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Pathophysiology Atherosclerosis and Atrial Fibrillation.pdf Flashcards
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What is atherosclerosis characterized by?
Atherosclerosis is characterized by patchy intimal plaques (atheromas) that encroach on the lumen of medium-sized and large arteries. The plaques contain lipids, inflammatory cells, smooth muscle cells, and connective tissue.
What are the risk factors for atherosclerosis?
Risk factors for atherosclerosis include dyslipidemia, diabetes, cigarette smoking, family history, sedentary lifestyle, obesity, and hypertension.
How is the diagnosis of atherosclerosis made?
The diagnosis of atherosclerosis is clinical and confirmed by angiography, ultrasonography, or other imaging tests.
What are the treatments for atherosclerosis?
Treatment for atherosclerosis includes risk factor modification, lifestyle and dietary changes, physical activity, antiplatelet drugs, and antiatherogenic drugs.
What is arteriosclerosis?
Arteriosclerosis is a general term for several disorders that cause thickening and loss of elasticity in the arterial wall.
Why is atherosclerosis considered the most serious form of arteriosclerosis?
Atherosclerosis is considered the most serious and clinically relevant form of arteriosclerosis because it causes coronary artery disease and cerebrovascular disease.
Which arteries can be affected by atherosclerosis?
Atherosclerosis can affect all large and medium-sized arteries, including the coronary, carotid, cerebral arteries, the aorta and its branches, and major arteries of the extremities.
What is the leading cause of morbidity and mortality in developed countries like the US?
Atherosclerosis is the leading cause of morbidity and mortality in the US and most developed countries.
How many deaths worldwide were attributed to cardiovascular disease, primarily coronary and cerebrovascular atherosclerosis, in 2019?
In 2019, cardiovascular disease, primarily coronary and cerebrovascular atherosclerosis, caused about 18 million deaths worldwide accounting for 30% of all deaths.
How many people died of cardiovascular disease in the US in 2019?
In 2019, about 558,000 people died of cardiovascular disease in the US.
What is the clinically relevant form of arteriosclerosis that causes coronary artery disease and cerebrovascular disease?
Atherosclerosis
Which arteries can be affected by atherosclerosis?
Coronary, carotid, cerebral, aorta, branches of the aorta, and major arteries of the extremities
What is the leading cause of morbidity and mortality in the US and most developed countries?
Atherosclerosis
How many deaths worldwide were caused by cardiovascular disease primarily coronary and cerebrovascular atherosclerosis in 2019?
About 18 million deaths worldwide
How many people died of cardiovascular disease in the US in 2019?
About 558,000
Where is atherosclerosis rapidly increasing in prevalence?
Low and middle-income countries
What is the earliest visible lesion of atherosclerosis?
Fatty streak
What are the three major components of an atherosclerotic plaque?
Lipids, inflammatory cells, smooth muscle cells
What is the connective tissue matrix that may contain thrombi and calcium deposits in an atherosclerotic plaque?
A connective tissue matrix
What is considered to be an inflammatory response to injury in atherosclerosis?
All stages of atherosclerosis, from initiation and growth to complication of the plaque (e.g., myocardial infarction, stroke)
What role is thought to have a primary initiating role in atherosclerosis?
Endothelial injury
What kind of blood flow is associated with the initiation of atherosclerosis?
Non-laminar or turbulent blood flow (e.g., at branch points)
What are the three major components of the atherosclerotic plaque?
Lipids, inflammatory and smooth muscle cells, connective tissue matrix
What is the primary initiating role in endothelial injury leading to atherosclerosis?
Nonlaminar or turbulent blood flow
What is inhibited by nonlaminar or turbulent blood flow in the arterial tree?
Endothelial production of nitric oxide
What stimulates endothelial cells to produce adhesion molecules that recruit inflammatory cells?
Nonlaminar or turbulent blood flow
What are some risk factors for atherosclerosis mentioned in the text?
Dyslipidemia, diabetes, cigarette smoking, hypertension, oxidative stressors, systemic infection, and inflammation
What is the net effect of risk factors on endothelial cells in atherosclerosis?
