Atherosclerosis and Venous Disorders Quiz

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Questions and Answers

Which symptom is commonly associated with deep vein incompetency?

Dizziness

Inflammation (correct)

Shortness of breath

Nausea

What is considered a threshold value for venous inflow to keep pace with ejection from deep veins?

40 mmHg

50 mmHg

20 mmHg

30 mmHg (correct)

Which method is recommended for diagnosing post-thrombotic disease when intervention is planned?

Venography (correct)

Physical examination

Ultrasound

CT scan

Which of the following factors is NOT considered a potential cause of aneurysms?

Frequent exercise Signup and view all the answers

What type of aneurysm occurs in the brain?

Cerebral aneurysm Signup and view all the answers

What is a characteristic feature of unstable atherosclerotic plaques?

Thin fibrous cap and large lipid cores Signup and view all the answers

Which type of atherosclerotic lesion is characterized by the presence of macrophage foam cells?

Type I Signup and view all the answers

Which type of lesion represents the intermediate stage between fatty streaks and atheromas?

Type III Signup and view all the answers

What is the primary constituent of the fibrofatty plaques found in atherosclerosis?

Lipid and necrotic debris Signup and view all the answers

How do stable plaques typically present compared to unstable plaques?

They are asymptomatic. Signup and view all the answers

Which type of atherosclerotic lesion consists of thick layers of fibrous connective tissue?

Type V Signup and view all the answers

What primarily drives atherogenesis in the development of atherosclerosis?

Endothelial cell dysfunction Signup and view all the answers

What is the primary role of the renin-angiotensin system in blood pressure regulation?

Raising blood pressure by increasing peripheral resistance and blood volume Signup and view all the answers

Which condition is least likely associated with dysfunction in the renal excretory function?

Hyperthyroidism Signup and view all the answers

What is a common etiology of vasculitis?

Immune complex deposition Signup and view all the answers

In which situation would increased renal blood flow be compensatory?

Impairment of renal excretory function Signup and view all the answers

Which of the following endocrine disorders is characterized by adrenocortical hyperfunction?

Cushing syndrome Signup and view all the answers

Which of the following factors is NOT involved in the etiology of hypertension?

Decreased plasma volume Signup and view all the answers

Which type of vasculitis typically affects specific vessels based on caliber and location?

Systemic vasculitis Signup and view all the answers

What is a recognized mechanism underlying non-infectious vasculitis?

Antineutrophil cytoplasmic antibodies Signup and view all the answers

Which hormone can inhibit sodium reabsorption and the renin-angiotensin system?

Natriuretic peptide Signup and view all the answers

What is the most common congenital cardiac disease identified?

Ventricular septal defect (VSD) Signup and view all the answers

Which congenital cardiac disease accounts for 8% of cases?

Pulmonary stenosis (PS) Signup and view all the answers

Which of the following changes in plaque can lead to acute myocardial infarction?

Rupture/fissuring of plaque Signup and view all the answers

At what level of coronary artery obstruction do symptoms likely occur even at rest?

90% Signup and view all the answers

What percentage of congenital cardiac diseases does coarctation of the aorta represent?

5% Signup and view all the answers

Which statement correctly describes the role of vasospasm in ischemic heart disease?

It is a reversible phenomenon. Signup and view all the answers

Which congenital defect has the same prevalence as truncus arteriosus (TA)?

Total anomalous pulmonary venous connection (TAPVC) Signup and view all the answers

Which of the following conditions is characterized by giant cell granuloma affecting mainly the temporal arteries?

Giant cell (temporal) arteritis Signup and view all the answers

What is NOT a consequence of acute plaque change?

Blood vessel dilation Signup and view all the answers

What is the primary issue that leads to ischemic heart disease (IHD)?

Diminished coronary perfusion Signup and view all the answers

Which condition is known to primarily affect young children and involves the coronary arteries?

Kawasaki disease Signup and view all the answers

What type of vasculitis is characterized by necrotizing fibrinous inflammation affecting medium-sized arteries?

Polyarteritis nodosa Signup and view all the answers

Which of the following is a common outcome associated with myocardial infarction?

Chronic heart failure Signup and view all the answers

Which of the following conditions is associated with segmental thrombosing inflammation in heavy smokers?

Thromboangiitis obliterans Signup and view all the answers

Which vasculitis involves small arterioles, capillaries, and venules, often associated with systemic diseases?

Microscopic polyangiitis Signup and view all the answers

What distinguishes malignant vascular tumors from benign vascular tumors?

