Cardiovascular Dysfunction - Arterial

olanjones's version from 2016-02-25 15:31

Section 1

Question Answer
What are the four steps of atherosclerosis development?1. Endothelial cell injury 2. Migration of inflammatory cells 3. Lipid accumulation and SMC proliferation 4. Plaque structure
Describe how endothelial cell injury occursFactors such as smoking, high LDLs, or pressure from HTN instigate the inflammatory process causing monocyte and platelet adhesion, LDLs deposited in the intimal layer
Describe the migration of inflammatory cell stageMonocytes migrate into the intima (becoming macrophages) and engulf lipoproteins
What happens during the lipid accumulation and SMC proliferation phaseActivated macrophages oxidize and ingest LDL, resulting in foam cell formation (primary component of atherosclerotic lesion). Macrophages instigate SMC proliferation and ECM elaboration which extends into lumen of vessel
Discuss the plaque structure and its complicationsThe fibrous cap (composed of SMC and ECM) is formed and a necrotic core/lipid pool composed of lipid-laden foam cells and fatty debris are contained beneath it. Lesion may be stable or vunerable dependant on thickness of cap, size of lipid pool, number of inflammatory and muscle cells
What is a complicated lesion?An unstable or vulnerable plaque that can rupture, ulcerate, or erode leading to hemorrhage into the plaque or thrombotic occlusion of the vessel. This process can repeat itself. If thrombosis breaks off it becomes an emboli
What are the manifestations of atherosclerosis?Partial vessel obstruction (TIA, pain, disability, MI), Ischemia, Arterial bruits

Section 2

Question Answer
What is gestational hypertension?An elevation in BP (after 20th week of pregnancy) of 140/90 or higher on two separate occasions without proteinuria
What is pre-eclampsia?BP of 140/90 or higher (after 20th week of pregnancy) on two separate occasions with proteinuria. Patient is put on bed-rest
What indicates severe pre-eclampsia?BP of 160/110 or higher with additional symptoms such as edema or headache
What is eclampsia?BP of 160/110 or higher, medical symptoms, and tonic-clonic seizures
What causes edema in pre-eclampsia?Protein loss in urine leads to a decrease of protein in vascular fluid, interstitial oncotic pressure increases fluid pull into interstitial space

Section 3

Question Answer
Why does the prevalence of hypertension increase with age?Sclerotic (decreased elastin, increased collagen = thickened intima) changes in large arteries, decrease in baroreceptor sensitivity, increased in peripheral vascular resistance
What are causes of secondary hypertension?Other underlying disease processes or medications that raise peripheral vascular resistance of cardiac output
What are modifiable causes of primary hypertension?Smoking, insulin resistance, dyslipidemia, obesity, inflammation. These factors can vessel walls more susceptible to lipid invasion
How can atherosclerosis cause an increase in BP aside from restricting blow flow?Sclerosis of renal arteries can reduce flow causing the kidney to secrete renin, instigating the RAAS system
What is chronic vascular insufficiency?The decreased ability for lower extremity veins to return blood to the heart
What is orthostatic hypotension?A decrease in BP of 20 or greater systolic, 10 or greater diastolic upon changing position (laying to sitting, sitting to standing)

Section 4

Question Answer
How is peripheral vascular resistance regulated?Via SNS, release of catecholamines and hormones
What is peripheral vascular disease (PVD)?Obstruction of the large arteries, often used to refer to atherosclerotic blockages in lower extremities
What are the 4 "p"s of PVD and other signs? Pulseless, pallor, paresthsia, pain. Erythema above site, shiny skin, lack of hair growth
What is intermittent claudication?Leg cramping when walking that is relieved by rest
What is thromboangitis obliterans (Buerger disease)?Non-atherosclerotic inflammation of small/medium blood vessels, usually in the lower extremities
What is an aneurysm?The localized dilation of an arterial wall due to constant stress.
How do aneurysms occur?Atherosclerosis, HTN, Congenital weakness, or Trauma cause changes in the collagen/elastin making vessel vulnerable to intravascular pressures

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