03-09-22 – Vascular disease Flashcards
Learning outcomes
- Classify vascular diseases
- Describe the characteristics of atheroma and its complications
- Define, classify and describe the types of aneurysm
- Define varicose veins
- Define vasculitis
- Classify vascular tumours
What are vascular diseases called that affect the arteries, veins, and all vessels?
- Vascular diseases called that affect the arteries, veins, and all vessels:
1) Arteries
* Arteriosclerosis - atherosclerosis
2) Veins
* Thrombosis – phlebothrombosis and thrombophlebitis
* Thrombophlebitis is a condition in which inflammation of the vein wall has preceded the formation of a thrombus (blood clot).
* Phlebothrombosis is the presence of a clot within a vein, not associated with inflammation of the wall of the vein
* Formation of varicosities - Varicose veins are swollen and enlarged veins that usually occur on the legs and feet.
3) All vessels
* Vasculitis (inflammation)
* Radiation damage
4) Tumours
What are 3 age-related vascular changes?
What do all of these changes lead to?
- Age-related vascular changes:
1) Fibrosis of tunica intima and media
2) Accumulation of ground substance – ground substance in blood is plasma
3) Elastic lamellae fragmentation of the vessel walls - Elastin in the arterial wall is organized into concentric lamellar layers of approximately the same thickness throughout the arterial wall
- The lamellar unit is designed to support and evenly distribute the mechanical load in the arterial wall.
- All of these changes lead to thicker blood vessels
What are atheromas In atherosclerosis?
What vessels does atherosclerosis affect?
What 3 things is it characterised by?
What are 10 risk factors for atherosclerosis?
- Atheroma are the fatty deposits that build up in atherosclerosis
- Affects large and medium-sized elastic and muscular arteries
- Atherosclerosis is characterised by
1) Lipid deposition
2) Fibrosis
3) Chronic inflammation - Risk factors for atherosclerosis:
1) Age
2) Sex
3) Hypertension
4) Hyperlipidaemia (particularly LDL)
5) Diabetes
6) Smoking
7) Obesity
8) Sedentary lifestyle
9) Low socio-economic status
10) Low birth-weight
What is hypercholesterolaemia?
How does this affect endothelial function?
Where does LDL accumulate in this condition?
What does this cause?
What happens when Macrophages ingest LDL?
What are these chemotactic for?
What happens to the motility of macrophages?
What does this stimulate the release of?
How do these effect endothelial and smooth muscle cells?
- Hypercholesterolaemia is a form of hyperlipidaemia, where there is too much bad LDL cholesterol in the blood
- This impairs endothelial function
- In this condition, LDL cholesterol accumulates in the tunica intima, which causes oxidative modification of LDL
- When macrophages in the tunica intima ingest oxidised LDL cholesterol via scavenger receptors, they become foam cells
- These foam cells are very chemotactic for monocytes, which come into the tunica intima and become macrophages
- Ingesting the LDL cholesterol will inhibit motility in the macrophages
- This stimulates the release of cytokines from foam cells, which are cytotoxic to endothelial and smooth muscle cells
What are the 3 roles of macrophages in the development of atherosclerosis?
- Role of macrophages in development of atherosclerosis:
1) Macrophages engulf oxidised LDL to from Foam cells
2) The secret various factors, such as Interleukin 1 and Growth factors, which will be chemotactic for more monocytes
3) Macrophages can form a fatty streak, which the first grossly visible (to the naked eye) lesion in the development of atherosclerosis
What does the fatty streak mature into?
What 3 steps is this done in?
- The fatty streak matures into fibrofatty atheroma
- Steps of this process:
1) The smooth muscle enters the tunica intima, which help in formation of collagen on the surface of fibrous tissue, causing a fibrous cap
2) In the centre of the atheroma, foam cells will eventually die, the LDL cholesterol will crystalise and will group together in the centre forming a lipid necrotic debris
3) It is now a full formed fibrofatty atheroma
What is morphology?
What is the morphology of atherosclerosis?
What are the 6 sites atheromas can occur from most likely to least likely?
What are 5 complications that can rise due to atheroma?
- Morphology is the visual study of anomalies caused by diseases
- Morphology of atherosclerosis is an atheromatous (fibrofatty, fibro-lipid) Plaque which:
1) Is patchy and raised white to yellow 0.3-1.5cm
2) Has a core of lipid
3) Has a fibrous cap - 6 sites atheromas can occur from most likely to least likely:
1) Abdominal aorta
2) Coronary arteries
3) Popliteal arteries
4) Descending thoracic aorta
5) Internal carotid arteries
6) Vessels of the circle of Willis - 5 Complications that can rise due to atheroma;
1) Cerebral Infarction
2) Carotid Atheroma - an emboli causing transient ischemic attacks or cerebral infarcts
3) Myocardial Infarct/ cardiac failure
4) Aortic aneurysm - rupture causes sudden death
5) Peripheral vascular disease with intermittent caudation
6) Gangrene
What are 7 complications from atherosclerosis?
