Term
| Normal fluid homeostasis requires appropriate: what three things? |
|
Definition
-Vessel wall integrity
-Intravascular pressure
-Plasma colloid osmotic (oncotic) pressure |
|
|
Term
|
Definition
| Increased fluid in interstitial tissue spaces |
|
|
Term
| What are the two types of edema? describe them. |
|
Definition
-Transudate: protein-poor fluid, typically caused by alterations in hemodynamic forces (SG <1.012)
-Exudate: protein-rich fluid, typically caused by inflammation and the associated increased vascular permeability (SG > 1.020) |
|
|
Term
| What are the 5 causes of edema: what type of increased pressure, what causes this? What type of decreased pressure, what causes this? Obstruction of what, caused by what? Retention of what, caused by what? Increased permeability, caused by what? |
|
Definition
-Increased hydrostatic pressure, caused by reduction in venous return
-Decreased plasma colloid osmotic pressure, caused by reduction in plasma proteins
-Lymph obstruction, caused by scarring, tumors, certain infections
-Primary renal sodium retention, caused by renal failure
-Increased vascular permeability, caused by inflammation (plasma proteins get out and cause inflammation) |
|
|
Term
| Why is generalized subcutaneous tissue edema important? |
|
Definition
| It may not be initially critical, but the underlying cause of cardiac or renal failure is important |
|
|
Term
| What are two types of edema that are rapidly fatal? Why? |
|
Definition
-Pulmonary: in the lungs you won't be transferring oxygen efficiently and its infection prone
-Brain: there is no room for any expansion |
|
|
Term
| Define hyperemia and congestion. Which process is active, which is passive? Describe the color of tissue associated with each. |
|
Definition
Increased volume of blood in a particular tissue
-hyperemia: active process; caused by arteriolar dilation, such as sites of inflammation or in skeletal muscle during exercise; tissue is redder than normal (erythema)
-Congestion: passive process; caused by impaired venous return out of tissue; tissue is bluer than normal (cyanosis) |
|
|
Term
|
Definition
| rupture of blood vessels with loss of blood |
|
|
Term
|
Definition
Pin point hemorrhages or spots under the skin or on the mucous membranes. Usually caused by platelet issue, or we don't have enough platelets, or problem with the coagulation system.
-1-2 mm |
|
|
Term
|
Definition
| 3-5 mm, like petechiae but bigger |
|
|
Term
|
Definition
| A bruise. 1-2 cm, subcutaneous bruise; hgb (blue-red), bilirubin (blue-green), hemosiderin (golden-brown) |
|
|
Term
| A hemorrhage can be external or internal. What is another name for an internal hemorrhage? |
|
Definition
|
|
Term
| What are two examples of hemorrhage in a body cavity? |
|
Definition
-hemothorax
-hemopericardium |
|
|
Term
| The clinical significance of a hemorrhage depends on the site and volume of blood loss, what are the consequences of a massive hemorrhage? |
|
Definition
| blood loss, hypovolemic shock, exsanguination, death |
|
|
Term
| The clinical significance of a hemorrhage depends on the site and volume of blood loss, what are the consequences of a hematoma? |
|
Definition
|
|
Term
| The clinical significance of a hemorrhage depends on the site and volume of blood loss, what are the consequences of a intracerebral hemorrhage? |
|
Definition
|
|
Term
| The clinical significance of a hemorrhage depends on the site and volume of blood loss, what are the consequences of chronic hemorrhage? |
|
Definition
| slow blood loss, iron deficiency anemia |
|
|
Term
|
Definition
| A normal process that maintains the blood in a fluid state and produces a local hemostatic plug at sites of vascular injury |
|
|
Term
|
Definition
| The pathologic form of hemostasis. The formation of a blood clot (thrombus) in an uninjured or minimally injured vessel |
|
|
Term
| Hemostasis and thrombosis are dependent on what three factors? |
|
Definition
-vascular endothelium
-platelets
-coagulation system |
|
|
Term
| The vascular endothelium has antithrombotic properties and prothombotic properties, name 3 of each. |
|
Definition
