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Pathology 2 Block 1

Cardiovasular Dr. Kashif

QuestionAnswer
What is the means of lipid transport in the blood plasma Lipoproteins
VLDL--->LDL via which enzyme lipoprotein lipase
What enzyme is attached to capillar endothelial cells lipoprotein lipase
What is the major cholesterol carrying lipoprotein in the blood plasma LDL
What is atherosclerosis Plaque formation in the blood vessels
What is a risk factor for atherosclerosis? elevated LDL
Circulates to peripheral tissue and removes cholesterol from tissue cells HDL
lipoprotein that does reverse cholesterol transport HDL
Where can cholesterol be excreted into bile
Prostaglandin (PG)I 2 causes __________(vasoconstriction/vasodialation) and prevents ______ _________ vasodilation and prevents platelet aggregation
PGI 2 is produced by which cells endothelial
Are PGI 2 effects desirable? Why yes, prevent clots thus atherosclerosis
Inhibits platelet aggregation PGI 2
Thromboxane 2 (TXA 2) causes __________(vasoconstriction/vasodialation) and causes ______ ________ vasoconstriction and platelet aggregation
What is necessary in stopping hemorrhage platelet aggregation
TXA 2 is produced by which cells platelets
What will occur in a patient lacking PGI 2 start forming clots
What is the first cause of vascular disease endothelial damage/dysfunction
What initiates atherosclerosis endothelial dysfunction
The endothelium also controls the ___________ of arterioles which regulates_______ caliber, blood pressure
What other factor regulates blood pressure Cardiac output
Formation of a blood clot within a blood vessel Thrombosis
What are thrombi composed of fibrin and platelets
in a thrombus, the platelets contain trapped ____ &____ in response to exposed subendothelial damage RBCs and WBCs
What 3 factors predispose to thrombus formation endothelial injury, alteration of blood flow, alteration of blood itself
What is arteriosclerosis hardening of the arteries
Specific arteriosclerosis affecting muscular arteries (does not narrow lumen itself) Monckeberg Medial calcific sclerosis
arteriolosclerosis affects _______ and arterioles small arteries
What are the 2 variants of arteriolosclerosis Hyaline and hyperplastic
what are the 5 participating cells in atherosclerosis 1. endothelial, 2. macrophages, 3. VSM, 4.Platelets, 5. T lymphocytes
Blood monocytes mirgrate to the ______ and transform into macrophages
LDL should not be in the blood, if they are, macrophages will ingest them and become foam cells
Macrophages ingest oxidized ___ and become ____ cells LDL, foam cells
Vascular smooth muscle undergoes _________ to thicken the vessel wall hyperplasia
VSM cells may transform into fibroblasts and produce _______ Collagen
What is present in atherosclerotic plaques and participates in the infammatory proccesses in the plaque T lymphocytes (CD4 & CD8)
All major risk factors in atherosclerosis are preventable? TRUE
What will be formed in the advanced plaque fibrofatty atheroma
In the clinical phase of atherosclerosis, mural thrombosis embolization and wall weakening can lead to aneurysm and rupture
In the clinical phase of atherosclerosis, progressive plaque growth can lead to critical stenosis
In the clinical phase of atherosclerosis occlusion by thrombus and critical stenosis both cause ischemia which can cause necrosis
What are the most commonly involved arteries in atherosclerosis predilection? Lower abdominal aorta and iliac arteries
What is atherosclerosis predilection? systemic arterial disease
T or F the majority of coronary artery thrombi cause angina? F
80-85% of coronary artery thrombi produce less than 75% fixed narrowing therefore ____________ no anginal symptoms
Ischemic heart disease refers to ischemia to the ____________ myocardium left ventricular
What results if blood supply to the left ventricle is suddenly cut off by coronary artery thrombosis Acute myocardial infarction (acute MI)
Do cardiac myocytes have the ability to regenerate? No
Infarcted cardiac myocytes are removed by an inflammatory reaction and are replaced by __________ non contractile collagenous fibrous tissue
The replacement of infarcted heart cells to fibrous tissue reduces the ____ efficiency of the left ventricle resulting in _________ pump, left ventricular heart failure
left ventricular heart failure causes a decrease in ______ ______ ejection fraction
more than 90% of Ishemic Heart Disease cases are due to atherosclerotic coronary artery obstruction
