CLIN PATH: EXAM #1 (ATHERO/HYPERTN/SHOCK)

The aorta, the large arteries, and the arterioles are made up of an outer layer of connective tissue, the _________________.

Adventitia

The middle layer of smooth muscle, the ___________.

Media

The inner layer of smooth muscle is known as what?

Intima

The walls of the aorta and the large arteries contain abundant elastic tissue.

A prominent band between the intima and the media is known as?

A. Internal elastic lamina

B. External elastic lamina

Internal elastic lamina

The walls of the aorta and the large arteries contain abundant elastic tissue.

A prominent band between the media and the adventitia is known as?

A. Internal elastic lamina

B. External elastic lamina

External elastic lamina

The arteries and the arterioles offer considerable resistance to the flow of blood and are known as the _______________.

resistance vessels

On the upstream side, the openings of the capillaries are surrounded by smooth muscle ______________________

precapillary sphincters

The walls of the veins, unlike those of the arteries and arterioles, are easily distended and can expand to hold more blood without much increase in intravascular pressure. Therefore, they are known as __________________.

capacitance vessels

_________________: Helps ensure increased blood flow necessary to support increased tissue activity

A. Autoregulation

B. Vasodilator Metabolites

Vasodilator Metabolites

What three vasodilator metabolites ensure increased blood flow necessary to support increased tissue activity?

CO2, K+, Adenosine

One factor is the myogenic response to stretch of the smooth muscle in arterioles; as pressure inside a vessel rises, its smooth muscle is stretched, and its response is to contract. What regulatory mechanism is this?

A. Autoregulation

B. Vasodilator Metabolites

Autoregulation

What two organs are primarily responsible for autoregulation regulatory mechanism?

Brain and Kidneys

________________ responds to flow changes (shear stress), stretch, a variety of circulating substances, and inflammatory mediators

Endothelium

________________ causes platelet aggregation and vasoconstriction

A. Thromboxane A2

B. Prostacyclin

Thromboxane A2

prostacyclin promotes _______________

vasodilation

Chronic administration of small doses of ____________ reduces intravascular clotting for prolonged periods and is of value in preventing myocardial infarctions, unstable angina, transient ischemic attacks, and stroke

aspirin

NO is produced from arginine in a reaction catalyzed by ________________ (NOS).

nitric oxide synthase

The NO that is formed in endothelial cells diffuses to adjacent vascular smooth muscle cells --> activates soluble guanylyl cyclase --> producing cyclic guanosine monophosphate (cGMP) which mediates relaxation of __________________

vascular smooth muscle

_______ is responsible in large part for reactive hyperemia, the vasodilation and increased blood flow that occur in tissues and organs after a transient obstruction of their blood supply is removed

Nitric Oxide

_____________ is a major local regulator of blood flow

Nitric Oxide

_____________ is acting in a chronic fashion to keep the vascular system dilated

Nitric Oxide

Endothelial cells also produce endothelin-1 (ET-1), the most potent __________________

vasoconstrictor agent

Name 2 principle vasoconstrictors

A. Kinins, Natriuretic peptides

B. Norepi, Epi

Norepi, Epi

Name 3 principle vasodilators

A. Kinins, Natriuretic peptides, Vasoactive intestinal peptide (VIP)

B. Norepi, Epi, Adenosine

Kinins, Natriuretic peptides, Vasoactive intestinal peptide (VIP)

____________ increase blood flow to actively secreting glands by producing vasodilation, and when injected systemically they are relatively potent vasodilators.

A. Norepi

B. Kinins

Kinins

________________: secreted from the atria when atrial myocytes are stretched.

Atrial natriuretic peptide (ANP)

___________________ was originally isolated from the brains of experimental animals, but in humans it is secreted by the ventricular myocytes.

Brain natriuretic peptide (BNP)

Circulating levels are increased in heart failure, and measurement of circulating _________________ is seeing increased use in the differential diagnosis and evaluation of heart failure

β-type natriuretic peptide

____________________ is characterized by localized fibrous thickenings of the arterial wall associated with lipid-infiltrated plaques that may eventually calcify

Atherosclerosis

Old plaques are also prone to ulceration and rupture, triggering the formation of ___________ that obstruct flow

thrombi

Endothelium is subject to _______________ --> most marked at points where arteries branch, and this is where the lipids accumulate to the greatest degree

shear stress

________ are oxidized or altered in other ways --> activate various components of innate immune system including macrophages, natural antibodies, and innate effector proteins such as C-reactive protein and complement

A. HDLs

B. LDLs

LDLs

Where would you expect to see fatty streaks in the first decade of life?

A. Cerebral Arteries

B. Aorta

Aorta

Where would you expect to see fatty streaks in the second decade of life?

A. Cerebral Arteries

B. Coronary Arteries

Coronary Arteries

Where would you expect to see fatty streaks in the 3rd and 4th decade of life?

