Path 2 quiz 3

• Bacterial colonies develop on the cusps of the aortic valve (MC) or mitral valve (2nd MC)
• Colonies are loosely attached & can be dislodged into the circulation causing an ischemic stroke due to embolism
• More common in young women

• Dental infections
• Tonsillitis
• Genitourinary infections (ovaries/prostate)
• Strep cutaneous infections
• Pulmonary infections
• Gallstones

Congenital or acquired biscupid aortic valve, small ventricular septal defect, tetralogy of fallot, patent ductus arteriosus, mild residual changes of rheumatic mitral valve stenosis

• Caused by staph aureus
• More dangerous

• Caused by strep viridans (aka strep mitis)
• More benign

• Clubbing of the fingernails
• Nail hemorrhages
• Hemorrhages of the retina
• Petechial rash of the hands, mouth, kidneys, & spleen
• Enlarged distal phalanx

• Perforation of heart valves by bacterial enzymes
• Bacterial embolism leading to ischemic infarction
• Lung infarction due to non-obliterated ductus arteriosus- vegetations of bacteria in the pulmonary trunks can go into the lungs, very painful
• Complete obliteration of the ductus arteriosus-> fatal
• Ischemic-hemorrhagic stroke

• Ischemic stroke caused by bacterial embolus
• Once the bacterial embolus settles, the bacteria release destructive enzymes that perforate the blood vessels-> hemorrhage

loss of artery wall elasticity

Plaquing of the arterial wall

• Ring like calcification within the media of medium to small muscular arteries of obscure cours
• Occurs in people over 50
• Typically the femoral, tibial, ulnar, & radial arteries & the arteries to the sexual organs
• Never results in lumen narrowing

• Glass like protein deposits in the wall of small vessels (due to increase pressure)
• Homogenous enlargement/thickening of vessel under microscope
• Long term hypertension is a risk factor
• Vessel may undergo obstruction or rupture
• May occur in elderly w/o hypertension
• Common in diabetes mellitus
• Causes benign nephrosclerosis- kidney contraction (especially in diabetics)
• Narrowing of lumen
• Can happen in young people

• Thickening of the basement membrane; hyperplasia of smooth muscle cells (looks like onion)
• Malignant hypertension (diastolic > 120, can't be controlled, increase mortality rate, 1-2 years)
• Appears laminated under microscope
• Causes necrotizing arteriolitis of the kidneys (development of fibronoid necrosis within vascular walls

• A group of closely related disorders which are caused by the imbalance b/w myocardial oxygen demands & blood supply
• Caused primarily by atherosclerosis- formation of plaques in the subentimal layer of the vessel wall-> lumen obstruction (MC arteries- coronary, cerebral, mesenteric, & arteries of lower extremities)
• 75% of vessel obstruction (critical stenosis) needed for clinical manifestations
• Leads to MI

• Smoking (60/1000)
• Hypercholesterolemia or hypertension (60/1000)- both together (90/1000), both + smoking (200/1000)

• Brain- stroke
• Kidneys- extrarenal stenosis

• 1. Acute changes in heart morphology (atheroma)
• 2. Platelet aggregation (formation of a platelet plug)
• 3. Coronary artery thrombosis
• 4. Coronary artery vasospasm aka Prinzmetal's variant- increased concentration of vasoconstrictors (thromboxane) that are released w/ sympathetic activity-> causes death

• 1. Calcification
• 2. Ulceration & breaking of plaques
• a. debris may go into opening-> emboli
• b. hemorrhage into atheroma-> ballooning of atheroma-> obstruction (immediate death)
• c. thrombosis-> MC & most serious- activation of von Willebrand factor
• 3. Roughening of wall leading to injury of passing cells-> promotes formation of thrombis
• 4. Lumen narrowed-> turbulent blood flow-> thrombosis

• Fat
• Connective tissue cap
• RBC's & smooth muscle cells