Podcast
Questions and Answers
Which endothelial cell function is primarily responsible for maintaining blood vessel permeability?
Which endothelial cell function is primarily responsible for maintaining blood vessel permeability?
What role do prothrombotic molecules play in endothelial cell function?
What role do prothrombotic molecules play in endothelial cell function?
Which molecules are known to act as vasodilators in the endothelial response?
Which molecules are known to act as vasodilators in the endothelial response?
What is the main factor that regulates the endothelial cell phenotype during pathophysiologic stimuli?
What is the main factor that regulates the endothelial cell phenotype during pathophysiologic stimuli?
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Which molecule is produced by endothelial cells that contributes to inflammation and immune response?
Which molecule is produced by endothelial cells that contributes to inflammation and immune response?
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Which of the following functions is NOT performed by endothelial cells?
Which of the following functions is NOT performed by endothelial cells?
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What is a critical factor involved in the pathogenesis of atherosclerosis according to the function of endothelial cells?
What is a critical factor involved in the pathogenesis of atherosclerosis according to the function of endothelial cells?
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Which growth inhibitors produced by endothelial cells limit excessive vascular growth?
Which growth inhibitors produced by endothelial cells limit excessive vascular growth?
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What characterizes a thoracic aortic aneurysm (TAA)?
What characterizes a thoracic aortic aneurysm (TAA)?
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Which of the following is NOT a common cause of heart failure?
Which of the following is NOT a common cause of heart failure?
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The term 'berry aneurysm' is associated with which type of aneurysm?
The term 'berry aneurysm' is associated with which type of aneurysm?
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What is a primary complication associated with aneurysms?
What is a primary complication associated with aneurysms?
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In the context of heart failure, which compensatory mechanism aims to maintain tissue perfusion?
In the context of heart failure, which compensatory mechanism aims to maintain tissue perfusion?
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What typically occurs during left ventricular failure leading to pulmonary complications?
What typically occurs during left ventricular failure leading to pulmonary complications?
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Which is a common location for peripheral aneurysms?
Which is a common location for peripheral aneurysms?
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Which of the following statements about dissections is accurate?
Which of the following statements about dissections is accurate?
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Which change in the heart is a direct consequence of the Frank–Starling mechanism in heart failure?
Which change in the heart is a direct consequence of the Frank–Starling mechanism in heart failure?
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What is a likely effect of liver congestion in right ventricular failure?
What is a likely effect of liver congestion in right ventricular failure?
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What is the primary role of natriuretic peptides in the renal system?
What is the primary role of natriuretic peptides in the renal system?
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What is a common immunologic cause of vasculitis?
What is a common immunologic cause of vasculitis?
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Which of the following vasculitis variants primarily affects the temporal arteries?
Which of the following vasculitis variants primarily affects the temporal arteries?
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What type of tumors are hemangiomas classified as?
What type of tumors are hemangiomas classified as?
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What is the primary pathological feature of ischemic heart disease?
What is the primary pathological feature of ischemic heart disease?
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In which condition does 90% obstruction of the coronary artery lumen typically cause symptoms?
In which condition does 90% obstruction of the coronary artery lumen typically cause symptoms?
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Which congenital cardiac defect has the highest prevalence?
Which congenital cardiac defect has the highest prevalence?
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What systemic manifestation is commonly associated with vasculitis?
What systemic manifestation is commonly associated with vasculitis?
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Which of the following features indicates acute myocardial infarction at the 1 to 3-day mark?
Which of the following features indicates acute myocardial infarction at the 1 to 3-day mark?
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Which type of vasculitis is associated with pulmonary and renal involvement?
Which type of vasculitis is associated with pulmonary and renal involvement?
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What is a major consequence of myocardial infarction?
What is a major consequence of myocardial infarction?
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Which congenital defect primarily affects the development of the aorta?
Which congenital defect primarily affects the development of the aorta?
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What is typically the most common feature of acute plaque changes in coronary artery disease?
What is typically the most common feature of acute plaque changes in coronary artery disease?