- Complications from atherosclerosis:
1) Cerebral infarction
2) Carotid atheroma – emboli causing transient ischaemic attacks or cerebral infarcts
3) Myocardial infarction
4) Heart failure
5) Aortic aneurysms – rupture causes sudden death
6) Peripheral vascular disease with intermittent claudication - Claudication is pain in the legs or arms that occurs while walking or using the arms due to lack of blood flow
7) Gangrene – lack of blood causes tissue to die
What causes peripheral vascular disease?
What does it cause?
What are 4 effects of Peripheral vascular disease?
- Peripheral vascular disease is caused by atheromas of distal aorta / iliac / femoral arteries
- It causes ischaemia of lower limbs
- 4 effects of Peripheral vascular disease:
1) Intermittent claudication (muscle pain due to lack of oxygen)
2) Pain
3) Ulcers
4) Gangrene
What are aneurysms?
What are the 6 different types of aneurysms?
What are the 4 different ways aneurysms present?
- Aneurysms are localised, permanent, abnormal dilatation of blood vessel or the heart
- Different types of aneurysms:
1) Atherosclerotic
2) Dissecting
3) Berry
4) Micro-aneurysms
5) Syphilitic
6) Mycotic - 4 different ways aneurysms present:
1) True aneurysm – saccular
2) True aneurysm – fusiform
3) False aneurysm – blood escapes from the lumen of the vessel and forms a haematoma
4) Dissection – tear between intima and media, leading to pooling of blood
Where are atherosclerotic aneurysms usually found?
What groups do atherosclerotic aneurysms appear in more often?
What is morphology?
What are the 4 factors in the morphology of atherosclerotic aneurysms?
What are the 6 clinical consequences of abdominal aorta atherosclerotic aneurysms?
How does it usually present?
- Atherosclerotic aneurysms usually present in the abdominal aorta distal to the renal arteries
- Atherosclerotic aneurysms appears in women, smokers, and those over the age of 50 more often
- Morphology is the visual study of anomalies caused by diseases
- 4 factors in the morphology of atherosclerotic aneurysms:
1) saccular or fusiform
2) 15 to 25 cm in length
3) Wall diameter > 50%
4) Frequently contains mural thrombus - thrombi that attach to the wall of a blood vessel and cardiac chamber - Clinical consequences of abdominal aorta atherosclerotic aneurysms:
1) Thrombosis
2) Embolism
3) Rupture
4) Obstruction of a branch vessel
5) ischemic injury
6) Impingement on an adjacent structure - It usually presents as a pulsating abdominal mass, which can be repaired
What groups does dissecting aortic aneurysm appear in the most often?
When might it appear in younger people?
What condition is this associated with?
What are the 3 factors in the morphology of Dissecting aortic aneurysm?
What are the clinical symptoms of dissecting aortic aneurysms?
What can it be confused with?
What is the most common cause of death?
- Dissecting aortic aneurysm appear in Men x3 more than women, aged 40 to 60, with hypertension
- It can appear in younger patients with systemic or localized abnormalities of connective tissue
- Marfan syndrome is a genetic condition that affects connective tissue, which provides support for the body and organs
- 3 factors in the morphology of Dissecting aortic aneurysm:
1) Usually initiates with an intimal tear
2) 1-2 cm from aortic valve
3) Dissection can extend along the aorta retrograde toward the heart or distally, sometimes into the iliac and femoral arteries - Clinical symptoms of dissecting aortic aneurysms:
1) The sudden onset of excruciating, tearing pain
2) Beginning in the anterior chest, radiating to the back between the scapulae, and moving downward as the dissection progresses; - The pain can be confused with that of myocardial infarction.
- The most common cause of death is rupture of the dissection outward into the pericardial, pleural, or peritoneal cavities
Where do Berry aneurysms occur?
What groups does it occurs in?
What sign does it often present with?
What condition is it associated with?
What vessel do berry aneurysms typically occur in?
What other 2 places can capillary berry aneurysms occur?
- Berry aneurysms occur in the circle of Willis
- The Circle of Willis is the joining area of several arteries at the bottom (inferior) side of the brain
- They occur in young people
- Berry aneurysms often present with hypertension
- They are associated with sub-arachnoid haemorrhage
- Berry aneurysms typically occur in anterior cerebral arteries
- These berry aneurysms can also occur in:
1) Basilar artery
2) Middle cerebral artery
What 2 conditions are capillary micro-aneurysms associated with?
Where can capillary micro-aneurysms be found?
What is this associated with?
