Pathology Long Exam 3 - Cardiovascular Pathology

Hypertension

It is a heart disease that is related to high blood pressure.

Essential Hypertension

It is the most common type of hypertension responsible for about 90-95% of hypertension cases.

Secondary Hypertension

It is a type of hypetension that is caused by underlying conditions like renal artery disease.

Atherosclerosis, Heart Failure, Multi-Infarct Dementia, Aortic Dissection, Renal Failure

Hypertension increases risk for what conditions (AHMAR)?

True

True or False:
Essential hypertension is known to be idiopathic which means it has no identifiable cause.

Genetic factors, Insufficient renal sodium excretion, Vasoconstrictive influence, Environmental factors

What are some of the major factors that contribute to hypertension?

Insufficient Renal Sodium Excretion

What factor that contributes to hypertension is said to be the key intiating event and final common pathway?

Cardiac Output and Peripheral Vascular Resistance

What two factors are multiplied to account for blood pressure?

High blood volume, Stronger contraction, Constricted blood vessels

What are the possible causes for high blood pressure?

Sodium

What key factor in blood pressure homeostasis is excreted by the kidneys?

Increase Dietary Intake

How can a person increase his sodium levels?

Increase in BP

What will happen if there is an increase in sodium levels?

Stretch of the Heart

How is the volume of the heart detected?

Atrial Natriuretic Peptide

What does the heart secrete when it detects a volume overload?

Natriuresis

It is a process that describes the excretion of salt in urine.

False

True or False:
Vasoconstriction of peripheral vessels will lead to an increase in PVR.

True

True or False:
The kidney requires a steady blood flow

Glomerulus

The kidney can detect the amount of blood present via what?

Renin-angiotensin-aldosterone system

If there a decrease in blood flow by any cause, what is triggered?

Angiotensin I

In the RAAS, what does renin convert angiotensinogen to?

Lungs

In the RAAS, angiotensin I is converted to angiotensin II, where?

Angiotensin-converting enzyme

What enzyme helps convert angiontensin I to angiotensin II?

Aldosterone

In the RAAS, Angiotensin II stimulates the section of what?

Adrenals

In the RAAS, where does the stimulation brought upon by Angiotensin II occur?

Peripheral Vasoconstriction

Except the stimulation to secrete aldosterone, angiotensin II is also known to cause what?

Increase sodium reabsorption in kidneys

What does aldesterone do?

Intima

Episodes of increased blood presure can cause vascular injury, it can cause smooth muscle migration and thickening in what layer of the blood vessel?

Hyaline Arteriosclerosis

You examine a histology slide, you observed that there is a homogenous, and pink thickening in the hyaline, where the intima thickens and the lumen narrows. What condition is being shown by the slide?

True

True or False:

The signs of hyaline arteriosclerosis can be present even in elderly normotensive patients.

Hyperplastic arteriolosclerosis

It appears as a concentric laminations, bearing a resemblance to an “onion-skin”.

Severe Hypertension

You examine a histology slide and notice onion-like laminations in the slide. This means that the patient experienced what?

False

Ventricular hypertrophy leads to lower blood pressure.

Heart Failure

When there is continous salt intake and insufficient excreation, it will result to a higher “normal” blood pressure which will lead to an adaption via ventricular hypertrophy. If there are maladaptive changes, what does it lead to?

Hypertensive Heart Disease

What is the most common cause of heart failure?

Ventricular Hypertrophy Maladaptation

What is the second monst common cause of heart failure?

RAAS

What is the main mechanism involved in hypertension?

ACE-i

What type of medication do captopril and enalapril fall into?

ARB

What type of medication do losartan, telmisartan, and valsartan fall into?

CCB

What type of medication does amlodipine fall into?

Thiazide Diuretics

What type of medication does hydrochlorothiazide fall into?

Arteriosclerosis

It is characterized by the hardening of arteries, involving thickening of the arterial wall and the loss of its elasticity.

Atherosclerosis

It is described as the chronic inflammatory and healing response of the arterial wall to injury.

Response to injury hypothesis

The currently accepted hypothesis for atherosclerosis is:

Arterial wall

Atherosclerosis primarily involves which structure?

Coronary, cerebral, and peripheral vascular diseases

Atherosclerosis underlies the pathogenesis of:

Genetics

Which of the following is a non-modifiable risk factor?

Hyperlipidemia

Which is a modifiable risk factor?

