Aortic and Peripheral Vascular Disease Flashcards
1
Q
Arteriosclerosis
- Definition
- 3 types
A
- Definition
- Hardening & thickening of artery walls
- 3 types
- Atheroslcerosis
- Mönckeberg medial sclerosis
- Arteriolar sclerosis
2
Q
Atherosclerosis
- General
- Risk factors
- Non-modifiable
- Major modifiable
- Minor modifiable
A
- General
- Often used itnerchangeably w/ arteriosclerosis
- Intimal atheromas (fibrofatty plaques)
- Leading cause of morbidity & mortality in the Western world (~50% of all deaths)
- Much of this mortality is realted to coronray artery disease
- Risk factors
- Non-modifiable
- Age, gender, genetics
- Major modifiable
- Smoking, diabetes, HTN, hyperlipidemia
- Minor modifiable
- Obesity, lifestyle
- Non-modifiable
3
Q
Mönckeberg Medial Sclerosis
A
- Calcification & often ossificaiton of the muscular media
- Does NOT impinge on vessel lumen
4
Q
Arteriolar Sclerosis
A
- Involves arteriorles
- 2 types
- Hyperplastic: intimal thickening
- Hyaline: acellular thickening
5
Q
Pathogenesis of Atherosclerosis
- Response-to-injury hypothesis
- Key points
- Fatty streak
- Atheromatous plaque
- Complicated plaque
A
- Response-to-injury hypothesis
- Intimal (endothelial) injury
- Inflammation
- Key points
- Turbulent flow & lipids are most important in plaque development
- Endothelial cell loss due to any type of injury results in intimal thickening
- The role of infection isn’t conclusive
- Fatty streak
- Earliest lesion
- Flat
- Can be seen outside of lipid pathology setting (infants, adolescents)
- Atheromatous plaque
- Raised
- Impinges on vessel lumen
- Eccentric (not around entire circumference)
- Can enlarge, change shape, & calcify
- Complicated plaque
- Calcified
- Ulcerated
- More thrombosis on surface
- Can rupture & embolize
- Add image from Atherosclerosis flashcard
6
Q
True or False: You have to have high cholesterol to get atheroslcerosis
A
False
7
Q
Atherosclerosis Sites (In Descending Order)
A
- Lower abdominal aorta
- Coronary arteries
- Popliteal artery
- Internal carotid artery
- Circle of Willis
8
Q
Clinical Effects of Atherosclerosis
A
- Arterial narrowing
- Thrombosis
- Embolism
- Aneurysm
9
Q
Thrombosis
A
- Blood clot that formed at the site you found it
-
Acute change in plaque
- Erosion, ulceration, hemorrhage, rupture
- Small to medium sized vessels
- Typically in the setting of a vulnerable plaque
- Thin fibrous cap
- Moderate luminal narrowing
- Lipid rich center
10
Q
Embolism
A
- Blood clot that formed somewhere else & traveled to another site through vasculatur
- Initiated by rupture or erosion of plaque
- Most from aorta
- To organs or lower limbs (gangrene)
- If from carotid
- Stroke
- “Carotid bruit” ntoiced on exam (atheroma)
11
Q
Arterial vs. Venous Emboli
A
-
Arteriol embolus
- Leads to stroke, heart attack, gangrene
-
Venous embolus
- Leads to pulmonray embolism
12
Q
Aneurysms
- Pathophysiology
- Types
- Common aneurysms
A
- Pathophysiology
- Weakening of the vessel wall
- In atherosclerosis, this is due to damage to the media
- Dilation
- Rupture
- Weakening of the vessel wall
- Types
- Saccular
- Fusiform
- Dissecting
- (Mycotic)
- (Syphilitic)
- Common aneurysms
- Abdominal aortic aneurysm (AAA)
- Aortic dissection
- Cerebral berry aneurysm
- Mycotic aneurysm
- Syphilitic aneurysm
13
Q
Abdominal Aortic Aneurysm
- General
- Clinical considerations
- Treatment
A
- General
- Due to atherosclerosis
- True fusiform aneurysm
- Plaques damage & weaken media
- Abdominal aorta below renal arteries
- Men > women, >60yo
- Clinically significant when >5cm in diameter
- Clinical considerations
- “Pulsatile abdominal mass”
- Sudden death from rupture, leads to insanguination & hemodynamic collapse
- Treatment
- Placement of aortic / endoluminal graft
14
Q
Dissecting Aneurysm (Aortic Dissection)
- 2 types
- General
- Classic symptoms
- Classic chest x-ray finding
A
- 2 types
- Hypertensive / atherosclerotic
- Genetic (Marfan Syndrome)
- General
- Cystic medial degeneration
- Dissection usually starts in arch of aorta or aortic root
- Myxomatous degeneration of the aortic wall
- Fragments elastic fibers
- Weakens tunica media
- Classic symptoms
- Sudden onset of excruciating chest pain
- May radiate to middle of the back
- Classic chest x-ray finding
- Widening of the mediastinum due to mediastinal hemorrhage
15
Q
Cerebral Berry Aneurysm
- General
- Rupture results in…
- Clinical signs of rupture
A
- General
- Not atherosclerotic
- Congenital weakening of vessel wall
- Typically at branch points in Circle of Willis
- Rupture results in…
- Subarachnoid hemorrhage
- Intraparenchymal hematoma
- Clinical signs of rupture
- Sudden onset of excruciating headache
- Sudden loss of consciousness