Pathophysiology Course-PHMU 534 Lecture 6 PDF

Pathophysiology Course-PHMU 534 Lecture 6 Blood Vessel Diseases Prof. Dr. Nabila Hamdi MD, PhD in Molecular Medicine and Pathology  Outline I. STRUCTURE AND FUNCTION OF BLOOD VESSELS II. VASCULAR WALL RESPONSE TO INJURY III. ARTERIOSCLEROSIS ...

Pathophysiology Course-PHMU 534 Lecture 6 Blood Vessel Diseases Prof. Dr. Nabila Hamdi MD, PhD in Molecular Medicine and Pathology  Outline I. STRUCTURE AND FUNCTION OF BLOOD VESSELS II. VASCULAR WALL RESPONSE TO INJURY III. ARTERIOSCLEROSIS  HYPERTENSIVE VASCULAR DISEASE  Pathogenesis of Hypertension  Vascular Pathology in Hypertension  MONCKEBERG MEDIAL SCLEROSIS  ATHEROSCLEROSIS  Epidemiology  Pathogenesis  Morphology  Clinical Consequences 2  Competencies Demonstrate understanding of the pathophysiological mechanisms of the most relevant diseases of the blood vessels. Utilize the proper medical terms in pharmacy practice. Integrate knowledge from fundamental sciences to relate the mechanisms of disease to their clinical manifestations and possible complications. Recognize the role of physicians as members of the health care professional team and perform responsibilities in compliance with the professional structure. Relate etiology, epidemiology, pathophysiology, laboratory diagnosis, and clinical features of diseases to understand their pharmacotherapeutic approaches  STRUCTURE AND FUNCTION OF BLOOD VESSELS  Regional vascular specializations Elastic arteries Aorta, Iliac, pulmonary Expansion/recoiling Coronary, renal Vasoconstriction/ Vasodilation Arterioles are where blood flow resistance is regulated 4  STRUCTURE AND FUNCTION OF BLOOD VESSELS  Endothelial Cell Properties and Functions Injury or exposure to certain mediators results in endothelial activation, a state in which endothelial cells have adhesive, procoagulant surfaces and release factors that lead to smooth muscle contraction and/or proliferation and matrix synthesis. 5 STRUCTURE AND FUNCTION OF BLOOD VESSELS  Vascular Smooth Muscle Cells  SMC mediate the vasoconstriction or vasodilation that occurs in response to physiologic or pharmacologic stimuli.  Participate in both normal vascular repair and pathologic processes such as atherosclerosis.  When stimulated by various factors, SMC can: proliferate upregulate the production of ECM collagen, elastin, and proteoglycan elaborate growth factors and cytokines 6  VASCULAR WALL RESPONSE TO INJURY Thrombosis Atherosclerosis Hypertensive vascular disease Intimal Thickening: A stereotypical response of the vessel wall to any insult. Infection, inflammation, immune injury, physical trauma (e.g., from a balloon catheter or hypertension), or toxic exposure (e.g. oxidized lipids or cigarette smoke)  Neointimal smooth muscle cells lack the capacity to contract like medial smooth muscle cells, but do have the capacity to divide and have a considerably greater synthetic capacity than their medial colleagues. 7  ARTERIOSCLEROSIS  Arteriosclerosis literally means “hardening of the arteries”  It is a generic term reflecting arterial wall thickening and loss of elasticity.  Three distinct types are recognized, each with different clinical and pathologic consequences:  Hypertensive arteriosclerosis: affects small arteries and arterioles and may cause downstream ischemic injury. Two variants, hyaline and hyperplastic arteriolosclerosis are described in relation to hypertension.  Atherosclerosis is the most frequent and clinically important pattern of arteriosclerosis.  Mönckeberg medial calcific sclerosis is characterized by the presence of calcific deposits (dystrophic calcification) in medium and small muscular arteries, typically in persons older than 50. The lesions do not encroach on the vessel lumen and usually are not clinically significant. 8  ARTERIOSCLEROSIS https://webpath.med.utah.edu/CVHTML/CV168.html Researchgate.net https://radiopaedia.org/cases/monckeberg-medial-calcific-sclerosis?lang=us Medial calcific sclerosis is seen in this artery to the right of thyroid tissue. The arterial lumen is not compromised. Calcium deposits collect The calcified arteries may be visualized on radiographs in the media of muscular arteries. Mönckeberg medial calcific sclerosis 9  HYPERTENSIVE VASCULAR DISEASE Blood Pressure SBP DBP Classification mmHg mmHg Normal