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Flashcards in Cardiovascular disease ppt Deck (79)
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Atherosclerosis is characterized by intimal lesions called ________, which protrude into and obstruct vascular lumens and weaken the underlying media

(it's actually 3 names)

  • atheromas
  • or atheromatous
  • or fibrofatty plaques


atherosclerosis primarily effects what type of arteries?

elastic/muscular arteries


what are elastic and muscular arteries that atherosclerosis usually effects?



most common?

  1. elastic- Aorta, carotid, iliac
  2. Muscular- Coronary, popliteal
  3. most common- in smaller arteioles


symptomatic atherosclerotic disease most often involves the arteries supplying what organs

  1. Heart
  2. Brain
  3. kidneys
  4. LE


the major consequences of atherosclerosis are

  1. MI
  2. Cerebral infarction
  3. Aortic Aneurysm
  4. PVD


where does atherosclerosis start?

endothelial cells


what do the endothelial cells do?


  1. form semipermeable membrane
  2. thromboresistant smooth surface (anticoagulation)
  3. modulate vascular tone, inflammation
  4. modify lipoproteins and other cell growth



what begins the cycle of atherosclerosis

vascular injury in the endothelial cells


after vascular injury with atherosclerosis in the endothelial cells what occurs

(it's alot but well break it down shortly)

  1. endothelial dysfunction
  • rapid- induced by mediators
  • slow- activation and alterations in gene expression
  1. Vascular smooth muscle
  • provides risistance
  • synthesis of new tissue
  • ***** intimal thickening in response to injury
  1. Vascular injury begins the cycle
  • turbulent blood flow= HTN
  • ***** shear stress on the endothelium
  • the inability of the endothelium to adequately regulate lipoprotein proliferation and other cell growth
  • development of intimal thickening and fatty streak (xanthoma)
  1. over time Atheromas
  • raised focal plaque- cholesterol/fibrous cap
  • May rupture may progress




4 key stages

of atherosclerosis?

and name what is going on with each

  1. Intimal thickening- proteoglycan matrix/ xanthoma
  2. Pathologic intimal thickening- fatty pools-no necrosis
  3. Fibrous cap atheroma- lipid rich necrotic core, macrophage infiltration. late = stenosis r/t hemorrhage/ healing/layers
  4. Thin Fibrous cap- majorly vulnerable, major macrophage infiltration


3 main risk of advanced lesions of atherosclerosis

  1. patchy or massive calcification( norrow and brittle)
  2. focal rupture/ ulceration (highly thrombogenic)
  3. superimposed thrombus (aneurysmal dilation)


overall atherosclersosis in an intimal disease but causes damage where?

medial (from aneurysmal dilation)


what Cariac problems are associated with atherosclerosis?

(the cariac sequelae)

Acute coronary syndrome



the cardiac sequelae of atherosclerosis r/t ACS/AMI can result in what 3 things

  1. dysrhythmia
  2. CHF/cardiogenic shock
  3. Arrest/death


with atherosclerosis what causes the AMI

-physiology-thrombus, supplt/demand, mirco emboli



what are risk factors that increase mortality r/t AMI from atherosclerosis

  1. Age (40-60 increases 5 fold)
  2. Cariogenic shock
  3. papillary muscle rupture
  5. recurrent AMI


what are problems associated with atherosclerosis is the carotids?

  1. Bruit
  2. TIA
  3. CVA
  4. Amaurosis fugax (visoin loss)


what problems can occur from atherosclerosis in the peripheral?

  1. Intermittent claudication (cramping/aching/fatique/discomfort) (reproducible with exertion/ relieved with rest)
  2. Critical limb ischemia (acute or chronic) ( unrelenting rest pain/ ulcers/gangrene)
  3. Mesenteric Ischemia
  4. HTN
  5. Any organ system


4 primary causes of CHF

  1. systolic or diastolic (both) dysfunction
  2. HTN
  3. Aortic/ mitral valvular disease
  4. Non-ischemic mypcardial disease


what happens to the morphology of the heart from CHF

LV dilation/hypertrophy

LA dilation=a fib


left-sided heart failure is most often caused by

From book clarifying last cards

  1. Ischemic heart disease
  2. HTN
  3. Aortic and Mitral valve disease
  4. Non-ischemic myocardial disease



Clarification from book

Morphology of the heart from CHF

Left sided

  1. LVH
  2. hypertrophy and fibrosis of myocardium
  3. secondary enlargement of Left atrium which causes A-fib and thus increased risk for clots



what occurs in the lungs due to CHF (Left sided),


  1. Pressure increases in the pulm veins mounts and is transmitted retrograde to the cappillaries and arteries
  2. results in pulm congestion (pulm edema)
  3. ----eventually RHF




what are clinical manifestations of Pulmonary edema from left sided heart faliure

  1. Dyspnea ( earliest and cardinal sign)
  2. orthopnea
  3. Paroxysmal nocturnal dyspnea



what occurs in the kidneys from left sided CHF

  1. The decreased CO causes decreased Renal pefusion
  2. this activated the RAAS causing restention of Na+ and H2O
  3. leading to worsening of Pulmonary edema
  4. this compensatory reaction is countereacted by the release of ANP through atrial dilatio
  5. which acts to decrease ecessive blood volume
  6. If kidney perfusion becomes severe the impaired excretion of nitrogenoys products may cause azotemia (in this instance azotemia) 



Left atrial dilation > ___ = diastolic function



what occurs in neurological system as a result of Left sided HF

  1. in far advanced CHF, cerebral hypoxia may give rise to HYPOXIC ENCEPHALOPATHY



Clinical manifestations of hypoxic encephalopathy

  1. irritability
  2. loss of attention span
  3. restlessness
  4. stupor
  5. coma



what is the #1 cause of RHF


usually it is a secondary consequence of left-sided heart failure because any increase in pressure in the pulmonary circulation incidental to left-sided heart failure inevitably produces an increased burden on the right side of the heart. The causes of right-sided heart failure must then include all those that induce left-sided heart failure (Kumar 563)
Kumar, Vinay. Robbins & Cotran Pathologic Basis of Disease, 7th Edition. Saunders Book Company, 082004. <0-7216-0187-1>.


what is the #1 isolated cause of RHF

Severe pulm HTN

pure right-sided heart failure most often occurs with chronic severe pulmonary hypertension and thus is called cor pulmonale. In this condition, the right ventricle is burdened by a pressure workload due to increased resistance within the pulmonary circulation. Hypertrophy and dilation are generally confined to the right ventricle and atrium, although bulging of the ventricular septum to the left can cause dysfunction of the left ventricle (Kumar 563)
Kumar, Vinay. Robbins & Cotran Pathologic Basis of Disease, 7th Edition. Saunders Book Company, 082004. <0-7216-0187-1>.