Chapter 9 Flashcards
common, disabling lethal disease #1 cause of morbidity and mortality in US
vascular disease
vascular disease MC involves _______
2 types: NARROWING of ______ or WEAKENING of ________
arteries
lumen
vessel wall
hardening of arteries; non-specific
arteriosclerosis
dilation of vascular wall
aneurysm
passage of blood through layers of wall
dissection
blood clot in a vessel
thrombus
hardening of arteries, atheroma
atherosclerosis
dilation of vein
varicosity
open interior of a vessel
lumen
_____ is similar throughout cardiovascular system with 3 layers: ____, ____ & ______
vascular structure
intima
media
adventitia
smooth muscle in CVS is
involuntary
non-striated
intima is made of _______ and is the _____ layer
endothelia cells
deepest
media is made of ______ and is the ______ layer
smooth muscles
middle
adventitia is made of ______ and is the _____ layer
CT, nerves, vessels
superficial
DIFFUSION of blood from lumen occurs in _____ part of vascular wall
interior
_____ supplies the exterior vascular wall
vasa vasorum
tunica media is _____ in arteries than veins
larger (why cadavers have thicker arteries)
veins have ____ lumen and ____ walls; LOW pressure, leads to prone to dilation/compression
larger
thinner
lympathic vessels have ___ walls lined with _____ to drain ISF
thin endothelia
continuous lining of all vessels
non-thrombogenic interface
regulate vasoreactivity
endothelial cells
pro-inflammatory; trauma upsets homeostasis
endothelial activation
3 types of congenital anomalies
berry aneurysms
arteriovenous fistula (AVF)
fibromuscular dysplasia
dilation of cerebral vessels that leads to subdural hemorrhage
berry aneurysm
connection of arterial and venous systems, bypass capillaries
arteriovenous (AV) fistula
local thickening of medium/large artery walls thats leads to ischemia
may involve KIDNEYS
MC in adult females
fibromuscular dysplasia
kidneys detect decrease in blood supply –> INCREASE in Na absorption –> INCREASE in water retention –> INCREASE BP
renovascular HTN
’s for hypotension, which leads to _____
90/60 (or less)
decrease perfusion, dysfunction
’s for hypertension, which leads to _____
140/80 (or more)
atherosclerosis, hypertensive retinopathy
blood pressure regulation influences: ____ & ____
cardiac output
vascular resistance
INCREASE BP –> ____ heart –> _____
causes: _______ and ______
stretch
ANP
REDUCED sodium resorption
vasodilation
DECREASE BP –> ________
causes: ____ & _____
renin-angiotensin system
sodium resorption
vasoconstriction
normal #’s BP
120/80
BP > 140/90
damages vessels and end-organs
ASYMPTOMATIC -“SILENT KILLER”
25% of US adults
hypertension
95% of hypertensions cases are _______ aka “ESSENTIAL HTN”
risks: age, stress, obesity, smoking, inactivity
idiopathic
vascular wall response to injury:
1 endothelial injury/dysfxn
2 smooth muscle cel recruitment
3 growth of smooth muscle
4 irreversible intimal thickening (vessel stenosis)
benign HTN
CHRONIC hemodynamic stress
hyaline arteriosclerosis
severe HTN
hyperplasia arteriosclerosis
hardening of arteries, decrease elasticity
arteriosclerosis
hardening of SMALL arteries, possible ISCHEMIC INJURY
arteriOLOsclerosis
Ca++ within arteries, no stenosis, NOT clinically significant
monckenberg medial sclerosis
MC type of arteriosclerosis atheroma (plaque) stenosis rupture thrombosis
atherosclerosis
99% of all arteriosclerosis is __________
atherosclerosis
atheromas:
- protrude into ________, decrease flow, macrophages, lipids aka _________ , _____ debris and have a fibrous cap
- prone to _____ plaque , –> massive THROMBOSIS
- WEAKENS _______ –> risk for aneurysm
lumen foam cells Ca++ rupture tunica media
70% of occlusion of coronary arteries lead to _______ (build of up atheromatous plaque)
CAD (coronary artery disease)
risks of atherosclerosis
family hx
age
males
GENETICS
MI (myocardial infarction) risks of atherosclerosis
- if you have 2 symptoms, ___ x MI risk
- if you have all 3 symptoms, ____ x MI risk
hyperlipidemia HTN smoking 4x 7x
central obesity, insulin resistance, HTN, hypercoagulability are all symptoms of _______; a modifiable part of atherosclerosis
metabolic syndrome
characteristics of TRUE aneurysms
all 3 layers of a vessel affected and heart wall
characteristics of FALSE aneurysms
defect in vascular wall
blood enters arterial wall, may lead to hematoma
DISSECTION
Abdominal Aortic Aneurysm (AAA) is a dilation of >___% of normal; and a surgical diameter > ___ cm
50%
5 cm
risks for AAA are
male smokers >50 y.o. caucasian facial history of AAA atherosclerosis HTN
____ may obstruct vessels branching off aorta, affects kidneys, legs, spinal cord, GI
50% of ruptured ones are LETHAL
4-5 cm: ___ % per year
>6 cm: _____ % per year
AAA
1
25
blood splays apart the laminar planes of the media to form a blood-filled channel inside aortic wall –> massive hemorrhage
MALES
40-60 Y.O.
