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Aortic and Peripheral Arterial Diseases (Nichols) Flashcards

1
Q

an abnormal localized dilation of an artery, vein, or heart itself

A

aneurism

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2
Q

What layers of a vessel are involved?

A

all 3 are BALLOONED OUT

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3
Q

how is a false aneurysm different than a true aneurysm?

A

pseudoaneurysm is a RUPTURE of 1, 2, or 3 layers
if only or 2 layers, the adventitia is holding it together
if adventita is involved, then a perivascular thrombus is holding it together

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4
Q

What are the risk factors for developing an aortic aneurysm?

A 
elderly
family Hx
smoking**
Male
HTN**
Hyperlipidemia
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5
Q

Where in the bidy are aortic aneurysms most common?

A

abdomen (75%)

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6
Q

What is a universal finding with aneurysms?

A

thrombus formation (due to abn blood flow)

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7
Q

At the periphery of the aneurysm there is ____ flow and at the surface of an aneurysm there is _____ flow

A

stasis

turbulent

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8
Q

T or F: emboli can occur from thrombi that form at the site of an aneurysm.

A

T

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9
Q

What is the pathogenesis of aneurysms?

A

combo of

  1. artherloscleroerosis
  2. genetically determined degeneration of T media
    * 2 hit disease
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10
Q

WHat is the microscopic manifestation of aneurysms?

A

“cystic media degeneration”
fragmentation an loss of elastic fibers –>
cystic areas of myxoid matrix

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11
Q

Aneurysms are a disease of the _____
artherlosclerosis is a disease of the ____

What is the link between these

A 
T media (loss of elastic tissue in muscle)
T intima

Artherlosclerosis causes inflammation and it is thought that the inflammation in the T media spills over into the T media and causes destruction

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12
Q

person says “I dont feel good” then drops over dead

What killed them

A

AAA

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13
Q

marfan syndrome and Erlos Danlos

A

aortic aneurysm without artherlosclerosis

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14
Q

What is the 4 etiologies of aneuyrsms?

A
  1. spillover inflammation from artherlosclerosis brings MMPs which degrades collagen in T media
  2. Genetic: defects in fibrillin or collagen (marfan’s syndrome)
  3. infection
  4. vasculitis (giant cell arteritis)
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15
Q

giant cell arteritis

A

vasculitis as an etiology of AAA

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16
Q

What is the major determinant of whether the aneurysm will rupture?

A

the diameter of the bulge

**greater the diameter = greater risk of rupture

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17
Q

What are the 5 complications of aneurisms?

A
  1. rupture
  2. thrombus formation
  3. embolism of artheroma or thrombus
  4. obstruction of aortic branches
  5. aortoenteric fistula
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18
Q

continuous pounding of the wall of the aorta onto bowel –> damage to wall of intestines –> channel between aorta and bowel made –> blood goes into bowel

A

aortoenteric fistula

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19
Q

difference between a aortic dissection and an aortic aneurysm

A

dissection is a hole causing a bulge and aneurism is a bulge
dissection is a surgical emergency and an aneurysm is not

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20
Q

Symptoms of aortic aneurysm
Signs
Dx
Tx

A

usually none but may cause back pain if leaking, sometimes there is a pulsatile mass that is palpable in thin patients
none
imaging (ultrasound)
stenting or open repair

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21
Q

catastrophic tear of the tunica intima letting luminal blood enter under high pressure into the T media where it tunnels a 2nd lumen

A

aortic dissection

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22
Q

Aortic dissection is always _____

A

a medical emergency

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23
Q

Type A aortic dissection involves the _____
B involves ___
Which is more common? serious?

