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26 Cards in this Set
- Front
- Back
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What is endothelial activation?
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Endothelial cells respond to stimuli by adjusting usual function and expressing new properties
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What is endothelial dysfunction?
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Potentially reversible changes in functional state of endothelium in response to environmental stimuli
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What are the 3 steps in repairing damaged intima?
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Migration of sm mm cells --> SMC proliferation --> Elaboration of ECM by SMC
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What are the 2 major hemodynamic variables regulating normal BP?
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CO, TPR
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What happens with low and high blood pressure to the organs?
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Low BP - hypotension, inadequate organ perfusion
High BP - hypertension, vessel and end organ damage |
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Define Essential, Secondary, Benign and Malignant HTN?
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Essential - Idiopathic, 90%
Secondary - Secondary to renal disease, 5-10% Benign - HTN at modest level and stable over years, 95% Malignant - Accelerated above 200/120, leads to death within 2 years |
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What are the main 2 types of atherosclerosis?
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Hyaline and Hyperplastic
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What type of HTN is associated with hyaline and hyperplastic atherosclerosis?
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Hyaline - Benign HTN, characteristic in DM
Hyperplastic - Malignant HTN, |
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What is the morphology of hyaline and hyperplastic atherosclerosis?
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Hyaline - Homogenous pink hyaline thickening of the walls of arterioles with loss of underlying structural detail
Hyperplastic - related to severe, acute elevations of HTN Onionskin, concentric laminated thickening of walls of arterioles with progressive narrowing of lumen |
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What are the 3 patterns of Arteriosclerosis, which is the most important?
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Atherosclerosis (most important)
Monckeberg's Medial Calcific Sclerosis Arteriolosclerosis |
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What lesion characterizes atherosclerosis?
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Atheroma - fatty plaque
Raised focal plaque within intima with a lipid core and covering fibrous cap |
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What are the constitutional (non-modifiable) risk factors for ischemic heart disease?
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Age, Male, Family Hx, Genetics
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What are the modifiable risk factors for ischemic heart disease?
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HTN, hyperlipidemia, low HDL, cigarettes, DM, inflammation (C-reactive protein)
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What happens when you have 2 factors, what about 3?
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2 - 4x risk
3 - 7x risk, its multiplicative |
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What are the steps to the response to injury hypothesis?
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Endothelial dysfunction --> Accumulation of lipoproteins --> Monocyte adhesion to endothelium / migration / transform into macros and foam cells (Fatty Streak) --> Platelet adhesion --> SMC proliferation + ECM production --> Lipid acumulation (Atheroma)
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What are the 2 most important causes of endothelial injury?
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Hemodynamic disturbances + Hypercholesterolemia
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What is a fatty streak?
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Earliest lesion in atherosclerosis, multiple yellow spots coaelsce into elongated streaks, always present after 10yo
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Is the fatty streak related to atheromas?
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NO
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What are the 3 components of atherosclerotic plaque?
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Cells - SCM's, macros, T lymphos
ECM Lipids |
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What is the appearance of atheromatous plaque?
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Superficial luminal portion firm and white
Deep portions yellow, white and soft |
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What clinically important complications/changes can happen to a plaque?
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Calcification - pipe stem arteries
Rupture, ulceration, erosion of luminal surface Superimposed thrombosis Hemorrhage Aneurysmal dilation Atheroembolism |
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What is atherosclerotic stenosis?
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Plaque eventually occludes vessel lumen
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What is Acute plaque change?
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Rupturing/Fissuring - Erosion/Ulceration - Hemorrhage into the atheroma
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What is the difference between stable and unstable plaque?
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Stable - Mostly dense fibrous cap, little core
Unstable - Thin cap, large lipid core |
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How do atherosclerotic lesions cause damage?
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Narrowing of lumina with ischemia of tissues
Thrombosis / Embolization Sudden occlusion of the vessel by hemorrhage or superimposed thrombus Weakens vessel wall, aneurysm or rupture |
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What are the 4 consequences of Atherosclerosis?
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MI
Cerebral Infarct Aortic aneurysm PVD |
