systemic disease effecting CVS

Question 1

1- describe the 2 types of diabetes?
2- how can these cause cardiovascular disease?

Answer 1

1- diabetes type 1 (immune destruction of insulin production)
2- type 2 (insulin resistant)

3- too much glucose can non enzymatically stick to proteins (the protein will then be altered)
- the basement membrane integrity will be lost due to thickening which allows proteins to move out.

• Eg: if this were to happen in the arctic blood supply, thinking of that membrane will cause a lack of perfusion which will lead to atherosclerosis of that artery.

Question 2

what is the blood vessel that supplies the aorta?

Answer 2

vaso vasurum

Question 3

what is the most dominant cause of death in diabetics and why?

Answer 3

cardiovascular complications.
the reason for this remains unclear, but elevated oxidative stress levels have been detected in patient.

Question 4

what can hypertension cause?

Answer 4

accelerated vascular damage

Question 5

describe the impact of the body’s reaction to hypertension?

Answer 5

the body makes adaptions to facilitate for the changes in the body caused by. hypertension.
but, these changes will cause damage to other areas of the body causing secondary disease.

Question 6

if there is emphysema, how will this effect hypertension?

Answer 6

• there will no a lack of gas exchange in the lungs in the effected portions = bad tissue perfusion. (you will not get full blood oxygenation)
• you are going to have to push blood harder, therefore increased strain on the heart
  increasing pulmonary pressure.

Question 7

cor pulmonale?

Answer 7

• this is right sided heart failure
• an enlargement of the right ventricle due to high blood pressure in the lungs usually caused by chronic lung disease

Question 8

what may systemic amyloidosis be due to?

Answer 8

a plasma cell neoplasm (eg- myeloma) or a chronic inflammatory disorder

Question 9

what are the 2 major classes of amyloidosis?

Answer 9

AA- amyloid associated protein
AL- amyloid light chain associated

Question 10

what are amyloids composed of?

Answer 10

immunoglobulin light chains
serum amyloid protein A
peptide hormones
pre albumin

Question 11

1- what are amyloids?

2- what are common complications?

Answer 11

1 - starch like
- extra cellular beta pleated sheet material
- it will often impair the function of the organ in which it is deposited

2- heart failure and nephrotic syndrome

Question 12

AA (first class of amyloids)?

Answer 12

amyloid associated protein comes from SAA (serum amyloid associated protein)
- part of the acute phase inflammatory response

Question 13

AL (second class of amyloids)?

Answer 13

amyloid light chain associated
- small component of immunoglobulins
- If you have multimyloma (plasma tumour) this will show excess AL

Question 14

what amyloid will be associated with myeloma? (primary)

Answer 14

AL

Question 15

what amyloid will be associated with reactive things like inflammatory response?

Answer 15

AA

Question 16

what amyloid will be associate with alzhiemers disease?

Answer 16

A-beta (derived from amyloid precursor protein)

Question 17

what are common causes and consequences of systemic amyloidosis?

Answer 17

heart failure
nephrotic syndrome
organ enlargement (hepatomegaly)

Question 18

how much more are risk are people with rheumatoid arthritis to developing CVD?

Answer 18

50-70% more likely than the general population

Question 19

how much more at risk are people with osteoarthritis to developing CVD?

Answer 19

24% higher

Question 20

what is polyarteritis nodosa?

Answer 20

fibrinoid necrosis and heavy inflammatory cell infiltration in a medium sized artery

Question 21

what endocrine diseases and CVD are linked?

Answer 21

• thyroid
• cuschings syndrome (too much cortisol, increased BP and sodium retention)
• HGH/ grow factor

Question 22

what are sarcoids?

Answer 22

• they are a hypersensitivity immune reaction
• cell mediated
• forms granulomas
• they can forms in many different locations
• systemic disease

Question 23

describe the development of inflammation in sarcoids?

Answer 23

Question 24

describe the development of tissue scarring in sarcoids?

Answer 24

Question 25

what is the effect of nutrition on CVD?

Answer 25

exposure of under nutrition during post natal periods of development, including adolescence, may effect CV health in adult life.

Question 26

what is the effect of some drugs on CVD?

Answer 26

- anticancer drugs immunosuppressive - diabetogenic - anti inflammatory they will cause effects on other organs, allowing other disease to happen.

Question 27

What 10 systemic conditions/factors can affect the CVS?