A. Cerebral Arteries

B. Coronary Arteries

Cerebral Arteries

Oxidized LDLs have a number of deleterious effects, including stimulation of release of proinflammatory cytokines and __________________.

inhibition of NO production

Oxidized LDLs have a number of deleterious effects, including ________________________ and inhibition of NO production.

stimulation of release of proinflammatory cytokines

If acetylcholine is infused via catheter into normal coronary arteries, the vessels dilate; however, if it is infused when atherosclerosis is present, the vessels constrict. This indicates that endothelial secretion of NO is ____________.

defective

If acetylcholine is infused via catheter into normal coronary arteries, the vessels dilate; however, if it is infused when atherosclerosis is present, the vessels _____________.

constrict

Dietary cholesterol and triglycerides are packaged in the protein-coated ______________ in intestinal epithelial cells

chylomicrons

Under the influence of lipoprotein lipase, these particles release triglycerides to fat depots and muscles, and the resulting _______________________ are taken up by the liver

chylomicron remnants

The liver also synthesizes cholesterol and packages it with specific proteins to form ______________________.

very-low-density lipoproteins (VLDLs)

These lipoprotein particles enter the circulation and under the influence of lipoprotein lipase donate triglycerides to tissues --> cholesterol-rich intermediate-density lipoproteins (_____) and low-density lipoproteins (______) --> tissues

IDLs, LDLs

__________________ take cholesterol from peripheral cells and transport it to the liver where it is metabolized, keeping plasma and tissue cholesterol low.

High-density lipoproteins (HDLs)

________________ is generally asymptomatic until one of its complications develops

Atherosclerosis

In coronary arteries, atherosclerotic narrowing that reduces the lumen of a coronary artery more than 75% causes _________________

angina pectoris

In the cerebral circulation, arterial blockage at the site of atherosclerotic plaques causes _________________

thrombotic strokes

In the renal vessels, atherosclerosis clinically manifests as _________________

renovascular hypertension

In the circulation to the legs, ahterosclerosis clinically manifests as intermittent ______________ (fatigue and usually pain on walking that is relieved by rest)

claudication

____________ increases cholesterol removal by the liver, and the progression of atherosclerosis is less rapid in premenopausal women than in men.

Estrogen

Increased plasma levels of _________________ are associated with accelerated atherosclerosis, and the magnitude of the plasma elevation is positively correlated with the severity of the atherosclerosis

homocysteine

Men who smoke a _____________ have a 70% increase in death rate from ischemic heart disease compared with nonsmokers, and there is also an increase in women

pack of cigarettes a day

Lowering cholesterol and triglyceride levels and increasing ______ levels slows, and in some cases reverses, the atherosclerotic process

HDL

Because of the increased shear stress imposed on the endothelium by an elevated blood pressure, ______________- is another important modifiable risk factor for atherosclerosis

hypertension

In _______________, there are microvascular complications and macrovascular complications --> the latter are primarily related to atherosclerosis

diabetics

The nephrotic syndrome and hypothyroidism also accelerate the progression of _________________ and are treatable conditions

Atherosclerosis

What do you classify HTN where the cause is unknown?

Essential HTN (Primary HTN)

What do you classify HTN where the cause is known? (Ex: renal HTN, Cushing's Syndrome, Pheochromocytoma, Estrogen "pill HTN")

Secondary HTN

HTN increases ____________

A. Afterload

B. Preload

Afterload

β-adrenergic blocking drugs, inhibitors of the renin-angiotensin system, Ca2+channel inhibitors, and diuretics reduce blood pressure to help control ______

HTN

___________________: Congenital narrowing of the aorta usually occurs just distal to the origin of the left subclavian artery

Coarctation of the Aorta

_______________: Blood pressure is elevated in the arms, head, and chest but lowered in the legs

Coarctation of the Aorta

About 30% of whites with normal renal function and normal blood pressure are _________________ compared with 55% of AA with essential hypertension.

salt sensitive

___________________ increased blood pressure --> activation of RAS

Renal artery constriction

_________________ – primary hyperaldosteronism (Conn’s disease) is caused by a tumor in the adrenal cortex that secretes large amounts of aldosterone leading to HTN

Mineralocorticoid excess

Glucocorticoid excess: Excess secretion of catecholamines (__________________) - INC secretion of norepinephrine INC systolic and diastolic pressure

pheochromocytoma

OBESITY: Insulin resistance and hyperlipidemia are more prevalent with essential ______

HTN

Hypovolemic, Distributive (vasogenic or low-resistance), Cardiogenic, and Obstructive are all types of what?

A. Shock

B. HTN

Shock

If hypotension is prolonged, the build up of nitrogenous wastes (______________) can cause severe renal tubular damage & acute renal failure

prerenal azotemia