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Heart/Vascular Sys.
Heart/Vascular System
| Question | Answer |
|---|---|
| 2 principal mechanism of Vascular abnormalities that cause disease | 1. Narrowing or complete obstruction of the lumina 2. Weakening of the walls |
| 2 examples of narrowing/complete obstruction of the lumina | 1. Progressive (ex. Atherosclerosis) 2. Sudden (ex. Thrombosis or Embolism) |
| 4 Hypertensive Vascular Diseases | 1. Hypertension (95% Primary, 5% Secondary Pathoses) 2. Malignant Hypertension 3. Hyaline Arteriolosclerosis 4. Hyperplastic Arteriolosclerosis |
| Define Hypertension | SUSTAINED diastolic bp of >90mmHg or systolic bp of > 140mmHg |
| Rapidly rising blood pressure that is untreated leading to death within 1-2 yrs, systolic >200mmHg, diastolic >120mmHg | Malignant Hypertension |
| This occurs when plasma components leak across injured endothelial cells into the vessel wall & trigger production of excess connective component, leading to thickening of arteriolar walls & luminal narrowing. | Hyaline Arteriolosclerosis |
| Characteristic "onionskin" concentric laminations of replicated basement membrane material that encircles the vessel wall and narrow the lumen. | Hyperplastic Arteriolosclerosis. |
| "hardening of the arteries", refers to the thickening & inelasticity of arteries. | Arteriosclerosis |
| 3 pathologic process of Arteriosclerosis | 1. Atherosclerosis 2. Monckeberg Medial Calcific Sclerosis 3. Arteriolosclerosis |
| This is the most common type of vascular disease, responsible for most of the deaths secondary to cardiovascular disease. (involves large & medium sized muscular arteries) | Atherosclerosis (AS) |
| What is the name of the defining lesion of AS, a raised mass protruding in to the vessel lumen & composed of soft core, covered by dense cap and stromal elements. | Atheromatous Plaque (Atheroma) |
| 4 major Acquired Risk Factors for AS | 1. Hyperlipidemia 2. Hypertension 3. Cigarette smoking 4. Diabetes mellitus |
| This risk factor is associated with Hypercholesterolemia and Hypertriglyceridemia, DIRECT correlation with an increase of Low-Density Lipoprotein (LDL) | Hyperlipidemia |
| 4 Factors of "Response-to-injury Hypothesis" that leads to the pathogenesis of AS | 1. Focal Area of Chronic Endothelial injury or Dysfunction 2. Increased uptake & oxidation of LDL in area of injury 3. Intimal accumulation of macrophages & smooth muscle 4. Proliferation of smooth muscles in fatty streak |
| Hemodynamic damage (shear stress, turbulent flow) & adverse effects of hypercholesterolemia, endothelial cells are susceptible to injury, promote local accumulation of inflammatory cells & platelets, leads to smooth muscle cell migration & proliferation. | Focal Area of chronic Endothelial injury or Dysfunction |
| Subendothelial LDL accumulation that are oxidized, releasing toxins, draws inflammatory cells, forms insoluble complexes & stimulates growth factors and cytokines. | Increased uptake & Oxidation of LDL in area of injury |
| Oxidized LDL draws monocytes and cross over the endothelium & become macrophages that engulf intramural LDL, the lipid containing macrophage & smooth muscles form a macroscopically apparent FATTY STREAK. | Intimal accumulation of macrophages and smooth muscle |
| Smooth muscles cells that convert the Fatty Streak into mature Fibrofatty Atheroma through production of large amounts of extracellular matrix | Proliferation of the smooth muscle cells in the Fatty Streak |
| 2 main physical changes in association with Atherosclerosis | 1. Fatty Streak 2. Atheromatous plaque (Atheroma) |
| Term for a congenital or acquired localized abnormal DILATION of blood vessel or weakness of the wall. | Aneurysm |
| This type of Aneurysm involves all 3 layers of the arterial wall. | True Aneurysms |
| This Aneurysm is a breach in the vascular wall leading to an extravascular hematoma. | False Aneurysm |
| Aneurysm that refers to blood spreading between the layers of the wall of an artery. | Arterial Dissection |
| Congenital defects of intracranial arteries. | Berry Aneurysm |
| 2 Morphological types of Aneurysms | 1. Saccular (spherical in shape) 2. Fusiform (sessile & involving a long segment of the vessel) |
| This Aneurysm is by far the most common type of Aortic Aneurysms & most frequently seen over the age of 50, predominant in males, majority occur in the abdominal aortal below the renal arteries. | Abdominal Aortic Aneurysms (AAA) |
