Gen Path - Class 10

Front 1

What is difference between Arteriosclerosis and Atherosclerosis?

Back 1

Frequently the terms are used interchangeably, although atherosclerosis is the most common form of arteriosclerosis.

Front 2

What is Arteriosclerosis?

Back 2

group of diseases characterized by thickening /decreased elasticity of arterial wall.

Front 3

What is Atherosclerosis?

Back 3

MC type of arteriosclerosis, esp cardiac, carotid, cerebral, legs, kidney. Thickening of the arterial wall through atheroma formation - fibrous plaques within intima due to thickening of arterial wall by accumulation of lipids, macrophages, T-cells,ECM

Front 4

What is the etiology of atherosclerosis?

Back 4

Old age. Arterial lesions develop long before symptoms.

Front 5

What are the five steps of lesion formation?

Back 5

(1)Hypertension -- endothelial cell injury -- deposition of platelets and lipoproteins, (2)Proliferation of smooth mm cells, (3)Macrophages & sm. mm cells accumulate -- foam cells -- further damage, (4)of lipids in the vessel wall, (5)Hardening of arteries

Front 6

What is atheromas?

Back 6

Basic lesion of atherosclerosis. Characterized by excessive accumulation of lipids in the wall of aorta and major arteries. Central part – soft, lipids, cellular debris (porridge like). Surrounded by fibrous tissue (easily ruptured)

Front 7

How does a rupture affect a thrombus?

Back 7

initiates formation of blood clot -- thrombus

Front 8

What happens when a big artery ruptures?

Back 8

Big arteries (aorta) – not an immediate concern -- ultimately form into fibrous scars

Front 9

What happens when a small artery ruptures?

Back 9

Small arteries (coronary, cerebral) – complete occlusion of lumen -- infarction

Front 10

What are 11 risk factors for atherosclerosis?

Back 10

(1)Age, (2)Sex – more males than females until after menopause, (3)Heredity, (4)Lipid metabolism – elevated serum levels of cholesterol, lipoproteins and triglycerides, (5)Hyperlipidemia, (6)Familial – modify by diet (decrease unsaturated fatty acids), (7)Secondary – obesity, (8)Hypertension, (9)Clotting factors, (1)Cigarette smoking – not fully understood mechanism, (11)Behaviour – stress, activity level

Front 11

What are four major localized forms of atherosclerosis?

Back 11

(1)Atherosclerosis of the Aorta, (2)Peripheral Vascular Disease, (3)Coronary Heart Disease, (4)Cerebrovascular Disease

Front 12

What are the eight steps of progression of atherosclerosis of the aorta?

Back 12

(1)Mild – fatty streaks – small, raised fibrotic plaques, (2)Numerous atheromas form and occupy large surface areas, (3)Rupture of atheroma, (4)Formation of thrombi -- narrows lumen, (5)Calcification reduces aortic elasticity, (6)Rigid, calcified tube – internally covered with thrombi, (7)Hypertension develops – aorta can’t expand and narrow lumen, (8)Aneurysms form (Major danger = rupture)

Front 13

How common is atherosclerosis of the aorta?

Back 13

Almost everyone over 50 yrs old have some degree – especially men

Front 14

What is an aneurysm?

Back 14

abnormal stretching (dilation) in an artery wall (most common) or a vein or the actual heart with a diameter that is at least 50% greater than normal.

Front 15

What are the two most common sites for an aneurysm?

Back 15

(1)aortaforming a thoracic aneurysm, (2)abdominal aneurysm

Front 16

What four factors increase the risk of aneurysm?

Back 16

(1)Incidence increases with age (over 50), (2)Family members of anyone with an aneurysm have a four-fold increased risk of aneurysm, (3)More in men than in women, (4)½ of affected persons are hypertensive.

Front 17

What is the pathogenesis of an aneurysm?

Back 17

plaque formation -- weakened arterial wall & increased internal pressure -- bulging -- dissection or rupture

Front 18

What are nine risk factors for an aneurysm?

Back 18

(1)Atherosclerosis, (2)Trauma, (3)congenital or hereditary abnormalities of connective tissue (eg.Marfan’s synd - Congenital defect of the arterial wall), (4)inflammatory disease, (5)Infection, (6)Smoking, (7)Genetics, (8)Hypertension, (9)high cholesterol

Front 19

What are three symptoms of an aneurysm?

Back 19

(1)Persistent but vague substernal, back, neck, or jaw pain may occur as enlargement of the aneurysm impinges adjacent structures, (2)compression of adjacent tissues --pain, (3)Common sites: aortic arch, abdominal aorta (AAA),femoral a, popliteal a, cerebral

Front 20

What is peripheral vascular disease?

