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About 50-80% of cholesterol present in blood plasma is from what? (Endogenous) Synthesized from body cells
30-50% of cholesterol present in blood plasma is from what? (Exogenous) Derived from diet
The only way cholesterol leaves the body is through ________. (Either unmodified or after a conversion of ________ salts) Bile Bile
There are means of lipid transport in blood lasma The surface molecules are partly hydrophilic to solubilize the lipoprotein in plasma. The lipoprotein surface shell is a ___ _______. The center contains hydrophobic molecules like ________ and ___ ____. surface shell is lipid monolayer The center is triglycerides and cholesterol ester
___ is good cholesterol and ___ is bad cholesterol. They both have different functions and can be seperated by weight. LDL Good HDL Bad
VLDL (__________) transports _______ lipids LDL (_________) is derived from _______ by lipoprotein lipase HDL (________) is formed by ____________ and is the most dense. Very low density lipoproteins trasnport exogenous lipids Low density lipoproteins are from VLDL high density lipoproteins formed by hepatocytes
After formation at different sites lipoproteins have a similar course. During passage through capilaries in fat and muscle tissue the ________ is removed from the center of these lipoproteins and the 3 fatty acids are taken off by what enzyme and why? triglycerides (lipoprotein lipase) it allows the released fatty acid to go to its appropriate tissue
Lipoprotein lipase is an enzyme that is attached to capillary __________ _______ in fat, muscle, and the heart. The glycerol is trasnported to the liver and utilized by _______. endothelial cells heptocytes
The major cholesterol carrying lipoprotein in the blood is ____. If elevated there is a risk for ___________. LDL Atherosclerosis
About 70% of plasma LDL is taken up by _______ via LDL receptors. Hepatocytes in the liver and metabolized
About 30% of plasma LDL is taken up by other ______ _______ via the LDL receptor other tissue cells
When free cholesterol in the ________ increases the number of LDL receptors decreases and plasma LDL ________ as a result. hepatocyte increases
____ is produced by hepatocytes and secreted into the blood plasma. It circulates to perpheral tissue and removes _______ from other tissues. Then is cirulates back to the ________ and attaches to its receptor on the _______ and delivers the cholesterol. HDL Cholesterol Liver Hepatocytes
___ 2 causes vasodialation and prevents platelet aggregation. These are desirable effects for normal circulatory hemodynamics and it is produced by _________ cells. PGI 2 Endothelial cells
___ 2 causes vasoconstriction and platelet aggregation. These are undesirable effects for normal irulatory hemodynamics and it is produced by _______ cells. TXA 2 Platelet cells
_________ function is of critical importance in vascular health. ________ dysfunction is important in initiating vascular disease. It is a large but disbursed organ estimated 1000-2000 grams in weight. Endothelial function Endothelial dysfunction
Endothelial dysfunction initiates ________. which is a disease involving the largest artery the aorta and involves smaller arteries down to the smallest into precapillary arterioles. Atherosclerosis
_________ also controls the caliber of arterioles which regulates blood pressure. The other factor regulating blood pressure is ________ output. High pressure can cause rupture. Endothelium Cardiac output
________ is a moving clot commonly found in the ear. ________ is a stationary clot in the blood stream. Embolus-moves Thrombus-stationary
Thrombi are composed of ______ and _________ with trapped RBC and WBC in response to ____________ damage. fibrin and platelets Subendothelial damage
Three factors predispose to thrombus formation. ________ injury, alteration in blood flow (__________), or alteration in the ______. endothelial injry, turbulence or stasis, alteration in blood itself
Thrombosis in arteries are caused by ________ or ________. Thrombosis of the heart valve is caused by __________ caused by infection. atheroma or aneurysm inflammation
Lack of blood flow will lead to ________. Necrosis
________ is hardening of the arteries. There are three types. ___________ affects large, medium, and medium to small arteries. Arteriosclerosis Atherosclerosis
Another type of arteriosclerosis is _________ _______ _______ sclerosis which affects muscular arteries but do not narrow the lumen. (Calcify the arteries). Monckeberg medical calcific sclerosis
Another type of arteriosclerosis is ___________. It affects small arteries and arterioles. There are two varients formed ________ and _________. Arteriolosclerosis Hyaline and hyperplastic