Exhibition of cytologic atypia Signup and view all the answers

Which of these vascular tumors is noted for its locally aggressive behavior and has an intermediate degree of malignancy?

Kaposi sarcoma Signup and view all the answers

What is a common feature of benign vascular tumors?

Presence of obvious vascular channels Signup and view all the answers

Which condition involves a destructive type of vasculitis that can cause acute necrotizing granulomas?

Wegner's granulomatosis Signup and view all the answers

What defines vascular ectasias?

Dilation of existing vessels Signup and view all the answers

Which characteristic is typical of a stable atherosclerotic plaque?

Thick fibrous cap Signup and view all the answers

What is a critical factor contributing to the development of atheromas?

Endothelial cell dysfunction Signup and view all the answers

In which type of atherosclerotic lesion do lipid-laden smooth muscle cells constitute the primary feature?

Type II lesions Signup and view all the answers

What type of atherosclerotic plaque is more likely to cause acute ischemic complications?

Vulnerable plaques Signup and view all the answers

What feature distinguishes Type IV atherosclerotic lesions from Type III lesions?

Confluent extracellular lipid Signup and view all the answers

Which of the following statements accurately describes fatty streaks in atherosclerosis?

They appear in the aorta of children over the age of 10. Signup and view all the answers

What is primarily responsible for the progression from fatty streaks to atheromatous plaques?

Chronic endothelial cell injury Signup and view all the answers

Which of the following components is NOT a principal part of atherosclerotic plaques?

Proteins Signup and view all the answers

Which complication is NOT associated with atherosclerotic plaques?

Metastasis Signup and view all the answers

What is the most common form of hypertension?

Essential hypertension Signup and view all the answers

Which of the following risk factors is considered a major non-modifiable risk factor for ischemic heart disease?

Family history Signup and view all the answers

Which of the following statements about the pathogenesis of atherosclerosis is true?

Oxidation of cholesterol increases endothelial injury Signup and view all the answers

Which of the following is a recognized secondary cause of hypertension?

Kidney diseases Signup and view all the answers

What type of cell primarily contributes to the formation of foam cells in atherosclerosis?

Macrophages Signup and view all the answers

Which of the following is an essential characteristic of hypertension?

Sustained diastolic pressure greater than 90 mm Hg Signup and view all the answers

Which of the following conditions is most closely associated with hypertensive heart disease?

Cardiac hypertrophy Signup and view all the answers

What primary mechanism contributes to the thickening and deformity of mitral or tricuspid valves in chronic rheumatic heart disease?

Organization of acute inflammation and subsequent fibrosis Signup and view all the answers

Which of the following is a major clinical manifestation of acute rheumatic fever?

Erythema marginatum Signup and view all the answers

Which consequence results from reactivation of rheumatic heart disease after an initial attack?

Exacerbation of carditis with cumulative damage Signup and view all the answers

What type of hypersensitivity reaction is thought to be involved in the pathogenesis of acute rheumatic fever?

Type III hypersensitivity Signup and view all the answers

What occurs in the venous system during muscle relaxation in the calves?

Blood from superficial veins enters deep veins Signup and view all the answers

What is a common characteristic of subacute endocarditis?

Associated with low virulent bacterial infections in abnormal hearts. Signup and view all the answers

What is the primary causative organism in cases of bacterial endocarditis?

Streptococcus viridans. Signup and view all the answers

Which congenital cardiac disease has the highest prevalence?

Ventricular septal defect (VSD) Signup and view all the answers

Which of the following is a predisposing factor for rheumatic heart disease?

Diabetes mellitus. Signup and view all the answers

What percentage of congenital cardiac diseases is attributed to transposition of great arteries (TGA)?

4% Signup and view all the answers

What histopathological feature is pathognomonic for rheumatic fever?

Aschoff bodies. Signup and view all the answers

Which acute plaque change is characterized by the exposure of highly thrombogenic plaque constituents?

Rupture/fissuring Signup and view all the answers

Which condition is least likely to result in seeding of blood with microorganisms leading to endocarditis?

Routine vaccination. Signup and view all the answers

What is the outcome of myocardial involvement in acute rheumatic fever?

Development of Aschoff bodies. Signup and view all the answers

At what level of coronary artery obstruction do symptoms appear typically during rest?

90% Signup and view all the answers

Which of the following statements about septal defects is true regarding subacute endocarditis?

They can lead to significant bacterial colonization. Signup and view all the answers

Which condition is primarily characterized by diminished coronary perfusion relative to myocardial demand?

Ischemic heart disease (IHD) Signup and view all the answers

Which of the following organisms is associated with a higher risk in deformed heart valves?