Back 20

Atherosclerosis of arteries that supply blood to the extremities and major abdominal organs. Affects: elderly, diabetics, hyperlipidemia, hypertension.

Front 21

Which visceral arteries commonly have peripheral vascular disease with atherosclerosis of aorta?

Back 21

Renal arteries

Front 22

Describe peripheral vascular disease of the renal arteries.

Back 22

Reduced renal function. Release of renin -- hypertension. Reduced excretion of urine agg. HTN -- damage of kidneys. Can lead to KD failure.

Front 23

Describe peripheral vascular disease of the intestinal arteries.

Back 23

Ischemia in small and large intestines. Progressive GI problems – constipation, poor digestion, intolerances, malabsorption.Acute occlusion --massive intestinal infarction (high mortality)

Front 24

T/F: Peripheral vascular disease primarily affects the arms.

Back 24

False, peripheral vascular disease primarily affects the legs.

Front 25

Describe peripheral vascular disease in the extremities.

Back 25

Chronic ischemia – due to progressive narrowing of the femoral or popliteal arteries. Inadequate blood supply at rest. Intermittent claudication – long distance walking/run -- cramping. Acute occlusion – smaller arteries - Gangrene

Front 26

Describe a coronary heart disease.

Back 26

Atherosclerosis of the coronary arteries. Leads to myocardial ischemia.

Front 27

What are five factors that can influence the clinical features of coronary heart disease?

Back 27

(1)Extent of occlusion, (2)How fast ischemia develops, (3)Extent of atherosclerosis in other coronary arteries, (4)Anatomical location of occlusion, (5)Presence of other issues –hypertension

Front 28

What are two types of myocardial ischemia?

Back 28

(1)Chronic progressive, (2)Sudden occlusion

Front 29

Describe chronic progressive myocardial ischemia.

Back 29

Not enough blood reaches the myocardium. Slowly causing pump failure. Asymptomatic or angina pectoris. Eventually leads to congestive heart failure

Front 30

Describe sudden occlusion myocardial ischemia.

Back 30

MI in anatomically defined area. Most common – anterior descending branch of the left coronary artery.

Front 31

What are three clinical presentations of myocardial ischemia?

Back 31

(1)angina pectoris, (2)myocardial infarction, (3)congestive heart failure - progressive ischemia

Front 32

What is angina pectoris?

Back 32

Episodic/temporary chest pain (or discomfort) which occurs when the cardiac workload exceeds the oxygen supply to the heart and ischemia occurs. The symptomatic expression of cardiac ischemia.

Front 33

What are five symptoms of angina pectoris?

Back 33

(1)transient pain or discomfort in the chest & possibly left arm, (2)usually described as mild to moderate in degree, (3)generally lasts 1-3 minutes, but can persist for up to 20min, (4)most types relieved by rest or nitroglycerin (vasodilator), (5)symptoms can have abnormal presentation in women

Front 34

What are the three types of angina pectoris?

Back 34

(1)Chronic Stable A. (aka Classic A.), (2)Unstable A. (aka Preinfarction A.), (3)Prinzmetal’s A. (aka vasospastic or variant a.)

Front 35

Describe Chronic Stable A. angina pectoris.

Back 35

Exertion pain, relieved by rest or nitro; Most Common type.

Front 36

Describe Unstable A. (aka Preinfarction A.) angina pectoris.

Back 36

Prolonged, recurrent pain at rest; = worsening ischemia. VERY CONCERNING

Front 37

What is the etiology for angina pectoris?

Back 37

Increased O2 heart demands; increased CO; decreased blood flow to the

Front 38

What are two risk factors for angina pectoris?

Back 38

(1)CAD accounts for 90% of angina, (2)Early mornings, strong emotions, physical exertion

Front 39

What is a myocardial infarct?

Back 39

Heart attack

Front 40

What causes a myocardial infarction?

Back 40

Caused by rapid, sudden occlusion of a coronary artery. Sudden death in 25% of all cases. Cardiac arrest = asystole

Front 41

What are three potential results of a patient surviving a myocardial infarction?

Back 41

(1)Signs of heart failure, (2)Cardiogenic shock, (3)Systemic major organ failure, a)Cerebral ischemia – longer than a few minutes causes irreversible damage b(Kidney’s most commonly damaged -- monitor urine output for KD failure

Front 42

What is the pathogenesis of a myocardial infarction?

Back 42

Ischemia -- necrosis (in the ‘zone of infarction’) -- fibrous scar tissue formation from fibroblasts [overall: approx. 6 weeks]. The remaining myocardial cells enlarge to compensate.

