Diseases of Blood Vessels
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Questions and Answers

Which endothelial cell function is primarily responsible for maintaining blood vessel permeability?

  • Elaboration of prothrombotic molecules
  • Maintenance of permeability barrier (correct)
  • Extracellular matrix production
  • Regulation of inflammation and immunity
  • What role do prothrombotic molecules play in endothelial cell function?

  • They induce anticoagulation.
  • They assist in blood vessel healing.
  • They promote vasodilation.
  • They facilitate blood clot formation. (correct)
  • Which molecules are known to act as vasodilators in the endothelial response?

  • Nitric oxide and prostacyclin (correct)
  • Heparin and TGF-β
  • Endothelin and ACE
  • IL-1 and IL-6
  • What is the main factor that regulates the endothelial cell phenotype during pathophysiologic stimuli?

    <p>Cytokine activation (D)</p> Signup and view all the answers

    Which molecule is produced by endothelial cells that contributes to inflammation and immune response?

    <p>VCAM-1 (B)</p> Signup and view all the answers

    Which of the following functions is NOT performed by endothelial cells?

    <p>Production of LDL (D)</p> Signup and view all the answers

    What is a critical factor involved in the pathogenesis of atherosclerosis according to the function of endothelial cells?

    <p>Advanced glycosylation end products (C)</p> Signup and view all the answers

    Which growth inhibitors produced by endothelial cells limit excessive vascular growth?

    <p>Transforming growth factor beta (TGF-β) (D)</p> Signup and view all the answers

    What characterizes a thoracic aortic aneurysm (TAA)?

    <p>Occurs in the chest portion of the aorta (C)</p> Signup and view all the answers

    Which of the following is NOT a common cause of heart failure?

    <p>Pulmonary hypertension (B)</p> Signup and view all the answers

    The term 'berry aneurysm' is associated with which type of aneurysm?

    <p>Cerebral aneurysm (A)</p> Signup and view all the answers

    What is a primary complication associated with aneurysms?

    <p>Rupture leading to hemorrhage (C)</p> Signup and view all the answers

    In the context of heart failure, which compensatory mechanism aims to maintain tissue perfusion?

    <p>Increase mean arterial pressure (A)</p> Signup and view all the answers

    What typically occurs during left ventricular failure leading to pulmonary complications?

    <p>Increased pulmonary capillary pressure (B)</p> Signup and view all the answers

    Which is a common location for peripheral aneurysms?

    <p>Femoral arteries (B)</p> Signup and view all the answers

    Which of the following statements about dissections is accurate?

    <p>Dissections involve the separation of arterial wall layers (A)</p> Signup and view all the answers

    Which change in the heart is a direct consequence of the Frank–Starling mechanism in heart failure?

    <p>Increased ventricular volume (A)</p> Signup and view all the answers

    What is a likely effect of liver congestion in right ventricular failure?

    <p>Development of ascites and fluid build-up (C)</p> Signup and view all the answers

    What is the primary role of natriuretic peptides in the renal system?

    <p>Inhibit sodium reabsorption (D)</p> Signup and view all the answers

    What is a common immunologic cause of vasculitis?

    <p>Immune complex deposition (B)</p> Signup and view all the answers

    Which of the following vasculitis variants primarily affects the temporal arteries?

    <p>Giant cell arteritis (A)</p> Signup and view all the answers

    What type of tumors are hemangiomas classified as?

    <p>Benign tumors (D)</p> Signup and view all the answers

    What is the primary pathological feature of ischemic heart disease?

    <p>Diminished coronary perfusion (D)</p> Signup and view all the answers

    In which condition does 90% obstruction of the coronary artery lumen typically cause symptoms?

    <p>Even at rest (A)</p> Signup and view all the answers

    Which congenital cardiac defect has the highest prevalence?

    <p>Ventricular septal defect (VSD) (D)</p> Signup and view all the answers

    What systemic manifestation is commonly associated with vasculitis?

    <p>Malaise (B)</p> Signup and view all the answers

    Which of the following features indicates acute myocardial infarction at the 1 to 3-day mark?

    <p>Hyperemic, central yellow-tan softening (D)</p> Signup and view all the answers

    Which type of vasculitis is associated with pulmonary and renal involvement?

    <p>Wegner's granulomatosis (C)</p> Signup and view all the answers

    What is a major consequence of myocardial infarction?