The AHA (American Heart Association) classifies atherosclerotic lessions into 6 types of increasing severity. type 1 (initial lesion is a ______ dot, now seen in the ________ decade of life. fatty dot first decade
2nd type of atherosclerosis is lession in a ________ ________. fatty streak
types 3-6 of atherosclerosis is when lesions are of_______ severity increasing
Type 6 atherosclerosis is an advanced complicated lesion with a _______ _________. (Fatty atheroma) surface defect
Blood _______ initatiate atherosclerosis. __________ migrate into the intama , transform into ______________ and ingest oxidize LDL and become _______ cells. Blood monocytes macrophages Foam cells
Vascular smooth muscle undergoes ___________ to thicken the vessel wall and VSM cells may also transform into __________ and produce collagen after migrating into the intama. hyperplasia fibroblasts
_________ produce a growth factor that stimulates the atherosclerotic process and also participate in ___________ (a complication of atherosclerosis) Platelets Thrombosis
__________ both CD4 and CD8 are present in atherosclerotic plaques and participate in the inflammatory processes in the plaque. T lymphocytes
Major risk factors of atheroslecrosis are ________, __________, ______ ________, dyslipidemia or hyperlipidemia, ________, ______. Hypertension, smoking, diabetes mellitus, obesity, stress
Major nonmodifiable risk factors for atherosclerosis are _______, sex (______ more common), ______ ______. Age, males, genetic factors
Plaque formation is ______ __________. Lots of macrophages, smooth muscles, platelets Fibrofatty atheroma
__________ embolism death can result in a minutes or 2. Pulmonary embolism
These arteries aremost commonly involved in atheroslcerosis. lower abdominal _______ and ________ arteries. ______ _____ arteries, ________ and _______ arteries, internal carotid arteries, circle of willis, middle cerebra, and vertebral and _____ arteries low abdominal aorta and iliac arteries, proximal coronary arteries, femoral and popliteal arteries, thoracic aorta, internal carotid arteries, circle of willis, middle crebral, vertebral and basilar arteries.
________ thrombosis occus when there is a loss of surface ______ over an atheroslerotic plaque termed plaque fissuring or rupture. 80-85% of these thrombi occur on atherosclerotic plaues. Coronary thrombosis endothelium
_______ _______ disease refers to disease resulting from reduced or absent blood flow to the left ventricular myocardium. Ischemic Heart Disease
The most important cause of passive congestion of the lungs is ________ ______ disease. ischemic Heart Disease
If the blood supply to the left ventricle is suddenly cut off by coronary artery thrombosis, acute ________ _______ results. Myocardial infarcation (MI)
The infarcted cardiac myocytes are removed by an inflammatory reaction and they do NOT regenerate but are replaced by non contractile ______ _______ tissue. This reduces the pump efficiency of the left ventricle resulting in ______ ______ heart failure. collagenous fibrous tissue left ventricular heart failure
Ischemic Heart disease is due to decreased myocardial blood flow which in >90% of cases is due to atherosclerotic _______ _______ obstruction. Coronary artery obstruction
4 syndromes of ischemic heart disease are ________ _______, _______ ________ (MI), Chronic IHD with ________ _______ (CIHD), and sudden _____ ______ (SCD). Angina Pectoris, myocardial infarction, chronic IHD with heart failure, and sudden cardiac death
_________ ________ occurs when there is decreased myocardial perfusion with insufficient oxygen supplied to the myocardium relative to myocardial oxygen requirements. Angina Pectoris
Exercise with increased heart rate is a common setting where _______ _______ occurs. angina pectoris
Angina pectoris may also occur at rest which reflects a greater _________ in myocardial perfusion. decrease
______, _______ or exertional angina, occurs when there is fixed atherosclerotic ___________ of 75% or greater (Critical stenosis) Stable, typical or exertional angina (Narrowing)
_________ (prinzmetal) angina is due to ________ ________ spasm. It may be associated with coronary atherosclerosis or may occur with no demonstrable atherosclerotic narrowing. Varient due to coronary artery spasm
_______, ________ or preinfarction angina is due to slow buildup of a partially occluding thrombus on an atherosclerotic plaque or slow build up of plauque. Unstable, crescendo
1st type of myocardial infarction,_________ infarction the ______ part of the myocardium is spared, results from a partially oclluding thrombus in a coronary artery. (Non ST segment elevation). subendocardial infarction outer part
