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pathology 2
CVS PATHOLOGY
| Question | Answer |
|---|---|
| What 2 things are responsible for Normal circulatory hemodynamics? | PGI 2 (vasodilates, desirable, produced by endothelial cell) and TXA2 (vasoconstrict, undesirable, platelet aggregation, produced by platelets (good for stopping hemorrhage) |
| endothelial funciton is important in _________ and endothelial dysfunction is important in __________/ | vascular health... vascular disease |
| True or False: vascularization is a large but dispersed organ? | True |
| Endothelial dysfunciton initiates________ involving what types of arteries? | atherosclerosis; arteries big-small... aorta, small, smallest arteries, precappillary arterioles |
| endothelium controls the caliber of arterioles which regulates_______ | blood pressure (cardiac output also regulates blood pressure) |
| formation of a blood clot within a blood vessel | thrombosis |
| what is a stationary blood clot composed of? | fibrin and platelets (trapped RBS and WBC in response to exposed subendothelial damage) |
| What 3 factors predispose to thrombus formation? | endothelial injury, alteration in blood flow (turbulence or stasis), alteration in blood itself |
| what are some predispositions to thrombosis? | atheroma, aneurysms, slow flow, change in coagulability of blood |
| hardening of arteries is known as______. What are the 3 types? | arteriosclerosis; 1-atherosclerosis(large, medium, small arteries), 2-Monckeberg medial calcific sclerosis (muscular arteries-but does Not narrow lumen by itself, 3-arteriolosclerosis (small arteries and arterioles) |
| What are the 2 variants of arteriolsclerosis? | hyaline and hyperplastic |
| The American Heart Association(AHA) classifies atherosclerotic lesions into 6 types of increasing severity... | 1- initial lesion is fatty dot(1st decade of life), 2-fatty streak, 3-6- increasing severity, 6- advanced complicated lesion w/ surface defect (fatty atheroma) |
| What initiates the process of atherosclerosis? | when endothelial cells become dysfunctional |
| What are the participating cells of atherosclerosis? | endothelial cells, macrophages, vascular smooth muscle(VSM), Platelets, T-lymphocytes |
| How do macrophages participate in atherosclerosis? | blood monocytes transform to macrophages, ingest oxidized LDL and become foam cells |
| How does Vascular smooth muscle participate in atherosclerosis? | it undrgoes hyperplasia to thicken vessel wall and may also transform into fibroblasts and produce collagen after migrating into intima |
| How do platelets affect atherosclerosis? | produce growth factor which stimulates the process and also participates in thrombosis |
| How do T-lyphocytes participate in atherosclerosis? | both CD4 and CD8 are present in atherosclerotic plaques and participate in inflammatory process in plaque |
| Major risk factors for atherosclerosis | hypertension, cigarettes, diabetes mellitus, dyslipidemia (hyperlipidmia (high LDL cholesterol/and/or tryglycerides, low HDL also risk factor), obesity, sedentary life, stressful life, age males- equal after menopause, genetic factors |
| An advance atherosclerotic plaque can also be called | pulmonary embolism |
| a clot that moves is known as____ and is caused by ___ or ____ | embolus.... fat or air |
| a systemic arterial disease that affects the arterial system in a widespread manner... list 5 areas of involvement | atherosclerosis predilection...1-lower ABD aorta and iliac arteries, 2-proximal coronary arteries 3-femoral and polpliteal arteries, thoracic aorta, 4-internal carotid arteries, 5- circle of willis, middle cerebral, vertebral, basilar |
| loss of surface endothelium over an atherosclerotic plaque is called... most of these (85%) produce <75% fixed narrowing so cause NO anginal symptoms | coronary thrombosis (plaque fissuring or rupture) |
| heart disease resulting from reduced or absent blood flow to left ventricular myocardium | ischemic heart disease |
| the most important cause of passive congestion of the lungs | ischemic heart disease |
| what results if left ventricle is suddenly cut off by coronary artery thrombosis | acute myocardial infarciton |
| infarcted cardiac myocytes are removed by a ___________ and they __________regenerate but are _______ by noncontractile collagenous fibrous tissue.... resulting in.... | inflammatory reaction... do NOT... replaced....reduced pump efficiency of left ventricle =>left ventricular heart failure |