Staphylococcus aureus. Signup and view all the answers

What percentage of congenital cardiac diseases does patent ductus arteriosus (PDA) represent?

7% Signup and view all the answers

What type of inflammation is primarily observed in the pericardium during acute rheumatic fever?

Acute fibrous pericarditis. Signup and view all the answers

Which of the following is not considered a cause of obstruction in ischemic heart disease (IHD)?

Hyperlipidemia Signup and view all the answers

Which of the following factors is not directly related to the pathogenesis of endocarditis?

Excessive physical exercise. Signup and view all the answers

Which congenital cardiac defect accounts for 5% prevalence alongside coarctation of the aorta?

Tetralogy of Fallot (TOF) Signup and view all the answers

What is a characteristic feature of acute plaque changes in the context of ischemic heart disease?

Thrombosis Signup and view all the answers

Which congenital cardiac disease has the lowest prevalence among the listed conditions?

Tricuspid atresia Signup and view all the answers

Study Notes

Pathology of Cardiovascular System

This is a presentation on the pathology of the cardiovascular system, by Prof. Dr. Rafal Al-Saigh.

Diseases of Blood Vessels

Function of endothelial cells lined blood vessels:
- Maintenance of Permeability Barrier
- Elaboration of Anticoagulant, Antithrombotic, Fibrinolytic factors
- Regulators: Prostacyclin, Thrombomodulin, Heparin-like molecules, Plasminogen activator
- Elaboration of Prothrombotic Molecules: Von Willebrand factor, Tissue factor, Plasminogen activator inhibitor
- Extracellular Matrix Production (collagen, proteoglycans)
Modulation of Blood Flow and Vascular Reactivity:
- Vasconstrictors: endothelin, ACE
- Vasodilators: NO, prostacyclin
Regulation of Inflammation and Immunity:
- IL-1, IL-6, chemokines
- Adhesion molecules: VCAM-1, ICAM, E-selectin, P-selectin
- Histocompatibility antigens
Regulation of Cell Growth:
- Growth stimulators: PDGF, FGF
- Growth inhibitors: heparin, TGF-β
Oxidation of LDL:
Endothelial cells: Activated by cytokines and bacterial products; also affected by inflammation and septic shock, hemodynamic stress, lipid products, critical to atherosclerosis pathogenesis, advanced glycosylation end products (important in diabetes), viruses, complement components, and hypoxia.
Vascular smooth muscle cells: Response to stimuli resulting in vasoconstriction and dilation. Synthesize collagen, elastin, and proteoglycans; elaborate growth factors and cytokines; migrate to intima; and proliferate after injury.

Vascular Structure and Function

All vessels are lined by endothelium, sharing homeostatic properties.
Endothelial cells in specific vascular beds (e.g., renal glomeruli) have special features for tissue-specific functions.
The relative smooth muscle cell and matrix content of vessel walls varies according to hemodynamic demands (e.g. pressure, pulsatility).
Endothelial cell function is tightly regulated in both basal and activated states.
Pathophysiological stimuli induce endothelial activation and dysfunction altering the phenotype (e.g. pro- versus anticoagulative, pro- versus anti-inflammatory, and non-adhesive versus adhesive).

Atherosclerosis

Intimal lesions (atheromas) protrude & obstruct vascular lumens, causing ischemic heart disease.
The American Heart Association classifies into six types based on nomenclature and histology, progression sequences, main growth mechanism, earliest onset, and clinical correlation.
Atherosclerosis is an intima-based lesion: Composed of a fibrous cap and an atheromatous core (smooth muscle cells, ECMs, inflammatory cells, lipids, and necrotic debris).
Driven by vessel wall injury and inflammation.
Multiple risk factors cause dysfunction, influencing smooth muscle cell recruitment/stimulation.
Plaques slowly develop over decades; stable plaques cause chronic ischemia, unstable plaques cause potentially fatal ischemic complications related to rupture, thrombosis, or embolization.
Stable plaques have dense fibrous caps, minimal lipid accumulation, and little inflammation.
Unstable plaques have thin caps, large lipid cores, and relatively dense inflammatory infiltrates.
Type I lesion: increase in macrophages & formation of macrophage foam cells.
Type II lesion (fatty streaks): lipid-laden smooth muscle cells.
Type III lesion: intermediate stage between Type II & IV (atheroma).
Type IV lesion: larger, confluent, and more disruptive lipid core.
Type V lesion: Extracellular lipid with thick layers of fibrous connective tissue.
Type VI lesion: extracellular lipid containing fibrous tissue, fissure, hematoma, or largely calcified.
Fatty streaks are the earliest lesion of atherosclerosis.
Subendothelial lipid-filled foamy cells with few T lymphocytes.
Progresses to atheromatous plaques, damaging arteries.
Plaques can disrupt & precipitate thrombi, obstructing blood flow.
Components include cells (SMCs, macrophages, leukocytes), ECM (collagen, elastic fibers, proteoglycans), & intracellular/extracellular lipid (cholesterol & cholesterol esters).
Complications include rupture, ulceration, erosion, hemorrhage, thrombosis, and aneurysmal dilation.

