Exam Bank Solution Manual for Cardiovascular Pathology Rated 100%

Exam Bank Solution Manual for Cardiovascular Pathology Rated 100% What are the reasons for essential (primary) hypertension? - Answers Genetic variation that causes: - Increased basal level of sympathetic tone - Altered Na/K transport efficiency - Hyperactive renin-aldosterone system What are the causes of secondary HTN? - Answers - Renal diseases * Chronic renal failure * Renal Artery Stenosis * Glomerulonephritis - Endocrine Diseases * Secretory adrenal tumors (ADO, catecholamines) * Cushing's syndrome (cortisol) - Coarctation of the aorta - Drugs (corticosteroids, OCP, NSAIDs) What is Malignant Hypertension? - Answers - Unexplained, severe hypertension (200/120) - Least common, most emergent - young AA males - Causes Heart failure, renal failure, blurred vision, headache, cerebral hemorrhage What is CHF? - Answers - Inability of the heart to pump sufficient blood w/o extraordinary effort - Usually starts with problems on left, but progresses to both What causes Right-sided heart failure? - Answers - Pulmonary hypertension - Lung diseases - Pulmonary embolism - Valve damage Symptoms of Right-sided heart failure? - Answers - Diffuse edema (due to systemic congestion) - Hepato- and Splenomegaly - Ascites What causes Left-sided heart failure? - Answers - Damaged myocardium - Increased systemic pressure - Valve damage What are the symptoms of Left sided heart failure? - Answers - SOB (due to pulmonary congestion) - Orthopnea - Paroxysmal nocturnal dyspnea What is low output and high output? - Answers Low output= inability of heart to pump a normal amt of blood High Output= Inability of heart to compensate for a greater need of blood (pregnancy, water retention, cirrhosis, severe anemia) What is the normal range for ejection fraction (EF= SV/EDV)? - Answers 50-75% What is systolic failure? - Answers Heart contractions are ineffectual due to dilation or damage (EF 40%) What is diastolic failure? - Answers Poor refill of chamber after contraction due to stiff chamber wall (fibrosis, amyloidosis, restrictive pericardium) - EF is normal or increased Possible causes of edema - Answers - Increased vascular permeability (inflammation, allergy, burns, shock) - Increased venous hydrostatic pressure (thrombosis, heart failure) - Increased interstitial hydrostatic pressure (lymphatic obstruction- tumor, radiation fibrosis) - Decrease vascular oncotic pressure (nephrotic syndrome, liver disease, malnutrition) What serosal cavities can have edema? - Answers - Pericardial effusion - Pleural effusion - Peritoneal effusion (ascites) That is the difference between transudate vs. exudate edema? - Answers Transudate has less protein (2 g/dL) and has mostly benign causes Exudate has higher protein content and more serious causes What labs will you order than can indicate liver congestion? - Answers - Increased AST, ALT, GGT, alkaline phosphatase (ALP), bilirubin - Decreased synthesis of albumin, coagulation factors When are natiuretic peptides released? Effects? - Answers They are released in response to increased pressure - vasodilatory - natriuresis (ANP and BNP only) Why are BNP levels measured? - Answers They can help distinguish CHF vs. COPD, (CHF has higher levels of BNP) - BNP levels correlate with NYHA class - Prognosis- lower levels of BNP mean better outcome Why are ANP levels not monitored? - Answers ANP has a short half-life and thus high variability What are the characterisitics of NT-proBNP? - Answers Longer half-life than BNP, and almost exclusively cleared by the kidneys What is an atheroma? - Answers Intracellular lipid accumulation **Core of extracellular lipid Where does the initial lesion in atherosclerosis occur? - Answers - Sites of endothelial disrpution: - Branch points - Valves - Turbulent/irregular flow What is happening during the Fatty steak stage of atherosclerosis? - Answers LDL and other molecules are accumulating and becoming altered (oxidized, acetylated...) and becoming antigenic - Inflammatory response - Macrophages are recruited to phagocytose the abnormal molecules