| This Aneurysm is associated w/ hypertension and Marfan Syndrome | Throracic Aortic Aneurysm |
| Most common type of Throracic Aortic Aneurysm | Syphilitic Aneurysm (inflammation of the aorta associated with syphilis infection) |
| This Aneurysm arises from intimal tears that permit blood to enter the wall of the aorta & spread along LAMINAR planes, 90% occur w/in 10cm of aortic valve (descending aorta). | Aortic Dissection |
| 2 types of Aortic Dissection | 1. Double-barreled aorta 2. Cystic Medial Degeneration (cystic medial necrosis) |
| Blood reentering the aortic lumen through second intimal tear | Double-barreled Aorta |
| This Aortic Dissection refers to elastin fragmentation w/ formation of small cleft or cyst-like spaces filled with amorphous extracellular connective tissue matrix, frequently in patient w/ hereditary defects (Marfan Syndrome). | Cystic Medial Degeneration (cystic medial necrosis) |
| Term for non-specific for inflammation of vessels | Vasculitis |
| The noninfectious form of Vasculitis initiated by immunologic mechanism causing damage. | Systemic Necrotizing Vasculitides |
| Most common arteritides, centered around internal elastic membrane of the media & contains lymphocytes intermixed w/ multinucleated giant cells. | Giant Cell (Temporal) Arteritis |
| This disease is an acute illness of infancy & early childhood, genetically predisposed pts have immunoregulatory defects resulting in Vasculitis after exposure to infectious agents. Leading cause of acquired heart disease in children. | Kawasaki Disease (mucocutaneous lymph node syndrome) |
| Clinical feature & Oral feature of Kawasaki Disease | Fever, bilateral Conjuctivities, Erythema of palm and soles. Oral features are swollen tongue, red & enlarged fungiform papillae (STRAWBERRY TONGUE). |
| A necrotizing vasculitis of unknown pathogenesis, presents at age 40, w/ male predominance. Hyperplastic, erythematous & hemorrhagic lesions of gingiva & necrotic palatal lesion. | Wegener Granulomatosis (WG) |
| Patients with systemic vasculities present 2 distinct patterns | 1. Anti-myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) 2. Antiprotein-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) |
| Characteristic of Anti-myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) | antibodies attached to perinuclear myeloperoxidase granules |
| Characteristic of Antiprotein-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) | present in 95% of patients with Wegener Granulomatosis |
| Remitting, relapsing, inflammatory disorder that leads to thrombosis of medium and small-sized arteries, principally tibial and radial. | Thromboangiitis Obliterans (Buerger Disease) |
| What is the primary related cause of Buerger Disease | Use of Tobacco |
| Term for an exaggerated vasoconstriction of digital arteries and arterioles, induce pallor or cyanosis of the digits. | Raynaud Phenomenon |
| Characteristic of Primary Raynaud Phenomenon | seen in healthy individuals but an exaggeration of normal central and local vasomotor response to cold or emotion. |
| Characteristic of Secondary Raynaud Phenomenon | underlying systemic disorder such as scleroderma, systemic lupus, Buerger disease or Atherosclerosis |
| 2 types of Venous disorders | 1. Varicose veins 2. Phlebothrombosis (Thrombophebitis) |
| Abnormally dilated tortuous veins which results from prolonged, intraluminal pressure & loss support of vessel wall, common in people who stand for prolong periods, long automobile or airplane rides. | Varicose Veins |
| Varicose dilation of the veins in the anorectal junction | Hemorrhoids |
| Term Varices associated with portal hypertension of cirrhosis. | Esophageal Varices |
| 2 terms used to designate a single entity: thrombus formation in veins | Phlebothrombosis & Thrombophlebitis |
| Term for blood clot that occur in different locations. | Trouseau sign or Migratory Thrombophlebitis |
| 2 types of Lymphatic disorders | Lymphangitis & Lymphedema |
| Acute inflammation of the lymphatics, marked by overlying red streaks and tenderness | Lymphagitis |
| Accumulation of interstitial fluid in tissue as a result of lyphatic insufficiency or occlusion. | Lymphedema |
| Persistent edema leading to interstitial fibrosis that produce thickening of the skin that resemble texture of orange peel. | Peau d'orange |
