is the endocardium?

Includes the cadiac valves, chordea tendinae and the lining endocardium.

Define infective endocarditis.

The colonization/infection of the endocardium by infective organisms. Results in the formation of bulky, friable vegetations.

What type of organism is most responsible for infective endocarditis?

Bacterial infections.

Origin of infective endocarditis.

``` Poor dental hygiene Long term haemodialysis Systemic sepsis Recent surgery or non-surgical invasive procedure Localized suppurative inflammation IV drug use ```

Cause of Acute bacterial infective endocarditis.

Viruluent organisms, like staphylococcus aureus

Effect of acute bacterial infective endocarditis on valves.

Normal valve or a damaged valve may be involved.

Describe the vegetations in acute bacterial infective endocarditis.

At lines of valve closure At edges of defect Large and Friable Easily dislodged and embolise

What do the vegetations linked to acute bacterial infective endocarditis consist of?

Fibrin, proliferating bacteria and suppurative inflammation.

Clinical features of acute bacterial infective endocarditis.

``` Rapid onset Fever Rigors Malaise Chest pain Shortness of breath Rapid fatigue Rapid death ```

What type of organisms cause subacute bacterial infective endocarditis?

Low virulence organisms like streptococcal viridans gorup of bacteria.

What is the condition of the valves involved in subacute bacterial infective endocarditis?

Damaged valves | E.g. rheumatic valvulitis, or previous infective endocarditis.

Can subacute bacterial infective endocarditis involve prosthetic valves?

Yes | Can also edges of intracardiac congenital defects or iatrogenic defects

Describe the vegetations associated with subacute bacterial infective endocarditis.

At lines of valve closure At edges of defect Large and friable (smaller than acute) Easily dislodged and embolise

Which cells are associated with the vegetations of subacute bacterial infective endocarditis?

Fibrin and bacteria

Clinical features of subacute bacterial infective endocarditis.

``` Slower onset Fever Malaise Fatigue Loss of weight Clubbing Murmers Low mortality ```

What are the complications of infective endocarditis?

Ring abscesses (erodes into underlying myocardium Systemic embolization (brain abscesses, splenic and renal infarction, septic infarcts) Right side pulmonary septic infarcts Valve/chordae rupture Septicaemia Immune complex formation

Other term for congestion in cardiac terms?

Backward failure

Other term for reduced output?

Forward failure

Most common causes of cardiac failure?

Ischaemic heart disease Hypertension Valvular heart disease Chronic lung disease

Classifications of cardiac failure

Right sided failure (right ventricular) Left sided failure (left ventricular) Biventricular failure

Which circulation system does blood back up into in the case of left sided heart failure?

The pulmonary circulation

Which circulation system does blood back up into in the case of right sided heart failure?

The systemic circulation

Vascular Disease Flashcards

(66 cards)