-Antithrombotic: anti platelet effects, anticoagulant properties, fibrinolytic properties
-Prothrombotic: adhesion of platelets, synthesis of vWF, synthesis of tissue factor (thromboplastin) |
|
|
Term
| In tissue injury, platelets adhere to the extracellular matrix by binding to _______ and become activated |
|
Definition
|
|
Term
| Platelets release ______ and ________/____ for formation of a primary hemostatic plug |
|
Definition
ADP (platelet aggregation)
Thromboxane A2 (platelet activation and vasoconstriction) |
|
|
Term
| Interaction of what two things causes the coagulation cascade? What does this result in the production of? |
|
Definition
-Interaction of tissue factor (on endothelial cells) and platelet phospholipids
-Results in production of thrombin |
|
|
Term
| Thrombin cleaves circulating __________ into insoluble _______, which polymerizes to form a longer-lasting secondary _______ plug |
|
Definition
fibrinogen
fibrin
hemostatic |
|
|
Term
| In a person with Hemophilia A, where is the problem with the coagulation cascade? |
|
Definition
| PTT bc it is factor 8 that is effected |
|
|
Term
| When there is an injury, the tissue factor released from endothelial cells and platelets is activated where? |
|
Definition
| only at the sites of injury |
|
|
Term
| Anticoagulants are produced at the site of endothelial injury or during activation of the coagulation cascade, give three examples and what they inhibit. |
|
Definition
-Antithrombins inhibit the activity of thrombin
-Protein C and S inactivate cofactors Va and VIIIa
-Tissue factor pathway inhibitor (TFPI) inactivate factor Xa |
|
|
Term
| What is the fibrinolytic cascade? |
|
Definition
| Plasminogen activators (e.g. t-PA) convert plasminogen to plasmin, which breaks down fibrin |
|
|
Term
|
Definition
Three primary influences on thrombus formation:
-endothelial injury (biggest influence)
-stasis of turbulence of blood flow
-Blood hyper coagulability |
|
|
Term
| What are 4 examples of endothelial cell loss or injury that can lead to thrombosis? |
|
Definition
-MI
-ulcerated plaques in atherosclerotic arteries
-trauma
-inflammation (vasculitis) |
|
|
Term
| What are three subtle influences that alter endothelial function that can lead to thrombosis? |
|
Definition
-hypercholesterolemia
-radiation
-products absorbed from cigarette smoke |
|
|
Term
| Turbulence or stasis in blood flow causes what four things that can lead to thrombosis? |
|
Definition
-disruption of flow brings platelets into contact with endothelium
-prevent dilution of activated clotting factors
-retard inflow of clotting factor inhibitors
-promote endothelial cell activation |
|
|
Term
| What is hyper coagulability? How important is it with respect to thrombosis? |
|
Definition
-any alteration of the coagulation cascade that predisposes to thrombosis
-it is important, but less to thrombosis |
|
|
Term
| What is primary (inherited) and secondary (acquired) heritability? |
|
Definition
-Primary: mutations in coagulation factor genes or anticoagulant genes
-Secondary: prolonged bedrest, MI, tissue damage (surgery, fracture, burns), cancer |
|
|
Term
| Factor V Leiden thrombophilia is an inherited disorder of what? |
|
Definition
|
|
Term
| What is the most common inherited form of thrombophilia? |
|
Definition
Factor V Leiden Thrombophilia
-affects 2-15% of people with european ancestry |
|
|
Term
| People with Factor V Leiden Thrombophilia are highly susceptible to what? Women are at a slightly increased risk for what? |
|
Definition
-DVT (abnormal blood clots most often in legs, often move to lungs--> pulmonary emboli)
-miscarriage (most women have normal pregnancies) |
|
|
Term
| What are some risk factors for Factor V Leiden Thrombophilia? |
|
Definition
-age, obesity, smoking, injury, surgery, BC pills, hormone replacement therapy
-Factor V leiden mutation in combo with another mutation in the F5 gene (or other member of the coagulation cascade.) |
|
|
Term
| Factor V Leiden Thrombophilia is caused by a ________ mutation in coagulation factor V gene that results in single amino acid _________ (Arg506GIn) in the protein |
|
Definition
