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Questions and Answers
What is the main characteristic appearance of fibromuscular dysplasia on angiography?
What is the main characteristic appearance of fibromuscular dysplasia on angiography?
- Corkscrew pattern
- Fishnet pattern
- String of beads (correct)
- Solid masses
What causes luminal stenosis in fibromuscular dysplasia?
What causes luminal stenosis in fibromuscular dysplasia?
- Increased blood flow
- Vessel dilation
- Decreased viscosity
- Medial and intimal hyperplasia and fibrosis (correct)
What type of vessels are primarily affected by fibromuscular dysplasia?
What type of vessels are primarily affected by fibromuscular dysplasia?
- Capillaries
- Elastic arteries
- Small veins
- Medium and large muscular arteries (correct)
Which factors do endothelial cells produce that influence the vasoreactivity of smooth muscle cells?
Which factors do endothelial cells produce that influence the vasoreactivity of smooth muscle cells?
What condition can result from renal artery involvement in fibromuscular dysplasia?
What condition can result from renal artery involvement in fibromuscular dysplasia?
What is the known cause of fibromuscular dysplasia?
What is the known cause of fibromuscular dysplasia?
What characterizes endothelial dysfunction?
What characterizes endothelial dysfunction?
What nature do certain forms of endothelial dysfunction often take?
What nature do certain forms of endothelial dysfunction often take?
What vascular condition can be a complication due to a 'String of beads' morphology?
What vascular condition can be a complication due to a 'String of beads' morphology?
What is a characteristic feature of a fatty streak?
What is a characteristic feature of a fatty streak?
Which vessels are typically spared in atherosclerotic plaque formation?
Which vessels are typically spared in atherosclerotic plaque formation?
What is the gross appearance of atherosclerotic plaques?
What is the gross appearance of atherosclerotic plaques?
What factor affects the stability or fragility of an atherosclerotic plaque?
What factor affects the stability or fragility of an atherosclerotic plaque?
What can occur as a clinically important change in an atherosclerotic plaque?
What can occur as a clinically important change in an atherosclerotic plaque?
What causes hemorrhage into a plaque?
What causes hemorrhage into a plaque?
What happens when blood pressure is too low?
What happens when blood pressure is too low?
What is a major risk factor for atherosclerosis?
What is a major risk factor for atherosclerosis?
Which of the following blood pressure measurements indicates clinically significant hypertension?
Which of the following blood pressure measurements indicates clinically significant hypertension?
What does the recruitment of smooth muscle cells (SMC) in response to vascular injury cause?
What does the recruitment of smooth muscle cells (SMC) in response to vascular injury cause?
What role do endothelial cells play in response to vascular injury?
What role do endothelial cells play in response to vascular injury?
Why is both systolic and diastolic blood pressure important?
Why is both systolic and diastolic blood pressure important?
What is a consequence of high blood pressure?
What is a consequence of high blood pressure?
Which is true regarding blood pressure thresholds?
Which is true regarding blood pressure thresholds?
What is the consequence of chronic endothelial cell dysfunction?
What is the consequence of chronic endothelial cell dysfunction?
What condition does chronic high blood pressure contribute to in the long term?
What condition does chronic high blood pressure contribute to in the long term?
What is a characteristic feature of atheromas?
What is a characteristic feature of atheromas?
Which of the following factors can lower plasma cholesterol levels?
Which of the following factors can lower plasma cholesterol levels?
What is the impact of smoking one pack of cigarettes or more daily?
What is the impact of smoking one pack of cigarettes or more daily?
How does obesity affect health in relation to HDL levels?
How does obesity affect health in relation to HDL levels?
What class of drugs inhibits HMG-CoA reductase and lowers circulating cholesterol levels?
What class of drugs inhibits HMG-CoA reductase and lowers circulating cholesterol levels?
Which dietary component is known to be beneficial in increasing HDL levels?
Which dietary component is known to be beneficial in increasing HDL levels?
What is the primary risk factor for left ventricular hypertrophy?
What is the primary risk factor for left ventricular hypertrophy?
Which lifestyle change can reduce the risk associated with cigarette smoking?
Which lifestyle change can reduce the risk associated with cigarette smoking?
What can moderate ethanol consumption do to HDL levels?
What can moderate ethanol consumption do to HDL levels?
What dietary pattern is linked to a higher risk for atherosclerosis?
What dietary pattern is linked to a higher risk for atherosclerosis?
What triggers chronic inflammation in atherosclerosis?
What triggers chronic inflammation in atherosclerosis?
What is the role of Interleukin 1 (IL1) in inflammation?
What is the role of Interleukin 1 (IL1) in inflammation?
Which cells are primarily activated in response to chronic inflammation?