| Specific names for collection of fluid in certain cavities due to Lymphedema | Chylous Ascities (peritoneal cavity), Chylothorax (chest cavity), Chylopericardium (cardiac cavity) |
| Characteristic of Primary Lymphedema | Isolated congenital defects (Simple Congenital Lymphedema), or familial (Milroy Disease), both arise from faulty development of lymphatic channels present at birth. |
| Common Causes of Secondary Lymphedema | Postinflammatory scarring, Blockage by neoplasm, surgical excision, postradiation scarring, filariasis. |
| 5 Tumors of vessels | 1. Hemangioma 2. Lymphangioma 3. Angiosarcoma 4. Lymphangiosarcoma 5. Kaposi Sarcoma |
| Benign tumor of blood vessel endothelium, classified as capillary or cavernous. | Hemangioma |
| Tumor of lymphatics | Lymphangioma |
| Malignant tumors of blood vessel | Angiosarcoma |
| Malignant tumors of lymphatic vessel | Lymphangiosarcoma |
| Unique low-grade malignancy of vascular endothelium, associated with HHV 8. | Kaposi Sarcoma |
| Multisystem derangement that arise when the heart is no longer able to eject blood delivered by the venous system. | Congestive Heart Failure (CHF) |
| CHF is divided into what 2 heart failures? | Left-sided heart failure, Right-sided heart failure |
| Causes of Left-sided heart failure | Ischemic heart disease, aortic & mitral valve disease, Hypertension or primary myocardial disorder. (Left Ventricle is usually Dilated) |
| Major clinical manifestation of left-sided heart failure | 1. Dyspnea 2. Orthopnea 3. Paroxysmal nocturnal dyspnea |
| Left-sided heart failure contribute to decrease in Renal perfusion, which leads to increase nitrogenous products remaining in the blood, what is this called? | Prerenal Azotemia |
| Hypoxic brain include symptoms of irritability, restlessness, stupor and coma, what is this called? | Hypoxic Encephalopathy |
| Causes of Right-sided heart failure | 1. Pulmonic or tricuspid valve disease 2. Congenital right-to-left shunts 3. Increased pulmonary vascular resistance (COR PULMONALE) 4. Primary myocardial disease of the right ventricle. |
| Primary cause of right-sided heart failure | Cor Pulmonale |
| Congestion of the Sinusoid of hepatocytes are called what? | Nutmeg Liver |
| The sinusoid that rupture from Nutmeg liver bleeds and cause cells damage, what is this called? | Central Hemorrhagic Necrosis |
| Term for hypoxic hepatocytes around the central vein that undergo necrosis. | Centrilobular Necrosis |
| Term for heart abnormalities of the heart or great vessels that are present at birth, evident cardiac malformation. | Congenital Heart Disease |
| 3 Major types of Congenital Heart Disease | 1. Left-to-right Shunts (Most common type of Congenital cardiac malformation) 2. Right-to-left Cyanotic Shunts 3. Obstructive Congenital Anomalies |
| This occurs with Left-to-right Shunts, pressure overloading the right heart & pulmonary system leads to reversal of flow with unoxygenated blood shunted to the left side, what is this called? | Eisenmenger Syndrome (Tardive Cyanosis) |
| 3 types of Left-to-right Shunts | 1. Atrial Septal Defect 2. Ventricular Septal Defects 3. Patent ductus arteriosus |
| Term for failure of closure for the Foramen Ovale, occurs at birth when the flap does not overlap or fails to permanently fuse with the septum. | Atrial Septal defect |
| The most common congenital heart defects at birth, spontaneous septal closure of the left ventricles (0.5cm or smaller) | Ventricular Septal Defects (VSDs) |
| Left-to-right shunt that results in failure of closure of normal channel that courses between the pulmonary artery and the aorta during development, allowing blood to bypass the lungs, defect typically occurs at pulmonary artery & aorta. | Patent ductus arteriosus |
| This shunt is distinguished quickly because cyanosis is present at or near the time of birth, this defect typically bypass of non-oxygenated blood & emboli production. | Right-to-left Cyanotic Shunt |
| Term for emboli arising in peripheral veins bypass the filtration of the lungs and enter peripheral circulation. | Paradoxical Embolism |
| Severe, long-standing cyanosis is associated with clubbing of the fingertips and polycythemia. | Hypertrophic osteoarthrophy |
| 2 types of Right-to-left Cyanotic Shunts | 1. Tetralogy of Fallot 2. Transposition of the great arteries |
