Chapter 17 Disorders of Blood Flow and Blood Pressure

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Artery Structure
Tunica intima: endothelium Tunica media: smooth muscle

Tunica adventitia: collagen and elastic fibers

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Question
Which vessel layer can expand to accommodate pressure changes? a. Tunica intima

b. Tunica media
c. Tunica adventitia d. Tunica externa

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Answer
b. Tunica media Rationale: The tunica media is composed of smooth muscle, which can stretch/expand to accommodate changes in blood pressure.

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Vascular Endothelium
Food and O2 pass into tissues
Wastes and CO2 pass from tissues into blood Creates compounds that cause vasodilation or vasoconstriction Creates growth factors that can stimulate smooth muscle Forms a smooth lining of the blood vessels that resists clot formation Creates compounds to promote clot formation in injured areas
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Atherosclerosis
Lipids get into the vascular endothelium White blood cells try to clear them away foam cells WBCs and vascular endothelium release growth factors that promote plaque formation Plaques block the arteries

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Lipoproteins

The more protein, the higher the density

The more lipid, the lower the density

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Question
Tell whether the following statement is true or false. LDL is considered to be good cholesterol.

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Answer
False Rationale: LDL (low-density lipoprotein, which has more lipids and less protein) is the bad cholesterol. HDL (high-density lipoprotein) has more protein and less fat, and is considered good cholesterol.

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Lipid Transport in the Body

Dietary lipids absorbed as chylomicrons
Adipose and muscle cells take up lipids from chylomicrons Chylomicron remnants are intermediate-density lipoproteins

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Lipid Transport in the Body (cont.)

IDLs become lowdensity lipoproteins (bad cholesterol) These can deliver fat to the liver and by other tissues

LDL receptors are necessary for the liver to take them up

Some LDLs are taken up by scavenger cells like macrophages

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Fatty Streaks and Atherosclerotic Plaques

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Atherosclerosis
Atherosclerosis develops because scavenger cells encounter the fatty deposits in the artery lining and Try to destroy the fats by oxidizing them

Oxidized fats injure the endothelium

Clots form and release growth factors Smooth muscle grows over the fatty core

Try to remove the fats by eating them

Become foam cells in the core of the plaque

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Atherosclerotic Plaque
Macrophages CAP CORE Lipid-laden macrophage (foam cell) Smooth muscle cells Endothelial cell Lymphocytes

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Lipid Transport in the Body

High-density lipoproteins (good cholesterol) are made in the liver They go out to the peripheral tissues and pick up lipid Then they carry it back to the liver

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Scenario
A man has several genetic defects in his lipoprotein receptors. His liver lacks LDL receptors

His muscle cells lack receptors for the apoproteins on chylomicrons

His scavenger cells have extra LDL receptors

Question:
Why might he develop atherosclerosis?
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Stable Plaques
Have thick fibrous caps Partially block vessels Do not tend to form clots or emboli

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Unstable Plaques
Have thin fibrous caps
Plaque can rupture and cause a clot to form May completely block the artery The clot may break free and become an embolus

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Question
What immediate threat do unstable plaques present? a. Clot formation will increase pressure in the vessel. b. Plaque may lead to angina (chest pain). c. Clots may break loose and block blood flow to key organs. d. All of the above constitute immediate threats.

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Answer
c. Clots may break loose and block blood flow to key organs. Rationale: If a clot breaks loose, becoming an embolus, it may lodge in a blood vessel to the brain, heart, or lungs. When blood flow is significantly decreased or blocked altogether, the result is tissue deathin the examples here, stroke, heart attack, or pulmonary embolus. The other choices represent more longterm/chronic problems.

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Scenario
A woman complains of pain in her left leg. Her foot is cool and pale

She reports that it is often red and warm when she is sitting down
The pain occurs when she is walking to church on Sundays The skin on her left leg is shinier than on her right leg

Question:
What could have caused all this? How?

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Aneurysms
Wall of artery weakens and stretches

Risk of rupture and hemorrhage

Risk of clot formation

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Discussion
How would each of the following affect blood pressure?

Vasodilation
Decreased stretching of baroreceptors Hypoxemia

Inhibiting angiotensin-converting enzyme

Beta blockers Alpha-2 agonists

Calcium-channel blockers

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