Hypertension

Common disorder affecting 25% of the population.
Major risk factor for atherosclerosis, congestive heart failure, and renal failure.
Essential hypertension: 95% of cases; complex, multifactorial disorder involving environmental and genetic influences.
Genetic polymorphisms influence sodium resorption, aldosterone pathways, and the renin-angiotensin system.
Sometimes caused by single-gene disorders or secondary to kidney, adrenal, or other endocrine organ diseases.

Vasculitis

Inflammation of vessel walls, frequently associated with systemic manifestations (fever, malaise, arthralgias) and organ dysfunction.
Vasculitis can result from infections, but more commonly from immunologic basis (immune complex deposition, anti-neutrophil antibodies, and anti-endothelial cell antibodies).
Different forms of vasculitis selectively affect vessels of specific caliber and location.
Non-infectious vasculitis: Including the giant cell arteritis, Takayasu's arteritis, polyarteritis nodosa, Kawasaki disease, microscopic polyangiitis, and Henoch-Schönlein purpura.
Giant cell arteritis: Affecting temporal arteries, associated with destructive giant cell granuloma.
Takayasu's arteritis: Involving carotids, subclavian, and arch aorta, often resulting in fibrosis leading to pulse less syndrome.
Polyarteritis nodosa: Involves medium-sized arteries, commonly extending to renal arteries, characterized by necrotizing fibrinous inflammation.
Kawasaki disease: In children; affects coronary arteries.
Microscopic polyangiitis: Leukocytoclastic vasculitis affecting smaller arterioles, capillaries, and venules (occurs in conditions like Henoch-Schonlein purpura and Churg-Strauss syndrome).
Wegener's granulomatosis: Affects lungs and kidneys, characterized by acute necrotizing granulomas, necrotizing vasculitis of small & medium-sized vessels, and renal disease.
Thromboangiitis obliterans (Buerger's disease): Segmental, thrombosing, and inflammatory condition affecting medium-sized arteries, mainly in hands and feet, almost exclusively affecting heavy smokers.

Vascular Tumors

Vascular ectasias not neoplasms, but dilations of existing vessels.
Vascular neoplasms derive from blood vessels or lymphatic vessels.
Composed of endothelial cells, or other vascular wall cells.
Most vascular tumors are benign (e.g. hemangiomas), some are intermediate/locally aggressive (e.g. Kaposi sarcoma), and others are highly malignant (e.g. angiosarcoma).
Benign tumors form obvious vascular channels lined by normal-appearing endothelial cells.
Malignant tumors are solid, cellular, exhibit cytologic atypia, and lack well-defined vessels.

Congenital Cardiac Diseases

Various congenital cardiac malformations are described, with percentages (%) mentioned for each.

Ischemic Heart Disease (IHD)

Diminished coronary perfusion relative to myocardial demand, with several factors including complex interactions of fixed atherosclerotic narrowing/intraluminal thrombosis overlying a disrupted atherosclerotic plaque, platelet aggregation, and vasospasm.
Obstruction of 75% or more of the coronary artery lumen causes symptoms on exertion, and while 90% + obstruction causes symptoms even at rest (angina pectoris).
Acute plaque change leads to thrombosis and total occlusion with myocardial infarction. Acute plaque changes include rupture/fissuring, erosion/ulceration, & hemorrhage.

Morphologic Changes in Acute MI

Describes the gross and light microscopic changes in acute myocardial infarction (MI) over time (0-12 hours and later).

Consequences of MI

Contractile dysfunction.
Arrhythmias.
Myocardial rupture.
Pericarditis.
Infarct extension.
Infarct expansion.
Mural thrombus.
Ventricular aneurysm.
Papillary muscle dysfunction.
Progressive late heart failure.

