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Questions and Answers
Which symptom is commonly associated with deep vein incompetency?
Which symptom is commonly associated with deep vein incompetency?
What is considered a threshold value for venous inflow to keep pace with ejection from deep veins?
What is considered a threshold value for venous inflow to keep pace with ejection from deep veins?
Which method is recommended for diagnosing post-thrombotic disease when intervention is planned?
Which method is recommended for diagnosing post-thrombotic disease when intervention is planned?
Which of the following factors is NOT considered a potential cause of aneurysms?
Which of the following factors is NOT considered a potential cause of aneurysms?
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What type of aneurysm occurs in the brain?
What type of aneurysm occurs in the brain?
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What is a characteristic feature of unstable atherosclerotic plaques?
What is a characteristic feature of unstable atherosclerotic plaques?
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Which type of atherosclerotic lesion is characterized by the presence of macrophage foam cells?
Which type of atherosclerotic lesion is characterized by the presence of macrophage foam cells?
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Which type of lesion represents the intermediate stage between fatty streaks and atheromas?
Which type of lesion represents the intermediate stage between fatty streaks and atheromas?
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What is the primary constituent of the fibrofatty plaques found in atherosclerosis?
What is the primary constituent of the fibrofatty plaques found in atherosclerosis?
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How do stable plaques typically present compared to unstable plaques?
How do stable plaques typically present compared to unstable plaques?
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Which type of atherosclerotic lesion consists of thick layers of fibrous connective tissue?
Which type of atherosclerotic lesion consists of thick layers of fibrous connective tissue?
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What primarily drives atherogenesis in the development of atherosclerosis?
What primarily drives atherogenesis in the development of atherosclerosis?
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What is the primary role of the renin-angiotensin system in blood pressure regulation?
What is the primary role of the renin-angiotensin system in blood pressure regulation?
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Which condition is least likely associated with dysfunction in the renal excretory function?
Which condition is least likely associated with dysfunction in the renal excretory function?
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What is a common etiology of vasculitis?
What is a common etiology of vasculitis?
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In which situation would increased renal blood flow be compensatory?
In which situation would increased renal blood flow be compensatory?
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Which of the following endocrine disorders is characterized by adrenocortical hyperfunction?
Which of the following endocrine disorders is characterized by adrenocortical hyperfunction?
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Which of the following factors is NOT involved in the etiology of hypertension?
Which of the following factors is NOT involved in the etiology of hypertension?
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Which type of vasculitis typically affects specific vessels based on caliber and location?
Which type of vasculitis typically affects specific vessels based on caliber and location?
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What is a recognized mechanism underlying non-infectious vasculitis?
What is a recognized mechanism underlying non-infectious vasculitis?
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Which hormone can inhibit sodium reabsorption and the renin-angiotensin system?
Which hormone can inhibit sodium reabsorption and the renin-angiotensin system?
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What is the most common congenital cardiac disease identified?
What is the most common congenital cardiac disease identified?
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Which congenital cardiac disease accounts for 8% of cases?
Which congenital cardiac disease accounts for 8% of cases?
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Which of the following changes in plaque can lead to acute myocardial infarction?
Which of the following changes in plaque can lead to acute myocardial infarction?
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At what level of coronary artery obstruction do symptoms likely occur even at rest?
At what level of coronary artery obstruction do symptoms likely occur even at rest?
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What percentage of congenital cardiac diseases does coarctation of the aorta represent?
What percentage of congenital cardiac diseases does coarctation of the aorta represent?
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Which statement correctly describes the role of vasospasm in ischemic heart disease?
Which statement correctly describes the role of vasospasm in ischemic heart disease?
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Which congenital defect has the same prevalence as truncus arteriosus (TA)?
Which congenital defect has the same prevalence as truncus arteriosus (TA)?
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Which of the following conditions is characterized by giant cell granuloma affecting mainly the temporal arteries?
Which of the following conditions is characterized by giant cell granuloma affecting mainly the temporal arteries?
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What is NOT a consequence of acute plaque change?
What is NOT a consequence of acute plaque change?
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What is the primary issue that leads to ischemic heart disease (IHD)?
What is the primary issue that leads to ischemic heart disease (IHD)?
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Which condition is known to primarily affect young children and involves the coronary arteries?
Which condition is known to primarily affect young children and involves the coronary arteries?
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What type of vasculitis is characterized by necrotizing fibrinous inflammation affecting medium-sized arteries?
What type of vasculitis is characterized by necrotizing fibrinous inflammation affecting medium-sized arteries?
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Which of the following is a common outcome associated with myocardial infarction?
Which of the following is a common outcome associated with myocardial infarction?
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Which of the following conditions is associated with segmental thrombosing inflammation in heavy smokers?
Which of the following conditions is associated with segmental thrombosing inflammation in heavy smokers?
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Which vasculitis involves small arterioles, capillaries, and venules, often associated with systemic diseases?
Which vasculitis involves small arterioles, capillaries, and venules, often associated with systemic diseases?
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What distinguishes malignant vascular tumors from benign vascular tumors?
What distinguishes malignant vascular tumors from benign vascular tumors?