4 syndromes of IHD angina pectoris, MI, chronic IHD w/ heart failure, Sudden cardiac death (SCD)
Occurs when there is decreased myocardial perfusion w/ insufficient oxygen supplied to myocardium angina pectoris, MI, chronic IHD w/ heart failure, Sudden cardiac death (SCD)
Angina pectoris common setting exercise with increased heart rate
T or F angina may occur at rest T, which reflects great decrease in myocardial perfusion
Stable/ exertional angina occurs when there is fixed atherosclerotic narrowing of atleast _% 70%
Variant(Prinzmetal) angina is due to coronary artery spasm
T or F, Prinzmetal angina is associated with coronary atherosclerosis F, may or may not be associated with atherosclerosis
Angina due to slow buildup of a partially occluding thrombus or of plaque Unstable/crescendo/preinfarction angina
What are 2 anatomic types of mycardial infarctions Subendocardial and transmural
In which type of MI is the outer part of the myocardium spared? Subendocardial
Which MI results from a partially occluding thrombus, and which from an occluding thrombus in a coronary artery Subendocardial results form a partially occluding whereas transmural from a fully occluding
Which MI involves the entire thickness of myocardium? Transmural infarction
Which MI results from an occluding thrombus in a coronary artery (ST segment elevation)? Transmural infarction
What are complications of MI Myocardial perforations (7-10 days after), Mural endocardial thrombi, Left ventricular aneurysm formation
AHA classification of atherosclerotic lesions (1-6) what is type 1 initial lesion is a fatty dot (seen in 1st decade of life)
What is a type 2 atherosclerotic lesion Fatty streak
Type 6 atherosclerotic lesions advanced complicated lesion with a surface defect
What are 2 general causes of Vasulitis? Immune mediated and Infectious
4 criteria used to classify systemic vaculitides are 1. clinical manifestation 2. size of affected vessel 3. anatomic location of affected vessel and 4.________________ Histologic type of the inflammation
Poluarteritis nodosa is seen in what size of arteries Medium
What is most affected in Polyarteritis nodosa Kidneys
What are some signs of polyarteritis nodosa organ failure, sk muscle weekness, kidney failure
What is wegener granulomatosis Extensive granulomas in lung
Skin rash, muscle pain, joint diseae, mono, polyneuritis is seen in which condition Wegener Granulomatosis
Where is Giant cell Arteritis located Temporal artery and other arteries of the head, can affect muscular arteries
Giant Cell Arteritis is most common in Females, >50 years old
Takayasu Arteritis is also known as Pulseless Disease
Takayasu Arteritis is most common in females, under 40 years old
T or F Takayasue Arteritis is developed due to diet F, genetic predisposition
In a patient with Takayasu, no pulse will be found in the _______ upper limbs
In the pulseless disease, what ocular distubances may occur blindness, retinal atrophy, retinal hemorrhages
Mucocutaneous Lymph node syndrome is also known as _________Disease Kawasaki
Kawasaki disease is most common in 80% in children younger than 4
Kawasaki dd, Acute febrile illness with Erythema of (3) Oral mucosa and skin of palms and soles
Causes arteritis of large and medium arteries with Intimal thickening Kawasaki
Coronary artery complication with intimal thickening Coronary artery obstruction
Therapy for kawasaki can reduce the rate of symptomatic coronary artery disease to _% 4%
What is the most frequent cause of Myocardial infarction in children? Kawasaki
Affects tibial and radial arteries, gangrene of limbs seen in male smokers Buerger Disease
Thromboangiitis obliterans is also known as Buerger Disease
What are the 2 major categories of Hypertension Primary (essential) and secondary
Which category of HPT is there an underlying single definable cause? Accounts for %? Secondary, 5% of cases
What are some causes of secondary hypertension (phenochromocytoma and renovasular hypertension)
Blood pressure is equal to CO multiplied by Preipheral Resistance
Giant-cell arteritits, Takayasu arteritis involve what size of blood vessels Large vessel
Polyarteritis nodosa, Kawasaki disease involve what size of blood vessels Medium vessels
Microsopic polyangiitis, Wegner granulomatosis involve what size of blood vessels Small vessel
What vasulitis is caused by bacteria, viruses, SLE- has intense neutrophilic infiltration C3 deposits, with signs of red rash on skin Microscopic polyangiitis