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What type of atherosclerotic lesion is characterized by an increase in macrophages and formation of foam cells?
What type of atherosclerotic lesion is characterized by an increase in macrophages and formation of foam cells?
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Which of the following components is NOT part of atherosclerotic plaques?
Which of the following components is NOT part of atherosclerotic plaques?
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What is the primary cause of essential hypertension?
What is the primary cause of essential hypertension?
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Which risk factor is considered non-modifiable in the pathogenesis of ischemic heart disease?
Which risk factor is considered non-modifiable in the pathogenesis of ischemic heart disease?
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Which type of hypertension is characterized by being a complex, multifactorial disorder and represents 95% of cases?
Which type of hypertension is characterized by being a complex, multifactorial disorder and represents 95% of cases?
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Vulnerable unstable plaques in atherosclerosis typically have which characteristic?
Vulnerable unstable plaques in atherosclerosis typically have which characteristic?
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What process involves the migration of monocytes to the intima, leading to the formation of foam cells?
What process involves the migration of monocytes to the intima, leading to the formation of foam cells?
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Which lesion type contains large, confluent collections of extracellular lipid?
Which lesion type contains large, confluent collections of extracellular lipid?
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What complication is associated with atherosclerotic plaques, involving rupture, ulceration, and erosion?
What complication is associated with atherosclerotic plaques, involving rupture, ulceration, and erosion?
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What type of hypertension can develop from conditions related to renal disease, such as chronic renal failure?
What type of hypertension can develop from conditions related to renal disease, such as chronic renal failure?
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Which of the following is NOT a major controllable risk factor for atherosclerosis?
Which of the following is NOT a major controllable risk factor for atherosclerosis?
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Which type of atherosclerotic plaque is likely to produce symptoms related to chronic ischemia?
Which type of atherosclerotic plaque is likely to produce symptoms related to chronic ischemia?
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Which of the following factors contributes to both endothelial cell dysfunction and smooth muscle cell recruitment?
Which of the following factors contributes to both endothelial cell dysfunction and smooth muscle cell recruitment?
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Which element is crucial in the renin-angiotensin system for regulating blood pressure?
Which element is crucial in the renin-angiotensin system for regulating blood pressure?
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What distinguishes acute endocarditis from subacute endocarditis?
What distinguishes acute endocarditis from subacute endocarditis?
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Which microorganism is most commonly associated with infective endocarditis?
Which microorganism is most commonly associated with infective endocarditis?
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What is the role of Aschoff bodies in acute rheumatic fever?
What is the role of Aschoff bodies in acute rheumatic fever?
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Which statement about chronic rheumatic heart disease (RHD) is correct?
Which statement about chronic rheumatic heart disease (RHD) is correct?
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Which of the following is NOT a predisposing factor for infective endocarditis?
Which of the following is NOT a predisposing factor for infective endocarditis?
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What characterizes the pathogenesis of acute rheumatic fever?
What characterizes the pathogenesis of acute rheumatic fever?
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What is the likely complication of untreated venous incompetency?
What is the likely complication of untreated venous incompetency?
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How does the muscle pump function during the relaxation phase to aid venous return?
How does the muscle pump function during the relaxation phase to aid venous return?
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Which assessment method is commonly used for diagnosing varicose veins?
Which assessment method is commonly used for diagnosing varicose veins?
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Which of the following is a typical feature of migratory polyarthritis in rheumatic fever?
Which of the following is a typical feature of migratory polyarthritis in rheumatic fever?
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What is the consequence of septic emboli from infective endocarditis?
What is the consequence of septic emboli from infective endocarditis?
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Which veins are primarily affected in varicose veins?
Which veins are primarily affected in varicose veins?
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What is a key characteristic of the vegetations found in infective endocarditis?
What is a key characteristic of the vegetations found in infective endocarditis?
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What happens to blood flow during muscle relaxation in the context of veins?
What happens to blood flow during muscle relaxation in the context of veins?
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What does the presence of fibrinoid necrosis and vegetations indicate in the context of rheumatic fever?
