Exam 2 Patho Cardiac portion

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What are pulmonary and systemic circulations?

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What are pulmonary and systemic circulations?

<p>- Pulmonary: Blood going to the lungs</p><p>- Systemic: Body wide</p>

- Pulmonary: Blood going to the lungs

- Systemic: Body wide

<p>- Pulmonary: Blood going to the lungs</p><p>- Systemic: Body wide</p>
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What is pressure and volume distribution of the heart?

<p>4% of blood in L heart</p><p>16% of blood in arteries and arterioles</p><p>4% of blood in capillaries</p><p>64% in venules and veins</p><p>4% in right heart</p><p>Reference picture for pressure</p>

4% of blood in L heart

16% of blood in arteries and arterioles

4% of blood in capillaries

64% in venules and veins

4% in right heart

Reference picture for pressure

<p>4% of blood in L heart</p><p>16% of blood in arteries and arterioles</p><p>4% of blood in capillaries</p><p>64% in venules and veins</p><p>4% in right heart</p><p>Reference picture for pressure</p>
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What are the layers of the heart?

<p>endocardium, myocardium, epicardium (visceral pericardium), pericardial cavity, parietal pericardium, fibrous pericardium</p>

endocardium, myocardium, epicardium (visceral pericardium), pericardial cavity, parietal pericardium, fibrous pericardium

<p>endocardium, myocardium, epicardium (visceral pericardium), pericardial cavity, parietal pericardium, fibrous pericardium</p>
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What is the flow through the heart?

<p>-venous blood comes from the superior/inferior vena cava</p><p>-filters into the right atrium</p><p>-passes the tricuspid valve</p><p>-filters into right ventricle</p><p>-passes the pulmonary valve</p><p>-goes to the pulmonary trunk and then the right and left pulmonary arteries</p><p>-Right and Left lungs give O2</p><p>-blood rushes back into the left atrium</p><p>-passes the mitral valve (bicuspid valve)</p><p>-filters into the left ventricle</p><p>-passes the aortic valve</p><p>- goes to the aorta and rest of the body</p>

-venous blood comes from the superior/inferior vena cava

-filters into the right atrium

-passes the tricuspid valve

-filters into right ventricle

-passes the pulmonary valve

-goes to the pulmonary trunk and then the right and left pulmonary arteries

-Right and Left lungs give O2

-blood rushes back into the left atrium

-passes the mitral valve (bicuspid valve)

-filters into the left ventricle

-passes the aortic valve

- goes to the aorta and rest of the body

<p>-venous blood comes from the superior/inferior vena cava</p><p>-filters into the right atrium</p><p>-passes the tricuspid valve</p><p>-filters into right ventricle</p><p>-passes the pulmonary valve</p><p>-goes to the pulmonary trunk and then the right and left pulmonary arteries</p><p>-Right and Left lungs give O2</p><p>-blood rushes back into the left atrium</p><p>-passes the mitral valve (bicuspid valve)</p><p>-filters into the left ventricle</p><p>-passes the aortic valve</p><p>- goes to the aorta and rest of the body</p>
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What are the valves of the heart?

<p>Right and left atrioventricular (AV); aortic and pulmonic valves (semilunar valves)</p>

Right and left atrioventricular (AV); aortic and pulmonic valves (semilunar valves)

<p>Right and left atrioventricular (AV); aortic and pulmonic valves (semilunar valves)</p>
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What are the artery layers?

<p>tunica externa, tunica media, tunica intima</p>

tunica externa, tunica media, tunica intima

<p>tunica externa, tunica media, tunica intima</p>
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What are the differences between artery, vein, and capillary?

<p>Artery: round with thick boarder; largest, increased pressure, hollow, away from heart (usually oxygenated)</p><p>Vein: bendable, thin and squishy, goes toward heart</p><p>Capillary: smallest, "purple," connecting point between artery and vein</p>

Artery: round with thick boarder; largest, increased pressure, hollow, away from heart (usually oxygenated)

Vein: bendable, thin and squishy, goes toward heart

Capillary: smallest, "purple," connecting point between artery and vein

<p>Artery: round with thick boarder; largest, increased pressure, hollow, away from heart (usually oxygenated)</p><p>Vein: bendable, thin and squishy, goes toward heart</p><p>Capillary: smallest, "purple," connecting point between artery and vein</p>
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What is coronary artery disease?

atherosclerosis of the coronary arteries

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What is coronary heart disease?

the same as coronary artery disease

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What is the issue with coronary artery disease?

deprives heart of oxygen

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What is the leading cause of heart attack or stroke?

atherosclerosis

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What is an atheroma?