|
|
Term
| in Factor V Leiden Thrombophilia coagulation factor V cannot be _________ normally by activated ________/__ |
|
Definition
|
|
Term
| Factor V Leiden Thrombophilia is what type of mutation? What is the lifetime risk for DVT based on the number of alleles affected? |
|
Definition
-autosomal dominant gain-of-function
-one allele: 10%
-two alleles: 80% |
|
|
Term
| What is A mural thrombi of the heart and what is it caused by? |
|
Definition
thrombi occurring in heart chambers or in the aortic lumen
overlying myocardial infarct |
|
|
Term
| A valvular thrombi of the heart is caused by? |
|
Definition
|
|
Term
| An arterial thrombi is caused by? |
|
Definition
| atherosclerosis, aneurysms |
|
|
Term
| A venous thrombi is caused by? |
|
Definition
|
|
Term
| A microvascular thrombi is caused by? |
|
Definition
| disseminated intravascular coagulation (DIC) |
|
|
Term
| Name three arteries and three veins that are common sties for thrombus formation. |
|
Definition
-coronary
-cerebral
-femoral
-femoral
-popliteal
-iliac |
|
|
Term
| If a patient survives the initial thrombosis, some combination of the many things can occur. What is propagation? |
|
Definition
| thrombus increases in size and obstructs vessel |
|
|
Term
| If a patient survives the initial thrombosis, some combination of the many things can occur. What is embolization? |
|
Definition
| thrombus dislodges or fragments, and moves to other locations in vessels. |
|
|
Term
| If a patient survives the initial thrombosis, some combination of the many things can occur. What is dissolution? |
|
Definition
| thrombus is removed by fibrinolytic activity |
|
|
Term
| If a patient survives the initial thrombosis, some combination of the many things can occur. What is organization? |
|
Definition
| thrombus induces inflammation and fibrosis; may be incorporated in vessel wall |
|
|
Term
| If a patient survives the initial thrombosis, some combination of the many things can occur. What is recanalization? |
|
Definition
| re-establish some degree of blood flow |
|
|
Term
| What is an embolus? What percentage of emboli are part of a dislodged thrombus? |
|
Definition
-an detached solid, liquid, or gaseous mass carried by the blood to a site distant from its origin
99% |
|
|
Term
| Emboli can be either arterial or venous. What percentage of arterial emboli arise from the heart? Where doe the majority of venous emboli arise from? |
|
Definition
85%
majority arise from the legs |
|
|
Term
| Pulmonary thromboemboli arise mainly from ______ in the ______ |
|
Definition
|
|
Term
| The effect of a pulmonary thromboembolism depends on the size of the embolus, what are 5 possible outcomes? |
|
Definition
-60-80% are small and clinically silent
-sudden death
-R heart failure (for pulmonale)
-infarction |
|
|
Term
| What does the term systemic thromboemboli refer to? |
|
Definition
| emboli in the arterial circulation |
|
|
Term
| 80% of systemic thromboemboli arise from what? |
|
Definition
| intracardiac mural thrombi |
|
|
Term
| Name 4 things that Intracardiac mural thrombi can be possibly caused by |
|
Definition
-L ventricular wall infarcts
-dilated L atria secondary to mitral valve defects
-aortic aneurysm
-atherosclerotic plaque |
|
|
Term
| Name the two major sites for arteriolar embolization |
|
Definition
-lower extremities (75%)
-brain (10%) |
|
|
Term
|
Definition
| an area of ischemic necrosis within a tissue or organ that is produced by occlusion of either its arterial supply or its venous drainage |
|
|
Term
| Name four common infarctions that are important causes of clinical illness |
|
Definition
-MI
-cerebral infarction
-pulmonary infarction
-bowel infarction |
|
|
Term
| Name four factors that influence the development of an infarct. |
|
Definition
-availability of an alternative blood supply
-rate of development of the occlusion (the longer the period of time, the more chance the body has to develop an alternative source of blood)
-susceptibility of a tissue to hypoxia (heart cells can live for about 30 mins w/o O2, neurons can last about 2 mins
