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Hannah CPR > Blood Vessels Lecture > Flashcards

Blood Vessels Lecture Flashcards

1
Q

most common caused of death in untreated HTN

A

1/2 die of ischemic heart dz or congestive heart failure

-another 1/3 die of stroke second to mult-infarcts in the brain

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2
Q

Common traits of Abdominal Aortic aneurysm (AAA)

A

-mainly due to atherosclerosis

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3
Q

nevus flammeus vs port wine stain

A

nevus - “birthmark” vascular ectasia (local dilation of structure) that is flat and usually regresses with time
-port wine stain is a special type of nevus that grows during childhood, thickens, and is permanent (no fading over time)

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4
Q

what is Takotsubo Cardiomyopathy

A

“broken heart syndrome”

  • myocardial vessel vasospasm associated with emotional stress
  • can cause sudden cardiac death from ischemia or infarct of the heart
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5
Q

two most important causes of aortic aneurysm is

A

atherosclerosis and HTN

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6
Q

what factors can cause activation of endothelium to prothrombogenic state? and expression of what is increased in this state?

A

caused by: HTN , cytokines, lipid products, cig smoke, turbulent flow

expression: procoagulants, adhesion molecules, growth factors , cytokines, chemokines

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7
Q

primary vs secondary Raynauds phenomenon

A

primary (Raynaud DZ)- induced by cold or emotion

  • symmetric
  • young women
  • benign

secondary - component of arterial dz (SLE, scleroderma, Beurgers)

  • asymmetric
  • progressive
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8
Q

when to use a synthetic graft vs a graft utilized from elsewhere in the body to treat vascular replacements

A
  • large-bore synthetic graft works for high-flow locations (large arteries) like aorta; but cause thrombosis or intimal hyperplasia in small vessels
  • saphenous vein and internal mammary a. used as small-bore grafts for coronary arteries
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9
Q

what is defined by the loss of elastic tissue , scarring, inadequate extracellular matrix synthesis, and increased production of ground substance (proteoglycans) seen bc smooth muscle cell loss of degenerative changes

A

cystic medial degeneration

“degenerative changes sometimes causes by medial ischemia”

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10
Q

what is thrombophlebitis and its most important risk factor

A

another name for DVT

-risk: LE prolonged inactivity/immobilization

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11
Q

where are cavernous lymphangiomas common

A

aka “cystic hygroma”
neck of turners syndrome patients
-responsible for “webbed neck” look

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12
Q

what is a double-barreled aorta

A

when an aortic dissection reenters through a second intimal tear causing the formation of a false vascular channel that saves the pt from a hemmorhage.
-the new channel can become endothelized and a recognizable chronic dissection

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13
Q

Wegener granulomatosis common features

A
  • polyangitis noninfectious vasculitis of small vessels; T cell mediated hypersensitivity
  • necrotizing granulomatous
  • nasopharynx, lungs , kidneys
  • sx: middle aged men with sinusitis, hemoptysis, hematuria
  • focal necrotizing often cresenteric glomerulonephritis
  • C-ANCA associated (PR3-ANCA)
  • untx= fatal, survivors = chronic relapsing and remitting
  • may have lung cavitations like TB
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14
Q

define hemangioma (or angioma)

A
  • neoplasm defined by abnormal BV growth from the dilation or new formation of blood vessels
  • common childhood tumors (neoplasms) marked by increased numbers of normal or abnormal vessel filled with blood.
  • typically localized to head and neck
  • most are congenital, increase initially, then regress spontaneously (“cherry angiomas” )
  • malignant transmformation is rare
  • if it diffuses proliferation and becomes extensive internally (esp to liver) it is called angiomatosis
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15
Q

Buerger DZ common features

A
  • thromboangitis obliterans
  • smoking dz
  • necrotizing vasculitis of digits–> ulcers and gangrene
  • digit amputation
  • Raynauds Phenonmemon seen
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16
Q

what do drug-eluting stents incorporate to decrease risk of restenosis at 1yr compared to regular stents