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Which of these vascular tumors is noted for its locally aggressive behavior and has an intermediate degree of malignancy?
Which of these vascular tumors is noted for its locally aggressive behavior and has an intermediate degree of malignancy?
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What is a common feature of benign vascular tumors?
What is a common feature of benign vascular tumors?
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Which condition involves a destructive type of vasculitis that can cause acute necrotizing granulomas?
Which condition involves a destructive type of vasculitis that can cause acute necrotizing granulomas?
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What defines vascular ectasias?
What defines vascular ectasias?
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Which characteristic is typical of a stable atherosclerotic plaque?
Which characteristic is typical of a stable atherosclerotic plaque?
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What is a critical factor contributing to the development of atheromas?
What is a critical factor contributing to the development of atheromas?
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In which type of atherosclerotic lesion do lipid-laden smooth muscle cells constitute the primary feature?
In which type of atherosclerotic lesion do lipid-laden smooth muscle cells constitute the primary feature?
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What type of atherosclerotic plaque is more likely to cause acute ischemic complications?
What type of atherosclerotic plaque is more likely to cause acute ischemic complications?
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What feature distinguishes Type IV atherosclerotic lesions from Type III lesions?
What feature distinguishes Type IV atherosclerotic lesions from Type III lesions?
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Which of the following statements accurately describes fatty streaks in atherosclerosis?
Which of the following statements accurately describes fatty streaks in atherosclerosis?
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What is primarily responsible for the progression from fatty streaks to atheromatous plaques?
What is primarily responsible for the progression from fatty streaks to atheromatous plaques?
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Which of the following components is NOT a principal part of atherosclerotic plaques?
Which of the following components is NOT a principal part of atherosclerotic plaques?
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Which complication is NOT associated with atherosclerotic plaques?
Which complication is NOT associated with atherosclerotic plaques?
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What is the most common form of hypertension?
What is the most common form of hypertension?
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Which of the following risk factors is considered a major non-modifiable risk factor for ischemic heart disease?
Which of the following risk factors is considered a major non-modifiable risk factor for ischemic heart disease?
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Which of the following statements about the pathogenesis of atherosclerosis is true?
Which of the following statements about the pathogenesis of atherosclerosis is true?
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Which of the following is a recognized secondary cause of hypertension?
Which of the following is a recognized secondary cause of hypertension?
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What type of cell primarily contributes to the formation of foam cells in atherosclerosis?
What type of cell primarily contributes to the formation of foam cells in atherosclerosis?
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Which of the following is an essential characteristic of hypertension?
Which of the following is an essential characteristic of hypertension?
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Which of the following conditions is most closely associated with hypertensive heart disease?
Which of the following conditions is most closely associated with hypertensive heart disease?
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What primary mechanism contributes to the thickening and deformity of mitral or tricuspid valves in chronic rheumatic heart disease?
What primary mechanism contributes to the thickening and deformity of mitral or tricuspid valves in chronic rheumatic heart disease?
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Which of the following is a major clinical manifestation of acute rheumatic fever?
Which of the following is a major clinical manifestation of acute rheumatic fever?
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Which consequence results from reactivation of rheumatic heart disease after an initial attack?
Which consequence results from reactivation of rheumatic heart disease after an initial attack?
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What type of hypersensitivity reaction is thought to be involved in the pathogenesis of acute rheumatic fever?
What type of hypersensitivity reaction is thought to be involved in the pathogenesis of acute rheumatic fever?
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What occurs in the venous system during muscle relaxation in the calves?
What occurs in the venous system during muscle relaxation in the calves?
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What is a common characteristic of subacute endocarditis?
What is a common characteristic of subacute endocarditis?
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What is the primary causative organism in cases of bacterial endocarditis?
What is the primary causative organism in cases of bacterial endocarditis?
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Which congenital cardiac disease has the highest prevalence?
Which congenital cardiac disease has the highest prevalence?
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Which of the following is a predisposing factor for rheumatic heart disease?
Which of the following is a predisposing factor for rheumatic heart disease?
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What percentage of congenital cardiac diseases is attributed to transposition of great arteries (TGA)?
What percentage of congenital cardiac diseases is attributed to transposition of great arteries (TGA)?
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What histopathological feature is pathognomonic for rheumatic fever?
What histopathological feature is pathognomonic for rheumatic fever?
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Which acute plaque change is characterized by the exposure of highly thrombogenic plaque constituents?
Which acute plaque change is characterized by the exposure of highly thrombogenic plaque constituents?
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Which condition is least likely to result in seeding of blood with microorganisms leading to endocarditis?
Which condition is least likely to result in seeding of blood with microorganisms leading to endocarditis?
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What is the outcome of myocardial involvement in acute rheumatic fever?
What is the outcome of myocardial involvement in acute rheumatic fever?
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At what level of coronary artery obstruction do symptoms appear typically during rest?
At what level of coronary artery obstruction do symptoms appear typically during rest?
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Which of the following statements about septal defects is true regarding subacute endocarditis?
Which of the following statements about septal defects is true regarding subacute endocarditis?