    <p>Arrhythmias (A)</p> Signup and view all the answers

    Which congenital defect primarily affects the development of the aorta?

    <p>Coarctation of the aorta (C)</p> Signup and view all the answers

    What is typically the most common feature of acute plaque changes in coronary artery disease?

    <p>Rupture or fissuring of plaque (B)</p> Signup and view all the answers

    What type of atherosclerotic lesion is characterized by an increase in macrophages and formation of foam cells?

    <p>Type I Lesion (C)</p> Signup and view all the answers

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

    <p>Neutrophils (C)</p> Signup and view all the answers

    What is the primary cause of essential hypertension?

    <p>Unknown in most cases (A)</p> Signup and view all the answers

    Which risk factor is considered non-modifiable in the pathogenesis of ischemic heart disease?

    <p>Increasing age (A)</p> Signup and view all the answers

    Which type of hypertension is characterized by being a complex, multifactorial disorder and represents 95% of cases?

    <p>Essential hypertension (D)</p> Signup and view all the answers

    Vulnerable unstable plaques in atherosclerosis typically have which characteristic?

    <p>Large lipid cores (C)</p> Signup and view all the answers

    What process involves the migration of monocytes to the intima, leading to the formation of foam cells?

    <p>Endothelial injury (B)</p> Signup and view all the answers

    Which lesion type contains large, confluent collections of extracellular lipid?

    <p>Type IV (C)</p> Signup and view all the answers

    What complication is associated with atherosclerotic plaques, involving rupture, ulceration, and erosion?

    <p>All of the above (D)</p> Signup and view all the answers

    What type of hypertension can develop from conditions related to renal disease, such as chronic renal failure?

    <p>Secondary hypertension (B)</p> Signup and view all the answers

    Which of the following is NOT a major controllable risk factor for atherosclerosis?

    <p>Family history (D)</p> Signup and view all the answers

    Which type of atherosclerotic plaque is likely to produce symptoms related to chronic ischemia?

    <p>Stable plaques (C)</p> Signup and view all the answers

    Which of the following factors contributes to both endothelial cell dysfunction and smooth muscle cell recruitment?

    <p>Chronic inflammation (C)</p> Signup and view all the answers

    Which element is crucial in the renin-angiotensin system for regulating blood pressure?

    <p>Aldosterone (C)</p> Signup and view all the answers

    What distinguishes acute endocarditis from subacute endocarditis?

    <p>Acute endocarditis leads to destruction of a normal heart valve. (C)</p> Signup and view all the answers

    Which microorganism is most commonly associated with infective endocarditis?

    <p>Streptococcus viridans (C)</p> Signup and view all the answers

    What is the role of Aschoff bodies in acute rheumatic fever?

    <p>They are foci of collagen surrounded by lymphocytes. (B)</p> Signup and view all the answers

    Which statement about chronic rheumatic heart disease (RHD) is correct?

    <p>Chronic RHD leads to valvular thickening and retraction. (A)</p> Signup and view all the answers

    Which of the following is NOT a predisposing factor for infective endocarditis?

    <p>Chronic kidney disease (C)</p> Signup and view all the answers

    What characterizes the pathogenesis of acute rheumatic fever?

    <p>Hypersensitivity reaction to M proteins from streptococci. (D)</p> Signup and view all the answers

    What is the likely complication of untreated venous incompetency?

    <p>Crural ulcer (A)</p> Signup and view all the answers

    How does the muscle pump function during the relaxation phase to aid venous return?

    <p>It reduces deep venous pressure facilitating blood return. (D)</p> Signup and view all the answers

    Which assessment method is commonly used for diagnosing varicose veins?

    <p>Doppler ultrasound (C)</p> Signup and view all the answers

    Which of the following is a typical feature of migratory polyarthritis in rheumatic fever?

    <p>Inflammation shifts from joint to joint over time (B)</p> Signup and view all the answers

    What is the consequence of septic emboli from infective endocarditis?

    <p>Septic infarcts in distant organs. (A)</p> Signup and view all the answers

    Which veins are primarily affected in varicose veins?

    <p>Superficial veins. (A)</p> Signup and view all the answers

    What is a key characteristic of the vegetations found in infective endocarditis?

    <p>They are fragile and bulky. (B)</p> Signup and view all the answers

    What happens to blood flow during muscle relaxation in the context of veins?

    <p>Blood enters deep veins as superficial pressure decreases. (C)</p> Signup and view all the answers

    What does the presence of fibrinoid necrosis and vegetations indicate in the context of rheumatic fever?

    <p>Localized inflammation along cardiac valves. (A)</p> Signup and view all the answers

    Flashcards

    What are endothelial cells?

    A specialized lining in blood vessels that controls factors like permeability, coagulation, and blood flow.

    What is the significance of endothelial cell activation?

    Activated endothelial cells contribute to inflammation and blood clotting, while healthy ones prevent these.

    What is LDL oxidation?

    A major process in atherosclerosis, it involves the buildup of cholesterol and other substances within the artery walls.

    What is the role of vascular smooth muscle cells?

    Vascular smooth muscle cells help regulate blood vessel diameter and synthesize important components of the vessel wall.

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    How do smooth muscle cells contribute to atherosclerosis?

    In response to injury, smooth muscle cells move from the outer layer to the inner layer of the vessel, contributing to the thickening of artery walls.

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    How does blood vessel structure differ?

    Blood vessels vary in structure and function based on their location and the demands of the tissue they serve.

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    How is endothelial cell function regulated?

    Endothelial cells are dynamic and their function can change based on various stimuli, leading to different outcomes for blood vessel health.

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    What are some of the key activators of endothelial cells?

    Factors that trigger endothelial cell activation include inflammation, lipid products, advanced glycation end products, and viruses.

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    Atherosclerosis

    A buildup of fatty deposits, inflammation, and scar tissue within the inner lining of arteries, leading to narrowing and hardening of the vessels.

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    Atherogenesis

    The process of atherosclerosis development, involving injury to blood vessel walls, inflammation, and accumulation of lipids.

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    Stable Plaque

    An atheromatous plaque that has a thick fibrous cap, minimal lipid accumulation, and little inflammation.

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    Unstable Plaque

    An atheromatous plaque that has a thin fibrous cap, large lipid core, and significant inflammation.

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    Fatty Streak

    The earliest visible lesion of atherosclerosis, characterized by subendothelial lipid-filled foamy cells.

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    Components of Atheromatous Plaque

    The main components of an atherosclerotic plaque: cells, extracellular matrix, and lipids.

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    Complications of Atherosclerosis

    The rupture of a plaque, ulceration, erosion, bleeding into the plaque, thrombosis, or aneurysmal dilatation.

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    Hypertension

    A sustained increase in blood pressure, often asymptomatic, affecting approximately 25% of the population.

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    Essential Hypertension

    Hypertension with an unknown cause, accounting for 95% of cases. It involves multiple factors like genetics and environment.

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    Secondary Hypertension

    Hypertension caused by identifiable underlying medical conditions.

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    Kidney's Role in Blood Pressure Regulation

    The renin-angiotensin system, prostaglandins & nitric oxide (NO), and sodium reabsorption.

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    Angiotensin II (Ang II)

    A hormone that raises blood pressure by increasing peripheral resistance and blood volume.

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    Prostaglandins & Nitric Oxide (NO)

    A group of hormones that contribute to vasodilation, lowering blood pressure

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    Sodium Reabsorption

    Retention of sodium by the kidneys, leading to increased blood volume and blood pressure.

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    Hypertension as a Risk Factor

    A major risk factor for atherosclerosis, heart failure, and kidney failure.

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    What is Vasculitis?

    A group of disorders characterized by inflammation of blood vessel walls, often accompanied by systemic symptoms like fever, fatigue, and joint pain.

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    Immune complex deposition in vasculitis

    The process of immune complex deposition, where antibodies bind to antigens, forming complexes that deposit in blood vessel walls, triggering inflammation.

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    Antineutrophil cytoplasmic antibodies (ANCAs)

    Autoantibodies targeting neutrophils, a type of white blood cell. These ANCAs can damage blood vessels, leading to vasculitis.

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    Anti-endothelial cell antibodies

    Antibodies that target endothelial cells, the cells lining blood vessels. These antibodies can damage the endothelium, contributing to vasculitis.

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    Giant cell (temporal) arteritis

    A type of vasculitis primarily affecting the temporal arteries, characterized by destructive giant cell granulomas.

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    Takayasu's arteritis

    A type of vasculitis affecting the arteries in the neck, specifically the carotid and subclavian arteries, leading to fibrosis and narrowing of the vessels.

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    Polyarteritis nodosa

    A form of vasculitis affecting medium-sized arteries, often involving the renal arteries. Characterized by necrotizing fibrinous inflammation.

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    Kawasaki disease

    A type of vasculitis primarily affecting young children. It involves the coronary arteries.

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    Microscopic polyangiitis

    A type of vasculitis involving small arterioles, capillaries, and venules. It can be seen in Henoch-Schonlein purpura and Churg-Strauss syndrome.

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    Wegener's granulomatosis

    A type of vasculitis causing destruction, often involving the lungs and kidneys. It can present with granulomas, necrotizing vasculitis, and kidney inflammation.

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    Thromboangiitis obliterans (Buerger's) disease

    A type of vasculitis affecting medium and small arteries, particularly the tibial and radial arteries. It's almost exclusively seen in heavy smokers.

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    Vascular ectasias

    Not true tumors but rather dilations of existing blood vessels.

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    Vascular neoplasms

    Abnormal growths originating from blood vessels or lymphatic vessels. These tumors can be composed of endothelial cells, which line blood vessels, or other vascular wall cells.

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    Hemangiomas

    A common type of benign vascular tumor, composed of endothelial cells.

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    Kaposi sarcoma

    A type of vascular neoplasm with an intermediate degree of malignancy. It can show locally aggressive behavior.

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    Angiosarcoma

    A highly malignant tumor originating from blood vessels. These tumors are solid and often lack regular vessel structures.

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    Aneurysm

    A localized, balloon-like bulge in an artery caused by weakening or destruction of the arterial wall.

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    Dissection

    A tear in the inner lining of an artery, allowing blood to enter the wall and separate the layers.

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    Abdominal Aortic Aneurysm (AAA)

    Aneurysm that occurs in the abdominal portion of the aorta.

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    Thoracic Aortic Aneurysm (TAA)

    Aneurysm that occurs in the chest portion of the aorta (above the diaphragm).

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    Peripheral Aneurysm

    Aneurysms that occur in arteries other than the aorta and brain arteries.

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    Heart Failure

    A condition where the heart is unable to pump blood efficiently to meet the body's needs, resulting in fluid buildup and congestion.

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    Frank-Starling Mechanism

    The heart's ability to increase its output by stretching its muscle fibers, a temporary solution for heart failure.

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    Ventricular Remodeling

    The thickening of the heart muscle in response to increased workload, another temporary solution for heart failure.

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    Neurohormonal Systems Activation

    The body's attempt to maintain blood pressure by activating hormones that constrict blood vessels and retain fluid.

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    Pulmonary Edema

    The buildup of fluid in the lungs, a common complication of heart failure, making breathing difficult.

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    What is infective endocarditis (IE)?

    Infective endocarditis is a serious infection of the heart valves or inner lining of the heart caused by bacteria, fungi, or other microbes. It involves the formation of abnormal growths called vegetations on the heart valves, composed of blood clots, inflammatory cells, and the infecting organisms. These vegetations can damage the heart valves, leading to complications like heart failure, stroke, and even death.

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    What is acute endocarditis?

    Acute endocarditis is a rapidly progressing and severe form of infective endocarditis, typically caused by highly virulent bacteria. It affects previously healthy heart valves and can lead to death within days if not treated promptly.

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    What is subacute endocarditis?

    Subacute endocarditis is a milder form of infective endocarditis that develops more gradually. It usually occurs on pre-damaged heart valves and progresses slowly, allowing for a higher chance of successful treatment.

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    What are predisposing factors for infective endocarditis?

    Predisposing factors for infective endocarditis are conditions or situations that increase a person's risk of developing the infection. These factors include conditions that weaken the heart valves, damage the immune system, or make it easier for microbes to enter the bloodstream.

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    What are the most common causes of infective endocarditis?

    The most common cause of infective endocarditis is Streptococcus viridans, a type of bacteria commonly found in the mouth. Other common culprits include Staphylococcus aureus, especially in people with already damaged heart valves.

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    What is microbial seeding?

    Microbial seeding refers to the process by which microbes enter the bloodstream and reach the heart valves. This can occur through various events like dental procedures, surgery, injections with contaminated needles, or infections in other parts of the body.

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    What is rheumatic heart disease?

    Rheumatic heart disease is an autoimmune reaction to a streptococcal infection (usually strep throat). This inflammation can damage the heart valves, potentially leading to chronic heart problems.

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    What are Aschoff bodies?

    Aschoff bodies are characteristic inflammatory lesions found in the heart muscle during acute rheumatic fever. These lesions are composed of swollen collagen fibers surrounded by immune cells.