ADOLESCENTS with CT disorders (marfans, ehlers-danlos)
aortic dissections
pain for aortic dissections is common ________
- type ___ is MC, near ______ and MOST SEVERE
- type ____ is distal to _________
between scapulae
type A
ascending aorta
left subclavian artery
inflammation of the vascular wall that is MC in SMALL ARTERIES
vasculitis
vascular invasion occurs in ______ vasculitis
example – ______
infectious
hepatitis B
immune-mediated, ADRs is part of ______ vasculitis
examples– ____ & ____
non-infectious
SLE
penicilin
misc factors that may lead to vasculitis
irradiation
trauma (physical or chemical)
MC type of vasculitis in OLDER ADULTS
-idiopathic
giant cell arteritis (temporal arteritis)
artery affected with giant cell arteritis causes: diplopia sudden blindness facial pain HA PYREXIA
ophthalmic artery
MC vasculitis in YOUNGER INDIVIDUALS (<50 y.o.)
granulomatous vasculitis, possibly from autoimmune disease
takayasu arteritis
system-wide vasculitis, transmural necrosis SMALL and MEDIUM sized arteries in KIDNEYS, VISCERA, HEART, LIVER 2/3 is IDIOPATHIC *treatment= corticosteroids*
polyarteritis nodosa (PAN)
MC vasculitis in YOUNG ADULTS EPISODIC/paroxysmal weight loss fatigue *END-ORGAN DAMAGE* renal and GI tract
polyarteritis nodosa (PAN)
_____ results in remission of cure in 90% of polyarteritis nodosa cases
immunosupression
pediatric vasculitis (80% ** MI usually resolve within 2 years
kawaski disease
characteristics of kawaski disease
idiopathic
fever
cervical lymphadenopahy
STRAWBERRY TONGUE
uncommon type of vasculitis that causes inflammation
type II hypersensitivity
kidneys, upper/lower respiratory tract - nose, sinuses, trachea lungs
middle ages MALES
if untreated, lethal after 1 year
wegner granulomatosis
vasculitis that affects MEDIUM sized arteries thrombosis --> vascular insufficiency affects HANDS & FEET PAINFUL extremities CYANOSIS GANGRENE CIGRARETTE SMOKING
thromboangiitis obliterans
exaggerated arteriole vasoconstriction pallor and cyanosis chronic --> atrophy of skin ADOLESCENT/YOUNG ADULTS MC IN FEMALES *may be secondary to atherosclerosis, buerger disease, lupus, scleroderma
raynaud phenomenon
broken heart syndrome or cardiac raynaud
stress cardiomyopathy
increase in catecholamine production (stress hormone)
may affect coronary arteries
takotsubo cardiomyopathy
3 types of venous diseases that make up 90% of all cases
varicose veins
phlebothrombosis
thrombophlebitis
venous thrombosis following inflammation
thrombophlebitis
-superficial veins are DILATED and TORTUOUS LEGS (MC)
- increase in intraluminal pressure
-congestion/edema, pain, thrombosis
1/3 females
varicose veins
varicose veins main risk is _____ & MC of _______ to people affected
obesity
cosmetic concern
thrombophlebitis AKA
deep vein thrombosis (DVT)
90% of all vein issues are _____; symptoms include cyanosis/rubor, edema, dolor
risks: recent surgery, pregnancy, surgery, obesity, immobolization
possible PULMONARY EMBOLISM
DVT
bronchogenic carcinoma
mediastinal lymphoma
compression or invasion of area
congested UE veins, possible cyanosis, edema in arms, neck, head
superior vena cava syndrome
hepatocellular carcinoma
renal cell carcinoma
compression or invasion
congestion of LE veins; edema, proteinuria
inferior vena cava syndrome
obstruction –> tissue expansion
RARE
LYMPATHIC OBSTRUCTION
lymphedema
primary lymphedema is ________
Kilroy disease, hypoplasia or agencies of lymph vessels
congenital
secondary lymphedema is _____
neoplasia
infection
thrombosis
obstruction (of previously normal lymph vessel)
two types of CHRONIC lymphedema
peau d’orange
brawny induration
ACUTE lymphatic vessel inflammation
bacterial seeding
subcutaneous RED STREAKS, painful
lymphangitis
vascular tumors are MC ______; occasionally fairly _____, rarely highly _______
originate from ______ or ______
benign aggressive malignant ENDOTHELIAL CELLS CT tissue or vessels
common benign tumor in 1:200 newborns
increase LOCAL CAPILLARY growth
usually on head/face
75-90% resolve by 7 y.o.
hemangioma
malignancy of lymphatic endothelial cells
HUMAN HERPESVIRUS 8
AIDS
(rare in USA)
kaposi sarcoma
MALIGNANT endothelial neoplasia
extremely variable
RECUR locally, spread widely (lymph nodes)
MC among OLDER adults
angiosarcoma
2 types of angiosarcoma
differentiated
anaplastic – (INVASIVE, POOR PROGNOSIS)
MC locations of angiosarcoma
skin
breast
liver
irradiation, foreign bodies are risk for
angiosarcoma
arsenic, PVC, irradtionation and lymphedema are symptoms for
hepatic angiosarcoma
vascular interventions
endovascular stenting
endovascular stenting preserves __________, common in ______ cases and risk of thrombosis w/ ongoing ________
luminal patency
CAD
antithrombotic meds
vascular replacement
vascular grafts
REPLACE or BYPASS arteries
LT vessel patency is LIMITATION
can be autologous (transplant) or synthetic
vascular grafts
artery MC used in vascular grafts
internal mammary artery (USED TO BE great saphenous vein)
synthetic vascular graft may lead to
increase thrombosis
