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Questions and Answers
What is a primary consequence of thrombosis in blood vessels?
What is a primary consequence of thrombosis in blood vessels?
- Formation of new blood vessels
- Complete occlusion of the artery (correct)
- Enhanced oxygen delivery
- Increased blood flow to tissues
Which of the following best describes the autoimmune mechanism of vasculitis that involves direct damage to endothelial cells?
Which of the following best describes the autoimmune mechanism of vasculitis that involves direct damage to endothelial cells?
- Molecular mimicry by B cells (correct)
- Increased fibrin deposition
- Indirect damage by free radicals
- Infection by pathogens
What type of symptoms would you expect with vasculitis?
What type of symptoms would you expect with vasculitis?
- Local swelling and redness
- General symptoms like fever and fatigue (correct)
- Increased appetite and energy
- Enhanced mental clarity
Which vascular condition is primarily indicated by chest pain?
Which vascular condition is primarily indicated by chest pain?
What is a potential trigger for the development of complications in vasculitis?
What is a potential trigger for the development of complications in vasculitis?
In terms of lifestyle, which factor is most likely to worsen vascular health?
In terms of lifestyle, which factor is most likely to worsen vascular health?
What is the primary cause of inflammation in large vessel vasculitis?
What is the primary cause of inflammation in large vessel vasculitis?
Which of the following is NOT a consequence of vasculitis?
Which of the following is NOT a consequence of vasculitis?
Which of the following risk factors is considered inherent and non-modifiable for atherosclerosis?
Which of the following risk factors is considered inherent and non-modifiable for atherosclerosis?
What is a defining characteristic of atherosclerosis plaques?
What is a defining characteristic of atherosclerosis plaques?
In which of the following populations is atherosclerosis now exceeding that of the US?
In which of the following populations is atherosclerosis now exceeding that of the US?
Which of the following treatments is commonly used for addressing vascular diseases related to atherosclerosis?
Which of the following treatments is commonly used for addressing vascular diseases related to atherosclerosis?
What consequence can occur from the rupture of atherosclerosis plaques?
What consequence can occur from the rupture of atherosclerosis plaques?
Which symptom is commonly linked to coronary artery involvement of atherosclerosis?
Which symptom is commonly linked to coronary artery involvement of atherosclerosis?
What primary factor contributes to endothelial loss in the context of atherosclerosis pathology?
What primary factor contributes to endothelial loss in the context of atherosclerosis pathology?
What is a common effect of atherosclerosis on the kidneys?
What is a common effect of atherosclerosis on the kidneys?
Which of the following conditions is NOT considered a risk factor for atherosclerosis?
Which of the following conditions is NOT considered a risk factor for atherosclerosis?
What pathological feature is typical of atherosclerosis?
What pathological feature is typical of atherosclerosis?
Which treatment option is least likely to be effective for managing a patient with an arteriovenous fistula?
Which treatment option is least likely to be effective for managing a patient with an arteriovenous fistula?
How does moderate exercise influence vascular health?
How does moderate exercise influence vascular health?
Which of the following global trends is most concerning regarding cardiovascular diseases?
Which of the following global trends is most concerning regarding cardiovascular diseases?
According to hypertension management guidelines, which factor is essential for accurate blood pressure measurement?
According to hypertension management guidelines, which factor is essential for accurate blood pressure measurement?
In the context of atherosclerosis, what role does angiotensin II play?
In the context of atherosclerosis, what role does angiotensin II play?
Which pharmacologic class is NOT typically suggested for reducing cardiovascular events in hypertension patients?
Which pharmacologic class is NOT typically suggested for reducing cardiovascular events in hypertension patients?
Which dietary approach is recommended for improving vascular health in hypertensive patients?
Which dietary approach is recommended for improving vascular health in hypertensive patients?
What is the role of aldosterone in blood pressure regulation?
What is the role of aldosterone in blood pressure regulation?