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Which condition is primarily characterized by diminished coronary perfusion relative to myocardial demand?
Which condition is primarily characterized by diminished coronary perfusion relative to myocardial demand?
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Which of the following organisms is associated with a higher risk in deformed heart valves?
Which of the following organisms is associated with a higher risk in deformed heart valves?
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What percentage of congenital cardiac diseases does patent ductus arteriosus (PDA) represent?
What percentage of congenital cardiac diseases does patent ductus arteriosus (PDA) represent?
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What type of inflammation is primarily observed in the pericardium during acute rheumatic fever?
What type of inflammation is primarily observed in the pericardium during acute rheumatic fever?
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Which of the following is not considered a cause of obstruction in ischemic heart disease (IHD)?
Which of the following is not considered a cause of obstruction in ischemic heart disease (IHD)?
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Which of the following factors is not directly related to the pathogenesis of endocarditis?
Which of the following factors is not directly related to the pathogenesis of endocarditis?
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Which congenital cardiac defect accounts for 5% prevalence alongside coarctation of the aorta?
Which congenital cardiac defect accounts for 5% prevalence alongside coarctation of the aorta?
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What is a characteristic feature of acute plaque changes in the context of ischemic heart disease?
What is a characteristic feature of acute plaque changes in the context of ischemic heart disease?
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Which congenital cardiac disease has the lowest prevalence among the listed conditions?
Which congenital cardiac disease has the lowest prevalence among the listed conditions?
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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
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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)
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Modulation of Blood Flow and Vascular Reactivity:
- Vasconstrictors: endothelin, ACE
- Vasodilators: NO, prostacyclin
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Regulation of Inflammation and Immunity:
- IL-1, IL-6, chemokines
- Adhesion molecules: VCAM-1, ICAM, E-selectin, P-selectin
- Histocompatibility antigens
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Regulation of Cell Growth:
- Growth stimulators: PDGF, FGF
- Growth inhibitors: heparin, TGF-β
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Oxidation of LDL:
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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.
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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
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Intimal lesions (atheromas) protrude & obstruct vascular lumens, causing ischemic heart disease.
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The American Heart Association classifies into six types based on nomenclature and histology, progression sequences, main growth mechanism, earliest onset, and clinical correlation.
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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).
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Driven by vessel wall injury and inflammation.
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Multiple risk factors cause dysfunction, influencing smooth muscle cell recruitment/stimulation.
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Plaques slowly develop over decades; stable plaques cause chronic ischemia, unstable plaques cause potentially fatal ischemic complications related to rupture, thrombosis, or embolization.
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Stable plaques have dense fibrous caps, minimal lipid accumulation, and little inflammation.
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Unstable plaques have thin caps, large lipid cores, and relatively dense inflammatory infiltrates.
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Type I lesion: increase in macrophages & formation of macrophage foam cells.
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Type II lesion (fatty streaks): lipid-laden smooth muscle cells.
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Type III lesion: intermediate stage between Type II & IV (atheroma).
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Type IV lesion: larger, confluent, and more disruptive lipid core.
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Type V lesion: Extracellular lipid with thick layers of fibrous connective tissue.
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Type VI lesion: extracellular lipid containing fibrous tissue, fissure, hematoma, or largely calcified.
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Fatty streaks are the earliest lesion of atherosclerosis.
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Subendothelial lipid-filled foamy cells with few T lymphocytes.
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Progresses to atheromatous plaques, damaging arteries.
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Plaques can disrupt & precipitate thrombi, obstructing blood flow.
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Components include cells (SMCs, macrophages, leukocytes), ECM (collagen, elastic fibers, proteoglycans), & intracellular/extracellular lipid (cholesterol & cholesterol esters).
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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
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Inflammation of vessel walls, frequently associated with systemic manifestations (fever, malaise, arthralgias) and organ dysfunction.
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Vasculitis can result from infections, but more commonly from immunologic basis (immune complex deposition, anti-neutrophil antibodies, and anti-endothelial cell antibodies).
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Different forms of vasculitis selectively affect vessels of specific caliber and location.
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Non-infectious vasculitis: Including the giant cell arteritis, Takayasu's arteritis, polyarteritis nodosa, Kawasaki disease, microscopic polyangiitis, and Henoch-Schönlein purpura.
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Giant cell arteritis: Affecting temporal arteries, associated with destructive giant cell granuloma.
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Takayasu's arteritis: Involving carotids, subclavian, and arch aorta, often resulting in fibrosis leading to pulse less syndrome.
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Polyarteritis nodosa: Involves medium-sized arteries, commonly extending to renal arteries, characterized by necrotizing fibrinous inflammation.
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Kawasaki disease: In children; affects coronary arteries.
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Microscopic polyangiitis: Leukocytoclastic vasculitis affecting smaller arterioles, capillaries, and venules (occurs in conditions like Henoch-Schonlein purpura and Churg-Strauss syndrome).
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Wegener's granulomatosis: Affects lungs and kidneys, characterized by acute necrotizing granulomas, necrotizing vasculitis of small & medium-sized vessels, and renal disease.
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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.