Answer 27

* Systemic conditions/factors that can affect the CVS: 1) Diabetes mellitus 2) Hypertension 3) Chronic obstructive pulmonary disease 4) Amyloidosis 5) Rheumatoid arthritis 6) Vasculitis & SLE (systemic lupus erythematosus) 7) Thyroid disease 8) Sarcoidosis 9) Nutrition 10) Drugs

Question 28

What is the dominant cause of mortality in diabetic patients? What are 5 examples of diabetes associated metabolic disorders? What are these conditions associated with?

Answer 28

* The dominant cause of mortality in diabetic patients is cardiovascular complications. * Diabetes associated metabolic disorders: 1) Hyperglycaemia 2) Hypertriglyceridemia 3) Hypercholesterolemia 4) Hypoalphalipoproteinemia 5) Increased levels of advanced glycation of end products, glycated and oxidized lipoproteins * These disorders are associated with oxidative stress

Question 29

What is glycation? Why does glycation occur in diabetes? What proteins can it occur in? How can this lead to accelerated vascular damage? How can this cause kidney disease? How can glycation of haemoglobin be used to measure the effectiveness of diabetes treatment?

Answer 29

* Glycation is the covalent attachment of a sugar to a protein/lipid, which can lead to cross-linking of proteins * Glycation occurs in diabetes due to hyperglycaemia (increased blood sugar) * Glycation can affect haemoglobin in the blood * Glycation of haemoglobin can lead to accelerated vascular damage * This is because proteins are repelled away from cell membranes in the vessels by charge * Glycation can alter the charge of proteins, meaning proteins can become trapped in the basement membrane, which can affect the integrity of the vessel walls and affect permeability * If this occurs in the glomeruli of the kidneys, this can lead to kidney disease * The life cycle of RBCs is 90 days * We can measure the effectiveness of diabetes treatment by checking to see levels of glycation every 90 days, as if treatment is effective, the glycation rate should have decreased heavily

Question 30

What is hyperlipidaemia? What is familial hypercholesterolaemia (FH)? What is it caused by? How does it affect blood lipid levels? How can this affect vessels? What is a familial disease? When might we suspect FH? What 6 conditions can atherosclerosis cause?

Answer 30

* Hyperlipidaemia is above normal lipid (fat) levels in the blood, which include several types of lipids, including triglycerides * Familial Hypercholesterolaemia (FH) is an inherited condition that is passed down through families and is caused by one or more faulty genes. * It's caused by a genetic mutation that means your liver is unable to remove excess 'bad' cholesterol, known as LDL. * This leads to an increase in levels of LDL cholesterol in the blood (hypercholesterolaemia) * An increase in lipids in the blood can lead to the accumulation of fatty deposits in the artery walls, which can lead to atherosclerosis * 'Familial' disorders are those which appear to have a genetic component, affecting more family members than would be expected by chance alone. * We may suspect FH when the patient is young, as it is less likely that the cause of hypercholesterolaemia is from diet * Atherosclerosis can cause: 1) Hypertension 2) Heart attack 3) Stroke 4) Aneurysm 5) Blood clot - plaque may rupture. Platelets clump together to form clots at the site of the damage. 6) Emboli

Question 31

What is COPD? How is COPD and CVD disease related? How can pulmonary hypertension affect the right side of the heart? What is cor pulmonale How does this affect the pumping of the right side of the heart? What are 7 causes of pulmonary hypertension?

Answer 31

* Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties * Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone. * Potential complications of pulmonary hypertension include: Right-sided heart enlargement and heart failure (cor pulmonale). * Cor pulmonale causes the right ventricle to enlarge and pump blood less effectively than it should. * The ventricle is then pushed to its limit and ultimately fails * It has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries * Cause of pulmonary hypertension: 1) Acute or chronic left ventricular failure * Increase in ventricular pressure and backlog of blood in pulmonary circulation leads to pulmonary hypertension 2) Mitral stenosis * Increase in atrial pressure and backlog of blood in pulmonary circulation leads to pulmonary hypertension 3) Chronic bronchitis and emphysema * Chronic bronchitis and emphysema often occur together and make up COPD * The inability to get enough oxygen into the blood raises the risk of developing hypoxia (low blood oxygen levels) * Sustained hypoxia reinforces vasoconstriction, which cause pulmonary hypotension 4) Emphysema * In people with emphysema, the air sacs in the lungs (alveoli) are damaged. * Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. * We don’t perfuse tissues that don’t contribute to gaseous exchange, which leads to vasoconstriction to these damaged alveoli * This will cause an increase in venous pressure * Lack of capillaries due to damaged alveoli will lead to low levels of oxygen in the blood (hypoxia), which will also cause vasoconstriction and shortness of breath * The main cause of emphysema is long-term exposure to airborne irritants, including: Tobacco smoke. Marijuana smoke. Air pollution 5) Recurrent pulmonary emboli * Blocked blood vessel in lungs * Causes hypertension 6) Primary pulmonary hypertension * Cause of raised pulmonary pressure unknown 7) CHD shunts