Front 43

What are three longterm outcomes for survivors?

Back 43

(1)Arrhythmias, (2)Congestive Heart Failure, (3)Recurrent infarcts

Front 44

What are three symptoms of myocardial infarction in men.

Back 44

(1)Prolonged crushing chest pain, (2)possibly w/ radiation (throat, neck, back, jaw, shoulder, arm), (3)Pain is constant lasting 30 min to several hours; m/b with pallor, s.o.b., sweating but cold

Front 45

What are three symptoms of myocardial infarction in women.

Back 45

(1)SOB in middle of night, (2)chronic unexplained fatigue, (3)also m/b continuous pain in mid t-spine, neck, or shoulders; heartburn

Front 46

What is coronary heart disease?

Back 46

Congestive heart failure. Hypoxia to muscle -- heart is unable to pump sufficient blood -- back pressure impedes venous blood to return to heart. Can be both sides of the heart, or predominantly right-sided or left-sided. CHF not itself a disease – more of a collection of symptoms caused by inadequate pump action.

Front 47

What are seven risk factors for congestive heart failure?

Back 47

(1)Stress, (2)Inactivity, (3)Obesity, (4)DM, (5)Nutritional deficiency (thiamine, vitamin c), (6)Pre-existing pulmonary dz, (7)Some medications (steroids, NSAIDS)

Front 48

What is the etiology of right-sided congestive heart failure?

Back 48

Left sided heart failure. Pulmonary disease (Cor pulmonale) – ex. Pulmonary embolism. Cor Pulmonale (hypertrophy of the right ventricle caused by a disorder of the lungs or of the pulmonary blood vessels). Causes congestion of the peripheral organs and extremities

Front 49

What are two symptoms of right-sided congestive heart failure?

Back 49

(1)Swollen legs (especially towards the end of the day, liver enlargement (with pain), (2)Also jugular venous distension

Front 50

What is the etiology of left-sided congestive heart failure?

Back 50

Failure of the Left Ventricle. HTN (in younger women). CAD (older pop’ns). MI. valvular disease. Congenital. Endocarditis. Causes Pulmonary Edema.

Front 51

What are three symptoms of right-sided congestive heart failure?

Back 51

(1)Dyspnea, (2)Spasmodic cough, (3)Fatigue w/ muscle weakness

Front 52

What is the pathogenesis of congestive heart failure?

Back 52

Structural changes in the heart muscle lead to weakening contractions, and inefficient pumping. Neurohormonal cascade of events that ultimately result in impaired heart function and circulatory congestion. Over long period of time – symptoms often very gradual because of this.

Front 53

Compare right and left CHF.

Back 53

Left: Respiratory, Fatigue, Weakness, Irritability/confusion/sleep problems

Right: Peripheral edema, Jugular vein distension, Abdominal distension/ascites, URQ pain (liver congestion); possible jaundice

Front 54

What is cerebrovascular disease?

Back 54

Caused by atherosclerosis of the arteries supplying the brain

Front 55

What are two potential conditions that cerebrovascular disease can lead to?

Back 55

(1)Transient Ischemic Attack (TIA), (2)Cerebrovascular Accident (Stroke)

Front 56

What is a transient ischemic attack (TIA)?

Back 56

Short term ischemia. No acute infarction (death) of tissues. Similar symptoms as stroke. Usually resolves within a few minutes to 24 hours.

Front 57

What is a cerebrovascular accident (stroke)?

Back 57

Rapid loss of brain function due to ischemia. Weakness of loss of function in one side of body.

Front 58

What is hypertension?

Back 58

Persistent elevation of systolic (>140mmHg), diastolic(>90mmHg) or both measured on at least 2 separate occasions at least 2 weeks apart.

Front 59

What is blood pressure?

Back 59

The force exerted against the walls of arteries and arterioles.

Systolic: pressure when the heart contracts

Diastolic: pressure when the heart is relaxed

Front 60

What is the pathogenesis of hypertension?

Back 60

BP is regulated by cardiac output (C.O.) and total peripheral resistance (TPR). Most common cause of increased BP is the narrowing of arterioles.

Front 61

What two mechanisms control blood pressure?

Back 61

(1)Autonomic regulation (SNS), (2)Renin-angiotensin system (kidneys)

Front 62

Is blood pressure increased or decreased with hypertension?

Back 62

increased blood pressure

Front 63

Is blood pressure increased or decreased with hypotension?

Back 63

decreased blood pressure

Front 64

What is primary hypertension?