<p>cholesterol rich plaque</p>

cholesterol rich plaque

<p>cholesterol rich plaque</p>
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What is the issue with an atheroma?

allows less blood flow, causing less oxygen delivery

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Coronary artery disease can be _____.

systemic

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What is arteriosclerosis?

hardening of the arteries, part of the normal aging process

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What is the issue with arteriosclerosis?

Become less compliant in the hardening process, is not as elastic so causes higher BP

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What is the stroke volume?

the amount of blood ejected by the heart in any one contraction; 70 mL

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What is something important to take away from atherosclerosis?

it is not a single disease

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What are the 5 arteries that are more likely to be clogged?

1) abdominal aorta, 2) coronary arteries, 3) femoral/popliteal arteries, 4) internal carotid arteries, 5) vertebral, cerebral, basilar

- In order of frequency to be clogged

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Information about the abdominal aorta?

- size of a quarter, can get more clogged since so big

- most common for cholesterol build up

- ilia region

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Information about the coronary arteries?

- size of coffee straw, so small can tell effects easier

- heart

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Information about the femoral/popliteal arteries?

- build up here causes cut off blood to legs, peripheral

- leg and back of knee

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Information about the internal carotid arteries?

- increases risk stroke

- neck going up

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Information about the vertebral/cerebral/basilar arteries?

- increases risk of stroke

- clavicle region and L region

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What are some nonmodifiable risk factors of atherosclerosis?

1. age: as get older arteries harden and cholesterol builds up

2. biological sex

3. genetic predisposition: familial hypocholesterolemia

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Why does biological sex affect risk of getting atherosclerosis?

- females are less likely to get than age matched males before menopause

- after menopause they are the same (estrogen drops)

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What is a modifiable risk factor for atherosclerosis?

- hypercholesterolemia

- hypertension

- hyperhomocysteinemia

- inadequate diabetes mellitus care

- tobacco use

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What are some primary causes of hypercholesterolemia?

- defective synthesis of apoproteins (transport lipids)

- means that the body physically cannot make the transport lipids

- lack of receptors for the lipids to bind to

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What are some secondary causes of hypercholesterolemia?

obesity, diabetes mellitus, increased cholesterol intake from diet

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Why are lipids insoluble in plasma?

they are primarily water

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How are lipids transported?

lipoproteins

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What are the protein component in lipoproteins?

apoproteins

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What are some examples of apoproteins?

A,B,C, and E

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What are the things transported in lipoproteins?

triglycerides, phospholipids, cholesterol

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Where are triglycerides found?

in American diets

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What are the exogenous and endogenous pathways for triglyceride and cholesterol transport?

<p>map out the picture shown</p>

map out the picture shown

<p>map out the picture shown</p>
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What and where does chylomicron drop off?

triglycerides; adipose and skeletal muscle tissue

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What and where does LDLs drop off?

cholesterol; LDL receptor on the liver

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If cholesterol enters the blood stream, who would pick it up to take it to the liver?

HDLs

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How are lipoproteins classified?

by density

more protein = higher density

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HDLs are?

high density lipoproteins; lots of this is healthy

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LDLs are?

low density lipoproteins; lots of this lethal

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Why is cholesterol important?

- part of plasma membrane

- helps with production of estrogen, progesterone, testosterone, vitamin D, adrenal gland cortisol, aldosterone

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What does cortisol stress do?

- reduces B cell, T cell, Cytoxic cell productions

- lack vitamin D

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What are low density?

chylomicrons and LDLs

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What are high density?

HDLs

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What is the percentage of carrying for chylomicrons?

80-90% of triglycerides, 2% proteins

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What is the percentage of carrying for LDLs?

10% triglycerides, 50% cholesterol, 25% protein

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What is the percentage of carrying for HDLs?

5% triglycerides, 20% cholesterol, 50% protein

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Chylomicrons are in where?

small intestine

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LDLs are made by what?

hepatocytes

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When LDLs drop of cholesterol what is it used to make?

estrogen, progesterone, and testosterone

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Where does the rest of the cholesterol go?

On LDL receptor to the small intestine to be excreted

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If there is an excessive amount of cholesterol, it will attract what?

macrophages

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What is hypertension?

high blood pressure

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Hypertension does what in regards to anthromas?

increases risk of anthroma

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What is normal BP?

