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Pathophysiology HTN and Athrosclerosis
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155
Physiology
Graduate
11/06/2013

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Term
Veins
Definition
Have valves, larger wrapping of connective tissue than arteries, have IVs placed in them, lower pressure system, thinner elastic membranes, thinner smooth muscle layer, veins are more superficial
Term
Arteries
Definition
thicker elastic membranes, thicker smooth muscle layer, have more resistance than veins, produce more pressure, BP is reflection of arterial work, and arteries are deeper in body than veins
Term
Never start IV where?
Definition
Area where there is a vein juncture
Term
Vesicular transport?
Definition
Large particles
Term
Small particles are transported how?
Definition
Via movement of vesicles, openings in junctions, and crossing the cytoplasm.
Term
What is vasomotion?
Definition
Vascular relaxation through vasodilators such as nitric oxide and prostacyclin and Vascular constriction via vasoconstrictors such as enothelin and angiotensin II
Term
What are examples of vasodilators?
Definition
Nitric oxide and prostacyclin
Term
What does nitric oxide inhibit?
Definition
Growth of vascular smooth muscle cells, and platelet aggregation (prevents clots from floating around in body)
Term
Nitric Oxide
Definition
promotes low arterial tone at rest and inhibits platelet aggregation
It also decreases inflammatory reaction by inhibiting the expression of adhesion molecules and the activity of pro-inflammatory cytokines THUS decreasing amount of monocytes/ macrophages to cell well.
Term
Prostacyclin?
Definition
Inhibits vasoconstrictive effects of angiotensin and inhibits platelet aggregation
Term
Which class of endothelin is most potent?
Definition
ET1
Term
What does ET1 cause?
Definition
Adhesion and aggregation of neutrophils and stimulates smooth muscle growth
Term
Inner layer?
Definition
Endothelium
Term
Where is nitric oxide secreted from?
Definition
Intimal layer
Term
What does the Von Willebrand Factor 8 do?
Definition
increases the clotting to prevent hemorrhage and promote healing
Term
What happens as factor 8 is secreted upon injury to a vessel?
Definition
Nearby tissues secrete heparin to increase clot and to not allow injury to healthy tissue.
Term
What happens while the clot is being further formed?
Definition
breakdown of clot to prevent ischemia of tissue beyond clot is occurring so that there is not huge functional deficit
Term
TPA drug is used for what kind of stroke?
Definition
Ischemic stroke
Term
Why is TPA not used for hemorrhagic stroke?
Definition
It is used to prevent coagulation, if patient hemorrhaged, patient could bleed out.
Term
When should a TPA be given?
Definition
2-3 hours after incident
Term
During clotting process, why do different functions happen?
Definition
Simultaneously
Term
What does inflammation express?
Definition
Adhesion molecules that allow for monocyte and neutrophils margination and diapedesis
Term
What does "hand-in-hand" with the pathogenesis in vessels?
Definition
Oxidized lipid proteins going into smooth muscle layer through the intima.
Term
Ask mom about visiting ashton gardens during thanksgiving break
Definition
Term
Diapedesis
Definition
allows white and red blood cells to pass through the vessel walls without damage to the vessel.
Term
Pressure
Definition
Force exerted on liquid per unit area
Term
What factors affect blood flow?
Definition
pressure, velocity, compliance, resistance
Term
Resistance
Definition
Increased resistance = decreased flow, it is an opposition to force, diameter and length of the blood vessels contribute to resistance (increased length= increased resistance) and (decreased radius= increased resistance)
Term
Viscosity
Definition
blood consistency
Term
Increased viscosity=
Definition
decreased speed of flow
Term
What does turbulent flow indicate?
Definition
increased resistance
Term
What is laminar flow?
Definition
decreased resistance
Term
Compliance
Definition
Elastic fibers are more compliant than muscular fibers
Term
Blood flow
Definition
AMOUNT of blood moved per unit in time
Term
Less resistance =
Definition
greater the flow amount
Term
Increased length =
Definition
increased resistance to flow
Term
Velocity
Definition
the distance blood travels in a unit of time, usually centimeters per second
Term
How is velocity related to blood flow (amount of blood moved per unit of time)?
