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Cardio > Aortic and Peripheral Arterial Diseases (Nichols) > Flashcards

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
Q

What is the pathogenesis of aortic dissection?

A

intimal tear: cannot tell

medial tear: assc with cystic medial degeneration (degenerative disease)

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26
Q

false lumen

A

aortic dissection

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27
Q

double barrel aortia

A

aortic dissection

28
Q

What are the symptoms of aortic dissection?

A

A: sudden severe sharp “tearing” chest pain
B: sudden severe pain between scapulae

29
Q

sudden and severe arm pain/weakness normal EKG

A

subclavian dissection

30
Q

sudden altered mental status

A

carotid dissection

31
Q

How is the pain of an MI different than the pain of an aortic dissection

A

MI: dull
AD: sharp and tearing

32
Q

T or F: As the pain assc with an aortic dissection moves, the dissection progresses

A

true

33
Q

What are complications of aortic dissections? (2)

A

occlusion of aortic branches

rupture commonly into pericardium and less often into left pleural cavity

34
Q

How is the Dx of an aortic dissection made?

A

Tranesophageal ECG or CT or MRI

35
Q

What is the Tx for aortic dissection?

A

reduce BP to low normal

surgery (esp type A)

36
Q

Will the aorta ever become obstrcted by the false lumen? Why?

A

No bc the pressure in the false lumen is always lower than the true lumen

37
Q

chronic artherosclerotic occlusive disease of large and medium arteries, primarily in the legs

A

peripheral arterial disease

38
Q

limb pain brought on by exercise, relieved by rest

A

intermittent claudication

peripheral arterial disease

39
Q

limb pain at rest and ulcers indicates

A

severe peripheral arterial disease

40
Q

when the intermittent claudication occurs in the calf muscles what arteries are diseased?

A

femoral or popliteal

peripheral arterial disease

41
Q

signs of peripheral arterial disease

A 
diminished or lost dital pulses 
bruits
pallor or cyanosis
skin atrophy
muscle atrophy
ulceration
gangrene necrosis
42
Q

What is the Tx for peripheral arterial disease?

A

EXERCISE (esp walking) bc it develops collateral circulation)

43
Q

uncommon condition due to thromboemboli from heart (80% cases)

A

acute arterial occlusion

44
Q

acute arterial occlusion is a _______

A

medical emergency

45
Q

What are the 5 signs and symptoms of acute arterial occlusion?

A 
5 Ps 
pain
pallor
paralysis
parasthesia 
pulselesness in the legs (70%) or arms (8%)
46
Q

Where can acute arterial occlusion occur?

A

legs > arms > brain > intestines, kidneys, spleen

47
Q

What is the Tx for acute arterial occlusion?

A

heparin
intra-arterial thrombolytic therapy
pull out with catheter
surgery

48
Q

chronic thrombosing inflammatory disease of small and medium arteries and veins of arms and legs

A

buerger disease

49
Q

100% of buerger dosease cases are assc with ______

A

smoking

50
Q

another name for buerger disease

A

thromboangiitis obliterans

51
Q

Epidemiology of buergers

A

SE asian in 20s and no older than 40s

52
Q

what is the microscopic pathology of acute buerger’s disease

chronic?

A

segmental tranmural inflammation without necrosis = vasculitis
+thromboses
+granulomas
+giant cells

Chronic: organization of thrombus with neovascularization and fibrosis

53
Q

What is the big difference between buerger’s disease and acute arterial occlusion?

A

buergers can involve the hands and fingers

54
Q

What are the symptoms of beurger’s?

Signs?

Tx:

A

instep claudication
cold feet
raynaud’s phenomenon

gangrene, nodular thrombophlebitis, ulcerations

stop smoking an amputation

55
Q

WHat is ectasia?

A

generalized dilation of a blood vessel that is usually assc with aging

56
Q

Where can aneurysms form?

A

artery, vein, or heart

57
Q

Elevated blood levels of ____ and ____ are assc with the formation of aneurysms

A

C-reactive protein and IL-6

58
Q

_____ accelerates the rate of growth of an aneurysm and _____ is a major factor in the rate of growth

A

HTN and BP

59
Q

in motor vehicle accidents, an intimal tear of the _____ or rupture of the ____ can lead to the development of an aneurysm

A

ligamentum arteriosum

vasa vasorum

60
Q

pain brought on by exercise and relieved by rest

A

intermittent claudication (peripheral arterial disease)

61
Q

65% of the thrombi in acute arterial occlusion come from …

A

mural thrombi that developed after an MI

62
Q

acute arterial occlusion is occasionaly due to thrombus formation in situ… what 3 conditions most commonly cause this in situ thrombus formation

A

artherosclerotic plaque ulcer or rupture
HIT (heparin induced thrombocytopenia)
anti-phospholipid Ab syndrome

63
Q

microscopically, thromboses with “microabscesses” in thrombus

A

buerger disease

64
Q

Angiogram shows stenoses (more distally) with corkscrew collaterals

A

Buerger syndrome

65
Q

What is raynaud’s syndrome?

A

vasospasm of finger arteries with cold exposure –> white –> blue –> red

Cardio (26 decks)

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