What does the presence of fibrinoid necrosis and vegetations indicate in the context of rheumatic fever?
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Flashcards
What are endothelial cells?
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?
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?
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?
What is the role of vascular smooth muscle cells?
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How do smooth muscle cells contribute to atherosclerosis?
How do smooth muscle cells contribute to atherosclerosis?
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How does blood vessel structure differ?
How does blood vessel structure differ?
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How is endothelial cell function regulated?
How is endothelial cell function regulated?
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What are some of the key activators of endothelial cells?
What are some of the key activators of endothelial cells?
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Atherosclerosis
Atherosclerosis
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Atherogenesis
Atherogenesis
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Stable Plaque
Stable Plaque
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Unstable Plaque
Unstable Plaque
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Fatty Streak
Fatty Streak
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Components of Atheromatous Plaque
Components of Atheromatous Plaque
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Complications of Atherosclerosis
Complications of Atherosclerosis
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Hypertension
Hypertension
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Essential Hypertension
Essential Hypertension
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Secondary Hypertension
Secondary Hypertension
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Kidney's Role in Blood Pressure Regulation
Kidney's Role in Blood Pressure Regulation
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Angiotensin II (Ang II)
Angiotensin II (Ang II)
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Prostaglandins & Nitric Oxide (NO)
Prostaglandins & Nitric Oxide (NO)
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Sodium Reabsorption
Sodium Reabsorption
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Hypertension as a Risk Factor
Hypertension as a Risk Factor
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What is Vasculitis?
What is Vasculitis?
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Immune complex deposition in vasculitis
Immune complex deposition in vasculitis
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Antineutrophil cytoplasmic antibodies (ANCAs)
Antineutrophil cytoplasmic antibodies (ANCAs)
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Anti-endothelial cell antibodies
Anti-endothelial cell antibodies
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Giant cell (temporal) arteritis
Giant cell (temporal) arteritis
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Takayasu's arteritis
Takayasu's arteritis
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Polyarteritis nodosa
Polyarteritis nodosa
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Kawasaki disease
Kawasaki disease
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Microscopic polyangiitis
Microscopic polyangiitis
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Wegener's granulomatosis
Wegener's granulomatosis
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Thromboangiitis obliterans (Buerger's) disease
Thromboangiitis obliterans (Buerger's) disease
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Vascular ectasias
Vascular ectasias
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Vascular neoplasms
Vascular neoplasms
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Hemangiomas
Hemangiomas
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Kaposi sarcoma
Kaposi sarcoma
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Angiosarcoma
Angiosarcoma
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Aneurysm
Aneurysm
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Dissection
Dissection
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Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm (AAA)
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Thoracic Aortic Aneurysm (TAA)
Thoracic Aortic Aneurysm (TAA)
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Peripheral Aneurysm
Peripheral Aneurysm
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Heart Failure
Heart Failure
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Frank-Starling Mechanism
Frank-Starling Mechanism
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Ventricular Remodeling
Ventricular Remodeling
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Neurohormonal Systems Activation
Neurohormonal Systems Activation
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Pulmonary Edema
Pulmonary Edema
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What is infective endocarditis (IE)?
What is infective endocarditis (IE)?
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What is acute endocarditis?
What is acute endocarditis?
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What is subacute endocarditis?
What is subacute endocarditis?
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What are predisposing factors for infective endocarditis?
What are predisposing factors for infective endocarditis?
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What are the most common causes of infective endocarditis?
What are the most common causes of infective endocarditis?
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What is microbial seeding?
What is microbial seeding?
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What is rheumatic heart disease?
What is rheumatic heart disease?
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What are Aschoff bodies?
What are Aschoff bodies?
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What is pancarditis?
What is pancarditis?
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What is chronic rheumatic heart disease?
What is chronic rheumatic heart disease?
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What are varicose veins?
What are varicose veins?
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What is the venous system?
What is the venous system?
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How do muscle pumps work?
How do muscle pumps work?
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What is deep vein incompetency?
What is deep vein incompetency?
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What is venography?
What is venography?
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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.