-oxygen content of the blood (cardiac patients who are not efficient at oxygenating blood are already at a disadvantage) |
|
|
Term
|
Definition
-anemic
-caused by arterial occlusion
-usually in solid tissues |
|
|
Term
|
Definition
-hemorrhagic
-caused by venous occlusion
-loose tissues
-dual or extensive collateral blood supply
-could be bringing blood into an already necrotic area |
|
|
Term
| Shock causes systemic __________, which leads to reduced what two thing? |
|
Definition
hypoperfusion
-CO
-circulating blood vol |
|
|
Term
| Shock is the final common pathway for many potentially lethal clinical events, give three examples. |
|
Definition
heart failure---> cardiogenic shock
blood loss ----> hypovolemic shock
infections----> septic shock |
|
|
Term
| What is the mortality rate of septic shock? |
|
Definition
|
|
Term
| Describe what causes septic shock |
|
Definition
| it is an innate immune response to systemic release of endotoxins: bacterial cell walls (Lipopolysaccharides (LPS) have a fatty toxin--endotoxin) |
|
|
Term
| What are some consequences of septic shock? |
|
Definition
| hypotension, decreased myocardial contractility, endothelial injury, disseminated intravascular coagulation (DIC), fibrinolysis (plasmin) |
|
|
Term
| Septic shock causes bleeding due to consumption of _______ factors and activation of _________ |
|
Definition
|
|
Term
| What is the #1 cause of death in ICU's? |
|
Definition
|
|
Term
| Shock of any kind can cause tissue injury bc of prolonged hypoxia, what happens to the brain? |
|
Definition
|
|
Term
| Shock of any kind can cause tissue injury bc of prolonged hypoxia, what happens to the heart? |
|
Definition
| subendocardial hemorrhages and necrosis |
|
|
Term
| Shock of any kind can cause tissue injury bc of prolonged hypoxia, what happens to the kidneys? |
|
Definition
| acute tubular necrosis or diffuse cortical necrosis |
|
|
Term
| Shock of any kind can cause tissue injury bc of prolonged hypoxia, what happens to the GI tract? |
|
Definition
| patchy hemorrhages and necrosis |
|
|
Term
| Shock of any kind can cause tissue injury bc of prolonged hypoxia, what happens to the liver? |
|
Definition
| fatty change or central hemorrhagic necrosis |
|
|
Term
| What are the two types of cells that mostly make up normal vessel walls? |
|
Definition
| endothelial cells and smooth muscle cells. |
|
|
Term
| Arteries have a thicker ______, veins have a larger __________ |
|
Definition
|
|
Term
| The large (elastic) arteries such as the aorta, common carotid, and the iliac, are composed of lots of _______ fibers. Use one word to describe them. |
|
Definition
|
|
Term
| Medium (muscular) arteries, such as the coronary and renal arteries, are mostly composed of what type of cell? |
|
Definition
|
|
Term
| The small arteries/arterioles are made up of strictly what type of cell? What is controlled here? |
|
Definition
smooth muscle cells
blood pressure controlled here |
|
|
Term
| How big are capillaries? Describe the amount of capillaries, the walls of them, and the speed of flow through them. What are capillaries great for? |
|
Definition
-diameter of a RBC
-thin walls
-slow flow
-great for exchanging oxygen and nutrients |
|
|
Term
| Describe the diameter and thickness of the walls of venules/veins. What is a special feature that is unique to veins? Are veins compressible? |
|
Definition
-large diameter
-thin walls
-they have valves
-compressible, penetrable by tumor |
|
|
Term
| What is the function of lymphatics? What happens when lymph passes through lymph nodes? Where does the lymph return the pathogens to? |
|
Definition
-drain excess interstitial fluid
-pass through nodes checking for infection
-returns pathogens (and tumor cells) to circulation |
|
|
Term
| In response of vessel wall cells to injury, signals from the ECs, platelets, and macrophages, as well as complement and coagulation factors activate ________ |
|
Definition
| SMCs (smooth muscle cells) |
|
|
Term
| _________ disease is responsible for more morbidity and mortality than any other category of human disease |
|
Definition
|
|
Term
| What are the two major mechanisms of vascular disease? |
|
Definition