Which cells are primarily activated in response to chronic inflammation?
What do activated macrophages produce to enhance LDL oxidation?
What do activated macrophages produce to enhance LDL oxidation?
Which process is driven by growth factors produced by activated macrophages?
Which process is driven by growth factors produced by activated macrophages?
What is a consequence of IL1 production during chronic inflammation?
What is a consequence of IL1 production during chronic inflammation?
What initiates the activation of inflammasomes during atherosclerosis?
What initiates the activation of inflammasomes during atherosclerosis?
What type of immune cells are primarily affected by the cytokines produced during chronic inflammation?
What type of immune cells are primarily affected by the cytokines produced during chronic inflammation?
What effect do reactive oxygen species from activated macrophages have on LDL?
What effect do reactive oxygen species from activated macrophages have on LDL?
What is primarily recruited to the site of inflammation due to the activation of IL1?
What is primarily recruited to the site of inflammation due to the activation of IL1?
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Study Notes
Fibromuscular Dysplasia
- Focal irregular thickening in medium and large muscular arteries.
- Affects renal, carotid, splanchnic, and vertebral vessels.
- Cause unknown.
- Characterized by medial and intimal hyperplasia and fibrosis, resulting in luminal stenosis.
- Leads to renovacular hypertension when affecting renal arteries.
- "String of beads" appearance on angiography.
- Can lead to vascular outpouching (aneurysms) that can rupture.
Endothelial Cells (ECs)
- Influence vasoreactivity of underlying smooth muscle cells (SMCs).
- Produce both vasodilating (relaxing) and vasoconstrictive factors.
- Vasodilating factors include nitric oxide (NO).
- Vasoconstrictive factors include endothelin.
Endothelial Dysfunction
- Occurs due to altered endothelial phenotype, seen in various conditions.
- Often proinflammatory and prothrombogenic.
- Some forms of endothelial dysfunction are rapid in onset.
Systemic and Local Blood Pressure
- Must be maintained within a narrow range.
- Low pressure leads to inadequate organ perfusion and tissue death.
- High pressure (hypertension) leads to end-organ damage.
- Hypertension is a major risk factor for atherosclerosis.
Clinically Significant Hypertension
- Individuals with diastolic pressure greater than 80 mmHg or systolic pressures greater than 120 mmHg.
Atherosclerosis
- Underlies coronary, cerebral, and peripheral vascular disease.
- Risk factors include acquired, inherited, and gender- and age-associated factors.
Atheromas
- Also known as atheromatous or atherosclerotic plaques.
- Intimal lesions that protrude into vessel lumens.
- Raised lesions with a soft, grumous core of lipid covered by a fibrous cap.
Intimal Thickening
- Vascular injury, associated with EC dysfunction, stimulates SMC recruitment and proliferation.
- Leads to intimal thickening that can compromise vascular flow.
- Endothelial cells migrate from adjacent uninjured areas into denuded areas.
Chronic Inflammation & Atherosclerotic Lesions
- Contributes to both initiation and progression of atherosclerotic lesions.
- Triggered by accumulation of cholesterol crystals and free fatty acids in macrophages and other cells.
- Leads to inflammasome activation, resulting in IL1 production.
Interleukin 1 (IL1)
- Proinflammatory cytokine.
- Recruits and activates mononuclear cells, including macrophages and T lymphocytes.
- Leads to local production of cytokines and chemokines.
Macrophage Activation
- Activated macrophages produce reactive oxygen species, enhancing LDL oxidation.
- Elaborate growth factors that drive SMC proliferation.
T Lymphocyte Activation
- Participate in the growing atherosclerotic plaque.
Fatty Streak
- Collection of foamy macrophages in the intima.
Atherosclerotic Plaque
- Intimal thickening + lipid accumulation = plaque.
Atherosclerotic Plaque: Gross Appearance
- Color can be white-yellow and encroach on the lumen of the artery.
- Can be red-brown due to superimposed thrombus over ulcerated plaque.
- Varies in size and can coalesce to form larger masses.
Clinically Important Changes in Atherosclerotic Plaque
- Vessels of the circle of Willis usually spared.
- Vessels of the upper extremities usually spared.
- Mesenteric and renal arteries usually spared (except at their ostia).
Stability of Atherosclerotic Plaque
- Thickness and ECM content of fibrous cap impact stability and fragility.
- Influences the tendency to undergo secondary changes.
Secondary Changes in Atherosclerotic Plaque
- Rupture, ulceration, or erosion of the intimal surface can induce thrombosis.
- Thrombus can organize and become incorporated into growing plaque.
- Hemorrhage into a plaque can rupture the overlying fibrous cap or thin-walled vessels in areas of neovascularization.
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