Infective Endocarditis (IE)

Colonization or invasion of heart valves/mural endocardium by microbes, with formation of bulky, friable vegetations; often associated with destruction of underlying cardiac tissues.
Classified into: Acute & Subacute endocarditis. Acute IE is caused by highly virulent microorganisms; subacute IE is caused by low virulent microorganisms infecting an abnormal heart.
Predisposing factors such as rheumatic heart disease, myxomatous mitral valve, degenerative calcific valvular stenosis, neutropenia, immunodeficiency, malignancy, diabetes mellitus, alcoholism, and intravenous drug abuse.

Causative Microorganisms

IE caused by various microorganisms such as Streptococcus viridans, Staphylococcus aureus, enterococci, Haemophilus, Acinetobacter, Gram-negative bacilli, and fungi.
Microorganisms are seeded into blood after dental extraction, surgical procedures, and contaminated needles.

Rheumatic Heart Disease (RHD)

Acute, immunologically mediated, multisystem inflammatory disease triggered by group A streptococcal pharyngitis.
Associated with: Focal inflammatory lesions (Aschoff bodies) in tissues, especially those within the heart.
The inflammatory lesions consist of foci of swollen eosinophilic collagen surrounded by lymphocytes (primarily T cells), and occasionally plasma cells, and plump macrophages, called Anitschkow cells, a feature pathognomonic for rheumatic fever.

Varicose Veins

Dilatation of superficial veins; Veins are capacious & thin-walled blood vessels (70% of total blood volume); Upright position.
Bicuspid valves responsible for unidirectional flow; aided by muscle pump; Superficial & deep systems & perforant veins between them.

Deep Vein Incompetency

Retrograde flow in deep veins, possible complications are crural ulcer & thrombosis; Etiology of incompetency includes thrombosis & congenital factors.

Diagnostics Method

Venography is recommended in post-thrombotic patients, especially prior to planned intervention; Ascending venography with injection of contrast material into the foot is common.

Aneurysm and Dissections

Aneurysm: Distention of an artery due to arterial wall weakening/destruction, forming a balloon-like bulge; may be congenital or acquired, involving the entire thickness of heart/blood vessels.
Dissection: Blood enters the vessel wall, separating the layers.
Complications result from rupture, thrombosis, & embolization of branching vessels.

Types of Aneurysms

Aortic (abdominal and thoracic).
Cerebral.
Peripheral (in arteries other than aorta).

Aortic Aneurysms

Abdominal aortic aneurysm (AAA): Aneurysm in the abdominal portion of the aorta.
Thoracic aortic aneurysm (TAA): Aneurysm in the thoracic portion of the aorta.

Brain Aneurysms

Aneurysms in brain arteries, often berry-sized.

Peripheral Aneurysms

Aneurysms in arteries other than aorta & brain arteries.

Heart Failure

Clinical syndrome when the heart fails to provide adequate blood flow to meet metabolic needs; Can occur due to:
Ischemic heart disease.
Hypertension.
Diabetes.

Compensatory Mechanisms in Heart Failure

Increasing cardiac output via Frank–Starling mechanism.
Increasing ventricular volume and wall thickness via ventricular remodeling.
Maintaining tissue perfusion with increased mean arterial pressure via neurohormonal systems.

Pathophysiology of Heart Failure

Heart's inability to provide sufficient blood to meet metabolic needs leads to organ congestion from pulmonary and systemic venous pressure elevation.
Primary abnormalities include systemic issues from cardiomyocyte dysfunction, collagen turnover of the extracellular matrix, structural cardiac defects, rhythm abnormalities, or high metabolic demands such as thyrotoxicosis.

Left Ventricular Failure (LV Failure)

Reduced cardiac output.
Increased pulmonary venous pressure causes fluid extravasation from capillaries to interstitial space and alveoli; reducing pulmonary compliance, increasing breathing work, and altering V/Q relationships.
Marked fluid accumulation in alveoli (pulmonary edema).
Decreasing systemic arterial oxygenation, causing dyspnea, increased minute ventilation, decreasing PaCO2, and increasing blood pH.

Right Ventricular Failure (RV Failure)

Increased systemic venous pressure causing fluid extravasation in dependent tissues (feet, ankles, and abdominal viscera).
Congestion can affect the liver, stomach, and intestine.
Fluid accumulation in peritoneal cavity (ascites).
Sequels include moderate hepatic dysfunction impaired liver breaks down less aldosterone; contributing to fluid accumulation, anorexia, malabsorption, and protein-losing enteropathy.

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Description

Test your knowledge on conditions affecting veins and arteries, including deep vein incompetency and atherosclerosis. This quiz covers key symptoms, diagnostic methods, and characteristics of various vascular lesions. Challenge yourself with questions about aneurysms and atherogenesis.