Definition
Directly
Term
Vascular compliance
Definition
The increase in volume a vessel can accommodate for given increase in pressure.
Term
What does compliance depend on?
Definition
The ratio of elastic fibers to muscular fibers in the vessel wall
Term
When does compliance decrease?
Definition
Development athrosclerosis
Term
Where do we see more compliance?
Definition
In arteries closer to the heart because of their elastin percentage
Term
Velocity has an inverse relationship with ?
Definition
resistance
Term
Laminar flow =
Definition
decreased resistance
Term
Turbulent velocity =
Definition
increased resistance
Term
Stricture (constriction)
Definition
Area has a change in diameter. Diameter decreases in area of stricture.
Term
How is outside of heart oxygenated?
Definition
After systole the heart allows some backflow after blood is pushed into aorta for the coronary arteries
Term
Cardiac output
Definition
heart rate and stroke volume
Term
Sympathetic
Definition
epinephrine and norepinephrine
Term
Parasympathetic
Definition
Cholinergic receptors
Term
Blood pressure =
Definition
cardiac output x total peripheral resistance
Term
What happens when the HR is too low?
Definition
Decrease in pressure in vessels
Term
Stroke volume
Definition
How much blood is ejected out with each systolic cycle
Term
Baroreceptors?
Definition
They are stretch sensors found in aorta and carotid sinus. They send msgs via afferent neurons and innervate cardiovascular center.
Term
If baroreceptors sense more stretch in smooth muscle fibers...
Definition
There will be a decrease in HR
Term
If baroreceptors sense a low degree of stretch...
Definition
There will be an increase in HR
Term
Baroreceptors job is to?
Definition
adjust heart rate in response to volume
Term
What do chemoreceptors do?
Definition
Sense osmolality of blood?
Term
What happens when nerve fibers bind to Beta 1 receptors in the heart?
Definition
Stimulates HR and contractility
Term
Which nerve fibers exert control over whole peripheral vascular system (minus capillaries) and innervate tunica media?
Definition
Nerve fibers in the thoracic and upper lumbar spinal tracts
Term
What do sympathetic nerve fibers release?
Definition
Norepi
Term
What happens when norepi binds with alpha receptors?
Definition
Smooth muscle contraction (vasoconstriction)
Term
What happens when Beta 2 receptors are stimulated by Norepi?
Definition
Vasodilation
Term
What happens when nerve fibers bind to cholinergic receptors?
Definition
HR is decreased
Term
Blood pressure is regulated/ maintained by?
Definition
Cardiac output
Term
When HR is too low the baroreceptors pick up on volume changes
Definition
Term
ADH is also known as what?
Definition
Vasopressin
Term
ADH is released from where?
Definition
Posterior pituitary
Term
What does ADH do?
Definition
causes reabsorption of water from kidneys in response to increase osmolality or decreased BP
Term
Adrenomedullin functions as what?
Definition
vasodilator and it also regulates growth cytokines and neurotransmission
Term
RAA system results in?
Definition
Vasoconstriction and BP increase
Term
When is renin release inhibited?
Definition
When BP is increased or Sodium is increased
Term
When is renin released?
Definition
When BP goes down or sodium is down
Term
RAA stands for what?
Definition
Renin Angiotensin Aldosterone Mechanism
Term
Circulating renin leads to what?
Definition
Conversion of angiotensinogen to angiotensin I
Term
Angiotensin converting enzyme (ACE) does what?
Definition
Converts angiotensin I to angiotensin II
Term
What is Angiotensin II known for?
Definition
Vasoconstricton of the arterioles. Leads to increased resistance and therefore increase in BP
Term
What does Angiotensin II cause release of?
Definition
Aldosertone
Term
What does aldosterone do?
Definition
It circulates in the kidneys and causes renal tubules to increase sodium and water reabsorption
Term
Primary HTN is also known as what?
Definition
Essential HTN
Term
Primary HTN
Definition
Increased arteriole vasoconstriction... origin is unknown.
