Blood Vessels Chapter 9 Basic Robbins Chapter 11 Big ...

Blood Vessels Chapter 9 Basic Robbins Chapter 11 Big Robbins

M. E. Bauman, MD

Intima (figure 9-1)

Structure and Function of Blood Vessels

Internal elastic lamina

Media

External elastic media

Adventitia

Vasa vasorum:

Vascular Organization Large elastic arteriessmall arteriesarteriolescapillariespostcapillary venulesveins

Pericytes Lymphatics

Endothelial Cells Continuous lining of entire vascular tree Interendothelial junctions

Fenestrations

Blood-brain barrier Endothelial activation (figure 9-2) Endothelial dysfunction

Vascular Smooth Muscle Cells

Congenital Anomalies

Saccular (berry) aneurysms : see aneurysm section below Arteriovenous fistulae (fistulas) (figure 22-11)

Jill Bolte Taylor: My Stroke of Insight

Fibromuscular dysplasia (Figures not in book)

Blood vessels page 2

Blood Pressure Regulation

BP = Cardiac Output X Peripheral Resistance (figure 9-3)

Blood vessels page 3

Angiotensinogen

Renin

ACE Angiotensin I

Vasodilators

Adrenal aldosterone

Atrial natriuretic peptides (figure 9-4)

Angiotensin II

Hypertensive Vascular Disease

Epidemiology of Hypertension "140/90 mm Hg" Morbidity increases with other cardiovascular risk factors

"Malignant hypertension"

"Essential hypertension" Mechanisms

Morphology (figure 9-5) Hyaline arteriolosclerosis

Nephrosclerosis Hyperplastic arteriolosclerosis

Blood vessels page 4

Vascular Wall Response to Injury

Etiologies of vascular injury

Responses to vascular injury (figure 9-6)

Stenosis =

Arteriosclerosis

Arteriolosclerosis (see above) M?nckeberg medial sclerosis (figure not in book)

Atherosclerosis =

Atherosclerosis

Atheroma/ Atheromatous plaque (figures 9-7 and 9-13)

Blood vessels page 5

Epidemiology of Atherosclerosis Framingham Heart Study

Constitutional Risk Factors Genetics: family history is the most important independent risk factor for atherosclerosis

Age:

Gender:

Modifiable Risk Factors Hyperlipidemia/Hypercholesterolemia LDL

HDL

Diet Omega-3 fatty acids Exercise/EtOH Statins: inhibit hydroxymethylglutaryl coenzyme A (HMG-CoA)

Hypertension

Blood vessels page 6

Cigarette smoking

Diabetes mellitus

Additional Risk Factors C-Reactive Protein (CRP figure from Protein Data Bank)

Wikipedia: The physiological role of CRP is to bind to phosphocholine expressed on the surface of dead or dying cells (and some types of bacteria) in order to activate the complement system. CRP binds to phosphocholine on microbes and damaged cells and enhances phagocytosis by macrophages. Thus, CRP participates in the clearance of necrotic and apoptotic cells.

CRP serum test (< 8.0 mg/L) hsCRP serum test (detects to 0.2 mg/L)

Hyperhomocysteinemia Homocysteine: an amino acid homologue of cysteine (homocysteine has an additional methylene ?CH2- group)

Doubtful utility for assessment of cardiovascular risk

Pathogenesis of atherogenesis: Response to injury hypothesis (Figure 9-10) Endothelial injury

Endothelial dysfunction

VCAM-1

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