What type of necrosis is associated with Microscopic Polyangiitis Fibrinoid necrosis
Which Vasculitis is a "disease that comes and goes" Relasping and remitting? Buerger Disease
Type of HPT that is has a rapid elevation of BP above their normal, producong acute damage to arterioles Malignant Hypertension
Diastolic BP above ____mmHg would always be considered ________ and requires aggressive treatment 130, malignant
T or F Malignant Hypertension can occur in pregnancy or eclampsia? TRUE
L. ventricular cardiac hypertrophy resulting from systemic hypertension is called Hypertensive Heart disease
In concentric hypertrophy, the L ventricular wall _______, the heart _______(does/does not) dialate Thickens, does not
In Eccentric hypertrophy, the L ventricular wall _______, the heart ________(does/does not) dilate Thickens, does
What also dialates in eccentric hypertrophy? Right sided cardiac chambers
Congestive heart failure is associated with concentric or eccentric hypertrophy? Eccentric hypertrophy
In cardiac valve stenosis the valve fails to _________ properly with resulting ________ open, narrowing of the aperture
In cardiac valve insufficiency the valve fails to _________ properly with resulting ________ Close, regurgitation
What is the MC valvular diease, tends to occur in older persons Calcific aortic valve stenosis
What % of population have a congenital bicuspic aortic valve and thus develop calcific aortic valve stenosis 1-2%
persons with a normal tricuspid aortic valve develop it after what ages 60-65
3 major symptoms occur in advanced aortic stenosis Angina, syncope, CHF
Enlarged mitral valve prolapse or Balloon into L atrium during left ventricular systole Mitral valve prolapse
In mitral valve prolaspe severe cases may also have ______ ________ with _______ mitral insufficiency with regurgitation
Mitral valve prolaspe is MC in______ of ages _____ women, 20-40
T or F , Most patients with mitral valve prolase experience palpitations, fatgue or atypical chest pain False, most are symptomatic, some may experience the previous symptoms
What is the treatment for pt who develop complications, mitral regurgitation, CHF (only 3% experience) Surgical valve repair
Infective Endocarditis is caused by which type of bacteria Strep.
What condition is the MC predisposing condition for endocarditis? mitral valve prolaspe
endocarditis tends to involve previously abnormal cardiac valves
Valve most commonly involved in rheumatic carditis mitral
Mitral valve stenosis is usually a complication of rheumatic fever with rheumatic carditis
What causes stenosis in mitral valve stenosis? thickening of valve cusps& fusion of commissures
Rheumatic fever can affect (3) and cause __________ heart valves, joints, kidneys and may cause Aschoff's nodules
basic indices of cardiac function with relate to HF Ejection fraction
Normal ejection fraction should be btw 50-75%
As ventricular contractility of L myocardium declines __________ also declines Ejection fraction
As EJ decreases, heart will _______ in order to maintain stroke volume dialate
Cardiac dilation will cause volume of blood in L ventricle to be greater than normal at the beginning of ventricular __________(diastole/systole) systole
Venous inflow pressures into the heart _______(increase/decrease) with CHF increase
inability of heart to pump blood into the arterial circulation at a sufficient rate to meet needs or only able to if cardiac filing pressures are abnormally high is the definition of Congestive Heart Failure
The usual cause of HF is ischemic heart disease cause _________________ CHF
Blood plasma volume (blood volume) is __________(increased/decreased) in CHF increased
Usual cause of CHF is pump failure due to loss of normal _________ contractility of ventricles
Loss of normal contractility of ventricles is due to ischemic heart disease causing _______________________ of the left ventricle Fibrous scarring
Dilated heart is seen in CHF
What is the most prominent symptom on CHF Dyspnea on exertion (DOE)
What is another symptom of CHF Leg edma
Up regulation of which system occurs in most pt w/ CHF and is an important cause of increase plasma (blood) volume? Renin Angiotensin Aldosterone System (RAAS)
In CHF the heart dialates undergoing _________ hypertrophy w/ elgongation and thickening of _________ eccentric, cardiac myocytes
an increaed amount of blood in an organ or tissue is congestion
Active congestion is due to __________(increased/decreased) arterial inflow of blood into an organ or tissue, lnflammation or exercising muscle increased
