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Flashcards in Vascular Heart Disease Deck (20):
1

What is the intimal response to vascular injury?

Intimal Thickening
1. recruitment of smooth muscle cells
2. smooth muscle cell mitosis and ecm matrix
3. more thick and harder to provide nourishment to inner layers-->ischemic change

2

What is arteriosclerosis?

Hardening of the arteries (arterial wall thickening and loss of elasticity)
-Atherosclerosis
-Monckeberg's medial calcific sclerosis
-Arteriosclerosis-hypertension induced

3

Atherosclerosis

Elastic Arteries and Muscular Arteries

Response to Injury Hypothesis:
-Atherosclerosis is a chronic inflammatory response of the arterial wall to endothelial injury

-Lesion progression involves interaction of lipoproteins, monocyte-derived macrophages, T lymphocytes and the cellular constituents

4

What is an atheroma?

Intimal Process!

Fibrous cap: smooth muscle cell, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans, neovascularization

Necrotic center: cell debris, cholesterol crystals, foam cells, calcium

5

What can happen to complicated plaques?

1. rupture/ulceration/erosion
2. emboli
3. hemorrhage
4. weakening of media-aneurysm formaiton
5. calcification, growth, lumen occlusion
6. thrombosis

6

What are some complications that can arise from atherosclerosis?

1. Myocardial ischemia-->angina, infarcts, sudden death

2. cerebral ischemia-->stroke, TIA

3. Peripheral Vascular Disease-->claudication, gangrene

4. Aneurysms-->rupture

7

What is Monckeberg's Medial Calcific sclerosis?

Media process!
1. Calcific deposits
2. Location: Medium sized muscular arteries
3. Nonobstructive

8

Hypertension Induced Arteriosclerosis:
Hyaline arteriosclerosis

Location: Arterioles

Hemodynamic Stress causes leakage of plasma proteins (because endothelial cells are no longer tight) which results in homogenous pink hyaline thickening and lumen narrowing

-kidney and brain-->subtle ischemic changes over time

9

Hypertension Induced Arteriosclerosis:
Hyperplastic arteriosclerosis

Caused by: severe acute blood pressure elevation

Results in: onion skin concentric thickening get:
-smooth muscle with thickened, reduplicated membranes
-->progressive luminal narrowing

10

What is an aneurysm?

localized abnormal dilation of a blood vessel

saccular: one side
fusiform: two sides
false: injury to wall of blood vessel and blood is encased-filling up to look like outpouching

11

What are 3 ways aneurysms happen?

1. poor intrinsic quality of vascular wall connective tissue
-marfans(defect fibrillin), ehlers danlos (defect type 3 collagen)
-bad connective tissue

2. weakened vascular wall through loss of smooth muscle cells or inappropriate synthesis of extracellular matrix
-ischemia ( atherosclerosis, HTN, Syphilis) --cystic medial degenreation
-loss of smooth muscle

3. altered balance of collagen degradation and synthesis
-inflammation
-destructive proteolytic enzymes: matrix metalloproteinases
-degradation of collagen

12

What causes aneurysms?

1. atherosclerosis
2. HTN
3. Congenital defects
3. Inflammation: vasculitis, infection
4. trauma

13

What is cystic medial degeneration?

elastin fragmentation-->loss of smooth muscle cells leading to areas resembling cystic spaces

-degradation of elastin

14

How do abdominal aortic aneurysms happen?

1. Destruction of aortic wall connective tissue
-matrix metalloproteinases play a key role

Atherosclerosis
-compress media
-compromises nutrient and waste diffusion from vascular lumen into arterial wall
-media undergoes degradation and necrosiss
-arterial wall weakness and thinning

15

Where do AAA happen?

infrarenal
-above aortic bifurcation

16

Who is most likely to get AAAs? What are the complications?

men, smokers, >50
complications:
1. compression/obstruction/embolism
2. rupture

17

What is an aortic dissection? Why does it happen?

blood splays apart laminar planes of the media to form a blood filled channel within the aortic wall
-no specific underlying pathology
-cystic medial degeneration(elastin injury)

18

A vs B aortic dissection?

A-proximal
B-not proximal

19

What are the symptoms, complicaiotns, management of aortic dissection?

sudden onset
ripping chest pain
radiating to back

Complicaitons:
rupture
extenion

Management:
medical-blood pressure control
surgical

20

What is vasculitis?

Direct invasion of vascular wall by infectious pathogens
-immune mediated inflammation