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Pathology 2 Block 1
Cardiovasular Dr. Kashif
| Question | Answer |
|---|---|
| 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
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