Term
In primary HTN...
Definition
There is increased susceptibility to stimuli and increased stimulation, slight arteriole diameter decrease which could cause a MAJOR increase in peripheral resistance (increased afterload and increased diastolic pressure)
Term
In primary HTN...
Definition
decreased radius in arterioles can lead to decreased renal perfusion and an increase in renin, angiotensin, aldosertone
Term
Cause of primary HTN?
Definition
unknown
Term
Slight decrease in radius/ diameter of arteriole =
Definition
MAJOR increase in peripheral resistance
Term
Normal BP
Definition
120/80
Term
Pre-hypertensive BP
Definition
>120/80 and <139/89
Term
Stage One HTN
Definition
140/90-159/99
Term
Stage two HTN
Definition
160/100 or greater
Term
Primary HTN risk factors
Definition
Increase of age, men affected earlier and more frequently and more severely, African Americans have higher incidence, high sodium diet and excessive alcohol intake, prolonged or recurrent stress, smoking, inflammation
Term
What happens in inflammation?
Definition
Decreased elasticity and decreased compliance
Term
SNS
Definition
Causes increased HR and systemic vasoconstriction leading to BP increase
Term
SNS leads to structural changes in blood vessels which cause ...
Definition
vascular remodeling
Term
Shift in natriuresis curve=
Definition
renal sodium retention
Term
SNS leads to...
Definition
insulin resistance, increased renin and angiotensin levels and procoagulant effects
Term
RAA influences...
Definition
sodium and water retention by kidneys, and angiotensin II mediates arterial remodeling which causes structure of vessel to change and thus causes an increase in peripheral resistance
Term
ANP (atrial natriuretic peptide)functions to..
Definition
Increase in response to atrial stretch/pressure, promotes loss of sodium via urine, as sodium is lost water is lost, circulating volume is decreased and BP is lowered, works as an antagonist to ADH and aldosterone.
Term
ANH (ANP) is released by cells where?
Definition
In an upper chamber of the heart called the atrium
Term
As BP becomes abnormally high...
Definition
secretions of ANG increase in response to increase in atrial wall stretch.
Term
Principal effect of ANH is to...
Definition
promote loss of sodium
Term
Water loss results in what?
Definition
A decrease in blood volume and decrease in BP
Term
Primary effect of ANH is also to...
Definition
oppose increases of blood volume and blood pressure
Term
Natriuretic..
Definition
release of sodium through urine
Term
In a chronic injury..
Definition
vasoconstriction is seen overtime and causes a decrease in oxygenation of injured tissue
Term
Acute injury..
Definition
vasodilation is seen
Term
In an endothelial injury...
Definition
you see decreased production of nitric oxide
Term
What is released in inflammation?
Definition
vasoactive cytokines (prostaglandins)
Term
What happens in an endothelial injury?
Definition
There is a decreased production of vasodilators such as nitric oxide
Term
What is increased in endothelial injury?
Definition
production of vasoconstrictors such as endothelin
Term
Adducin is what?
Definition
a membrane skeleton protein
Term
What can happen with mutations to the gene that codes for adducin?
Definition
An increase in tubular renal absorption reabsorption of sodium in the anglo pop of about 50-70%
Term
Those with adducin mutations will be more responsive to what?
Definition
Diuretic therapy
Term
There is a genetic link to increase receptors for...
Definition
norepi in heart and vascular smooth muscle
Term
Insulin resistance...
Definition
decreased release of nitric oxide and other vasodilators, it is also associated with overactivity of SNS and RAA system
Term
Insulin resistance
Definition
more important in HTN
Term
Negative effect of insulin on vessels..
Definition
increase production of toxic oxygen radicals and inflammatory mediators, increased clot formation and increased endothelial destruction
Term
Insulin has a negative effect on what metabolism?
Definition
lipid
Term
HTN results from what?
Definition
Sustained increase in peripheral resistance (arterial vasoconstriction), an increase in circulating blood volume, or both.
Term
Primary HTN results from..