Back 64

a.k.a. essential or idiopathic. 90-95% of all HTN

Front 65

What is the etiology of primary hypertension.

Back 65

idiopathic, but assoc w smoking, obesity, cholesterol, stress, alcohol. Also highly genetic – familial and racial (i.e. Black men have very high incidence of HTN)

Front 66

What are the risk factors for primary hypertension?

Back 66

modifiable (smoking, stress, alcohol intake, weight) vs. non-modifiable risk factors (age, family history, gender, ethnicity)

Front 67

What is secondary hypertension?

Back 67

5-10% of all HTN. From an identifiable cause

Front 68

What is the etiology of secondary hypertension.

Back 68

renal dz (renal parenchema or renal art. stenosis) -- stimulation of renin-angiotensin system which causes BP to increase. Endocrine problems (1degree aldosteronism as in Cushing’s dz, acromegaly, pheochromocytoma, hyperthyroidism). Coarctation of aorta.

Front 69

What are the risk factors for secondary hypertension?

Back 69

modifiable (smoking, stress, alcohol intake, weight) ) vs. non-modifiable risk factors (age, family history, gender, ethnicity)

Front 70

What are 11 symptoms of hypertension?

Back 70

(1)Mostly Asymptomatic, (2)HA (occipital, worse waking in a.m., better activity), (3)Vertigo, (4)flushed face, (5)spontaneous epistaxis (nosebleed), (6)blurred vision, (7)Dyspnea, (8)Orthopnea (shortness of breath while recumbant), (9)chest pain, (10)edema in legs, (11)Nausea/vomiting

Front 71

What is cardiomegaly?

Back 71

Enlargement of the heart – especially left ventricle (1.2cm to 2.5cm). Enlarged cells need more blood (Often die of ischemia, Replaced by fibrous tissue)

Front 72

How does the heart pump with cardiomegaly?

Back 72

Left ventricle pumps inefficiently. Increases pulmonary artery pressure. .Hypertrophy of right ventricle and failure (Cor pumonale)

Front 73

Describe benign and malignant hypertension.

Back 73

Benign hypertension – chronic, long term

Malignant hypertension – sudden onset

Front 74

What is hypertension encephalopathy?

Back 74

Vascular changes in brain that cause acute or chronic cerebral ischemia. Hypertensive stroke (aka. Stroke) – sudden rupture of artery -- hemorrhage

Front 75

What is hypertensive retinopathy?

Back 75

May impair vision and eventually cause blindness. Retinal arteries are easily seen by ophthalmologists. Often first sign of hypertension.

Front 76

What is rheumatic fever?

Back 76

systemic disease related to streptococcal infections

Front 77

What is rheumatic heart disease?

Back 77

Rheumatic fever affecting theHT. 15 million cases each year.

Front 78

What is the etiology of rheumatic heart disease?

Back 78

RF typically occurs 2 wks after strep throat. Antibodies against streptococcal antigens find similar antigensin human heart, joints, skin, brain. Cell-mediated immune response and cytotoxic T-cells involved as well

Front 79

What is the pathology of rheumatic heart disease?

Back 79

Affects all parts of the heart (endocarditis, myocarditis, pericarditis)

Front 80

Describe endocarditis.

Back 80

Left Endocardium -- valve destruction -- Incompetent valves (mitral and aortic) or stenosis

Stenosis: Mitral – stagnation of blood in the left atrium -- Left atrial , pulmonary and right ventricular hypertension. Aortic – impedes blood flow from left ventricle to aorta -- Left ventricular hypertrophy

Front 81

Describe myocarditis.

Back 81

Inflammation of myocardium

Dx: Aschoff bodies – May cause arrhythmias

Front 82

Describe pericarditis.

Back 82

Only in severe cases

Front 83

What type of bacterial infection can cause endocarditis?

Back 83

Staphylococcus or Streptococcus

Front 84

How does a bacterial infection affect the heart valves?

Back 84

Causes inflammation -- destroys portions of the valves causing deformities. Infected valvular vegetations form -- may become emboli.

Front 85

What are clinical features of endocarditis?

Back 85

Many murmurs – blood flowing over deformed valves. Valvular insufficiency.

Front 86

What are the risks of endocarditis?

Back 86

Damaged valves d/t RF or surgery, congenital valvular defects

Front 87

What causes myocarditis?

Back 87

Caused by viruses. Invade cardiac muscle cells -- damage organelles -- cell death. Invasion of T-lymphocytes also kills cells.

Front 88

What are clinical features of myocarditis?

Back 88

Vague. Fever, shortness of breath. Signs of heart failure: tachycardia, cyanosis, pulmonary edema

Front 89

What is pericarditis?