120/80 mmHg

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What does mmHg mean?

millimeters of mercury

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Why is it mmHg?

how far the BP can push a column of mercury

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What does the 120 stand for?

Refers to the systolic pressure (Ventricular Contraction)

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What does the 80 stand for?

Refers to the diastolic pressure (Ventricular Relaxation)

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What is stroke volume?

the amount of blood ejected by the heart in any one contraction (ventricle per minute)

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What is ejection force?

how forceful the blood is

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What influences ejection force?

blood calcium levels

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How does blood calcium levels influence ejection force?

more calcium = more contraction = more force

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What is artery compliance?

elasticity of artery

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How does atherosclerosis relate to artery compliance?

no give to arteries (increases BP)

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What are the 3 things that influence systolic pressure?

stroke volume, ejection force, artery compliance

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What influences diastolic pressure?

peripheral resistance

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What is peripheral resistance?

resistance of the arteries to blood flow moving forward

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What influences peripheral resistance?

- a lot of capillaries (very big to small)

- think of a highway to an ally

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If you weigh more, you will have more what?

capillaries

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What does the RAAS system stand for?

renin-angiotensin-aldosterone system

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where does RAAS take place?

kidneys, lungs, liver,

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What does the RAAS do?

responsible for regulation of body's blood pressure by Juxtaglomerular (JG) cell

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Some examples of what makes low BP?

dehydration and body positions

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What is the flow of RAAS?

<p>draw out and reference photo here and in book</p><p>pg 718</p>

draw out and reference photo here and in book

pg 718

<p>draw out and reference photo here and in book</p><p>pg 718</p>
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People with high BP will take what?

ACE inhibitor supplements

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What will ACE inhibitors do?

it will inhibit production of ACE production from Angiotensin I (this causes vasoconstriction), which allows for vasodilation

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What is essential (primary) hypertension?

- increases with age

- more common in men than women (equal after menopause)

- more common in Black people

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What produces renin in the kidneys?

JG cells

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What organ produces ACE?

lungs

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What organ produces angiotensinogen?

liver

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What is the other way that the body raises BP?

neurohypophysis

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What is neurohypophysis?

posterior lobe of the pituitary gland

- produces antidiuretic hormone to conserve water to higher blood volume to higher BP

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What happens with chronic untreated hypertension?

- left ventricular hypertrophy

- retinopathy

- kidney disease

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What is the issue with left ventricular hypertrophy?

has to work harder to open aoritc valve (smaller lumen and more o2 and muscle too thick to contact symmetrically)

- think open a door with lots of people outside

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What is the issue with retinopathy?

causes blindness (due to pressure)

- damages blood vessels

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What is the issue with kidney diseases?

higher BP causes kidney cell damage

- consequences: no regulate BP, accumulate metabolic waste

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What is hyperhonocysteinemia?

- too much homocystein (inhibits anticoagulation cascade)

- clot would persist longer

- heavy coffee drinking is associated with high levels

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how to lower homocysteine levels

- take folate to lover levels

- vegetables/multivitamins

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What is diabetes mellitus?

An error in glucose metabolism

- primarily causes high glucose levels, increases free radicals

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What are long term effects of diabetes mellitus?

- reduces nitric oxide: creates higher BP

- abnormal metabolites: increases thrombus, formation, promotion of inflammation

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What does nitric oxide do?

vasodilation

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What is the issue with tobacco use?

- smoking a pack a day increases likelihood of coronary thrombosis and heart attack

- when acute myocardial infarction does occur it is more fatal in smokers

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Why is smoking very dangerous/causes high BP?

- damages vascular endothelium

- enhances platelet aggregation

- lowers HDL levels

- nicotine stimulates release of epinephrin and norepinephrine (vasoconstriction)

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What are the functions of endothelium tissue?

- regulates platelet adhesion

- regulates immune/inflammatory reactions

- regulars smooth muscle cell growth

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What are the 5 portions of development of atherosclerosis in the abdominal aorta?

- damage to endothelial cells (the ones that make up the tunica intimia)

- blood platelets and lipoprotein deposits

- platelets release growth factors that penetrate into vessel wall

- monocytes adhere to the injured endothelium

- proliferating smooth muscle and fibroblast surround fatty streak

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What can damage the endothelial cells?

- increased cholesterol = macrophages swarm area = inflammation

- smoking

- higher BP

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What happen with the blood platelets and lipoprotein deposits?

- high LDLs will deposit these on the inside lining and aggrogate

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