- Capillary micro-aneurysms are associated with hypertension and diabetes mellitus
- Capillary micro-aneurysms can be found as small aneurysms of middle cerebral artery
- This is associated with intra-cerebral haemorrhage
Where do syphilitic aneurysms occur?
What do mycotic aneurysms affect?
Where do they occur?
What can they occur secondary to?
- Syphilitic aneurysms typically affect the thoracic aorta
- Mycotic aneurysms typically affect the wall of arteries weakened by infection (bacteria or fungi e.g can be associated with infective endocarditis in the heart) and often occur in the brain secondary to embolism (blockage)
What are varicose veins?
What causes varicose veins?
What systems do they usually occur in?
What are risk factors for varicose veins?
What are 4 conditions associated with varicose veins?
What are 3 symptoms associated with varicose veins?
- Varicose veins are abnormally dilated, tortuous (twisted) veins
- Varicose veins are produced by prolonged, increased intraluminal pressure, loss of vessel wall support, and venous valve incompetence, with blood flowing from the deep veins to the superficial veins (wrong way)
- They usually occur in the saphenous system of the lower limbs
- Risk factors of varicose veins:
1) Age
2) Sex
3) Heredity
4) Posture
5) Obesity - Conditions associated with varicose veins:
1) Oesophageal varices - Oesophageal varices are abnormal, enlarged veins in the oesophagus
2) Haemorrhoids – lumps inside and around the anus
3) Varicocele – mass of varicose veins
4) Stasis dermatitis – common eczema in those who have poor blood flow - Symptoms associated with varicose veins:
1) Cosmetic problems
2) Aching in legs
3) Skin ulceration and bleeding
What age/gender groups does Giant-cell (temporal) arteritis affect more often?
What is giant-cell arteritis?
What vessels does it affect?
What 3 places does it affect? What is it characterised by?
How long does it take to develop?
What does self-limited mean?
Can this condition be self-limited?
What 4 things does Giant-cell (temporal) arteritis present with?
How does it present histologically?
- Giant-cell (temporal) arteritis often affects those over 50, with the average onset age of 70, and it being more prominent in woman than men
- Giant-cell (temporal) arteritis is granulomatous inflammation of large to small-sized arteries
- It is:
1) Temporal (temples of the head)
2) Vertebral
3) Ophthalmic (eyes) - Giant-cell (temporal) arteritis is characterised by a cord like nodular thickening
- It develops in 6 – 12 months,
- It can be self-limited - A condition that resolves on its own and has no long-term harmful effect on a person’s health (assuming that they are not immunosuppressed).
- Giant-cell (temporal) arteritis presents with:
1) Patchy lesion
2) Throbbing temporal pain
3) Malaise – general feeling of discomfort
4) Fever - Histologically, Giant-cell (temporal) arteritis present with giant nucleated cells
Why is Takayasu arteritis called pulseless disease?
What groups of people does it affect?
What is Takayasu arteritis?
What vessels does it occur in?
What 2 places can these vessels be found?
What can it cause in vessels?
What 5 symptoms does it present with?
What does it present with histologically?
How is it treated?
- Takayasu arteritis is often called pulseless disease because it often presents with no pulses in the upper limbs
- Takayasu arteritis is more common in woman <30 years old
- Takayasu arteritis is granulomatous vasculitis of medium and larger arteries
- Occurs in the upper limbs (+arch of aorta)
- It can cause fibrous thickening around blood vessels, causing swelling
- Symptoms associated with Takayasu arteritis:
1) Dizziness
2) Visual disturbances
3) Dyspnoea – shortness of breath
4) Intermittent claudication upper limbs – pain due to lack of blood flow
5) Asymmetric BP - Histologically, it presents with giant cells, showing that this is an autoimmune, chronic type of inflammation
- It is treated with steroids
What are benign vascular tumours called?
What are the 2 different types of angioma?
What are the 4 different types of benign Vascular tumours?
Where do they affect?
What is a type of malignant vascular tumour?
- Benign vascular tumours are angiomas
- Angiomas are benign tumours of blood vessels (haemangioma) or of lymph vessels (lymphangioma).
- 4 different types of benign Vascular tumours (angiomas):
1) Juvenile (strawberry) haemangioma
* Occur in the skin
2) Capillary haemangioma (ruby spots)
* Occurs in the skin, spleen, and kidneys
* Most common orbital tumour in childen
3) Cavernous haemangioma (port wine stains)
* Occurs in the skin, spleen, liver, pancreas
4) Lymphangioma
* Capillary and cavernous tumours
What are the 2 types of malignant vascular tumors?
Where do they occur?
Malignant vascular tumours:
1) Angiosarcoma
* Occurs in skin, soft tissue, breast, bone, liver and spleen
2) Kaposi’s sarcoma
* Associated with HIV / AIDS
* Angioproliferative tumour derived from endothelial cells
