PAS 534 Cardiovascular: Key Terms & Definitions in Biology

What are lipoproteins?

Lipids complexed w/ proteins ("fat-carrying proteins")

What types of lipoproteins can form atherosclerotic plaques?

non-HDL

What lipoprotein do all others come from?

VLDL

What lipoprotein transports triglycerides from liver to peripheral tissues?

VLDL

What lipoprotein is formed from the lipase removal of triglyceride from VLDL?

IDL

What lipoprotein is formed from the lipase removal of triglyceride from IDL?

LDL

What lipoprotein transports cholesterol to body cells

LDL

What lipoprotein removes cholesterol from peripheral tissues?

HDL

What carries triglycerides from the small intestine to body cells?

chylomicrons

High LDL _________ risk for cardiovascular disease

increases

1 multiple choice option

HDL is:

non-atherogenic

1 multiple choice option

VLDL & LDL are:

atherogenic

1 multiple choice option

What is dyslipidemia?

abnormal amounts of lipids in the blood

What would an increase in cholesterol, triglycerides, or lipoproteins in the blood cause?

hyperlipidemia (HLD)

When is hypercholesterolemia confirmed?

↑ total cholesterol (> 200 mg/dL)

When is hypertriglyceridemia confirmed?

↑ triglyceride levels (> 150 mg/dL)

What is primary (familial) dyslipidemia?

Inborn derangement of lipid metabolism and/or transport

What is the most common cause of hyperlipidemia in children?

primary (familial)

What is secondary (aquired) dyslipidemia?

Secondary to other underlying diseases or behaviors

What can cause secondary (acquired) dyslipidemia?

- sedentary lifestyle

- obesity

- DM

- chronic kidney disease

- ETOH consumption

What is atherosclerosis pathogenesis?

Buildup of fats & fatty plaques in arterial walls

What is the first precipitating step in the pathogenesis of atherosclerosis?

endothelial dysfunction

What are risk factors for atherosclerosis that cause endothelial dysfunction?

- HTN

- DM

- smoking

- high LDL

What does activation of endothelial cells by oxidized LDLs cause?

expression of leukocyte adhesion molecules --> inflammation

Inflammation recruits _________ which then differentiate into __________

monocytes; macrophages

How are foam cells formed?

macrophages phagocytize LDL

What do foam cells form?

fatty streak

What is the earliest visible sign of atherosclerosis?

fatty streak

What surrounds the lipid core created by foam cells?

fibrotic cap

What does lipid core surrounded by fibrotic cap create?

atheroma

If the lipid core is expanding and the fibrotic cap is thin, the atheroma is ________ and can ________

unstable; rupture

What are collections of lipid laden foam cells in intimal layer of artery?

fatty streak

What is peripheral arterial disease (PAD)?

Atherosclerotic occlusive disease of the peripheral arteries

What is seen in peripheral arterial disease (PAD)?

Chronic ischemia of affected limb due to restricted blood flow

What is the most important cause of PAD?

atherosclerosis

What is the most common site affected by PAD?

superficial femoral artery (Hunter canal)

What peripheral arteries are most commonly affected by PAD?

lower extremities

What does arterial narrowing in PAD cause?

decrease in blood flow and subsequent tissue ischemia

Atherosclerosis enables:

plaque formation

What does plaque formation in atherosclerosis result in?

vessel narrowing --> increase resistance

What does vessel narrowing in atherosclerosis lead to?

restricted blood flow

Restricted blood flow in atherosclerosis leads to:

chronic ischemia

What are the 5 P's of PAD?

- pulseless

- pale

- reProducible

- pain

- polar

What is the manifestation of pain in PAD?

pain in tissues distal to occlusion

What is intermittent claudication?

reproducible pain with activity & relieved by rest

What is the most common manifestation of PAD?

intermittent claudication

What causes dependent rubor with PAD?

neovascularization

PAD causes a/an ____________ in palpable pulse

decrease

1 multiple choice option

In PAD, skin is __________ but _______ on elevation

dusky red; pale

PAD most commonly occurs in what artery?

superficial femoral

Where is pain most commonly felt in PAD?

calf

What is acute arterial occlusion?

