Blood Vessels and CVS Flashcards
What are the Three patterns of arteriosclerosis?
- Atherosclerosis
- Medial Calcific Sclerosis
- Arteriolosclerosis
• Atheromatous plaques project
into and obstruct the lumen
and weaken the media
Atherosclerosis
• Chronic inflammatory response of the arterial wall initiated by injury to the endothelium • Atheromatous plaques located in intima obstruct vessel lumen and weaken vascular wall
Atherosclerosis
- Calcification of media
* Does not encroach on vessel lumen
MEdial calcific sclerosis
• Affects arterioles • Thickened walls reduce lumen diameter causing ischemic injury • Hyaline arteriolosclerosis – Benign hypertension – Diabetes mellitus • Hyperplastic arteriolosclerosis – Malignant hypertension (200/120 mm Hg) • Ischemia: reduced blood flow • Hypoxia: deficiency of oxygen • Infarct: complete loss of blood supply causes localized area of necrosis
Arteriosclerosis
What are the 3 Stages in the Progression of Atherosclerosis in order?
- Fatty streak
- Atheroma (plaque): covered by fibrous
cap - Complicated plaque: ulcerated
Lipid-filled foam cells (macrophages) within
the intima
Fatty streak
Plaque-like lesion that begins
in the intima and impinges on
the vessel lumen
Atheroma
Complications of \_\_\_\_\_\_: 1. Ischemic injury: Compromised blood flow to distal organs 2. Disruption: Exposes thrombogenic substances 3. Thrombosis: Clotting on surface of ulcerated plaque causes further narrowing 4. Embolization: Thrombus or plaque material may embolize (thromboembolus) 5. Hemorrhage: A hematoma may expand or rupture plaque 6. Aneurysm: Weak wall may dilate and rupture
Atheromas
Major Clinical Consequences of \_\_\_\_\_\_\_ • Myocardial infarct: Heart attack • Cerebral infarct: Stroke • Aortic aneurysm: Rupture • Peripheral vascular disease: Gangrene of legs
Atherosclerosis
Risk Factors for _______
Constitutional (non-modifiable) risk factors
– Age– Gender– Family history– Genetic abnormalities
Major (modifiable) risk factors
– Hyperlipidemia– Hypertension– Cigarette smoking– Diabetes mellitus
- Multiple risk factors
multiplies risk
Additional risk factors
– Obesity– Physical activity– Personality type– Alcohol– Trans fatty acids– Lipoprotein A – Hyperhomocystinemia– Systemic inflammatory state (C-reactive protein CRP)
Atherosclerosis
• Total Cholesterol < 200 mg/dl • Low Density Lipoprotein < 100 mg/dl – “Bad cholesterol” – Delivers cholesterol to peripheral tissues • High Density Lipoprotein > 40 mg/dl – “Good cholesterol” – Mobilizes cholesterol from atheromas and transports it to the liver for excretion
Hyperlipidemia
- Syphilitic aortitis of ascending aorta may occur in tertiary syphilis
- Obliterative endarteritis of the vasa vasorum
Syphilitic Aneurysm
• An intimal tear allows dissection of blood into media: may rupture leading to massive
hemorrhage
• Risk factors: hypertension, connective tissue abnormality (Marfan Syndrome)
Arteria dissection
• Cirrhosis of liver causes portal
hypertension
• Rupture producing massive upper
GI bleed
Esophageal Varices
• Prolonged increased intraluminal pressure and loss of vessel wall support produces dilated, tortuous veins
valvular incompetence
• Venous stasis - congestion, edema, pain,
Varicose veins
- Lymphatic spread of bacterial infection
* Painful red streaks and regional lymphadenopathy
Lymphangitis
• Compression of superior vena cava by neoplasm obstructing venous return
Superior vena cava syndrome
• Inflammation of the blood vessel wall
• Etiology unknown: most cases are not infectious
• Clinical features
– Systemic : non-specific symptoms of inflammation
• Fever, fatigue, weight loss, myalgias
– Local : symptoms of organ ischemia due to luminal narrowing or thrombosis
Vasculitis
• Most common form of vasculitis in older adults: Females over 50y • Granulomatous vasculitis • Flu-like symptoms with muscle and joint pain. ESR elevated • Branches of carotid artery – Headache – Visual disturbances 50% – Jaw claudication • Treatment: Anti-inflammatory – Corticosteroids
Large Vessel Vasculitis: Temporal (Giant Cell) Arteritis
• Necrotizing arteritis involving multiple organs: lungs spared • Association with Hepatitis B • Classical presentation : young adults – Hypertension: Renal artery involvement – Abdominal pain with GI bleeding: • mesenteric artery involvement – Neurologic disturbances – Skin lesions
Medium Vessel Vasculitis: Polyarteritis Nodosa
• Necrotizing granulomatous vasculitis • Target organs: Nasopharynx, lungs, kidneys – Nasopharyngeal ulceration, sinusitis – Hemoptysis: Lung involvement – Hematuria: Renal involvement • Glomerulonephritis – ^ Middle-aged males • “Strawberry” gingiva • Antiproteinase-3 (PR3) • c-ANCA 95%
Small Vessel Vasculitis: Wegener Granulomatosis
• Optimal blood pressure:
<120 and <80
• Normal blood pressure
<130 and <85
• Stage I Hypertension
140-159 or 90-99
• The final common pathway of many forms of heart disease • Inability of the heart to pump a sufficient amount of blood through the body • Onset preceded by compensatory mechanisms (cardiac hypertrophy)
CHF