Endothelial binding of monocytes and T cells, migration of these cells, and initiation of vascular inflammatory response
What do monocytes in the subendothelium transform into?
Macrophages
What happens to lipids in the blood, particularly LDL and VLDL cholesterol, in atherosclerosis?
They bind to endothelial cells and are oxidized in the subendothelium
Pathophysiology Atherosclerosis and Atrial Fibrillation.pdf Flashcards
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What were the lifetime risks to develop AF at age 40 years for men and women in the Framingham Heart Study?
Men: 26, Women: 23
What were the lifetime risks to develop AF at age 55 years for men and women in the Rotterdam study?
Men: 23.8, Women: 22.2
What factor largely explains the higher incidence of AF in men compared to women, according to the text?
Underlying risk factors of AF and taller stature in men
After adjusting for AF-related risk factors, what did the CHARGE-AF Consortium report about male sex as an independent risk factor for AF?
Male sex was no longer an independent risk factor for AF
Which population had a consistently lower lifetime risk for AF in men compared to women across all age groups?
Chinese adults
Which racial group is reported to have a lower prevalence of AF compared to individuals of European ancestry?
Individuals of African ancestry
What did the Multi-Ethnic Study of Atherosclerosis (MESA) report about the prevalence of AF in Hispanic and Asian individuals in the United States compared to white and African American individuals?
Hispanics: 61, Asians: 39, White: 112, African American: 58
What racial and ethnic differences in AF prevalence have been observed in studies?
AF is less prevalent in individuals of African descent compared to European ancestry. Hispanics and Asians in the United States have lower incidence rates of AF compared to whites and African Americans.
What did the MultiEthnic Study of Atherosclerosis (MESA) report about the prevalence of AF in Hispanics and Asians in the United States?
MESA reported a lower prevalence of AF in Hispanics and Asians, with age and sex-adjusted incidence rates of 61 in Hispanics and 39 in Asians compared to 112 in whites and 58 in African Americans.
Which racial and ethnic groups have been found to have a lower risk of AF compared to whites, according to The Healthcare Cost and Utilization Project?
Hispanics and Asians have been found to have a lower multivariable-adjusted risk of AF compared to whites, with a hazard ratio of 0.78 and 95% CI of 0.77-0.79.
What are some modifiable risk factors for AF related to physical activity and lifestyle?
Physical inactivity and sedentary lifestyle, hypertension, obesity, and diabetes are known risk factors for AF. Obstructive sleep apnea (OSA) is common in obese individuals and has been associated with a sedentary lifestyle.
How does a sedentary lifestyle contribute to the risk of AF?
A sedentary lifestyle is known to increase the risk of AF by inducing structural and electrical remodeling of the atrium. Conditions such as hypertension, obesity, diabetes, and obstructive sleep apnea (OSA) are associated with sedentary behavior and can lead to AF.
What are the primary mechanisms contributing to the pathogenesis of AF in endurance athletes?
The pathogenesis of AF in endurance athletes is attributed to increased vagal tone, which may shorten and increase the dispersion of atrial effective refractory period (ERP), promoting pulmonary vein firing and localized reentry.
What is a modifiable risk factor for atrial fibrillation specifically in comparison to whites?
Hypertension
How does a sedentary lifestyle increase the risk of atrial fibrillation?
By inducing structural and electrical remodeling of the atrium
What is obstructive sleep apnea (OSA) associated with in obese individuals?
Sedentary lifestyle
What are the two primary mechanisms attributed to the pathogenesis of atrial fibrillation in endurance athletes?
Increased vagal tone and progressive cardiac remodeling
What are some of the factors contributing to the excess risk of atrial fibrillation in obesity?
Left atrial enlargement, increased left ventricular mass, and diastolic dysfunction
According to the Framingham Heart Study, how much increased risk of atrial fibrillation was observed in men and women with diabetes respectively?
40% in men and 60% in women
What may be more predictive of atrial fibrillation risk than the actual diagnosis of diabetes in older adults?