A

release anti proliferative drugs targeting the smooth muscle cells

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17
Q

at risk population for aortic dissection

A

hypertensive males., age 40-60

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18
Q

what is Kawasaki Dz and common features of it

A
  • noninfectious vasculitis of infants and small children
  • often of the coronary a.
  • can cause aneurysm –> acute MI in 4 yo
  • sx: redness of eye, and oral mucosa, and rash on palms and soles , cervical LN enlarged
  • tx: IVIg and Aspirin
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19
Q

define telangiectasia

A

permanent dilation of preexisting small vessels that form a discrete red lesion
*NOT TRUE NEOPLASMS

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20
Q

define bacillary angiomatosis

A
  • vascular (capillary) proliferation in response to gram negative bartonella bacilli
  • often in immunocompromised pts.
  • form red papule,
  • use warthrin-starry stain to identify bacteria
  • tx with macrolide abx
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21
Q

define acute plaque change seen as a possible consequence to atherosclerosis

A
  • an acute thrombus that may form over the plaque occluding the artery , or an hemorrhage of the plaque causing volume expansion and arterial occlusion
  • can occur following rupture of the plaque or erosion/ulceration of the plaque surface
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22
Q

most common site of atherosclerosis

A

places with hemodynamic turbulence (opening of exiting vessels, branch points, posterior abdominal aorta)

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23
Q

define arterial dissection

A

blood entering an arterial defect in the arterial wall and causing a tunnel between its layers

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24
Q

what causes the kidney to release renin from the JG cells in the afferent arteriole

A

low blood volume, low resistance, renal artery stenosis, decreased GFR

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25
Q

main IL released during atherosclerosis

A

IL-1

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26
Q

what can result from a rupture of an arterial aneurysm into the adjacent vein ? and how can it be used surgically?

A

an AVM

-surgical fistula can provide vascular access for chronic hemodialysis

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27
Q

____ causes outer media ischemia of the aortic media from obliterative endarteritis to the vaso vasorum of the thoracic aorta causing aneurysmal dilation and possible aortic valve regurg

A

tertiary syphilis

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28
Q

classic presentation of aortic dissection

A

sudden onset of severe chest pain (anterior chest) radiating to the back between the scapulae and moving downward as the dissection progresses
-can be confused with AMI

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29
Q

Define a Berry “saccular” Aneurysm and its most common traits

A
  • an aneursym that bulges from one side of an artery with a neck leading to it
  • most commonly found near major branch points in the anterior circulation of the Circle of Willis, also in AD polycystic kidney Dz
  • most frequent cause of subarachnoid hemorrhage
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30
Q

primary vs secondary lymphedema

A

primary- caused by isolated congenital defect of familial Milry Dz (lymphatic agenesis or hypoplasia)

secondary- caused by blockade of previously NL lymphatic , malignant tumor (breast cancer is common), mastectomy with node dissection, post-irradiation fibrosis, filariasis, ; peau d’ orange (orange peel) of skin overlying the breast cancer, where draining lymph is clogged with tumor cells. see chylous liquid from it

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31
Q

Giant cell (temporal) arteritis and aortitis common features

A
  • affects large vessels
  • T-cell mediated non-infectious vasculitis
  • common site is branches off carotid A.
  • sx: temporal HA , visual disturbance, jaw claudication, flu-like arthralgia, myalgia (polymyalgia arteritis), facal pain
  • common population: most common vasculitis in older patients
  • see giant cells, intimal fibrosis/thickening, medial granulomatous inflammation, elastic lamina fragmentation
  • *unique ft = diplopia/ vision loss
  • *negative biopsy does not rule out dx
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32
Q

define mycotic aneurysm

A
  • a rare aneurysm caused by infected artery wall due to
    1. embolization of septic emboli from infective endocarditis
    2. direct infection from circulating organism
    3. extension of adjacent suppurative process
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33
Q

define angiosarcoma

A

malignant endothelial tumor

  • can be induced by radiation exposure,
  • common sites: skin, soft tissue, breast, liver
  • use CD31 or vWF markers for malignancy
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34
Q