2nd type of myocardial infarction ________ infarction involves the ______ _________ of the myocardium from teh endocardium out to teh epicardial surface, results from an occluding thrombus in a coronary artery (ST segment elevation) Transmural infarction entire thickness
________ _________ occurs about 7-10 days after the acute myocardial infarction through the softened infarcted muscle, may cause pericardial ________. Myocardial perforation Tamponade
_______ __________ ________, may cause embolization after a myocardial infarction. (Ex to the brain). Mural endocardial thrombi
Last complication of a Myocardial infarction is _______ _________ _______ formation. left ventricular aneurysm formation
_______ is inflamation of a blood vessel, artery or vein.There are two main causes. ________ mediated and _________. Vasculitis Immune mediated Infectious
Four criteria are used to classify systemic vasculitides. _______ manisfestations, __________ of the involved blood vessel, anatomic ________ of the blood vessel, and __________ type of the inflammation. Clinical manifestations Size of blood vessel anatomic location of blood vessel histologic type of inflammation
What syndrome affects capillaries? Good Pastures Syndrome
________ __________, hypersensitivity or __________ vasculitis is caused by bacteria, viruses or SLE. There is intense nutrophilic infiltration with fibrinoid necrosis and C3 deposits. This mostly affects ________ sized vessels. Microscopic Polyangitis or leukocytoclastic vasculitis small vessels
________ _________ mostly affects kidneys followed by heart and liver. It causes organ failure, skeletal muscle weakness, and kidney failure. It mostly affects ______ sizes arteries. Polyarteritis nodosa medium arteries
_________ _________ is extensive granulomas in the lung. This also can be called __________ vasculitis or ________ glomerulonephritis. It causes skin rashes, muscle pain, joint disease, mono or polyneuritis, and requires immunosuppressive therapy. Wegener Granulomatosis, necrotizing vasculitis, necrotizing glomerulonephritis
_________ (Giant Cell) _______ usually affects the temporal artery with other arteries of the head. It can affect muscles of the arm. This is most common after age __ and is more common in _______. Temporal Arteritis 50 years or older and females
____ _____ or pulseless disease mainly affects the aorta, pulomary artery, and major branches. It has a genetic predisposition. Occular disturbances, such as blindness, retinal atrophy or retinal hemorrhages are common. No pulse in ___ ____. Age and sex? Takaysu Arteritis no pulse in upper limbs under 40 females
__________ disease is also termed mucocutaneous lymph node syndrome. 80% of patients are age __ or ____. Kawaski Disease 4 years or younger
Kawaski disease presents as an acute febrile illness with _______ of the oral mucosa and skin of the _____ and ______. ________ lymph node is also present. This causes ________ with inflammation of large and medium sized arteries with intimal thickening. erythema palms and soles Cervical lymph nodes Arteritis
20% of untreated patients with kawaski disease develop ________ complications including ______ ________ aneurysms which may rupture or may thrombose producing ________ infarction. cardiovascular complications coronary artery aneurysms myocardial infarction
_______ _________ is the most frequent cause of myocardial infarction in children. With appropriate therapy the rate of symptomatic coronary artery disease is reduced to 4%. Kawasaki Disease
__________ disease (_________ obliterans) is a disease that comes and goes. It mainly affects the tibial and radial arteries causing tingling sensations. Vascular insufficiency and ________ of the limbs may develop. Buerger disease (Thromboangitis obliterans) gangrene
________ hypertension (essential) is due to multiple pathophysiologic causitive factors. It accounts of __% of cases. Primary hypertension 95%
________ hypertension is where there is an underlying single definable cause (pheochromocytoma, renovascular hypertension). It is __% of cases of all hypertension. Secondary 5%
Stage 3 hypertension is BP above ____ systolic and ___ diastolic. 180/110
_________ hypertension is characterized by a rapid elevation of BP above the previous level which produces acute damage to arterioles. Malignant hypertension
Diastolic BP above ___ mmHg would always be considered ________ hypertension requiring aggressive treatment. 130 malignant
Malignant hypertension may occur in a background of either primary or secondary hypertension. It occurs in <1% of ______ hypertension. Occurance is somewhat higher in _____ hypertension depending on the precise cause. May occur in pregnancy or preclampsia primary Secondary
