Chapter 9 Flashcards
What are the 2 categories of vascular disease
- Narrowing/obstruction
2. Damaged vessel wall
What are some types of narrowing/obstructing vascular diseases
- atherosclerosis=gradual
- thromboembolism=rapid
What are some types of vascular diseases involving damaged vessel wall
- dilation=aneurysm
- rupture=dissection
List the layers of vascular structures
- Intima: endothelia cells (internal elastic lamina)
- Media: smooth muscles (external elastic lamina)
- Adventitia: CT, nerves, vessels
How does the interior and exterior of a blood vessel produce blood supply
- interior=diffusion
- exterior=vasa vasorum
What produce vascular resistance
Arterioles
Where is the site for edema and WBC diapedesis
Post-capillary venules
What are functions of endothelial cells
- regulate clots
- vasoreactivity
- regulates smooth muscle cell growth
What produces endothelial activation
Trauma causing pro-inflammatory effects
What is a berry aneurysm
Subarachnoid hemorrhage
What is it called when an artery inappropriately connects to a vein
Arteriovenous (AV) fistula
What is fibromuscular dysplasia
Local thickening of an arterial wall producing ischemia (renovascular HTN associated with this)
What are the numbers for hypotension and what happens
<90/60, decreased perfusion
What are the numbers for hypertension and what happens
Greater than or equal to 130/80, damages vessels/organs
What regulated blood pressure
Cardiac output and peripheral vascular resistance
In the heart and kidneys what is involved with vascular tone/blood volume in peripheral vascular resistance
- Heart: atrial natriuretic peptide (ANP)
- kidney: renin-angiotensin-aldosterone system
What happens in blood pressure regulation in increased BP
Stretch and ANP is released producing diuresis ad vasodilation
What happens in blood pressure regulation when there is a decreased BP
The renin angiotensin system is activated producing sodium resorption and vasoconstriction
What medications impact blood pressure regulation
ACE inhibitors, angiotensin 2 receptor blockers, diuretics
What are the categories and their numbers for blood pressure
- normal = <120, <80
- elevated = 120-129, <80
- HTN 1 = 130-139, 80-89
- HTN 2 = 140+/90+
- hypertensive crisis = >180,>120
What happens in HTN vascular disease without treatment
- 50% die of ischemic HA
- another 1/3 die of stroke
What happens to vascular system in HTN
Bp >140/90
Damages vessels and organs
What happens in HTN
Increased vascular resistance, decreased sodium excretion
What are factors influencing HTN
Age, stress, obesity, smoking, inactivity, increased salt intake, genetics (African Americans)
What is essential HTN and malignant HTN
- Essential HTN = about 90% of all HTN
- Malignant HTN = >180/120 (lethal, <5% cases)
What is a common identifier of malignant HTN
Papilledema, a retinal hemorrhage
What happens to endothelial in response to injury
Irreversible intimal thickening which produces stenosis creating tissue ischemia
What is arteriolosclerosis
- ischemic injury
- affects small arteries (arterioles)
- chronic HTN or diabetes
What is it called when the is Ca++ into the media, with no stenosis
Monckeberg Medial Sclerosis
What happens in atherosclerosis
- atheromas(plaques)
- stenosis, aneurysm, dissection, thrombus
- heart (CAD), brain, kidneys, GI
What happens if atherosclerosis ruptures
Thrombosis = macrophages + lipids(foam cells), debris which is MC cause of MI
What are foam cells
Fat laden macrophages
What produces 70% occlusion of coronary arteries in CAD
Artheromatous plaque
What is hemodynamic stress
Branch points or areas of turbulence
What happens when atherosclerosis weakens walls and what happens when it ruptures
Aneurysm and thromboembolism
What are the 3 major MI risk factors
Hyperlipidemia, HTN, smoking, any 2 risk increases 4x, any 3 risk increases 7x
What is metabolic syndrome
When you have any 3 of these 5 things: central obesity, HTN, insulin resistance, dyslipedemia
What is the difference between a true aneurysm and a false aneurysm
True is all 3 layers, false is defect in the inner wall causing extravascular hematoma
What happens in abdominal aortic aneurysm
The aorta is dilated by >50%. AAA is about 5cm normal is about 3cm
Who is more likely to get an AAA
Males, >50, smokers, caucasian, family history of HTN, atherosclerosis found by ultrasound
What are the chances of rupture for an AAA
4-5cm = 1% per year
>6cm = 25% per year
If ruptured 50% are fatal, decreasing by 5% during surgery
Who is most likely to have an aortic dissection
Males 40-60 years old
Early onset of aortic dissection is indicative of what
Marfans syndrome, ehlers danlos, wilson disease
Where does an aortic dissection project
May project posteriorly b/w scapulae
What describes an aortic dissection
Sudden severe tearing or stabbing
What are the two types of aortic dissections
Type A = proximal
Type B = distal
What is vessel wall inflammation
Vasculitis
What type of hypersensitivity is vasculitis
Type 3 immune mediated
What causes vasculitis
ADR’s (penicillin), irradiation, trauma
What is another name for temporal arteritis
Giant cell arteritis
What does temporal arteritis affect
50% of time ophthalmic artery
Who is effected by temporal arteritis
Elderly >50
What indicates temporal arteritis
Facial pain, HA, diplopia/sudden blindness, fever
What is polyarteritis nodosa
Autoimmune vasculitis affecting systemic, small/medium sized arteries
What is not affected by polyarteritis nodosa
Pulmonary arteries
What does polyarteritis nodosa produce and what are the symptoms
Ischemia/infarction; weight loss, fatigue, fever, malaise
Who is affected by polyarteritis nodosa
MC in young adults, 2/3 are idiopathic/autoimmune
What happens to the kidney and GI tract from polyarteritis nodosa
Sudden HTN (renovascular) and in GI abdominal pain and bloody stools
What is a symptom on the skin caused by polyarteritis nodosa
Widespread vascular lesions
What is kawasaki disease and who does it affect
Pediatric vasculitis and 80% are less than 4 years old
What are people with kawasaki’s disease at risk for?
Lethal MI (aneurysm or thrombi)
What causes kawasaki disease
It is rare and idiopathic mostly caused by genetics and viral antigens
What are indicators of kawasaki’s disease
Conjunctivitis, swollen extremities, desquamation, cervical lymphadenopathy
What symptom of the tongue is indicative of kawasaki disease
Oral erythema or “strawberry tongue”
What is reye syndrome
Damage to liver and brain by combination of aspirin and viral infection
What happens in reye syndrome
Encephalopathy and hepatic steatosis
What is a necrotizing vasculitis of kidneys and respiratory tract
Wegener granulomatosis
What type of hypersensitivity is wegener granulomatosis
Type 4 treated with immunosuppression
What are symptoms of wegener granulomatosis
Pneumonitis, sinusitis, kidney damage, nasopharyngeal inflammation/ulcers
What is another name for buerger disease
Thromboangiitis obliterans
Who is most affected by buerger disease
Tobacco smokers, males(3x), 25-35 years old show signs of vasculitis in hands and feet
What is raynaud phenomenon
Exaggerated arteriole vasoconstriction showing as pallor and cyanosis
What is primary raynaud phenomenon
Idiopathic, cold or strong emotions
What is secondary raynaud phenomenon
Atherosclerosis, SLE, buerger disease, or systemic sclerosis
Who is more likely to experience raynaud phenomenon
Onset during adolescent or young adult MC in females