| in ischemic heart disease there's >90% cases due to atherosclerotic coronary artery obstruction. What are the 4 syndromes of IHD: | 1-angina pectoralis, 2-myocardial infarction, 3-chronic IHD w/ heart failure (CIHD), 4-sudden cardiac death |
| occurs when there is decreased myocardial perfusion w/ insufficient oxygen supplied to myocardium... and what is a common setting | angina pectoris... exercise with increased HR, and at rest which reflects a greater decrease in myocardial perfusion |
| _______angina occurs when there's fixed atherosclerotic narrowing of 75% or greater | stable, typical or exertional angina |
| _______angina is due to coronary artery spasm, and may be associated with coronary atherosclerosis or No narrowing | variant (prinzmetal) angina |
| _______angina is due to slow buildup of a partially occluding thrombus on an atherosclerotic plaque | unstable, crescendo or preinfarction angina |
| the 2 anatomic types of Myocardial infarction | 1-subendocardial infarction -outer part of myocardium is spared -partially occluded thrombus in coronary artery [non ST segment elevation], 2-transmural infarction (entire thickness of myocar- occluding thrombus in a coronary artery [ST segment elevation] |
| 3 complications of MI | 1-myocardial perforation (7-10 days after acute MI through softened infarcted muscle may cause pericardial tamponade), 2-mural endocardial thrombi may cause embolism eg. brain, 3-left ventricular aneurysm formation |
| inflammation of a blood vessel, artery, or vein... 2 general causes? | vasculitis... 1. immune mediated (autoimmune) 2. infections- due to invasion of the blood vessel wall by an infectious pathogenic micro-organism |
| 4 criteria used to claassify systemic vasculitides | 1-clinical manifestations, 2-size of vessel, 3-anatomic location of involved vessel, 4-histologic type of inflammation |
| vessels involved in vasculitis 1 large vessel eg-_________2 medium sized vessel eg-________ 3- small vessel eg-_______ 4- capillary-_______ | 1 large vessel eg-giant cell arteritis, takayasu arteritis 2 medium sized vessel eg-polyarteritis nodosa, kawasaki disease 3- small vessel eg-microscopic polyangitis, wegener granulomatosis 4- capillary-goodpasture syndrome |
| What type of vasculitis results from bacteria, viruses, SLE, and has intense neutrophilic infiltration, has fibrinoid necrosis, and has C3 deposits | microscopic polyangiitis, hypersensitivity or leukocytoclastic vasculitis |
| What affects medium sized arteries, has organ failur, skeletal mm. weakness, kidney fx, affected most in this order kidney> heart>liver | polyarteritis nodosa |
| what usually presents with extensive granulomas in lung, necrotizing vasculitis, necrotizing glomerulonephritis, (also skin rash, muscle px, joint disease, mono, polyneuritis) | WEGENER GRANULOMATOSIS (immunosuppressive therapy is used) |
| what is more common in females, affects temporal artery with other arteries of head and can affect muscle arteries, usually above 50yrs | temporal (giant cell) arteritis |
| aorta, pulmonary artery and major branches affected, there's a genetic predisposition, and ocular disturbances (blindness, retinal atrophy, retinal hemorrhages, no pulse in upper limbs, <40 and females | takayasu arteritis |
| 80% pts <4 years, acute febrile illness w/erythema of oral mucosa, skin of palms and soles, cervical lymph node enlargement, large/medium arteries w/intimal thickening=>coronary artery obstruction (most frequent cause of MI in kids | Kawasaki disease (mucocutaneous lymph node syndrome)... w/ appropriate therapy rate of symptomatic coronary artery disease is reduced to 4% |
| this disease is found in smokers, males, relapsing and remitting, tibia and radial arteries, vascular insufficiency and gangrene of limbs | buerger disease (thromboangitis obliterans) |
| left ventricular cardiac hypertrophy resulting from systemic hypertension which increases the work load of the left ventricle.... WHAT ARE THE 2 TYPES? | hypertensive heart disease...1-CONCENTRIC HYPERTROPHY-left ventricular wall thickens, 2-ECCENTRIC HYPERTROPHY-left ventricular wall thickens and heart dilates, right sides also dilate =>CHF |
| when cardiac valve fails to open properly=>narrowing of aperature (orifice) | stenosis |
| when cardiac valve fails to close properly with resulting regurgitation of blood back through incompletely closed valve in next phase of cardiac cycle | insufficiency |
| the most common valvular disease which tends to occur in older persons (1-2% have congenital bicuspid aortic valves and develop it a younger age... if NL tricuspid aortic valve develop after age 60) | calcific aortic valve stenosis... when valve orifice is reduced by >50% the work load of Left ventricle significant increased |