Level of blood glucose
How do glucose intolerance and insulin resistance contribute to the development of the atrial fibrillation substrate in diabetes mellitus?
They mediate the development by altering cardiac structure through impaired mitochondrial function and oxidative stress
What is a well-established independent predictor of atrial fibrillation related to high blood pressure?
Increased left atrial size
What is the increased risk of atrial fibrillation (AF) in men with diabetes?
40% increased risk of AF in men with diabetes
What is the increased risk of AF in women with diabetes?
60% increased risk of AF in women with diabetes
What may be more predictive than the actual diagnosis of diabetes in older adults in relation to AF?
Level of blood glucose
What pathophysiological factors mediate the development of the AF substrate in individuals with glucose intolerance and insulin resistance?
Glucose intolerance and insulin resistance
What molecular mechanism is involved in the alteration of cardiac structure due to insulin resistance in individuals with AF?
Impaired mitochondrial function and oxidative stress
What is a well-established independent predictor of AF related to chronic hypertension?
Increased left atrial size
Apart from left atrial size, what other pathologic features of chronic hypertension are associated with AF?
Left ventricular hypertrophy and impaired diastolic dysfunction
What common factor among individuals with chronic hypertension increases left atrial pressure and volume, leading to AF?
Elevated left ventricular end-diastolic pressure
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Unit 6 Nerve ID.pdf Flashcards
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What is the capital city of France?
Paris
What is the largest planet in our solar system?
Jupiter
Who wrote the play 'Romeo and Juliet'?
William Shakespeare
What is the chemical symbol for gold?
Au
What is the powerhouse of the cell?
Mitochondria
What is the tallest mountain in the world?
Mount Everest
What is the capital city of Japan?
Tokyo
Who painted the Mona Lisa?
Leonardo da Vinci
What is the largest ocean on Earth?
Pacific Ocean
What year did the Titanic sink?
1912
What is the currency of Germany?
Euro
Who discovered penicillin?
Alexander Fleming
What is the largest desert in the world?
Sahara Desert
What is the chemical symbol for iron?
Fe
Who is known as the 'Father of Modern Physics'?
Albert Einstein
What are the components and functions of the Glossopharyngeal nerve?
1. Special Sensory (Taste from the Posterior 1/3 of the tongue) 2. Visceral sensory from the carotid sinus and carotid body 3. Visceral Motor (Parasympathetic Preganglionic motor fibers to the otic ganglia and then to the parotid gland secretomotor - Lesser petrosal nerve) 4. Somatic branchial Motor to stylopharyngeus muscle (nucleus ambiguous) 5. Somatic general Sensory from the posterior 1/3 of the tongue and oropharynx (Inner surface of tympanic membrane - Afferent limb of the gag reflex) 6. Superior and inferior ganglia at the level of the jugular foramen that contain sensory cell bodies
What are the components of the Lingual branch of the Glossopharyngeal nerve when tagged in the tonsillar bed?
1. Special sensation from the posterior third of the tongue 2. Somatic sensation from the posterior third of the tongue
What are the components and functions of the Superior Laryngeal nerve?
1. Somatic motor (External laryngeal nerve to cricothyroid) 2. Somatic general Sensation above the true vocal folds (Cough reflex) 3. Special sensation (Taste fibers from the epiglottis and root or very posterior of the tongue)
What are the components of the Internal Laryngeal nerve?
1. Somatic general Sensation above the true vocal folds (Cough reflex) 2. Special sensation (Taste fibers from the epiglottis and root or very posterior of the tongue) 3. Preganglionic parasympathetic secretomotor fibers to the mucosal glands
What are the functions of the Vagus nerve?