Back 89

Inflammation of pericardium and epicardium (aka. Visceral layer of pericardium). Often seen with open heart surgery. Associated with exudation of fluid into pericardial sac. Can lead to constrictive pericarditis which prevents diastolic dilation of the heart.

Front 90

What causes pericarditis?

Back 90

Bacteria or viruses

Front 91

What are clinical features of pericarditis?

Back 91

Sharp piercing chest pain, SOB, heart palpitations, fever, edema in legs

Front 92

What is cardiomyopathy?

Back 92

“ailment of the heart”. A group of diseases that affect the myocardium: Dilated, Hypertrophic, Restrictive. Incurable without heart transplant.

Front 93

What is the cause of a dilated myocardium?

Back 93

Caused by alcohol, viral myocarditis, chemo, or idiopathic

Front 94

What is the cause of a hypertrophic myocardium?

Back 94

Extensive thickening of left ventricular myocardium. Familial cause - autosomal dominant.

Front 95

What is the cause of a restrictive myocardium?

Back 95

Heart can not expand to fill. Amyloid infiltration.

Front 96

What are the symptoms of cardiomyopathy?

Back 96

Generally, the same symptoms as heart failure. Dilated: fatigue and weakness. Hypertrophic: asymptomatic - sudden death is usually first presentation (young, competitive athletes) – may be dyspnea. Restrictive: exercise intolerance, fatigue, SOB(manifestations of ’d CO)

Front 97

What is a cardiac arrhythmia?

Back 97

Disturbance of heart rate (SA-“pacemaker” node) or rhythm due to conduction problem. Normal heart rate: 60 – 100 bpm. Classified according to origin (atrial or ventricular), pattern (fibrillation or flutter), and speed (tachycardia (fast) or bradychardia (slow)).

Front 98

What is the etiology of a cardiac arrhythmia?

Back 98

Congenital. HTN w/ hypertrophy. MI. Valvular disease. Degeneration of conduction tissue (“sick sinus dz”). Often seen with CHF.

Front 99

What are six risk factors for a cardia arrhythmia?

Back 99

(1)Excessive alcohol intake/ binge drinking, (2)Obesity (high BMI), (3)Age, (4)Pre-existing heart dz, (5)Drugs – caffeine, decongestants, (6)hyperthyroid

Front 100

What are six types of dysrhythmia?

Back 100

(1)Ectopic beats, (2)Tachycardia, (3)Bradycardia, (4)Atrial fibrillation, (5)Ventricular fibrillation, (6)Heart block

Front 101

What are ectopic beats?

Back 101

Disturbance in cardiac rhythm in which beats arise from fibers outside the SA node. (Extra beat)

Front 102

What is tachycardia?

Back 102

Increased heart rate at rest (>100bpm)

Front 103

What is bradycardia?

Back 103

Decreased decreased HR at rest (<60bpm). Causes: beta-blockers, brain injury, tumour, vagal response.

Front 104

What is atrial fibrillation?

Back 104

Rapid, involuntary, irregular contractions of the atria

Front 105

What is ventricular fibrillation?

Back 105

Rapid, involuntary, irregular contractions of the ventricles – can be fatal

Front 106

What is heart block?

Back 106

SA node misfire or not transmitted through conduction system

Front 107

What is a sinus arrhythmia?

Back 107

Refers to a normal variation in the heart rhythm caused by respiration (inhale faster/exhale slower). Not a true arrythymia – actually a sign of a healthy well functioning heart.

Front 108

What are three examples of heart valve mechanical disorders?

Back 108

(1)Stenosis, (2)Insufficiency / regurgitation, (3)Prolapse

Front 109

What is a stenosis?

Back 109

narrowing /constriction of valve due to scars or leaflet deposits with increased load on previous chamber

Front 110

What is valve insufficiency / regurgitation?

Back 110

Valve fails to close properly, decreased cardiac output

Front 111

What is a valve prolapse?

Back 111

Mitral valve leaflets bulge back into atrium

Front 112

How do these mechanical defects affect cardia workload.

Back 112

These disorders increase cardiac workload -- initially asymptomatic tachycardia -- dyspnea -- cardiac failure. Can exacerbate other cardiac pathologies.

Front 113

What are nine clinical features of heart valve disorders?

Back 113

Symptoms will depend on the type of pathology and which valve is affected an include: (1)dyspnea with exercise, (2)fatigue, (3)right ventricular failure, (4)left ventricular hypertrophy, (5)murmur, (6)angina, (7)sudden death, (8)wide pulse pressure, (9)can also be asymptomatic