Cardiovascular Path 7 Flashcards
what kinds of end organ damage can you see with malignant HTN ?
- renal failure
- left ventricular failure
- hypertensive encephalopathy
the homogenous pink thickening of the walls of the arterioles in _____ arteriolosclerosis is due to ______
hyaline;
leakage of plasma components across vascular endothelium and ↑’ing extracellular matrix production by smooth muscle cells
chronic hemodynamic stress in HTN or the metabolic stress in DM can cause ______ arteriosclerosis
hyaline
______ arteriolosclerosis is related to more acute or severe elevations of BP
hyperplastic
necrotizing arteriolitis is seen in _____ arteriolosclerosis
hyperplastic
describe the histology appearance of a hyperplastic arteriosclerosis
onion skin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumen
depots of _______ and acute necrosis fo the vessel wall is seen in hyperplastic arteriosclerosis
fibrinoid material
what are two outcomes of the vessels in vasculitis?
stenosis or aneurysm
what are 3 main etiologies of vasculitis?
- immunological
- direct infection
- unknown: giant cell (temporal), takayasu, PAN
what are some classes of immunological causes of vasculitis?
- immune complex mediated: hep B/C, SLE/RA, drugs
- ANCA mediated: Wegener’s granulomatosis and Churgg Strauss
- direct antibody mediated: Kawasaki (anti endothelial cell ab’s)
- cell mediated: allograft organ rejection
________ antibodies is the cause of Kawasaki’s disease
anti-endothelial cell antibodies
what are examples of immune complex mediated causes of vasculitis?
- Hep B/C
- SLE
- Rheumatoid arthritis
- drug induced
SLE is a type _____ cause of vasculitis
type 3: immune response against antigen-antibody complexes
pauci immune vasculitis is seen in _______
ANCA mediated even though there are antibodies (they are against the neutrophils)
what are the two main types of ANCA
- c ANCA (PR3-ANCA)
- p ANCA (MPO- ANCA)
pr3 ANCA is the same as ____ ANCA
c- ANCA
___ ANCA is seen in microscopic polyangitis
P-ANCA
_____ ANCA is seen in Churgg Strauss and Wegener’s
C-ANCA
what arteries are mainly affected in giant cell arteritis?
- aorta
- temporal (most common)
- vertebral
- ophthalmic (can lead to blindness)
what is the difference between takayasu arteritis and giant cell arteritis?
- only the AGE;
< 50 = takayasu
> 50 = giant cell/temporal
most symptoms in giant cell arteritis are vague, but there can also be _____ symptoms such as:
ocular; diplopia, progressive hazy vision, loss of vision
fragmentation of internal elastic lamina is seen in the histology of what vasculitis disease?
giant cell vasculitis (along with giant cells in the intima and inner media)
is there reduction of the lumen in giant cell arteritis?
yes; focal, nodular thickening with reduction of the lumen
why must you take multiple sections in the temporal artery biopsy in diagnosing giant cell arteritis?
this disease has segmental narrowing so can get a segment that seem normal
giant cell arteritis is associated with ________-
polymyalgia rheumatica (inflammatory disorder that causes muscle pain and stiffness)
a 30 year old female patient complaining of visual disturbances, headaches and dizziness is found to have no pulse in her upper extremities and numbness in her fingers. what could this person have?
takayasu arteritis: look at the age (<50), PULSELESS/low BP in upper limb, ocular changes
presents just like giant cell and same histo, just age is different
what arteries are typically affected in PAN (polyarteritis nodosa)
- renal, visceral, and coronary, but SPARES THE PULMONARY CIRCULATION and arterioles, capillaries and venules
what type of inflammation in see in the small or medium sized arteries affected in PAN?
SEGMENTAL transmural necrotizing with fibrinoid necrosis at the inner half of the vessel wall ; (not like the segmental granulomatous type seen in giant cell or takayasu’s)
are the lungs affected in PAN?
NO
what are the most common sites of injury in PAN?
most frequent to least:
- kidney, heart, liver, GIT
what is a characteristic feature of PAN?
all stages of activity may coexist in different vessel or even within the same vessel
(heterogenous)
DOES NOT AFFECT LUNGS
what can you expect to see on histology of someone with PAN?
BOTH: transmural inflammation with fibrinoid necrosis AND inflammation that is replaced by fibrous thickening of the vessel wall
_____ Infection is most often associated with PAN
hepatits B (immune complex mediated)
Kawasaki disease presents and looks just like ______ except for pathogenesis and the invovlemtn of ______
PAN; Kawasaki is due to antibodies against the endothelial cells
Kawasaki involves the mucocutaneous lymph nodes
patient comes in with fever, conjunctival and oral erythema, edema on hands and feet, skin rash with desquamation, and enlargement of cervical lymph nodes. what do they have and how would you treat?
MCLNS (Kawasaki's) and treat with: aspirin and immunoglobulins CRASH and BURN C: conjunctival injetion R: rash (polymorphous → desquamating) A: adenopathy (cervical) S: strawberry tongue (oral mucositis) H: hand-foot changes (edema, erythema) BURN: fever
MI in a young age group such as < 10 year olds, should start to think ______ disease
Kawasaki disease because of its involvement with the coronary vessels that can leading to contrary aneurysm formation and associated thrombosis with MI
what vessels are mainly involved in Buerger disease
mainly the tibial and radial arteries and can sometimes secondarily extend to the veins and nerves of the extremities
______ is the largest predisposing factor of Buergers disease
smoking; HS reaction to tobacco → direct endothelial injury
what are some clinal symptoms of someone with Buerger disease
- superficial nodular phlebitis
- cold sensitivity aka Raynaud’s which is the the extremities go from pale to blue to red
- claudication pain on instep
- progressive pain on exercise and rest
- ulceration of toes, feet or fingers followed by gangrene
Raynaud’s phenomenon is a clinical feature of _______
Buerger’s disease, SLE, thromboangitis obliterans
how can you tell the difference between thromboangitis and atherosclerosis?
the pain in atherosclerosis is associated with activity but twitch Buerger’s disease for example, it can also affect the nerves so can get claudication on rest
thrombus that contains small micro abscesses marked by central focus of _____ surrounded by )____ inflammation is seen in the histology of ______
neutrophils surrounded by granulomatous inflammation is seen in Buerger’s disease
what is a complication of kawsaki disease / Mucocutaneous lymph node syndrome?
may develop coronary aneurysm formation associated with thrombosis with MI → death;
Kawasaki’s disease often involves the coronary arteries
how would you treat giant cell arteritis?
give high dose corticosteroids before temporal artery biopsy to prevent blindness
Takayasu arteritis most commonly affects _________ and on gross image you will see ___________
arch of the aorta;
irregular thickening of the aorta or branch vessel wall with intimal wrinkling and narrowing of the lumen
collagenous fibrosis involving all layers of the vessel wall and ____nuclear infiltrate of the media with granulomatous change with patchy necrosis of the media is seen in ______
mononuclear;
takayasu arteritis