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Study Notes
Atherosclerosis
- General term for arterial wall thickening and loss of elasticity
- Arteriosclerosis - hardening of the arteries
- Arteriolosclerosis - affects small arteries and arterioles
- Atherosclerosis - "gruel" and "hardening"
- Most common and most important clinically
- Hardening from a atheromatous plaque
Atherosclerosis - Big Picture
- Characterized by intimal lesions called atheromas (or atherosclerotic plaques)
- Cause of coronary, cerebral and peripheral vascular disease
- Plaques are raised lesions composed of soft friable lipid cores
- Lipids = cholesterol and necrotic debris
- Plaques enlarge
- Cause vascular obstruction and stenosis
- Can rupture resulting in thrombosis and sudden occlusion
- Thrombosis can break off and lead to emboli
- Weakens walls leading to aneurysm
Atherosclerosis - Big Picture - Areas Affected
- Heart - coronary artery
- Angina, vomiting, feeling faint, myocardial infarction (~25% of all US deaths)
- Carotid artery
- Weakness, dysphagia, headaches, facial numbness, stroke
- Peripheral Vascular disease
- Weakening, erectile dysfunction, hair loss
- Kidney
- Increases renin/BP, hand/feet swelling
Atherosclerosis - Risk Factors
- Constitutional (inherent, non-modifiable) Risk Factors
- Genetics: Family history most important independent risk factor for atherosclerosis
- Age: Death from ischemic heart disease increase with each
- Sex:
- Premenopausal women protected against atherosclerosis
- Postmenopausal women have similar risk to men
- Hypertension
Lymphatic System
- Thin-walled endothelium-lined channels
- Drain lymph from tissues
- Transport fluid and cells to lymph nodes
- Continuous monitoring for infection
- Returns cells via bloodstream via thoracic duct
Congenital Anomalies
- Artery Variants: 1-5% of the population
- Berry Aneurysm
- AV Fistula
Berry Aneurysm
- Definition: Thin-walled outpouching in the cerebral vessels
- Classically at branch points around circle of Willis
- Can spontaneously rupture - deadly
- TREATMENT: monitored or treated by clipping to prevent rupture
Arteriovenous Fistula
- Abnormal connection between artery and vein without intervening capillary bed
- Most commonly are developmental
- May lead to high-output cardiac failure or organ ischemia
- TREATMENT: Some cases require surgery
- Used intentionally in hemodialysis
Hypertension
- Determined by cardiac output and peripheral vascular resistance
- Hypotension (low blood pressure) leads to inadequate organ perfusion, organ dysfunction and tissue necrosis
- Hypertension (high blood pressure) causes vessel and organ damage and risk factor for atherosclerosis
Kidneys
- Sodium Balance
- Regulates Na and water levels
- Renin
- Produced by renal juxtaglomerular cells
- Released in response to low blood pressure
- Leads to activation of angiotensin II
- Angiotensin II
- Causes vasoconstriction
- Stimulates release of aldosterone
- Aldosterone
- Produced by adrenal gland
- Regulates Na and water levels
Blood Pressure Measurement
- Blood Pressure: Amount of pressure (force/area) that blood exerts on arterial walls
- Systolic Blood Pressure
- Measurement of pressure when heart is contracting
- Diastolic Blood Pressure
- Measurement of pressure when heart is relaxing
- NORMAL = 120mmHg / 80mmHg
Hypertension Clinical Guidelines
- 2017 American College of Cardiology-American Heart Association guidelines:
- Hypertension defined as BP ≥ 130/80
- Overall US prevalence: 46% (rate of control 46%)
- Hypertension defined as BP ≥ 130/80
- Diagnosis made by at least 2 BP measurements on 2 separate occasions
- Back supported, legs uncrossed, feet on floor, measurement arm resting on table at heart level
- After patient has sat quietly for 5 minutes
- Automated devices take 2-6 measurements serially
- Allow attendant to place cuff and leave room
- Minimizes ‘white coat’ effect
Hypertension Management
- Stage 1 HTN without pre-existing conditions
- Implement lifestyle modifications with 3-6 month follow up
- Sodium intake < 1500mg per day, increased potassium intake
- Weight loss if overweight
- 90-150 minutes of aerobic or resistance exercise per week
- Moderation of alcohol intake
- DASH diet: fresh produce, whole grains, low-fat dairy products
- Implement lifestyle modifications with 3-6 month follow up
- All other patients
- Lifestyle modifications plus pharmacologic therapy
- 4 drug classes reduce cardiovascular events:
- ACE inhibitors
- Angiotensin-receptor blockers
- Calcium-channel blockers
- Thiazide-type diuretics
Thrombosis
- If a thrombus forms, it can further narrow or completely occlude the artery, leading to reduced blood flow to the downstream tissues and potentially resulting in conditions such as:
- Angina (chest pain)
- Myocardial infarction (heart attack)
- Stroke
- Peripheral artery disease
Vasculitis
- Inflammation of blood vessels
- Mostly occurs in arteries
- Two main causes of inflammation of blood vessels:
- Direct invasion of vascular walls by infectious pathogens
- IMMUNOLGIC (AUTO-IMMUNE) attack of the blood vessels
- Consequences:
- Decreased blood flow
- Aneurysms
- Ischemic organs
Vasculitis - Inflammation Cause - Autoimmune - Mechanism: Direct Attack
- Known as molecular mimicry
- B cells mistake human endothelial cell for a foreign pathogen
- Endothelial cell layer destroyed
- OCCURS IN MEDIUM and LARGE VESSELS
Vasculitis - Inflammation Cause - Autoimmune Mechanism: Indirect Damage
- B cells attack other HUMAN cells
- Dead cells release free radicals which damage/kill endothelial cells
- OCCURS IN SMALL VESSELS
Vasculitis Mechanism
- Once damaged, ALL vasculitis follow same pattern:
- Collagen and tissue factor exposed
- Induces coagulation
- Repeated damage leads to fibrin deposition
- Blood vessels weakened
- Can lead to aneurysm
Overall Vasculitis Pattern:
- TRIGGER → VASCULITIS → COMPLICATION
- GENERAL SYMPTOMS
- Fever
- Weight Loss
- Fatigue
- SPECIFIC SYMPTOMS
- Depends on WHERE it is occurring in the body and organ affected
- Reduced blood flow
- Reduced vessel diameter (fibrosis)
- Blood clots (thrombosis)
- Organ ischemia
- GENERAL SYMPTOMS
Vasculitis - Specific Diseases
- Categorized by vessel size
- Large Vessel Vasculitis
- Giant Cell Arteritis
- Medium Vessel Vasculitis
- Small Vessel Vasculitis
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