Hyperlipidemia

The MOST important modifiable risk factor is:

Be sufficient by itself to cause atherosclerosis

Hyperlipidemia can:

Endothelium of arteries

The injury in atherosclerosis primarily affects the?

Hyperlipidemia, hypertension, smoking

Which combination is listed as causes of endothelial dysfunction?

Enhanced leukocyte adhesion

One of the early responses to endothelial injury is:

Permeability

Endothelial injury leads to increased:

Monocytes

Which cells migrate to the site of injury?

Entry of substances into the vessel wall

Increased permeability in atherosclerosis allows:

macrophages

In atherosclerosis, monocytes mature into what eventually?

Trapped in damaged endothelium

In antherosclerosis, circulating lipids such as LDL are what?

Small flat yellow macules

In the process of atherosclerosis, fatty streaks initially appear as?

Coalesce into streaks

The fatty streaks in atherosclerosis have the ability to further differentiate; eventually, they become what?

Precursors for plaques

These fatty streaks are considered as what?

No

It has been mentioned that the fatty streaks can change, do all fatty streaks progress to this change?

Atherosclerotic plaques

These yellow-tan presenting plaques are located on the wall of a blood vessel. They are typically patchy and not circumferential.

False

True or False:
Atherosclerotic or atheromatous plaques do not cause flow disturbances.

Smooth muscle cells and macrophages

Which cells are included in plaque components?

Hemoglobin

Which of the following is NOT one of the four principal components of an atheromatous plaque?

Late stage

Calcifications in plaques typically occur when?

Smooth muscle cells and dense collagen

Atherosclerotic plaque contains a fibrous cap, which is composed of what substances?

superimposed thrombus

Atherosclerotic plaques may develop over what ulcerated plaques?

Clinical outcomes of the plaque

The thickness of the fibrous cap of an atherosclerotic plaque influences:

Vulnerable

A thin fibrous cap in an atherosclerotic plaque is considered:

Plaque rupture and thromboembolism

A thin fibrous cap in an atherosclerotic plaque is most associated with:

Thromboembolism

Rupture of an atherosclerotic plaque with a thin fibrous cap may lead to:

Sudden cardiovascular events

Atherosclerotic plaques with thin fibrous caps are associated with:

Stable

A thick fibrous cap in an atherosclerotic plaque is considered:

Continuous arterial narrowing

Atherosclerotic plaques with thick fibrous caps are associated with:

Stenosis and ischemia

Continuous narrowing caused by stable atherosclerotic plaques with thick fibrous caps leads to:

Ischemia

Reduced blood flow due to progressive narrowing from stable atherosclerotic plaques results in:

Without causing signs or symptoms for a long time

In atherosclerosis, plaques may continue to grow:

Stenosis

Severe narrowing of the arterial lumen in atherosclerosis is called:

ischemia

Stenosis in atherosclerosis leads to:

Presence of major risk factors

The prognosis of atherosclerosis depends primarily on:

HMG-CoA reductase inhibitors (statins)

Which class of drugs is used in the management of modifiable risk factors in atherosclerosis?

Sudden onset manifestation of ischemic heart disease due to ischemia

Acute coronary syndrome (ACS) is defined as:

Ischemia

The underlying cause of acute coronary syndrome is:

Coronary artery disease

Acute coronary syndrome is also associated with:

Based on types of myocardial infarction and angina

Which best describes ACS classification?

STEMI, NSTEMI, unstable angina

Which grouping correctly lists all types of ACS?

Frank cardiac necrosis due to severe ischemia

Myocardial infarction is best defined as:

Ischemia → hypoxia → necrosis and infarction

The sequence leading to myocardial infarction is:

Hyperlipidemia, hypertension, smoking, diabetes mellitus

Which of the following correctly lists risk factors for myocardial infarction?

Subendothelial collagen and necrotic core

Disruption of an atherosclerotic plaque exposes:

Platelet aggregation

Exposure of subendothelial collagen leads to:

Platelet plug

Platelet aggregation results in the formation of:

Growing thrombus

Activation of coagulation factors leads to:

Complete occlusion of the lumen

A growing thrombus ultimately causes:

Cardiac tissue necrosis and infarction

Cessation of blood flow in coronary arteries leads to:

Cardiac tissue necrosis and infarction

Cessation of blood flow in coronary arteries leads to:

Plaque disruption → platelet aggregation → thrombus formation → occlusion

The sequence of events in myocardial infarction pathogenesis is best described as: