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CPR II > (1) Blood Vessels; Part 1 (Martin) > Flashcards

(1) Blood Vessels; Part 1 (Martin) Flashcards

1
Q

***Self Review***

What are the three layers within a blood vessel?

A

Intima

Media

Adventitia

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2
Q

***Self Review***

What differentiates the intima from the media?

A

Internal elastic lamina

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3
Q

***Self Review***

What is the clinical importance of the internal elastic lamina?

A

VERY common site for damage within vessels

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4
Q

***Self Review***

Describe a elastic artery

A

High elastin content

–> Allows for expansion during systole and recoil during diastole

Becomes less compliant with age

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5
Q

***Self Review***

Describe a muscular artery

A

Circumferentially oriented smooth muscle

Contribues to arteriolar:

Contraction=vasoconstriction

Relaxation=dilation

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6
Q

***Self Review***

Describe arterioles

A

Main point of physiologic resistance to blood flow

Resistance to fluid flow is INVERSELY proportional to the fourth power of the diameter

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7
Q

***Self Review***

What is contained within the adventitia?

A

Vasa Vasorum

“Vessels of the vessels”

Small arterioles supply O2 to the outer media of large arteries

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8
Q

***Self Review***

Describe the characteristics of capillaries

A

Diameter of RBC

No media

contains pericytes

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9
Q

***Self Review***

Describe the characteristics of veins

A

Most inflammatory reactions ooccur here

Larger lumens, thinner and less organized walls

Contains about 2/3 of total blood volume

Less rigid

Reverse flow due to gravity prevented in the extremities by venous valves

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10
Q

***Self Review***

Describe lymphatics

A

Thin walled, lined by specialized endothelium

Returns interstinal tissue and inflammatory cells to the bloodstream

Transports bacteria etc, tumor cells

*THE PATHWAY FOR DISEASE DISSEMINATION

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11
Q

Where does gas and nutrient exchange occur in the vasculature?

A

Capillary

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12
Q

Where is blood pressure regulated within the vasculature?

A

Arteriole

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13
Q

What structure is contained within veins but NOT arteries?

A

ONE WAY VALVES

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14
Q

What are the three primary vascular anomalies?

A
  • Aneurysms
  • Arteriovenous malformations (AVM)
  • Fibromuscular dysplasia
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15
Q

What is an aneurysm?

A

Localized abnormal dilation of a blood vessel or the heart

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16
Q

How does an aneurysm develop?

A

NOT present at birth

Develops over time due to underlying defect in the media of the vessel

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17
Q

Describe what arteriovenous malformations (AVM) are:

A

When arteries directly connect with veins without intervening capillaries

They are tangle, worm-like vascular channels with significant PULSATILE arteriovenous shunting with high blood flow

Large or multiple AVMs may shunt blood leading to cardiac failure

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18
Q

Describe what fibromuscular dysplasia is

A

Focal irregular thickening

in medium and large muscular arteries

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19
Q

How does fibromuscular dysplasia typically arise?

A

USUALLY developmental defect

rarely rises from trauma

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20
Q

Berry Aneurysms

Where does this commonly occur?

A

Circle of Willis

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21
Q

​Berry Aneurysms

What is the most common clinical report of patients with Berry Aneurysms?

A

“The worst headache I’ve ever had”

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22
Q

​Berry Aneurysms

Anatomically, where are they frequently found within the circle of willis?

A

Branch points of the anterior circulation

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23
Q

​Berry Aneurysms

Most frequent cause?

A

Subarachnoid hemorrhage (SAH)

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24
Q

​Berry Aneurysms

Typical size?

A

>10 mm in diameter

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25
_​Berry Aneurysms_ Approximatly 1/3 of ruptures are associated with...
Acute increases in intracrainal pressure eg Straining at stool, Sexual orgasm...nice
26
_​Berry Aneurysms_ Fatality percentage?
25-50% die with first rupture -Repeat bleeding common in survivors
27
What is a **mycotic aneurysm?**
Can be one of the three... 1. embolization of a **SEPTIC EMBOLUS** which is usually a complication of **infective endocarditis** 2. an _extension_ of an adacent suppurative process 3. circulating organisms *directly infecting* the arterial wall
28
What are the 4 types of aneurysm?
1. Saccular (berry) \*\*\*most common 2. Giant 3. Fusiform 4. Mycotic
29
Describe the appearance of an AVM:
Wormy, tangled
30
Why would you surgically induce an AVM?
To generate a arteriovenous fistula to provide vascular access for **chronic hemodialysis**
31
Describe the appearance of **fibromuscular dysplasia**
"String of beads" Focal irregular thickening in medium and large muscular arteries
32
What population is highly susceptible to **fibromusclar dysplasia?**
1st degree relatives YOUNG WOMEN
33
What is one of first responses of the vascular wall to injury?
Intimal thickening
34
Basal and Activated Endothelial Cell States What are some aggrevating factors that can activate an endothelial cell?
Turbulent flow Hypertension Cytokines Complement Bacterial products Lipid products Hypoxia Viruses CIGARETTE SMOKE
35
Basal and Activated Endothelial Cell States What occurs once an endothelial cell is ACTIVATED?
- **Increased** expression of **procoagulents, adhesion molecules** and **proinflammatory factors** - _Altered_ expression of _chemokines, cytokines and growth factors_
36
Describe the response to vascular injury in three steps
1. Recruitment of smooth muscle cells TO the intima 2. Smooth muscle cell mitosis 3. Elaboration of extracellular matrix
37
Define **Hypertensive vascular disease**
Sustained... Diastolic \>89 or Systolic \>139
38
What is a highly associated pathology associated with **hypertensive vascular disease?**
Atherosclerosis
39
What are the three subtypes of hypertension?
Secondary HTN Essential HTN Malignant HTN
40
What are the causes of: Seconary HTN Essential HTN Malignant HTN
Seconary HTN = underlying renal/adrenal dz Essential HTN = idiopathic Malignant HTN= pre-existing benign HTN
41
Which is the MOST and LEAST common? Seconary HTN Essential HTN Malignant HTN
Seconary HTN (LEAST) 5% Essential HTN (MOST) 90-95% Malignant HTN (LEAST) 5%
42
What population is at risk for essential HTN?
Increases with age African-american
43
Describe the origin of secondary HTN
The hypertension is secondary to **renal artery stenosis** which is caused by _increased production of renin_ from the ischemic kidney
44
What is the BP of a malignant HTN patient?
Systolic \>200mmHg Diastolic \>120mmHg
45
Neural factors that influence peripheral resistance What are the **constrictors?** What are the **dilators?**
Constrictors = alpha adrenergic Dilators = beta adrenergic
46
Humoral factors that influence peripheral resistance What are the constrictors? What are the dilators?
Constrictors = Angtiotensin II, Catecholamines, Thromboxane, Leukotrienes, Endothelin Dilators = Prostaglandins, Kinins, NO
47
Describe how blood volume and vascular tone are modified and maintained
RAAS System - With low volume/resistance, RENIN is released by JGG cells - RENIN cleaves angiotensinogen--\> _angiotensin I_ - Angiotensin I is cleaved to form _angiotensin II_ by ACE - Angiotensin II also stimulates release of _aldosterone_ which causes renal reabsorption of Na+ and H2O
48
What are the two forms of small blood vessel disease?
1. Hyaline arteriolosclerosis 2. Hyperplastic arteriolosclerosis
49
Describe the appearance of **Hyaline arteriolosclerosis**
Increase in smooth muscle matrix synthesis Homogenous pink (hyaline) thickening of the vessel wall (in nephrosclerosis, aquire glomerular scarring therefore non-functional)
50
When does **Hyperplastic arteriolosclerosis** occur? What does it look like?
Occurs in SEVERE HTN Smooth muscle cells form concentric lamellations ("onion skinning") --\> luminal narrowing
51
What does **arteriosclerosis** literally mean?
"hardening of the arteries" -Arterial wall thickening and loss of elasticity (generic term)
52
What is **Monckeberg medial sclerosis?** Population affected?
Calcification of muscular arteries, internal elastic membrane invloved. UNIQUE b/c there is NO narrowing of lumen and NO clinical significance \>50y/o
53
What causes more deaths in the western world than any other disorder?
ATHEROSCLEROSIS It accounts for aprox. half of all deaths in western world...damn
54
Describe what an **artherosclerotic plaque** is:
Raised lesion with a soft core of lipid covered by a fibrous cap
55
What impacts can an **artherosclerotic plaque** have clinically?
Mechanically obstructing blood flow Atherosclerotic plaques can rupture, leading to **catastrophic obstructive vascular thrombosis** Can increase diffusion distance from the lumen to the media
56
What is the most significant risk factor for atherosclerosis?
Hypercholesterolemia
57
Clinically, what does **C Reactive Protein (CRP)** help predict?
Cardiovascular risk
58
What are the two most important factors contributing to the pathogenesis of atherosclerosis?
1. Hemodynamic turbulence 2. Circulating lipids
59
IMPORTANT IMAGE Describe the arterial wall response to injury
1. Chronic endothelial injury 2. Endothelial dysfunction 3. Macrophage activation 4. Macrophages and smooth muscle cells engulf lipid 5. Smooth muscle proliferation + collagen + ECM deposition
60
What are the major immunologic contributors to inflammation in atherosclerosis?
IL-1 T-lymphocytes Macrophages
61
What is this image an example of?
Fatty streaks
62
What are these images?
A) Mild aortic atherosclerosis B) Severe aortic atherosclerosis
63
What are the potential consequences of **stenosis** of the **arterial lumen?**
May lead to chronic ischemia of myocardium, bowel, brain, the extremities, etc.
64
What is **Critical stenosis?**
Approx. 70% of lumen is occluded
65
Here's a summary of the clinical complications of atherosclerosis
66
What is the difference b/w a vulnerable and stable plaque?
67
What is the difference b/w a **"true"** vs **"false" aneurysm?**
True = an intact (but thinned) muscular wall at the site of dilation False= defect through the wall of the vessel, or heart, communicating with an extravascular hematoma that freely communicates with the intravascular space
68
What is an **arterial dissection?**
Blood enters a defect in the arterial wall and tunnels between it's layers
69
When would an **aneurysm** occur?
Whenever the connective tissue of the vascular wall is weakened 1. Defective vascular wall CT 2. Net degredation of vascular wall CT 3. Weakening of the vascular wall by ischemia
70
Tertiary syphilis is...
ischemia of outer media (thoracic aorta)
71
Describe the appearance of normal vs marfan elastin within the blood vessel
72
Where do abdominal aortic aneurysms (AAA) occur? What usually causes? How is it detected?
Usually **below the renal arteries** typically caused by atherosclerosis Pulsating mass in the abdomen
73
AAA's that are __ cm or greater are usually managed surgically
5cm
74
AAA are due to:
Hypertension or Marfans
75
What is Marfan?
AD Defective synthesis of fibrillin Leads to aberrant TGF-beta
76
What is the most characteristic description of an aortic dissection?
Sudden onset of severe chest pain that... **RADIATES to the back b/w the scapulae** and moving downwards as the dissection progresses
77
Most aortic dissections occur in the...
Ascending aorta w/in 10cm of the aortic valve
78
Describe the **Stanford classification scheme** os dissections
79

CPR II (30 decks)

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