______ _________ ______ hypertrophy results from systemic hypertension which increases the work load of the left ventricle. Left ventricular cardiac hypertrophy
_______ hypertrophy is when the left ventricular wall thickens but the heart does not dilate. oncentric hypertrophy
______ hypertrophy is when the left ventricular wall thickens and the heart dilates. The right sided cardiac chambers would also dilate in this situation and this would be accompanied by _________ ________ ________. Eccentric hypertrophy Congestive heart failure (CHF)
________ is when the valve fails to open properly with resulting narrowing of the aperture (orfice). Stenosis
________ is when the valve fails to close properly with resulting regurgitation of blood back through the incompletely closed valve in the next phase of cardiac cycle. Insufficiency
_______ ______ _______ ________ (valvular heart disease) is the most common vascular disease and tends to occur in _______ persons. Calcific aortic valve stenosis older persons
1-2% of the population have congenital ____ _____ valves and these persons may develop _____ _______ _______ stenosis at a younger age and are more prone to develop it. Bicuspid aortic valves valvific aortic valve stenosis
Persons with a normal tricuspid aortic valve develop _____ ________ ______ ________ later in life after age __-__. Calcific aortic valve stenosis age 60-65
When the area of the valve orifice is reduced by more then 50% of normal the work load the _______ _____ is significantly ________. left ventrical increased
Three major symptoms occur in advanced aortic stenosis. _______, ________, ______ _______ _______. Angina (pain) Syncope (fainting) Congestive Heart Failure (CHF)
________ ______ ________ is when the enlarged mitral valve leaflets prolapse or baloon into the left atrium during left ventricular _________. Mitral valve prolapse ventricular systole
In severe cases of mitral valve prolapse significant mitral _________ with ____________ may develop. Surgical valve repair may be required in severe symptomatic cases. mitral insufficiency with regurgitation
Mitral valve prolapse is fairly common. It occurs in 3-5% of ________ and usually presents between ages __-__. It is more common in _______. adults 20-40 women
Some patients with mitral valve prolapse experience palpitations, fatigue, or atypical chest pain but most are _________. asymptomatic
_________ (Bacterial) ____________ is caused by strep. It is classified into acute and subacute forms depending on rapidity of onset. The valve lesions are termed vegetations and are composed of fibrin, platelets, and bacteria. Infective Endocarditis.
_________ _________ tends to involve previously abnormal cardiac valves. Mitral valve _______ is the most common predisposing condition. Infective Endocarditis prolapse
_______ _______ ________ is usually a complication of rheumatic fever with _______ _______. Mitral valve is the most commonly involved valve. Thickening of the valve cusps and fusion of the commissures results in stenosis. Mitral valve stenosis rheumatic carditis
There are two important basic indices of cardiac function which relate to heart failure. _______ ________ which is the % of the end diastolic volume that the left ventrical ejects during systole. Normal ___ ___ is between 50-75%. Ejection fraction ejection fraction
As the ______ ______ goes down due to declinging contractility of the left ventricular myocardium the heart will _______ in order to maintain stroke volume. (CHF) Ejection fraction dilate
_____ ____ _____ is the instability of the heart to pump blood into the arterial circulation at a sufficient rate to meet the physiologic needs of the body or the ability to do so only if the cardiac filling pressures are abnormally high. Congestive Heart Failure
The usual cause of heart failure is _________ ______ disease causing increased blood plasma volume. Ischemic heart disease
Congestive heart failure refers to the fact that there is passive congestion of ________ on the venous or inflow sides of the left heart in left ventricular heart failure and right heart in right ventricular heart failure. organs
New york heart association classification of CHF. I to IV is based on limitation of _____ _____. Class 1- no limitation Class IV severe limitation symptoms present at ______. The most prominent symptom of CHF is _______ on exertion. Bilateral __ ___ too physical limitation IV limitation at rest Dyspnea (Breathlessness) Bilateral Leg Edema
Up-regulation of the REnin Angiotensin Aldosterone System occurs in almost all patients with ____ _____ ___________ and is an important cause of increase in plasma volume. The heart _______ undergoing eccentric hypertrophy. Congestive Heart Failure Dilates
Created by: T1NWHSU
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