Active congestion is due to increased ___________ of blood into an organ or tissue arterial inflow
Passive congestion is due to __________(increased/decreased) venous outflow of blood into an organ or tissue decreased
Passive congestion is due to decreased ___________of blood into an organ or tissue venous outflow
active or passive congestion refers to CHF or venous obstruction passive congestion
L. ventricular failure causes chronic or acute ___ _____ _____ Pulmonary passive congestion
Pulmonary edma is associated with __ (R/ L) ventricular failure Left
R. ventricular failure causes chronic __________ passive congestion
R. ventricular failure causes chronic passive congestion of what 1st Liver
What organs follow after passive congestion of the liver spleen, kidneys and bowels (develop slowly)
What is the most common cause of L (pump)sided heart failure Ischemic Heart Disease
What are the 4 causes of L sided HF Ischemic Heart Disease, Hypertensie Heart diseae, Aortic valve disease, Primary myocardial disease
**What primary mocardial diseases can cause L sided HF viral myocarditis, hemochromatosis
In CHF, BP increased due to kidneys activating the _ _ _ _ RAAS
What occurs when hydrostatic pressure of the blood in the mircrocirculation increases Edema
What occurs also when colloid osmotic pressure in blood plasma decreases edma
Acute pulmonary passive congestion may cause acute pulmonary ______ Edema
What is an important cause of Acute pulmonary edema Myocardial infarction
What results from chronic left ventricular HF chronic pulmonary passive congestion
What is inhibited with fluid in the lungs gas exchange
What is the MC cause of R. Sided HF? preexistent L. sided HF (95%)
R. sided HF results in increased pressure in the ____________ with chronic passive congestion of ____________ systemic veins, abdominal organs
What abdominal organs are affected in R. sided HF? organs which are inflow organs to the Right Heart --> Liver, spleen, kidneys
Liver appearance in R. Sided HF Nutmeg
What else is seen in R. Sided HF Ascites and edema
Right sided HF occuring with a NORMAL left heart is termed Cor pulmonale
Cor pulmonal is an unusual cause of R. sided HF
What deformity can raise the pressure in the pulmonary artery and thus increasing the work of the Right ventricle? Chest cavity deformity
Cor pulmonal results from primary disease in the lungs, pulmonary vessels or chest cavity deformity
What primary disease can cause Cor pulmonale emphysema
Congenital Heart Disease
T or F, Left to Right shunts are MC TRUE
Abnormal blood shunt from the arterial to venous circulation Left to Right shunt
Right to left shunts abnormally shunts blood from venous to the arterial circulation
What may be seen in R. to L shunt? Cyanosis
Why does cyanosis occur in R to L shunt? venous blood bypassing the lungs and directly entering arterial circulation
Cyanotic congenital heart disease and "blue babies" is seen in which type of shunt Right to Left shunt
What is the most common congenital Left to right shunt? (25-30%) Ventricular Septal Defects (VSD)
In which type of L to R shunt do ALL four chambers communicate w/ eachother? , this is occurs >33% of persons w/ Atrioventricular septal defect (AVSD), Downs syndrome
A shunt outside the heart from Aorta to Pulmonary artery (10-20%) Patent ductus arteriosus (PDA)
Tetralogy of Fallot is what type of shunt Right to Left shunt
What are the 4 components of Tetralogy of Fallot? 1.VSD, Obstruction/stenosis, Aorta that overrides the ventricular septum and VSD, Right ventricular Hypertrophy
Malformations are causes of Obstruction coarctation of the aorta, Pulmonary stenosis, Aortic stenosis
Localized narrowing of the aorta in the arch area? coarctation of the aorta
> 90% of dissecting aortic aneurysms occur in ___________ w/ hypertension Males 40-60
What condition is associated with dissecting aortic aneurysm Marfan's Syndrome
What bacteria causes rheumatic fever and rheumatic carditis A beta hemolytic streptococci
Immunologicall mediated with skin rash, erythema marginatum, subcutaneous nodules, sydenham chorea and migratory polyarthritis Rheumatic fever/carditis
What is migratory polyarthritis Joint pain that migrates
What is sydenham chorea, and what disease is it associated with Abnormal movements of hands, Rheumatic Fever/disease
Mitral valve prolaspe with Rheumatic fever can lead to Mitral Valve stenosis
Aschoff nodule are associated with Rheumatic Carditis
Created by: kfrancis