plaque stability in atherosclerosis is related to the strength of the

A 
fibrous cap 
(can be weakened by stress, , BP changes, or vasoconstriction )
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35
Q

common traits of fibromuscular dysplasia

A
  • common in young women
  • medial and intimal hyperplasia leads to luminal stenosis
  • renovascular HTN can be causes by fibromuscular dysplasia of renal arteries
  • “string of beads” on angiography
  • can develop an aneurysm that may rupture
  • NOT associated with oral contraceptive use
36
Q

formula for BP and CO is

A 
BP= CO x PVR 
CO= SV x HR (strongly influenced by BV regulated by sodium excretion)
37
Q

what is the first response to vascular wall injury

A

endothelial cell activation and intimal thickening (neointmal response) by smooth muscle cells migration and proliferation in the intimal

  • normalizing the injury can return the cells back to non-proliferative state
  • ***smooth muscle cells are associated with atherosclerosis
38
Q

obliterative endarteritis

A
  • characteristic of late-stage (tertiary) syphilis*
  • proliferative inflammation with predilection for small vessels of vasa vasorum of the thoracic aorta .
  • leads to ischemic injury of aortic outer media and aneurysmal dilation
39
Q

define pyogenic granuloma

A
  • *NOT PYOGENIC OR A GRANULOMA
  • is a capillary hemangioma, that presents as rapidly growing red resin on skin, gums, or oral mucosa
  • they bleed easy and often ulcerate
  • *granuloma gravidarum (pregnancy tumor) is common type that occurs rarely in gums of pregnant women
40
Q

what is “cardiac Raynaulds”

A

myocardial vessel vasospasm - excessive contraction of myocardial arteries or arterioles may cause ischemia or infarct

  • can be caused by vasoactive mediators (Epe, pheochromocytoma, or cocaine)
  • outcome: sudden cardiac death possible
41
Q

define epitheliod hemangioendothelioma

A

vascular tumor of adults, occur in med-large veins

  • vascular channels cells begin to resemble epithelial cells,
  • variable sx; 20-30% metastasize
42
Q

define hyperplastic arteriolosclerosis

A
  • occurs in severe malignant HTN
  • smooth muscle cells form concentric lamellations (“onion skinning”) leading to luminal narrowing and possible ischemic injury
  • can be accompanied by fibrinoid deposits and vessel wall necrosis (necrotizing arteriolitis) in the kidneys
43
Q

hereditary hemorrhagic telangiectasia (osler-weber-rendu- dz)

A

AD DO, mutations in genes for TGF-B, congenital capillary and venous dilations (telangiectasias)

  • in skin, moucus membranes, GI, and GU tracts
  • spontanous rupture can occur causing serious epistaxis, GI bleeding, or hematuria
44
Q

hepatic angiosarcoma associated with

A

arsenic, pesticide, throtrastm and PVC exposure (polyvinyl chloride)

45
Q

microscopic polyangitis common features

A
  • like Wegeners polyangitis
  • has P-ANCA (or MPO-ANCA)
  • only lungs and kidneys small vessels affected
  • sx: hemotpysis , hematuria, proteinuria, palpable purpura
  • apoptoic neutrophils seen (vs Churg Straus with esophinphila)
46
Q

___ measurement can predict cardiovascular risk

A

C-reactive protein

47
Q

aneurysms are usually managed surgically if greater than __cm

A

5cm

48
Q

pathogenesis of varicose veins

A

sustained increase intraluminal pressure–>valvular dysfunction–>dilated veins

  • complications: poor wound healing, infection, stasis dermatitis (pain and ischemia of overlying skin)
  • usually in superficial LE veins therefore embolism is rare
49
Q

risk of rupture in a saccular aneurysm

A

if >10mm diameter than it has 50% risk of bleeding per year
>6 mm = 25%
5-6cm = 11%
4-5 cm = 1%
<4 is negligible risk
-1/3 of ruptures associated with acute increases in intracranial pressure (straining at stool or sexual orgasm)
-repeat bleeding common in survivors