-narrowing, or total obstruction, of vessels
-weakening, leading to dilation or rupture |
|
|
Term
| What is a berry aneurysm? Where do they most typically occur? Are they fatal if ruptured? |
|
Definition
| Small dilations in cerebral vessels, typically in the circle of Willis; fatal if ruptured. |
|
|
Term
| What is an arteriovenous fistula? What can they cause? |
|
Definition
| Small direct connections between arteries and veins that bypass capillaries. May cause high output cardiac failure |
|
|
Term
| What is fibromuscular dysplasia? What can it result in? |
|
Definition
| A focal irregular thickening of the walls of medium to large sized arteries; results in luminal stenosis |
|
|
Term
| What does arteriosclerosis mean? |
|
Definition
| It is a generic term meaning hardening of the arteries, loss of elasticity. |
|
|
Term
| What are the three patterns of arteriosclerosis? |
|
Definition
-arteriosclerosis
-monckeberg medial clacific sclerosis
-atherosclerosis |
|
|
Term
| What vessels does arteriosclerosis commonly affect? What happens to these vessel walls? What other diseases is it associated with? |
|
Definition
-small arteries and arterioles
-vessel wall thickening
-often associated with HTM and/or DM |
|
|
Term
| What is monckeberg medial calcific sclerosis? What age group does it usually affect? Is it clinically significant? |
|
Definition
-calcium deposits in the muscle walls
-people older than 50
-usually no stenosis, and not clinically significant |
|
|
Term
| What is atherosclerosis characterized by? It causes ____% of all heart disease. |
|
Definition
-Characterized by intimal lesions called atheromas (atheromatous plaques or atherosclerotic plaques)
-80% |
|
|
Term
| Atherosclerosis is a systemic disease affecting the _______ |
|
Definition
|
|
Term
| Atherosclerosis is a chronic __________ response of the vascular wall to a variety of _________ |
|
Definition
|
|
Term
| Atherosclerotic lesions require _______ to become clinically significant |
|
Definition
|
|
Term
| Atherosclerotic plaques may acutely cause symptoms due to what 4 things? |
|
Definition
rupture
thrombosis
hemorrhage
embolization |
|
|
Term
| What are the two types of atherosclerosis |
|
Definition
-generalized: may affect all arteries in the body
-localized: symptoms that predominate in a single organ or region |
|
|
Term
| Name 4 types of localized atherosclerosis and their possible consequences |
|
Definition
-cerebral: stroke
-coronary: MI
-aortic: aortic aneurysm
-Peripheral: gangrene |
|
|
Term
| Atherosclerosis causes about _____% of all deaths in the western world, many of which are the result of ________ heart disease |
|
Definition
|
|
Term
| MI is responsible for about ______% of all deaths in the US |
|
Definition
|
|
Term
| _________atherosclerosis and _______ also cause significant morbidity and mortality |
|
Definition
|
|
Term
| What are 3 risk factors for atherosclerosis that cannot be changed? |
|
Definition
increased age
male gender
heredity |
|
|
Term
| Name some risk factors for atherosclerosis that can be controlled? |
|
Definition
| hyperlipidemia, hypertension, cigarette smoking, diabetes, obesity, C-reactive protein, physical inactivity, diet |
|
|
Term
| Multiple risk factors for atherosclerosis have a ________ effect |
|
Definition
multiplicative
-Two risk factors- risk increases four fold
-three- risk increases seven fold |
|
|
Term
| An atherosclerotic plaque is a soft ______ core covered by a firm ______ cap. It protrudes into the lumen, causing ________. It weakens the underlying arterial _______ |
|
Definition
|
|
Term
| What are two possible fates of an atherosclerotic plaque? |
|
Definition
-plaque ruptures in vessel, thrombus formation
-vessel wall expands, aneurysm, and rupture |
|
|
Term
| Describe a true aneurysm, saccular type. |
|
Definition
| the vessel wall focally bulges outward |
|
|
Term
| What is a true aneurysm, fusiform type? |
|
Definition
| circumferential dilation of the vessel |
|
|
Term
| What is a false aneurysm? |
|
Definition
| the wall is ruptured, collection of blood (hematoma) is bounded externally by extravascular tissues |
|