Sudden loss of OR interruption in arterial flow 2/2 arterial occlusion

What is the etiology of acute arterial occlusion?

arterial thrombosis, cardioembolic, trauma (posterior knee dislocation)

What does tissue hypoxia and acidosis in acute arterial occlusion lead to?

hypoxic cellular injury & death

What is the manifestation of acute arterial occlusion?

- acute onset and pain

- skin pallor

- cool skin

- absent pulse

- paralysis

- paresthesia

Prolonged acute arterial occlusion leads to:

irreversible ischemia

What are the 6 P's of critical limb ischemia?

- pain

- paraesthesia

- poikilothermia

- paralysis

- pallor

- pulse deficit

What is class I Rutherford Classification of Acute Limb Ischemia?

viable, not threatened; normal sensory exam

What is class IIa Rutherford Classification of Acute Limb Ischemia?

marginally threatened; minimal sensory loss

What is class IIb Rutherford Classification of Acute Limb Ischemia?

immediately threatened; mild sensory loss

What is class III Rutherford Classification of Acute Limb Ischemia?

irreversible; profound sensory loss

At what Rutherford Classification of Acute Limb Ischemia class is revascularization not an option?

class III

What are arterial aneurysms?

Pathologic dilation of a segment of a blood vessel

What does vessel wall weakness lead to?

aneurysm formation

What are causes of arterial aneurysms?

atherosclerosis, trauma, connective tissue disorders, infections

Anything that ________________ can precipitate aneurysm formation

weakens vascular walls

How do smoking, HTN, and atherosclerosis weaken vascular walls?

inflammation --> release of enzymes --> ECM breakdown

How do Marfan and Ehlers-Danlos weaken vascular walls?

altered ability to form fibrillin/collagen

Untreated aortic dissection or aneurysm may:

rupture

What type of aneurysm involves all 3 layers of vessel walls?

true

1 multiple choice option

What type of aneurysm does not involve all 3 layers of vessel walls?

false

1 multiple choice option

What type of true aneurysm has complete circumferential dilation?

fusiform

What type of true aneurysm involves portion of vessel circumference?

saccular

What type of true aneurysm has small, spherical dilation?

berry

Where are abdominal aortic aneurysms most common?

infrarenal area

Where are thoracic aortic aneurysms most common?

ascending aorta

What is the most common cause of an aortic aneurysm?

atherosclerosis

If someone less than 60 has an aortic aneurysm, what may be the cause?

Marfans, Ehlers-Danlos, bicuspid aortic valve, Turners syndrome

What RF other than atherosclerosis can cause aortic aneurysms?

↑ age, smoking, HTN, genetics, giant cell arteritis

What is the manifestation of a thoracic aortic aneurysm?

substernal CP, back or neck pain, dyspnea, stridor, cough, hoarseness, dysphagia

What is the manifestation of an abdominal aortic aneurysm?

pulsatile abdominal mass, abdominal / back pain, leg pain, numbness or tingling

What triad is associated with rupture of an abdominal aortic aneurysm?

abdominal pain, hypotension, pulsatile abdominal mass

What is an aortic dissection?

Hemorrhage into vessel wall & formation of a blood-filled channel

Where is the tear in an aortic dissection?

innermost layer of aorta (intima)

What occurs when blood flows into the media during aortic dissection?

creation of false lumen

What is the most common cause of aortic dissection?

atherosclerosis

What are the risk factors for aortic dissection?

atherosclerosis, HTN, smoking

How do aortic dissections manifest?

Abrupt onset excruciating tearing/ripping chest pain

Patients describe aortic dissection pain as:

tearing, stabbing, ripping

Where is pain felt in ascending aorta dissection?

anterior chest

Where is pain felt in descending aorta dissection?

back

Though BP increases in early stages of aortic dissection:

BP and pulse may be unobtainable later

What can be seen with aortic dissection?

- pseudohypotension on affected side

- reduced pulses on affected side

What is the Stanford classification type A aortic dissection?

ascending aorta; requires surgery

What is the Stanford classification type B aortic dissection?

descending aorta, beta blockers

The superficial and deep veins are connected by:

perforating veins (allow communication)

What do venous valves prevent?

retrograde blood flow

What acts as a pump for deep veins to move blood from legs to heart?

leg muscles

What are the deep veins?

Tibial, fibular, popliteal, femoral

What are the superficial veins?

Great saphenous vein & small saphenous vein