Chapter 11 Robins Flashcards
A patient comes in with subarachnoid hemorrhage.
What can we suspect is the cause?
90% of causes of subarachnoid hemorrhage are rupture of a Berry aneurism.
Fibromusclar dysplasia can lead to what?
Stenosis and aneurism that may rupture.
Alteration of endothelial phenotype seen in endothelial dysfunction is responsible for what pathologlogical changes?
- 1. Thrombus formation
- 2. Atherosclerosis
- 3. Vascular lesions of HTN
- High blood pressure (BP) can cause what?
- What is it a major risk factor for?
- End-organ damage
- Atherosclerosis
Fibromusclar dysplasia of the media and intime occurs in what arteries
medium and large (carotid, splanchnic, verterbral and renal)
How does HTN change vascular pathology in small, large and medium arteries?
Medium and large arteries: degrade walls, aortic dissection and CV hemorrhage
Small arteries: hyaline arteriolosclerosis and hyperplastic arteriolosclerosis
Nephrosclerosis due to chronic HTN is a form of what type of arteriosclerosis?
Hyaline arteriolosclerosis
What type of small blood vessel disease occurs with SEVERE HTN?
Hyperplastic arteriolosclerosis
Mockenberg medial sclerosis
Calcification of internal elastic lamina in muscular arteries => does not narrow lumen => not clinically important
Pts are over 50
What increases changes of getting CAD?
- high systolic BP
- Cholestrol
- Low HDL-C
- DB
- Cigs
- LVH
atherosclerosis occurs in what types of BVs?
Medium and large musclar and elastic vessels
Can we guess how someone with essential HTN will die?
Yes:
1/2 die from ischemic heart disease.
1/2 due from a stroke
What are the signs someone has malignant HTN
- renal failure
- Retinal hemorrhages
- papilledema
- SEVERE htn
- hyperplastic arteriolosclerosis (fibroid deposits + necrotizing arteriolitis)
arteriolosclerosis
Hardening of small arteries and arterioles, which can cause lack of O2 to organs => ischemic injury
What is extremely common in the developed world and causes more morbidity and mortality (almost HALF of all deaths) in the western world?
Atherosclerosis
At what age are people more at risk for atherosclerosis.
Who is somewhat protected from atherosclerosis?
40-60 Y
Young women d/t estrogen
People who have metabolic syndrome and obesity are more at risk for…
thrombus formation and endothelial dysfunction
What factors make ppl with metabolic syndrome and obesity more at risk for thrombus formation and endothelial dysfunction?
- Insulin resistance
- Dyslipidemia (high LDL and low HDL)
- Pro-inflammatory
- Pro-coagulants
- HTN
DB patients are 2x more likely to get what?
MI
What causes a fatty streak to become a mature atheroma?
Smooth muscle proliferation and ECM
-formed d/t IL-1=>
What growth factors do SMC release so that they can proliferate, make ECM and collagen and form a mature plaque?
- PDGF
- FBF
- TGF-a
if we find fatty streaks in the in a infant or adolescent, does this mean they are on their way to forming a atheroma?
NO.
Fatty streaks are common in [aorta of infants and almost all adolescents]
What can cause aneurism and rupture of an atherosclerotic plaque? ***
1. Mural thrombis: thrombi that attaches to the wall of the BV
2. Embolization
3. Wall weakening
What can cause occlusion by thrombus of an atherosclerotic plaque? *** (5)
- Plaque Rupture 2. Plaque Erosion 3. Plaque Hemorrhage 4. Mural thrombosis 5. Embolization
What can cause an aneurism by weakening the vascular wall by ischemia?
- Atherosclerosis: inner media
- HTN: outer media
- Tertiary syphillus: outer media of thoracic aorta
How can syphillus cause an aneurism
Cause obliterans endartitis (inflammation of adventitia, where vasa vassorum is located) => decrease O2 to outer media of THORACIC AORTA => aneyrm and sometimes aortic valve regurg
A patient comes in with an aortic aneurism.
This can is commonly due to.
- Atherosclerosis
- HTN
MCC of abdominal aortic aneurism
Atherosclerosis
MCC of ascending aortic aneurism
HTN (aorta is pusing out blood)
60 YO man who has been smoking for 40 years has atherosclerosis.
This patient is prime beef to get what?
Abdominal aortic aneurism
M
60 YO
smoker
What is the MAIN risk factor for aortic dissections?
HTN
What patient would we see and go BAM: AORTIC DISSECTION?
Severe anterior CP that radiates to the back between scapula and goes down the aorta