| Most common right-to-left shunt and most common cause of Cyanotic Congenital heart disease. | Tetralogy of Fallot |
| 4 major alteration that occur with Tetralogy of Fallot | 1. Ventricular septal defects 2. Dextraposed Aorta (heart forming on the opposite side of where it should) 3. Obstruction to right ventricular outflow (Stenotic pulmonary artery or valve) 4. Right Ventricular Hypertrophy |
| This occurs when the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. | Transposition of the great Arteries |
| 2 main types of Obstructive Congenital Anomalies | 1. Coarctation of the aorta 2. Valvular Anomalies |
| Narrowing or constriction of the aorta. | Coarctation of the Aorta |
| 2 main types of Coarctation of the Aorta | 1. Contriction proximal to the patent ductus arteriosus (cyanosis to the lower half of the body) 2. Constriction distal to the LIGAMENTUM ARTERIOSUM (asymptomatic, Hypertension of upper extremities & Lower pressure in lower extremities) |
| Aortic or pulmonary valve creating stenosis or occlusion of the lumen. | Valvular Anomalies |
| This heart disease is defined by Imbalance between Myocardial need and its supply of Oxygen. | Ischemic Heart Disease (IHD, coronary heart disease) |
| What % of vessel lumen obstruction causes symptomatic ischemia during periods of demand? | 70% |
| What % of vessel lumen obstruction causes symptomatic ischemia at rest? | 90% |
| Characteristics of Acute Plaque Changes | Fissuring, hemorrhage into the plaque and rupture w/ embolization of atherosclerotic debris into distal coronary arteries. |
| Characteristic of Coronary Artery Thrombosis | Arises form a plaque rupture that exposes the subendothelial collagen & initiates platelet aggregation and local coagulation. |
| Idiopathic spasm triggered by vasospastic mediators released during platelet aggregation or by other influences like smoking. | Coronary Artery Vasospasm |
| Severe arterial narrowing may result in what 4 syndromes? | 1. Angina Pectoris 2. Myocardial infarction 3. Chronic Ischemic Heart Disease 4. Sudden Cardiac Death |
| Intermittent chest pain caused by transient reversible myocardial ischemia short of infarction. | Angina Pectoris |
| Angina that is caused by vasospasm, typically arises at rest, may awaken patient from sleep, relieved by vasodilators. | Prinzmetal Angina |
| Angina that arises from AS stenosis combined with thrombosis, vasospasm and/or platelet aggregation, intense and prolonged pain, immediate danger of MI (PREINFARCTION ANGINA). | Unstable Angina (Crescendo Angina) |
| Defined area of Myocardial Necrosis caused by Local ischemia | Myocardial Infarction (MI) |
| Upon coronary occlusion, necrosis begins in what zone. | Subendocardial infarction |
| Continued ischemia will lead to necrosis and may involve full thickness of the ventricular wall, what is this called? | Transmural Myocardial infarction |
| Enzymes present in blood rest that indicate MI (typically up to 3 days) | Elevated Creatine Kinase (CK) particularly the MB Isoenzyme. |
| Enzyme that indicate an MI has occurred after 3 days when CK is no longer detectable. | Cardiac Troponin 1 (cTnI) (present 4-7 days after MI event) |
| List Therapeutic approaches to for MI | 1. Intracoronary Thrombolytic mediation (clot busters) 2. Coronary Artery bypass grafting (CABG) 3. Transluminal Angioplasty |
| This therapeutic approach utilizes the bypass of leg vein or internal mammary artery for MI | CABG |
| This therapeutic approach uses a rotating blade to destroy or compress stenosing atherosclerotic plaques. | Transluminal Angioplasty |
| This Disease is described as slow development of progressive congestive heart failure as a consequence of long-term ischemic myocardial injury. Insidious and appear with old age. | Chronic Ischemic Heart Disease (CIHD, ischemic cardiomyopathy) |
| Abnormal myocardial conduction and can be sustained or sporadic. | Arrhythmias |
| Term for Fast heart rate | Tachycardia |
| Slow heart rate | Bradycardia |
| Irregular rhythm without functional contraction | Ventricular Fibrillation |
| No heart contraction | Asystole |
| Term for unexpected death from cardiac causes within 24 hrs of onset. | Sudden Cardiac death |
| Term for Combination of hypertension and associated LEFT ventricular hypertrophy | Systemic hypertensive heart Disease (HHD) |