|
Term
|
Definition
| blood has entered (dissected) the wall of the vessel and separated the layers |
|
|
Term
| Atherosclerotic aneurysms occur most frequently where? |
|
Definition
|
|
Term
| What are 5 clinical consequences of AAA? |
|
Definition
-rupture into the peritoneal cavity; fatal hemorrhage
-obstruction of branch vessel leading to ischemic injury of tissue
-embolism from atherosclerotic plaque thrombus
-compression of adjacent structure
-may present as an abdominal mass that stimulates a tumor (often palpably pulsating) |
|
|
Term
| What are the two primary preventions of atherosclerosis? |
|
Definition
-lessen risk factors
-Statins: inhibit an enzyme in the liver that plays a key role in making bad cholesterol |
|
|
Term
| What are two secondary preventions of atherosclerosis? |
|
Definition
-aspirin (reduces inflammation, may reduce damage to the inside of arteries. Also increases expression of genes involved in making HDL), statins, beta blockers (block the activity of NE and other stress hormones)
-surgery |
|
|
Term
| What are 5 major phenotypic features of familial hypercholesterolemia? |
|
Definition
-age at onset: heterozygate- early to middle adulthood; homozygote- childhood
-hypercholesterolemia
-atherosclerosis
-xanthomas
-arcus corneae |
|
|
Term
| What is the inheritance pattern of familial hypercholesterolemia? |
|
Definition
| autosomal semi-dominant. with more severe disease in homozygotes |
|
|
Term
| Familial hypercholesterolemia (FH) is a disorder of ________ and ________ metabolism caused by mutations in the _______ receptor gene |
|
Definition
|
|
Term
| FH accounts for somewhat less than _____% of patients with hypercholesterolemia |
|
Definition
|
|
Term
|
Definition
| particles with protein and phospholipid coats that transport cholesterol and other lipids in the blood. |
|
|
Term
| LDLs are made up of ______% cholesterol |
|
Definition
|
|
Term
| HDLs are made up of _____% cholesterol. What is their main function? |
|
Definition
20
they are mainly int he periphery, bringing cholesterol back to the liver |
|
|
Term
| Risk of atherosclerosis is inversely related to what? |
|
Definition
| HDL/total cholesterol ratio |
|
|
Term
| What is the LDLR? Where is it expressed? What does it play a key role in? |
|
Definition
| a transmembrane glycoprotein predominantly expressed in the liver and adrenal cortex, it plays a key role in cholesterol homeostasis |
|
|
Term
| What protein binds to the LDLR? |
|
Definition
| apoprotein B-100, the only protein of LDL |
|
|
Term
| Hepatic LDLSRs clear ~______% of LDL from the circulation by ________. How is the remainder cleared? |
|
Definition
75
endocytosis
remainder cleared by LDLR-independent pathways |
|
|
Term
| Approx 90% of the mutations in the LDLR gene are______/_______/_______, which occur throughout the gene and alter different aspects of LDLR protein function. |
|
Definition
| single nucleotide substitutions |
|
|
Term
| Mutations in the LDLR gene cause accumulation of ____/____, what does this then cause? |
|
Definition
plasma LDL
this causes atherosclerosis by increasing clearance of LDL through LDLR-independent pathways, such as endocytosis of oxidized LDL by macrophages and histiocytes |
|
|
Term
| In FH heterozygotes, what is the usually the only finding in the first decade of life? |
|
Definition
| hypercholesterolemia, and it manifests at birth |
|
|
Term
| In FH heterozygotes of all ages, the plasma cholesterol is how much higher than in unaffected individuals? |
|
Definition
|
|
Term
| In FH heterozygotes, which two signs begin to show by the end of the second decade? |
|
Definition
arcus corneae
tendon xanthomas |
|
|
Term
| Describe the progression of signs and symptoms in a FH homozygote? |
|
Definition
| -first decade of life: arcus corneae and tenon xanthomas. Plasma CHO is twice that of CHO of heterozygotes and w/o aggressive treatment these pts will usually die by age 30 |
|
|
Term
| Besides diet changes, what is other management for FH heterozygotes? |
|
Definition
-bile acid sequestrants (divert a fraction of the increased CHO to bile acid synthesis, which increases the production of more hepatic LDLRs)