| what 3 major symptoms occur in advanced aortic stenosis | 1-angina, 2-syncope, 3-congestive heart failure |
| enlarged mitral valve leaflets prolapse /balloon into left atrium during left ventricular systole | mitral valve prolapse |
| the valve lesions are termed vegetations and are composed of fibrin, platelets, and bacteria... mitral valve prolapse is the most common predisposing condition | infective (bacterial) endocarditis |
| is usually a complication of rheumatic fever with rheumatic carditis.... there's thickening of valve cusps and fusion of commisures resulting in stenosis | mitral valve stenosis |
| the most prominent symptom of CHF is_______. _______ is another symptom | dyspnea on exertion... leg edema |
| up-regulation of _____ occurs in almost all CHF patients and is an important cause of increase in plasma blood volume | RAAS renin angiotensin aldosterone system |
| In CHF the heart dilates undergoing ______hypertrophy with both _____and _____ of the cardiac myocytes. The ejection fraction goes down due to decreased myocardial___________ | eccentric... elongation... thickening.... contractility |
| an increased amount of blood in an organ or tissue | congestion... (acive congestion due to increased arterial inflow of blood in an organ or tissue inflammation or exercising muscle) |
| due to decreased venous outflow of blood from an organ or tissue, CHF or venous obstruction | passive congestion |
| CHF refers to passive congestion of inflow or upstream organs to the L or R sides of the heart when the L or R ventricle fails in its pump function. L ventricular failure causes_____. R ventricular failure causes______. | L=> pulmonary passive congestion and brown deposits macrophages in lungs(acute or chronic), R=>chronic passive congestion of liver> spleen> kidney and bowel (ascites and edema also present) |
| causes of L ventricular pump failure (4) | 1-ischemic heart disease, 2-hypertensive heart disease, 3-aortic valve disease, calcific aortic stenosis, 4- primary myocardial disease, viral myocarditis, hemochromatosis |
| what's the most common cause of R sided heart failure? | preexistent L heart failure |
| R sided heart failure with a NL L heart (unusual cause of R heart failure)... results from primary disease in lungs (emphysema), pulmonary vessels or chest cavity deformity raising pressure in pulmonary artery and increasing work load of R ventricle | Cor Pulmonale |
| list 4 congenital left to right shunts | 1-atrial septal defect(ASD)l=>r atrium, 2-ventricular septal defect (VSD) L=>R ventricle(most common), 3-atrioventricular septal defect(AVSD) all 4 chambers communicate eg)downs synd, 4-patent ductus arteriosus (PDA) outside heart shunt aorta=> pulm arter |
| list the congenital right to left shunts | 1-tetralogy of fallot, 2-transposition of great arteries(TGA),3-truncus arteriosus, 4-tricuspid atresia |
| in rheumatic carditis or carditis ______ are the inflammatory focus in the myocardium and contain lymphocytes and may contain enlarged macrophages called__________ | aschoff nodule... anitschkow cells.......... the mitral valve is involved in 65% of cases and aortic valve involved in 25% casaes and R sided cardiac valves rarely involved |
| _____shock due to primary decrease in blood volume (ABD aneurysim rupture, GI bleed, 3rd degree burn, dehydration) | hypovolemic shock |
| ____shock due to pahological condition in heart (MI, cardiac tamponade, myocarditis, pulmonary embolism, arrhythmias) | cardiogenic shock |
| _____shock due to bacterial invasion into bloodstream (more gram + then gram -, fungi) | septic shock |
| ______shock has neurological causes or popularly known as nervous breakdown | neurogenic shock |
| 3 clinical phases of shock | 1-initial (nonprogressive shock), 2- progressive phase, 3- irreversible phase leading to death |
| an x-linked recessive genetic disorder with mutaion/deletion of dystrophin gene in skeletal and cardiac muscle... results in lack of scaffold protein | duchenne muscular dystrophy... die in early twenty/teen due to respiratory failure but cardiac arrhythmias and cardiac failure may also occur |
| 3/100,000 and <40 more frequent in females, ptosis and diplopia in extraocular muscles, generalized muscle weakness, thymic hyperplasi present in 65% pts and thyoma in 15%... removal of ABN thymus could improve muscle weakness | Myasthenia gravis... No cardiac involvement |
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abva
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