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    What is pancarditis?

    Pancarditis is inflammation of all three layers of the heart: the pericardium (outer layer), myocardium (muscle layer), and endocardium (inner lining). It can occur during acute rheumatic fever.

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    What is chronic rheumatic heart disease?

    Chronic rheumatic heart disease is the long-term consequence of repeated or untreated rheumatic fever. It involves scarring and thickening of the heart valves, causing them to malfunction and leading to various heart problems.

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    What are varicose veins?

    Varicose veins are dilated, twisted, and enlarged superficial veins, primarily affecting the legs. These veins often become visible on the skin's surface.

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    What is the venous system?

    The venous system is the network of veins that carry deoxygenated blood back to the heart. This system includes both superficial veins, closer to the skin's surface, and deep veins, located deeper within the muscles.

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    How do muscle pumps work?

    Muscle pumps are mechanisms that help move blood back to the heart, especially in the legs. As muscles contract and relax, they squeeze the deep veins, propelling blood upward against gravity.

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    What is deep vein incompetency?

    Deep vein incompetency is a condition where valves in the deep veins malfunction, allowing blood to flow backward instead of upward. This can lead to blood pooling in the legs and varicose veins.

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    What is venography?

    Venography is a medical imaging technique that uses a contrast dye to visualize the veins, allowing healthcare providers to assess vein health and identify problems like blockages or incompetent valves.

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    Study Notes

    Diseases of Blood Vessels

    • Endothelial cells line blood vessels and maintain permeability barrier. They produce anticoagulants, antithrombotics, and fibrinolytics, including prostacyclin, thrombomodulin, heparin-like molecules, and plasminogen activator.
    • They also produce prothrombotic molecules like von Willebrand factor and tissue factor, and plasminogen activator inhibitor.
    • Endothelial cells produce extracellular matrix (collagen, proteoglycans) and modulate blood flow/reactivity (e.g., vasodilators like NO and prostacyclin, vasoconstrictors like endothelin and ACE).
    • Endothelial cells regulate inflammation and immunity, using molecules like IL-1, IL-6, chemokines, VCAM-1, ICAM, E-selectin and P-selectin.
    • They also regulate cell growth, with stimulators like PDGF and FGF, and inhibitors like heparin and TGF-β.
    • Endothelial cells can be activated by cytokines, bacterial products, hemodynamic stresses, and lipid products, leading to inflammation, and contributing to atherosclerosis.
    • Advanced glycosylation end products (important in diabetes), viruses, complement components, and hypoxia can activate endothelial cells.
    • Vascular smooth muscle cells respond to stimuli to control vasoconstriction and dilation. They synthesize collagen, elastin, and proteoglycans; elaborate growth factors and cytokines; migrate to the intima, and proliferate after vascular injury.

    Vascular Structure and Function

    • All blood vessels are lined by endothelium, with specialized features in specific vascular beds (e.g., fenestrated endothelial cells in renal glomeruli).
    • Vessel wall composition (smooth muscle, matrix) varies according to hemodynamic demands (pressure, pulsatility) and function.
    • Endothelial cell function is tightly regulated in both basal and activated states, with various stimuli inducing activation and dysfunction.

    Atherosclerosis

    • Atherosclerosis forms intimal lesions called atheromas, obstructing vascular lumens.
    • It's the root cause of ischemic heart disease.
    • The American Heart Association classifies atherosclerotic lesions into six types.
    • Atherosclerosis is an intima-based lesion with a fibrous cap and atheromatous core, containing smooth muscle cells, ECM, inflammatory cells, lipids, and necrotic debris.
    • Atherogenesis stems from vessel wall injury and inflammation; various risk factors cause endothelial dysfunction and influence smooth muscle cell recruitment/stimulation.
    • Plaques develop slowly, with stable plaques causing chronic ischemia by narrowing vessels, and unstable plaques causing acute ischemic complications from rupture, thrombosis, or embolization.
    • Stable plaques have a dense fibrous cap, minimal lipid, and little inflammation, while unstable plaques have thin caps, large lipid cores, and dense inflammatory infiltrates.
      • Initial lesions (Type I) show macrophage increase and foam cell formation
      • Fatty streaks (Type II) are lipid-laden smooth muscle cells, followed by intermediate stages (Type III) with scattered extracellular lipid.
      • Atheromas (Type IV) have larger confluent lipid cores.
      • Type V plaques have thicker fibrous connective tissue, and Type VI lesions show more advanced stages with fibrous tissue, fissure(s), hematoma, and a thrombus.
    • Fatty streaks, the earliest lesion, are composed of lipid-filled foamy cells and are seen in the aorta of children over 10 years old. Some streaks can progress to atheromas, mainly in elastic and muscular arteries.
    • Atherosclerotic plaques have three components: cells (SMCs, macrophages), ECM (collagen, elastic fibers, proteoglycans), and intracellular/extracellular lipids (cholesterol, cholesterol esters).
    • Complications: rupture, ulceration, hemorrhage, thrombosis, and aneurysm formation.

