Chylomicron
diet-derived triglyceride
chylomicrons
absent during fasting, turbid supranate
CPL (capillary lipoprotien lipase
chylomicrons-->chylomicron remnant
CPL
located in adipose, muscle, myocardium
CPL
Induced by insulin
CPL
activated by apo CII
VLDL
liver-derived triglyceride
hypertriglyceridemia
causes turbidity in plasma
CPL
VLDL-->IDL-->LDL
VLDL=TG/5
VLDL concentration calculation?
LDL
transports cholesterol
LDL=CH-HDL-(TG/5)
how to calculate LDL?
serum CH
fasting not required
HDL
good CH
HDL
source of apolipoprotiens CII and E
HDL
removes cholesterol from plaques for disposal in the liver
increased VLDL causes decreased HDL
increased VLDL --> decreased HDL
Type I hyperlipoproteinemia
low CPL or low apo CII (deficiency)
Type I:
autosomal recessive, rare childhood disease,
Type II hyperlipoproteinemia
serum LDL >190; serum CH >260 mg/dL;
serum TG <300 type IIa
serum TG >300 type IIb
Type II
high LDL due to low LDL receptors; high CH synthesis, low CH excretion in bile
acquired causes of hypercholesterolemia
Primary hypothyroidism; Nephrotic syndrome; Extrahepatic cholestasis.
Famillial hypercholesterolemia
AD disorder, deficiency of LDL receptors, premature coronary artery disease and stroke; tendon xanthomas; xanthelasma.
Achilles tendon xanthoma
pathogmonic for familial hypercholesterolemia.
cholesterol deposit located over tendons.
polygenic hypocholesterolemia (type IIa)
most common hereditary cause, multifactorial inheritance, alteration in regulation of LDL levels, normal serum TG
Familial combined hypercholesterolemia (type IIB)
AD inheritance; serum CH and TG increase around puberty; associated w/ metabolic syndrome; increase in CH & TG and decrease in HDL
Type III hyperlipoproteinemia "remnant disease
remnant disease" Familial dysbetalipoproteinemia
deficiency apo E; increased chylo remnants and IDL
Type III
Palmar xanthomas
Type IV
increased VLDL; most common lipid disorder
Type IV
most common cause is alcohol excess
OCP
estrogen increased TG synthesis in liver
OCP
Variable effects on LDL and HDL
Type IV
eruptive xanthomas
Type IV Rx
decreased carbohydrae adn alcholol intake
type V hyperlipoproteinemia
TG > 1000mg/dl; normal CH and LDL
Type V
increased VLDL+ Chylomicrons
Type V
hyperchylomicronemia syndrome
(erruptive zanthomas;incrased incidence of acute pancreatitis; lipemia retinalis;..????)
Apo B deficiency
decreased chylomicrons, VLDL, LDL
Medial calcification
dystrophic calcification in muscular arteries
Artherosclerosis
endothelial cell injury; platelets/macrophages pivotal roles
Fibrous cap
pathognomonic lesion of artherosclerosis
C-reaction protein
excelent marker of disruptive fibrous plaques
Abdominal aorta
most common site for atherosclerosis; no vasa vasorum
complications of artherosclerosis
aneurysms, thrombosis, ischemia
hyaline arteriolosclerosis
diabetes mellitius, hypertension
Abdominal aortic aneurysm
most common aneurysm in men >55 yrs
Rupture triad
left flant pain, hypotension, pulsatile mass
Fungal vessel invaders
aspergillus, candida, Mucor
Bacterial vessel invaders
B. fragilis, P. aeruginosa, salmonella
CNS berry aneurysms
junction communicating branch with main vessel
Aortic arch aneurysm
tertiary syphilis; vasa vasorum vasculitis
Syphilitic aneurysm
produces aortic regurgitation;bonding pulses
Most common cause of death in Marfan syndrome and EDS
aortic dissection
Aortic dissection
cystic medial degeneration
Aortic dissection
pain radiates into the back; absent pulse
Aortic dissection
cardiac tamponade most common cause of death
Superficial varicosities
valve incompetence
Phlebothrombosis
stasis of blood flow most common cause (thrombosis of a vein w/o inflammation)
Stasis dermatitis
sign of DVT
Thrombophlebitis
pain and tenderness overlying the vein
SVC syndrome
compression of SVC by primary lung cancer
Thoracic outlet syndrome
Common among weight lifters; tight scalenus muscles.
Acute lymphangitis
Streptococcus pyogenes cellulitis
Turner's webbed neck
lymphatic abnormality
Bacillary angiomatosis
Bartonella henselae; common in AIDS
ANCA
antibodies against components of neutrophils
Small vessel vasculitis
palpable purpura
Medium-sized vessel vasculitis
thrombosis aneurysm formation
Large vessel vasculitis
absent pulse, stroke
SBP (systolic BP)
correlates with SV, aorta compliance
? SBP
?preload, ?contractility
? SBP
?preload, ? contractility,?afterload
? DBP (diastolic BP)
vasoconstriction peripheral resistance arterioles
? DBP
vasodilation peripheral resistance arterioles
DBP
correlates with tonicity of TPR arterioles
Pathogenesis hypertension
renal retention of sodium commonly involved
Most common type of hypertension
essential hypertension
Renovascular hypertension
most common cause of secondary hypertension
Renovascular hypertension
atherosclerosis in men; fibromuscular hyperplasia in women
Renovascular hypertension
activation of RAA system (renin-angiotensin-aldosterone system)
PRA (plasma renin activity)
? in involved kidney;? in unaffected kidney
fibromuscular hyperplasia
beaded" appearance of renal artery
complications of hypertension descending order
Acute MI, stroke, renal failure.