Question 32

What causes AL amyloidosis? Where can these deposits be placed? What are plasma neoplasms? What are 2 causes of systemic amyloidosis? What are amyloid deposits? What are they made from? How do amyloid deposits affect organs? What organs can it affect? What is rheumatoid disease? How is it caused? How is rheumatoid disease linked the amyloidosis?

Answer 32

* AL Amyloidosis (immunoglobin amyloidosis) is caused by an abnormality in plasma cells found in the bone marrow * The abnormal plasma cells produce abnormal forms of light chain proteins, which enter the bloodstream and can form amyloid deposits. * These deposits can be placed between cells and in the basement membrane, which can cause the lumen of tubular structures to be narrower * Plasma cell neoplasms are diseases in which abnormal plasma cells form tumours in the bones or soft tissues of the body * Systemic amyloidosis may be due to a plasma cell neoplasm (e.g myeloma – marrow cancer) or to a chronic inflammatory disorder * Amyloid deposits are an extracellular beta-pleaded sheet material made from: 1) Immunoglobulin light chains 2) Serum amyloid protein A 3) Peptide hormones 4) Prealbumin etc. * Amyloids deposits often impair the function of the organ in which they are deposited * These effects can include: 1) Heat failure 2) Nephrotic syndrome * Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine * Caused by AA amyloid 3) Organ enlargement (e.g hepatomegaly – liver enlargement) * Caused by AA amyloid * Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body (systemic disease that mainly affects joints) * Rheumatoid disease causes amyloidosis, meaning patients with rheumatoid disease have a higher instance of CV morbidity * Some of it will be due to inability to move and exercise, but some of it is to do with the systemic effects of amyloidosis

Question 33

What is vasculitis? What is it associated with? What 6 ways can it affect blood vessels? How can this affect the heart? What is the most common vasculitis that we are likely see?

Answer 33

* Vasculitis is inflammation of the vessels * It is sometimes associated with infection, but in particular, it is an auto-immune disease * Vasculitis can cause the vessel to become: 1) Thickened 2) Weakened 3) Narrowed (stenosis), 4) Blocked (occlusion), 5) Enlarged (aneurysm), or 6) Scarred * Vasculitis affecting the heart can cause congestive heart failure * Vasculitis as part of systemic lupus erythematosus (SLE) is what we are most likely to see * SLE is the most common form of lupus * Lupus is a condition that affects the immune system. * It can cause problems with your skin, joints, kidneys and other organs.

Question 34

What is the link between thyroid function and heart failure?

Answer 34

* Studies suggest patients with overt and subclinical thyroid dysfunction are at increased risk of heart failure

Question 35

What is sarcoidosis? What does it cause to develop? What are hypersensitive reactions? What type of hypersensitivity reaction Is sarcoidosis? What 3 structures does sarcoidosis often affect? How does cardiac sarcoidosis affect the heart?

Answer 35

* Sarcoidosis is a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body. * Hypersensitivity reactions are exaggerated or inappropriate immunologic responses occurring in response to an antigen or allergen * Sarcoidosis is a type 4 hypersensitivity reaction * It often affects the: 1) Lungs 2) Lymph nodes 3) Can also affect your skin. * In cardiac sarcoidosis, tiny collections of immune cells form granulomas (small areas of inflammation) and scarring in the heart tissue, which can interfere with normal functioning

Question 36

How does famine affect chances of developing CVD?

Answer 36

* Compared with the nonexposed participants, those who had been exposed to famine in early life had a significantly increased risk of total CVD , myocardial infarction, stroke, and coronary heart disease.

Question 37

What are 4 different types of drugs that can cause CVD?

Answer 37

* Different types of drugs that can cause CVD: 1) Anticancer 2) Immunosuppressive 3) Diabetogenic 4) Anti-inflammatory drugs