1. Special Sensation (Taste fibers from the epiglottis and the very root posterior of the tongue) 2. Visceral Sensory a. Monitors the Viscera (e.g., Heart and Baroreceptors at arch of aorta, Chemoreceptors of aortic bodies, Thoracic and Abdominal viscera) b. Sensory from the mucosa above and below the vocal folds (Afferent of the cough reflex) 3. Visceral Motor (Parasympathetic Preganglionic Motor Fibers to the Viscera - Heart, Lungs, Esophagus, Abdominal Organs, Microscopic ganglia in the walls of the organs, Secretomotor to the glands in mucosa - Dorsal motor nucleus) 4. Somatic Motor (Branchial motor - Motor fibers to the Muscles of the Palate, Larynx, and Pharynx - nucleus ambiguous, Efferent of the cough reflex) 5. Somatic Sensory (General sensation from some of the external meatus and part of the tympanic membrane - auricular branch, Dura of posterior cranial fossa) 6. Superior ganglia of the Vagus has cell bodies of the somatic sensory fibers 7. Inferior or Nodose ganglia has cell bodies of the visceral sensory fibers
What are the cell bodies of the somatic sensory fibers in the auricular branch of the posterior cranial fossa?
Superior ganglia of the Vagus
What are the cell bodies of the visceral sensory fibers in the auricular branch of the posterior cranial fossa?
Inferior or Nodose ganglia
Which muscle of the soft palate is innervated by V3 instead of the vagus nerve?
Tensor palatini
Which muscle of the pharynx is innervated by the glossopharyngeal nerve instead of the vagus nerve?
Stylopharyngeus
Which muscle of the tongue is innervated by the vagus nerve instead of the hypoglossal nerve?
Palatoglossus
Which nerve innervates all of the laryngeal muscles except the cricothyroid muscle?
Inferior Recurrent laryngeal nerve
Which nerve innervates the cricothyroid muscle instead of the inferior recurrent laryngeal nerve?
External laryngeal nerve
Which pharyngeal arch is associated with the Glossopharyngeal nerve and its functions?
Arch 3
Which pharyngeal arch is associated with the Vagus nerve, swallowing, superior laryngeal nerve, and pharyngeal branches?
Arch 4
Which pharyngeal arch is associated with the Vagus nerve, recurrent laryngeal nerves, and speaking functions?
Arch 6
Unit 6 Nerve ID.pdf Flashcards
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Controls voluntary movements and sensory information
Motor nerves
Regulates involuntary functions like heart rate and digestion
Autonomic nerves
Transmits information from the body to the brain and vice versa
Sensory nerves
Coordinates muscle movements and maintains balance
Cerebellum nerves
Regulates hormone production and the body's internal environment
Endocrine nerves
Controls conscious thoughts, reasoning, and decision-making
Cerebral cortex nerves
Regulates sleep, mood, and emotions
Limbic system nerves
Facilitates communication between the brain and spinal cord
Brainstem nerves
Controls reflex actions such as pulling hand away from a hot surface
Spinal cord nerves
Sensory fibers: Inferior or Nodose ganglia has cell bodies of the visceral sensory fibers
Innervation of muscle groups
Muscles of the soft palate innervation
Vagus except tensor palatini (V3)
Muscles of the pharynx innervation
Vagus except stylopharyngeus which is glossopharyngeal
Muscles of the tongue innervation
Hypoglossal except palatoglossus which is vagus
Innervation of laryngeal muscles
Inferior Recurrent laryngeal nerves except for the cricothyroid from external laryngeal nerve
Auricular branch Dura of posterior cranial fossa
Innervation of the Dura of posterior cranial fossa
Superior ganglia of the Vagus
Contains cell bodies of the somatic sensory fibers
Inferior or Nodose ganglia
Contains cell bodies of the visceral sensory fibers
Innervation of muscle groups
1. All muscles of the soft palate are vagus except tensor palatini which is V3 2. All muscles of the pharynx are vagus except stylopharyngeus which is glossopharyngeal 3. All muscles of the tongue are hypoglossal except palatoglossus which is vagus 4. All laryngeal muscles are innervated by the inferior recurrent laryngeal nerves except cricothyroid which is from the external laryngeal nerve
Branchial Pharyngeal Arches Arch 3
Glossopharyngeal nerve components and functions listed above
Branchial Pharyngeal Arches Arch 4
Vagus: Swallowing - Superior laryngeal nerve and Pharyngeal Branches Vagus: Recurrent Laryngeal nerves - Speaking