50
Q

most common site of vasculitis

A

arterioles, venues, capillaries

51
Q

capillary vs cavernous hemangioma

A

capillary- most common; occur in skin, sub q tissue, muous membranes of oral cavity, and lips, and maybe spleen, liver, kidneys.
-histologically = thin walled capillaries with scant storm

cavernous- large dilated vascular channels, more infiltrative and often involve deep structures, and do not spontaneously regress

  • mass is unencapsultaed,with infiltrative borders
  • intravascular thrombosis an and dystrophic calcifications are common
  • usually little clinical significance, but cosmetically troublesome and vulnerable to traumatic ulceration/blessing
  • part of VHL dz
52
Q

how does atherosclerosis and HTN lead to an aneurysm

A

atherosclerosis - ischemia of the inner media due to plaque thickening of intimal increasing the distance of nutrient diffusion leads to weaker vascular wall
HTN- ischemia of outer media due to stenosing of vasa vasorum arterioles leads to weaker vascular wall

-medial ischemia leads to degenerative changes known as cystic medial degeneration

53
Q

classic triad of Sx seen in Bechet Dz

A
  • noninfectoius vasculitis of small vessels
    1. ulcers of oral cavity
    2. genital ulcers
    3. uveitis
  • HLA-B51 associated
54
Q

SVC syndrome vs IVC syndrome

A

*both are caused by neoplasm invasion/compression
SVC
-bronchogenic carcinoma, mediastinal lymphoma, or aortic aneurysm
-dilation of veins in head, neck, arms with cyanosis
-possible respiratory distress if Pulmonary A. compresses

IVC

  • hepatocellular carcinoma, renal cell carcinoma,
  • LE edema, distention of superficial collateral veins of lower abdomen
  • if renal vein involved- mastic proteinuria
55
Q

is Kaposi sarcoma malignant or benign

A

it is intermediate because not sure how it will respond

56
Q

HTN is a major risk factor for

A

atherosclerosis, CHF, and renal failure caused by luminal stenosing and cardiac hypertrophy
-can also lead to aortic dissection or cerebrovascular hemmorhage

57
Q

premenopausal women are somewhat protected by ____due to estrogen levels

A

atherosclerosis

58
Q

most common site of aortic dissection

A

in the ascending aorta within 10cm of aortic valve

59
Q

type A vs Type B Aortic Dissection

A

A- involves the ascending aorta and is more associated with morbidity and mortality

60
Q

What part of the artery is responsible for blood pressure control

A

the arteriole

61
Q

Sturge-weber syndrome

A

-facial port wine stain, ipsilateral venous angiomas in cortical leptomeninges, mental retardation, seizures, hemiplegia, abnormal skull

62
Q

define glomus tumor

A

“glomangioma” or “paraganglioma”

  • benign but painful tumors
  • arise from smooth muscle cells (not endothelial cells like hemangioma)
  • commonly found in distal part of digits
63
Q

complications seen with thoracic aortic aneurysm

A

compression of respiratory tract, laryngeal nerves, and esophagus causes dyspnea, speech problems, and esophageal dysfunction

64
Q

point of critical stenosis

A

70% occlusion, can lead to ischemia of organ system

65
Q

what is migratory thomboplebitis

A
  • paraneoplastic syndrome associated with mucin-producing adenocarcinomas (lung, ovary, pancreas)
  • causes systemic hypercoagablity from mucin and can causes venous thrombi to appear at one site and disappear and reappear at another site
66
Q

causes of non-infectious vasculitis

A
  1. immune system mediated inflammation
    - immune complexes
    - ANCA
    - endothelial Abs
    - autoreactivity
  2. indirect infections
  3. trauma/injury
67
Q

