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Name the 3 layers of a blood vessel
1. Intima - lined by a single layer of endothelial cells (innermost layer)
2. Media - composed primarily of smooth muscle
3. Aventitia - composed of connective tissue (outermost layer)
Summarize the response-to-injury hypothesis regarding the pathogenesis of atherosclerosis and atherosclerotic plaques
1. Chronic endothelial injury
2. Causes damage to the endothelium (intima)
3. That causes emigration & activation of monocytes/macrophages
4. That causes emigration & proliferation of smooth muscle cells from the media into the intima
5. that results in deposition of cholesterol and other lipids at the site
6. that becomes covered with fibrosis forming fibrous plaque (atheroma)
7. Then the plaque may enlarge occluding the vessel lumen (stenosis) or undergo further degenerative changes resulting in plaque ulceration/rupture with thrombosis
Name the 4 stages of atherosclerosis
1. endothelial injury
2. fatty streak
3. fibrofatty plaque (aka fibrolipid plaque, atheroma)
4. advanced calcified/complicated (ulcerated) plaque
What are the 4 clinical complication of atherosclerosis
What are common effects of atherosclerosis with involvement of the cerebral arteries
TIAs, cerebral infarctions (stroke)
What are common effects of atherosclerosis with involvement of the celiac & mesenteric arteries
intestinal ischemia (angina) & infarction
What are common effects of atherosclerosis with involvement of the iliofemoral arteries
peripheral vascular disease (intermittent claudication), legs gangrene
The regulation of normal blood pressure is a function of what 3 components?
BP = CO x TPR (resistance of small arterioles at the periphery)
Distinguish between primary (essential) and secondary hypertension.
• Essential hypertension represents 90% to 95% of cases of hypertension and is a complex, multifactorial disorder resulting most likely from the combined effect of mutations or polymorphisms at several gene loci (e.g., sodium resorption, renin-angiotensin system, aldosterone) in association with a variety of environmental influences.
• Secondary hypertension is caused by diseases of the kidneys or endocrine glands. Underlying causes are treatable:
-chronic renal failure
-renal artery stenosis
-coarctation of the aorta
Differentiate between Stable angina pectoris and unstable angina pectoris
stable angina pectoris = a result of arteries stenosis
occurs with exertion
the heart demand for oxygen is increased greater than can be supplied by coronary arteries
goes away with rest or vasodilation (e.g. nitroglycerin under tongue)
unstable angina pectoris = a result of artery occlusion with thrombus
usually occurs at rest, and classically at night
the heart demand for oxygen is not increased
not related to exertion
is not relieved with rest
What area of the heart does the LAD supply
anterior left ventricle
anterior 2/3rds of the septum
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