Definition
complicated interaction of genetics and environment mediated by multiple neurhumoral effects. And a defect in gene producing adducin is one of the theories
Term
Severe HTN aeb
Definition
headache due to increased intracranial pressure, fatigue, malaise, dyspnea, palpations, angia, dizziness,
Term
HTN usually at first has...
Definition
NO SYMPTOMS
Term
What happens with sustained high BP overtime
Definition
damage to arterial wall, arteries become thick and hard, lumen of vessels narrows, vessel walls can tear, ischemia or necrosis could occur,
Term
With sustained high BP, which organs are most affected?
Definition
kidneys, brain, eyes
Term
Target organ damage could lead to ...
Definition
blindness, stroke, or renal failure
Term
Renal failure is due to...
Definition
high pressure in enclosed area
Term
What is secondary HTN?
Definition
caused by systemic disease process that raises peripheral vascular resistance or cardiac output
Term
Examples of secondary HTN?
Definition
Renovascular HTN, pheochromocytoma
Term
Isolated HTN is mostly seen in which population?
Definition
Elderly
Term
Isolated HTN is often seen because of what?
Definition
Arteriosclerosis
Term
Orthostatic hypertension..
Definition
decrease in both systolic and diastolic pressure
Term
Orthostatic hypertension could result from...
Definition
drugs, prolonged immobility, starvation, physical exhaustion, conditions affecting volume status, venous pooling (pregnancy), result of a 20mm drop
Term
Arteriosclerosis
Definition
Chronic disease of the arterial system, abnormal thickening of arteries, calcification of arterial walls, loss of vessel wall elasticity
Term
Plaque formation is specific to what?
Definition
Atherosclerosis
Term
In arteriosclerosis..
Definition
smooth muscle cells and collagen fibers move into the tunica intima and thus cause a thickening for that layer and eventually cause a narrowing of the lumen
Term
Athrosclerosis is a form of...
Definition
arteriosclerosis
Term
Thickening and hardening in Atherosclerosis is due to ...
Definition
accumulation of lipid laden macrophages in the arterial wall and plaque development
Term
Atherosclerosis is a condition that
Definition
affects large and small arteries and is characterized by an accumulation of fatty deposits, platelets, neutrophils, monocytes and macrophages throughout the tunica intima (endothelial layer) and EVENTUALLY into the tunica media.
Term
Which arteries are most often affected by atheroscerlosis
Definition
coronaries, aorta, and the cerebral arteries.
Term
What happens when macrophages go after LDLs into the area of injury?
Definition
Foam cells are created
Term
CAD is..
Definition
any vascular disorder that narrows or occludes the coronary arteries
Term
Risk factor of atherosclerosis..
Definition
hyperlipidemia, men over 45 and women over 55 or premature menopause, family history,
Term
The more protein...
Definition
the higher density
Term
The more lipid...
Definition
the lower the density
Term
What does cholesterol do?
Definition
facilitates absorption and transport of fatty acids, is a precursor for synthesis of steroid hormones, may precipitate with other compounds in gall bladder to form gallstones.
Term
What happens with high cholesterol?
Definition
cortisol and glucose secretions
Term
How do we increase HDLs?
Definition
exercise and staying active
Term
Chylomicrons...
Definition
formed in small intestines.. they carry ingested fat from intestinal mucosa via the thoracis lymphatic duct into plasma and then into liver and tissues.
Term
Triglycerides are converted into...
Definition
intermediate density lipoproteins
Term
IDLs are eventually converted into
Definition
LDLs
Term
Foam cells cause what?
Definition
fatty streaks
Term
oxidized LDLs encourage what?
Definition
inflammatory response
Term
When are LDLs oxidized?
Definition
when they enter into the subendothelial space (tunica intima)
Term
Fatty streaks...
Definition
go down vessel from point of original injury
Term
clinical manifestations of atherosclerosis...
Definition
intermittent claudication, symptoms occur late in disease, cold sensitivity in extremeties, changes in skin color, diminished peripheral pulses
Term
When could symptoms of a TIA be expected to dissolve?
Definition
Within 72 hours
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