Common ft of Churg Straus syndrome

A
  • small vessel necrotizing vasculitis, associated with asthma, allergic rhinitis, hyperesophinilia
  • also has granulomas
  • <1//2 have P-ANCA (MPO-ANCA)
68
Q

what are malignant vascular tumor markers

A

CD31 or vWF

69
Q

define malignant HTN

A

5% rapid increase in BP following with death in 1-2 years

  • > 200/120
  • causes renal failure, retinal hemorrhages and exudates with possible papilledema,
  • rare
70
Q

three pathogens most associated with infectious vasculitis

A 
pseudomonas 
aspergilus 
mucor 
*PAM*
-can lead to mycotic aneurysms
71
Q

define lymphangitis and its most common cause

A

acute inflammation or spread of bacterial infection into lymphatics

  • red painful sub-q streaks (inflamed lymph) with painful enlarged LN draining (lymphadenitis)
  • cause: Group A strep
72
Q

define Monckeberg medial sclerosis

A

in pt >50yo, calcifications of muscular arteries with involvement of internal elastic membrane leads to thinking of artery but not narrowing of the lumen therefore not clinically significant

73
Q

bopsy finding of numerous plump spindle cells surrounding jagged vascular channels

A

seen in karposi sarcoma lesions

74
Q

Takayasu arteritis common features

A
  • “pulseless dz” bc affects aortic arch
  • similar to Gaint Cell arteritis except the population affected is Japanese Women
  • sx: ocular disturbances and marked weak pulses in UE
  • medium and large arteries show granulomatous inflammation
  • pulmonary A. may be involved (Pulm HTN –> systemic HTN)
75
Q

define hyaline arteriolosclerosis

A

increased in smooth muscle proliferation at the arteriolar level leading to plasma protein leakage across damaged endothelium and possibly leading to ischemic injury
-homogenous pink (hyaline) thickening of the vessel wall leads to luminal narrowing and increased vascular resistance

76
Q

true vs false aneurysm

A

true- intact, thinned muscular wall at the site of dilation
false - ruptured muscular walll and a defect through the wall of vessel where intravascular space has communication with an extravascular hematoma (pulsating hematoma)

77
Q

which vasculitis is seen associated with geographic necrosis

A

granulomatosis with polyangitis, (wegener dz)

78
Q

which vasculitis is associated with cardiomyopathy

A

Churg Straus Syndrome

79
Q

Polyarteritis Nodosa (PAN) common features

A
  • systemic vasculitis of muscular medium a., immune complex mediated
  • most commonly seen in renal vessels and GI tract
  • *spares the pulmonary vessels
  • population: young adult
  • seen with Hep B patients and HBsAG-Ab complexes in vessels
  • fibrinoid necrotizing vasculitis, with segmental transmural inflammation causing “string of pearls” image
  • sx: young adult with rapid HTN, ab pain, melena, neuro problems, skin lesions, bloody stool
  • can be one-sided (non-circumferential)
80
Q

3 non AIDS associated ways Karposi Sarcoma is seen

A
  1. middle eastern/eastern european older men
  2. endemic in africa, pts < 40
  3. transplant pt associated
81
Q

artery to vein shunting without intervening capillary bed causing a tangled worm-like vascular channel with prominent pulsatile, high blood flow

A

arteriovenous malformation (AVM)

82
Q

role of endothelial cells in the vascular wall

A
  • mainyain blood in fluid state by nonthrombogenic smooth surface
  • influences vascular resistance by controlling medial smooth muscle tone
  • metabolizes hormones (angiotensin)
  • regulates inflammation
  • affect growth of cells (esp. smooth muscle cells)
83
Q

nephrosclerosis relationship to hyaline arteriosclerosis

A

nephrosclerosis is due to chronic HTN resulting in renal arteriolar narrowing (by hyaline arteriosclerosis) leading to diffuse impairment of renal blood supply and glomerular scarring

84
Q

focal or irregular thickening in medium and large muscular arteries (renal, carotids, splanchnic, vertebral)

A

fibromuscular dysplasia

85
Q

localized abnormal dilations of blood vessels or the heart that develop over time due to defects in underlying media (usually elastic layer) and connective tissue

A

aneurysm

86
Q

HTN secondary to _____ is caused by increased production of renin from the ischemic kidney; a bruit can be heard on auscultation of affected kidney

A

renal artery stenosis

Hannah CPR (7 decks)

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