-statin drugs (inhibit hepatic cholesterol synthesis) |
|
|
Term
| What are some management options other than diet changes for FH homozygotes? |
|
Definition
-LDL apheresis (venous blood is passing through a tube and the tube has a matrix coated with antibodies against apoB100, this will pull the LDL out of the pt's blood before returning it to their body)
-statin drugs may reduce plasma CHO by 70% |
|
|
Term
| Each child born to a FH heterozygous affected parent has _____% chance risk of inheriting the mutant LDLR allele |
|
Definition
50
bc it is autosomal dominant |
|
|
Term
| What is hypertension? What are some diseases that it is a risk factor for? |
|
Definition
atherosclerosis
coronary artery disease
cardiac hypertrophy/ heart failure
CVAs (strokes)
aortic dissection
renal failure |
|
|
Term
| What is essential hypertension: what must your pressure be consistently above? what percentage of the population does this affect? What percentage of cases are idiopathic? Is it compatible with a long life? |
|
Definition
-elevated BP, consistently above 140/90
-25% of total pop
-90-95% are idiopathic
-compatible with long life unless another complication develops such as MI or stroke |
|
|
Term
|
Definition
| HTN secondary to renal disease or adrenal glands |
|
|
Term
| What are four things that essential HTN is probably related to? |
|
Definition
-reduced renal sodium excretion
-vascular changes
-genetic factors
-environmental factors |
|
|
Term
|
Definition
| a localized abnormal dilation of a BV or the heart |
|
|
Term
| WHat are the two most important causes of aortic aneurysms? |
|
Definition
atherosclerosis
cystic degeneration of the arterial media |
|
|
Term
| What are 4 other possible causes of aneurysm? |
|
Definition
-trauma
-congenital defects (Berry aneurysm)
-infections (mycotic aneurysms)
-syphilis |
|
|
Term
| What is an aortic dissection? |
|
Definition
| blood splits apart the laminar planes of the media to form a blood-filled channel within the aortic wall |
|
|
Term
| What is a major consequence of an aortic dissection? What is the major risk factor? |
|
Definition
-may rupture into body spaces, causing massive hemorrhage or cardiac tamponade (hemorrhage into pericardial sac)
-HTN is the major risk factor |
|
|
Term
| Aortic dissections occur mainly in what two groups? |
|
Definition
-men ages 40-60 with prior HTN (90%)
-younger patients with abnormalities of CT int he aorta (Marfan's) |
|
|
Term
| What one symptom do aortic dissection pt's usually present with? |
|
Definition
| sudden onset of excruciating pain |
|
|
Term
| What is Marfan Syndrome: what type of genetic disorder? what does it affect? what do pt's look like? |
|
Definition
-autsomal dominant
-affects the skeletal, CV, and eyes
-pt's are tall and thin with long arms and legs and thin fingers |
|
|
Term
| Where is the mutation located in Marfan syndrome? |
|
Definition
| loss of function mutation in the fibrillin 1 (FBN1) gene, which is a major component of microfibrils in ECM; scaffold for elastin |
|
|
Term
| What are the CV effects of Marfan Syndrome? |
|
Definition
| it weakens the CT around the base of the aorta |
|
|
Term
| What is vasculitis? What are 4 symptoms? What is it usually caused by? What can it lead to? |
|
Definition
-inflammation of the vessel wall
-fever, malaise, myalgias, and arthralgias
-can be caused by direct invasion of vascular walls by infectious pathogens
-more commonly caused by immune-mediated inflammation
-may lead to occlusion, aneurysmal dilation, and may include necrosis |
|
|
Term
| What is the most common vasculitis? Who does it affect? What arteries does it affect? What are 2 symptoms? |
|
Definition
Giant-cell (temporal) arteritis
>50 yo
small and med. sized arteries (esp. cranial: temporal, opthalmic, vertebral)
pain and tenderness |
|
|
Term
| If the ophthalmic artery is involved in temporal arteritis what is a major consequence? |
|
Definition
| can lead to sudden and permanent blindness |
|
|
Term
| What is the possible cause of giant-cell (temporal) arteritis? |
|
Definition