A

ascending aorta
descending aorta
A and A

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24
Q

Aortic dissection is most common in

A

black (middle aged)

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25
What is the pathogenesis of aortic dissection?
intimal tear: cannot tell | medial tear: assc with cystic medial degeneration (degenerative disease)
26
false lumen
aortic dissection
27
double barrel aortia
aortic dissection
28
What are the symptoms of aortic dissection?
A: sudden severe sharp "tearing" chest pain B: sudden severe pain between scapulae
29
sudden and severe arm pain/weakness normal EKG
subclavian dissection
30
sudden altered mental status
carotid dissection
31
How is the pain of an MI different than the pain of an aortic dissection
MI: dull AD: sharp and tearing
32
T or F: As the pain assc with an aortic dissection moves, the dissection progresses
true
33
What are complications of aortic dissections? (2)
occlusion of aortic branches | rupture commonly into pericardium and less often into left pleural cavity
34
How is the Dx of an aortic dissection made?
Tranesophageal ECG or CT or MRI
35
What is the Tx for aortic dissection?
reduce BP to low normal | surgery (esp type A)
36
Will the aorta ever become obstrcted by the false lumen? Why?
No bc the pressure in the false lumen is always lower than the true lumen
37
chronic artherosclerotic occlusive disease of large and medium arteries, primarily in the legs
peripheral arterial disease
38
limb pain brought on by exercise, relieved by rest
intermittent claudication | peripheral arterial disease
39
limb pain at rest and ulcers indicates
severe peripheral arterial disease
40
when the intermittent claudication occurs in the calf muscles what arteries are diseased?
femoral or popliteal | peripheral arterial disease
41
signs of peripheral arterial disease
``` diminished or lost dital pulses bruits pallor or cyanosis skin atrophy muscle atrophy ulceration gangrene necrosis ```
42
What is the Tx for peripheral arterial disease?
EXERCISE (esp walking) bc it develops collateral circulation)
43
uncommon condition due to thromboemboli from heart (80% cases)
acute arterial occlusion
44
acute arterial occlusion is a _______
medical emergency
45
What are the 5 signs and symptoms of acute arterial occlusion?
``` 5 Ps pain pallor paralysis parasthesia pulselesness in the legs (70%) or arms (8%) ```
46
Where can acute arterial occlusion occur?
legs > arms > brain > intestines, kidneys, spleen
47
What is the Tx for acute arterial occlusion?
heparin intra-arterial thrombolytic therapy pull out with catheter surgery
48
chronic thrombosing inflammatory disease of small and medium arteries and veins of arms and legs
buerger disease
49
100% of buerger dosease cases are assc with ______
smoking
50
another name for buerger disease
thromboangiitis obliterans
51
Epidemiology of buergers
SE asian in 20s and no older than 40s
52
what is the microscopic pathology of acute buerger's disease chronic?
segmental tranmural inflammation without necrosis = vasculitis +thromboses +granulomas +giant cells Chronic: organization of thrombus with neovascularization and fibrosis
53
What is the big difference between buerger's disease and acute arterial occlusion?
buergers can involve the hands and fingers
54
What are the symptoms of beurger's? Signs? Tx:
instep claudication cold feet raynaud's phenomenon gangrene, nodular thrombophlebitis, ulcerations stop smoking an amputation
55
WHat is ectasia?
generalized dilation of a blood vessel that is usually assc with aging
56
Where can aneurysms form?
artery, vein, or heart
57
Elevated blood levels of ____ and ____ are assc with the formation of aneurysms
C-reactive protein and IL-6
58
_____ accelerates the rate of growth of an aneurysm and _____ is a major factor in the rate of growth
HTN and BP
59
in motor vehicle accidents, an intimal tear of the _____ or rupture of the ____ can lead to the development of an aneurysm
ligamentum arteriosum | vasa vasorum
60
pain brought on by exercise and relieved by rest
intermittent claudication (peripheral arterial disease)
61
65% of the thrombi in acute arterial occlusion come from ...
mural thrombi that developed after an MI
62
acute arterial occlusion is occasionaly due to thrombus formation in situ... what 3 conditions most commonly cause this in situ thrombus formation
artherosclerotic plaque ulcer or rupture HIT (heparin induced thrombocytopenia) anti-phospholipid Ab syndrome
63
microscopically, thromboses with "microabscesses" in thrombus
buerger disease
64
Angiogram shows stenoses (more distally) with corkscrew collaterals
Buerger syndrome
65
What is raynaud's syndrome?
vasospasm of finger arteries with cold exposure --> white --> blue --> red

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