    Risk Factors of Ischemic Heart Disease (IHD)

    • Major (Non-modifiable): increasing age, male gender, family history, and genetic abnormalities.
    • Potentially Controllable: hyperlipidemia, hypertension, cigarette smoking, and diabetes.
    • Minor: obesity, physical inactivity, stress, postmenopausal estrogen deficiency, high carbohydrate intake, alcohol intake, lipoprotein Lp(a), and hardened fats.
    • Infection: Chlamydia pneumoniæ

    Atherosclerosis Pathogenesis

    • Chronic endothelial cell injury.
    • Accumulation of lipoproteins (mainly LDLs).
    • LDL oxidation.
    • Monocyte migration to intima, phagocytosis of lipids (foam cells).
    • Platelet adhesion.
    • Smooth muscle cell migration and proliferation.
    • Enhanced lipid accumulation.

    Hypertension

    • Hypertension affects 25% of the population and is a major risk factor for atherosclerosis, heart failure, and renal failure.
    • Essential hypertension (95% of cases) is complex and multifactorial, involving environmental and genetic influences on sodium resorption, aldosterone pathways, and the renin–angiotensin system.
    • Other causes: single-gene disorders, kidney, adrenal, or other endocrine diseases.
    • Major risk factor for coronary artery disease and cerebrovascular accidents.
    • Can lead to heart hypertrophy, heart failure, aortic dissection, and renal failure.

    Hypertension Pathogenesis

    • Multifactorial, with unknown causes in most cases.
    • Defined as sustained diastolic pressure > 90 mmHg or systolic pressure > 140 mmHg.
    • Kidneys play a role: Renin-angiotensin system raises blood pressure, PG/NO lower BP, Na reabsorption maintains blood volume. Natriuretic peptides inhibit Na and renin-angiotensin.
    • Impaired renal function increases blood pressure to compensate for reduced volume.
    • Etiology: increased vascular resistance (e.g., reactivity, wall thickness), increased cardiac output (plasma/ECF volume → renal sodium and water retention),

    Vasculitis

    • Vasculitis is inflammation of vessel walls, often associated with systemic symptoms (fever, malaise, arthralgias) and organ dysfunction.
    • Can be caused by infections or (more often) immunologic factors (immune complex deposition, ANCA, anti-endothelial cell antibodies).
    • Different vasculitis forms affect specific vessel sizes and locations.
    • Pathogenesis of non-infectious vasculitis: immune complex deposition, antineutrophil cytoplasmic antibodies (ANCAs), and anti-endothelial cell antibodies.
    • Types include Giant cell arteritis (temporal arteries), Takayasu's arteritis (carotids, subclavian), polyarteritis nodosa (medium-sized vessels, often renal involvement), Kawasaki disease (coronary arteries in children), microscopic polyangiitis (small vessels), Wegener's granulomatosis (lungs, kidneys), and thromboangiitis obliterans (Buerger's disease, primarily small arteries, smokers).

    Vascular Tumors

    • Vascular ectasias are vessel dilations (not neoplasms).
    • Vascular neoplasms arise from blood/lymphatic vessels. They can be composed of endothelial cells (e.g., hemangioma, lymphangioma, angiosarcoma) or other vascular wall cells (e.g., glomus tumor).
    • Most are benign (hemangiomas), some are locally aggressive (Kaposi sarcoma), and others are highly malignant (angiosarcoma).