| possible T-cell mediated autoimmune response to vessel wall antigen |
|
|
Term
| What is Polyarteritis Nodosa (PAN)? Who does it usually affect? What are 3 symptoms? 30% are associated with what antigen? What can it lead to? What is the treatment? |
|
Definition
-segmental necrotizing inflammation of small to medium-sized arteries, esp the kidneys, heart, liver, and GI tract
-young adults
-malaise, weight loss, fever (typically episodic)
-can lead to aneurysms or even rupture
-remission or cure in 90% treated with corticosteroids |
|
|
Term
|
Definition
| yea, in most untreated cases from thromboses and rupture/ renal artery is common |
|
|
Term
| What is the leading cause of acquired heart disease in children? |
|
Definition
| Kawasaki disease, 80% of patients are under 4 yo |
|
|
Term
| What are some symptoms of kawasaki disease? |
|
Definition
-acute febrile (usually self limiting illness affecting arteries of all sizes)
-presents with erythema of conjunctiva, mouth, palms, and soles, edema of hands and feet, rash, enlargement of cervical lymph nodes |
|
|
Term
| What do 20% of Kawasaki patients develop if untreated? |
|
Definition
| coronary arteritis; can result in aneurysms that rupture or thrombus, causing acute MI |
|
|
Term
| In pt's with Kawasake disease, what is the tx for coronary artery disease? |
|
Definition
| IV immunoglobulin therapy |
|
|
Term
| Describe the tongue of many kawasaki pt's |
|
Definition
|
|
Term
| What is THrombangitis Obliterans (Buerger Disease) |
|
Definition
| superficial nodular phlebitis |
|
|
Term
| What are 4 common signs and symptoms of Buerger disease? |
|
Definition
-cold sensitivity in the hands
-pain in the instep of the foot
-severe pain, even at rest
-chronic ulceration of toes, feet, or fingers, which may be followed by gangrene |
|
|
Term
| What is Raynaud phenomenon |
|
Definition
| exaggerated vasoconstriction of digital arteries and arterioles |
|
|
Term
| What is the most common symptom of raynaud phenomenon |
|
Definition
| pallor or cyanosis of fingers and toes |
|
|
Term
| Who does raynaud phenomenon usually affect? What is the primary cause? |
|
Definition
prevalence of 3-5% usually in young women
-primary cause is usually benign
-secondary- caused by other vascular insufficiencies (may be first manifestation of those conditions) |
|
|
Term
| Where are varicose veins usually found? |
|
Definition
| typically superficial veins of lower extremities, but also anorectal (hemorrhoids), and gastroesophageal (portal HTN) |
|
|
Term
| What are 4 risk factors for varicose veins? |
|
Definition
| pregnancy, obesity, familial tendency, positional stasis |
|
|
Term
| What does varicose dilation lead to? |
|
Definition
incompetent valves
stasis
congestion
tortuosity |
|
|
Term
| Vascular tumors can originate from ______/______ or _______ |
|
Definition
| blood vessels or lymphatics |
|
|
Term
| Vascular tumors can be composed of endothelial cells, give 3 examples |
|
Definition
-hemangioma- benign
-lymphangioma- benign
-angiosarcoma- malignant |
|
|
Term
| Vascular tumors can be composed of vascular support cells,give two examples |
|
Definition
-glomus tumor- benign
-hemangiopericytoma-malignant |
|
|
Term
|
Definition
| an increased numbers of normal abnormal vessels |
|
|
Term
| Where are hemangiomas often found? |
|
Definition
| head and neck but also liver |
|
|
Term
| What is Kaposi Sarcoma most frequently associated with? |
|
Definition
|
|
Term
| What is KS characterized by? |
|
Definition
| red-purple macules and plaques of the skin |
|
|
Term
| What are the 4 forms of KS? |
|
Definition
classic (european)
endemic (african)
transplant-associated (immunosuppression)
AIDS associated |
|
|
Term
|
Definition
| Malignant proliferation of endothelial cells |
|
|
Term
| WHo do angiosarcomas usually affect? Where do they usually occur? What type are associated with carcinogenic exposures? DO they metastasize? What is the survival rate? |
|
Definition
older males, they are rare
skin, soft tissue, breast, and liver
hepatic angiosarcomas
metastasize readily
5 year survival rates approach 30% |
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