| This is a RIGHT ventricular enlargement secondary to pulmonary hypertension resulting from primary disorders of the lung parenchyma or pulmonary vasculature. | Pulmonary Hypertensive Heart Disease (Cor Pulmonale) |
| 2 types of Pulmonary Hypertensive Heart Disease | 1. Acute Cor Pulmonale 2. Chronic Cor Pulmonale |
| Term for right ventricular DILATION that follows the heart strain typically associated with massive pulmonary embolization. | Acute Cor Pulmonale |
| Term for right ventricular HYPERTROPHY secondary to prolonged pressure overload seen in association with any one # of disorders that create pulmonary hypertension. | Chronic Cor Pulmonale |
| Immunologically mediated, multisystem inflammatory disease that follows a group A beta-hemolytic streptococcal pharyngitis. | Rheumatic Fever |
| Nonspecific inflammatory process, involves predominantly large joins and leaves no residua. | Arthritis |
| Consist of scattered subcutaneous nodules in addition to erythematous maculopapular eruption which exhibit central clearing upon enlargement. | Skin lesions |
| Acute Rheumatic Heart Disease involves what layers of the heart? | all 3 layers (Pancarditis) |
| Fibrinous pericarditis overlies the myocardium which contain scattered collection of intramuscular inflammatory cells which forma patter of myocarditis. | Aschoff Bodies |
| Mass of granulomatous inflammation typically demonstrates a central zone of necrosis and contains scattered large macrophages. | Anitschkow Cells |
| 2 types of INFECTIVE endocarditis | 1. Acute Endocarditis 2. Subacute Endocarditis |
| Term for colonization of the heart valves or mural endocardium by microorganism leading to formation of thrombotic masses or organisms. | Vegetations |
| This Infective Endocarditis arises secondary to High virulent organism that infect the heart and what is the name of the organism? | Acute Endocarditis: Staphylococcus Aureus |
| Infective Endocarditis arising secondary to Low virulent organism that infect the heart, and what is the name of the organism? | Subacute Endocarditis: Streptococcus Viridans |
| 2 Primary Myocardial Diseases | 1. Cardiomyopathy 2. Myocarditis |
| Refers to the primary non-inflammatory disorder of myocardium in which there is no demonstrable etiology. | Cardiomyopathy |
| 3 forms of Cardiomyopathy | 1. Dilated Cardiomyopathy 2. Hypertrophic Cardiomyopathy 3. Restrictive Cardiomyopathy |
| Markedly dilated HYPOCONTRACTING heart with impaired contractile function usually with concurrent ventricular hypertrophy. | Dilated Cardiomyopathy |
| Characterized by a heavy, muscular HYPERCONTRACTING heart characterized by hyperplasia of the left ventricle and interventricular septum. | Hypertrophic Cardiomyopathy |
| Refers to a decrease in ventricular compliance, resulting in impaired ventricular filling during diastole. | Restrictive Cardiomyopathy |
| Refers to an inflammatory process that primarily results in injury of the heart muscle, usually caused by microbiologic agents. | Myocarditis |
| Inflammatory condition and effusion are the only common pathoses to effect the pericardium, secondary to local myocardial or mediastinal disorders or from certain systemic conditions such as uremia. | Pericardial Disease |
| 2 Pericardial Disease | 1. Pericarditis 2. Pericardial Effusions |
| Inflammation of the Pericardium usually secondary to myocardial or endocardial disease (MI, cardiac surgery,) or lesions in the pericardium by either direct or through blood vessels or lymphatics. | Pericarditis |
| Term for major consequence of Pericarditis, that develops adhesions from fibrous bands to encase the heart with dense fibrous connective tissue. | Constrictive pericarditis |
| A process that results in fluid accumulation in the pericardial sac. | Pericardial Effusion |
| 3 major types of Pericardial Effusioin | 1. Serous 2. Serosanguineous 3. Chylous |
| Common causes of the 3 major Pericardial Effusion | Serious = CHF or Hypoalbuminemia. Serosanguineous = Blunt chest trauma, malignancy. Chylous = Mediastinal lymphatic obstruction. |
| Compression of the heart by accumulation of fluid in pericardial sac, often leading to heart failure. | Cardiac Tamponade |
| When pure blood fills the pericardial space, often from penetrating cardiac trauma or rupture aneurysm or MI, this can lead to Cardiac Tamponade. | Hemopericardium |
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ddde227
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