    Congenital Cardiac Diseases

    • List of common congenital heart defects with approximate percentages. (Note: Specific percentages are not provided here; use the list from the original text)

    Ischemic Heart Disease (IHD)

    • IHD results from diminished coronary perfusion relative to myocardial demand, often from complex interactions among fixed atherosclerosis, intraluminal thrombosis, platelet aggregation, and vasospasm.
    • 75% coronary artery obstruction causes exertion-related symptoms, while 90% occlusion causes symptoms at rest (angina pectoris).
    • Acute plaque changes leading to thrombosis result in myocardial infarction. Acute plaque changes include rupture/fissuring, erosion/ulceration, and hemorrhage.
    • Morphologic changes in acute MI are detailed in a table (Note: a table is unsupported format for this summary)

    Infective Endocarditis (IE)

    • IE is the colonization/invasion of heart valves/mural endocardium by microbes, forming friable vegetations with thrombotic debris and organisms.
    • Types: Acute (destructive, high mortality, needs surgery) and Subacute (low virulence, abnormal heart).
    • Etiology & Pathogenesis: Predisposing factors include rheumatic heart disease, myxomatous mitral valve, degenerative calcific valvular stenosis.
    • Causative microorganisms: Streptococcus viridans, Staphylococcus aureus, others (enterococci, Hæmophilus, Acinetobacillus, etc.). Gram-negative bacilli and fungi are also sources.
    • Seeding of blood with microbes follows events like dental extraction, surgery, injection with contaminated needles or occult sources (gut, oral cavity).
    • IE leads to vegetations on heart valves, microabscesses in myocardium, and septic emboli/infarcts.

    Rheumatic Heart Disease (RHD)

    • RHD is an acute, immunologically mediated, multisystem inflammatory disease following group A streptococcal pharyngitis.
    • Acute rheumatic carditis can progress to chronic RHD.
      • Focal lesions (Aschoff bodies) are found in various tissues (most distinctive in the heart), consisting of swollen collagen, lymphocytes, and Anitschkow cells.
      • Pancarditis (inflammation in all heart layers) can occur.
      • Chronic RHD involves inflammation organization and fibrosis, causing lasting valvular changes (mitral valve, aortic valve).
    • Pathogenesis: thought to be a hypersensitivity reaction to group A streptococci causing cross-reactivity of antibodies with heart antigens.
    • Clinical features: migratory polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea. Recurrent attacks are possible, with increasing damage over time.

    Varicose Veins

    • Dilatation of superficial veins.
    • Veins are thin-walled, capacious vessels (70% of blood volume).
    • Upright posture, bicuspid valves, muscle pump, and perforant veins between deep and superficial systems are involved.
    • Varicose veins have symptoms including cosmetic issues, pain, inflammation, leg ulcers, and rupture.

    Aneurysm and Dissections

    • An aneurysm is a distended artery due to weakening or destruction of the artery wall, and can be congenital or acquired.
    • An aneurysm is a ballooning in an artery.
    • Complications include rupture, thrombosis, and embolization.
    • Dissection occurs when blood enters the vessel wall and separates its layers, complicating branch vessels.
    • Aneurysms and dissections arise from vessel wall structural weakness (loss of smooth muscle or insufficient ECM).
    • Types of aneurysms include abdominal aortic, thoracic aortic, cerebral aneurysms, and peripheral aneurysms

    Heart Failure

    • Heart failure is a clinical syndrome where the heart cannot adequately provide blood flow to meet metabolic needs.
    • Etiologies include ischemic heart disease (IHD), hypertension, and diabetes (less common: cardiomyopathies, valvular disease, myocarditis, infections, systemic toxins, and cardiotoxic drugs).
    • Compensatory mechanisms often lead to worsening heart failure.
      • Compensation includes the Frank–Starling mechanism, ventricular remodeling, and augmented neurohormonal systems.
    • Pathophysiology: inadequate blood flow to tissues, and increased pulmonary/systemic venous pressures causing organ congestion. This can result from systolic/diastolic dysfunction or both.
    • Left-sided (LV) failure: decreased cardiac output, increased pulmonary venous pressure, fluid extravasation into interstitial space/alveoli (pulmonary edema), decreased systemic oxygenation, and dyspnea.
    • Right-sided (RV) failure: increased systemic venous pressure, fluid extravasation (edema), and organ congestion (liver, abdomen).
    • Sequels are detailed regarding issues like hepatic dysfunction, contributing to fluid buildup, and issues in GI absorption and blood loss.

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    Description

    This quiz explores the structure and function of endothelial cells in blood vessels, including their roles in maintaining vascular health and regulating inflammation, immunity, and blood flow. It also discusses prothrombotic and anticoagulant factors produced by endothelial cells and their implications for diseases related to blood vessels.

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