Chapter 9 - Blood Vessels Pt. 1 Flashcards
Increased vascular resistance can lead to what vascular condition?
Hypertension
Deceased sodium excretion can lead to what vascular condition?
Hypertension
What risk factors are associated with hypertension?
Age, stress, obesity, smoking, inactivity, increased salt intake, genetics
What race is more likely to develop hypertension?
African Americans
What type of personality can put one at a higher risk of developing hypertension?
Type A personality
What is malignant hypertension?
Around 200/120 BP (5% of all hypertension cases) which is usually lethal within 1-2 years
How can malignant hypertension be detected early on?
Papilledema or retinal hemorrhage
How can malignant hypertension be detected in its later stages?
Renal failure
Increased blood pressure can increase the risk of what conditions?
Ischemic heart disease, stroke, congestive heart failure
What are the steps of vascular wall responses to injury?
- Endothelial injury/dysfunction
- Smooth muscle cell recruitment
- Growth of smooth muscle cell & ECM
- Irreversible intimal thickening
What can irreversible intimal thickening as a result of vascular injury lead to?
Vessel stenosis (tissue ischemia)
How can aging affect the tunica intima of vascular structures?
Slight stenosis but usually isn’t clinical
What is the term for hardening of the arterioles?
ArterioLOsclerosis
What is term for the hardening of arteries?
Arteriosclerosis
How does arteriosclerosis develop?
Decreased elasticity and arterial thickening
What condition involves the calcification of the tunica media?
Monckeberg medial sclerosis
Does Monckenberg medial sclerosis lead to stenosis?
No
What is the usual age range of Monckeberg medial sclerosis?
> 50 years old
What is the most common form of arteriosclerosis?
Atherosclerosis
What is atherosclerosis?
Formation of atheromas (plaques)
Where can atherosclerosis occur?
Heart (CAD), brain, intestines, kidneys, legs
What form of arteriosclerosis is age-related?
Monckeberg medial sclerosis
What organs are most sensitive to hyperplastic arteriolosclerosis?
Kidneys
Which arteriole reaction occurs in response to benign hypertension?
Hyaline arteriolosclerosis
Which type of arteriole reaction occurs in response to severe hypertension?
Hyperplastic arteriolosclerosis
Onionskin appearance is indicative of what arteriole response to hypertension?
Hyperplastic arteriolosclerosis
Prolonged diabetes mellitus is associated with which arteriole response to hypertension?
Hyaline arteriolosclerosis
What percentage of arteriosclerosis cases are actually atherosclerosis?
99%
What is the number one cause of morbidity and mortality in the U.S.?
Atherosclerosis (CAD, myocardial infarction, stroke)
What effect does atherosclerosis have on blood flow?
Decrease
What is the most common cause of myocardial infarction?
Atheromas due to atherosclerosis
What layer of the vessel is weakened in atherosclerosis?
Tunica media
A weakened tunica media is a risk for what issue?
Aneurysm
What are the foam cells seen in an atherosclerosis plaque?
Fat-laden macrophage
When is chest pain present in coronary artery disease?
When 70% of the arteries are occluded
Which type of plaque has inflammation present, as well?
Vulnerable
Which type of plaque has a fibrous cap providing support?
Stable plaque
What type of blood flow is seen with atherosclerosis?
Extra turbulent
Too many LDLs and too little HDLs (hyperlipidemia) increase the risk of what vascular condition?
Atherosclerosis
What things can make cholesterol levels better?
Exercise, moderate alcohol, statin meds
What kinds of things make cholesterol levels worse?
Obesity, smoking
What usually causes hypertension?
95% idiopathic
Can large amounts of alcohol have a beneficial effect against atherosclerosis?
No, only moderate levels
What are additional risk factors for atherosclerosis?
Family history, increased age, males
What is the response to injury hypothesis involved with atherosclerosis?
Chronic endothelial injury —> atherosclerosis
At what time do females have a protection against atherosclerosis and when does that protection change?
Premenopause; then females have roughly the same risk as males after menopause for atherosclerosis
What blood test can be used to measure inflammation in atherosclerosis?
C-reactive protein (levels usually high)
What are big risk factors for myocardial infarction?
Hyperlipidemia, hypertension, smoking
Metabolic syndrome presents a risk for what condition?
Cardiovascular disease
What issues can make up metabolic syndrome?
Central obesity, hypertension, insulin resistance, dyslipidemia, hypercoagulability/pro-inflammatory state (adipokines)
Peripheral vascular disease can lead to what condition following atherosclerosis?
Gangrene
What is a general aneurysm?
Local vascular dilation
What is the difference between a true and false aneurysm?
True aneurysm - all three layers of a vessel spread out
False aneurysm - defect in vascular wall leading to extravascular hematoma
What are some common locations for a true aneurysm?
Aortic arch, abdominal aorta, iliac arteries
What are risk factors for aneurysms?
Hypertension, atherosclerosis (lead to ischemia of tunica media)
Marfan syndrome, Ehlers-Danlos syndrome
What is the most common location for an abdominal aortic aneurysm?
Between renal and common iliac arteries
What is the size of an AAA?
Dilation of >50% of normal
Diameter >5cm
What are some risks for AAA?
Males, smoking, over 50 years old, Caucasian, familial history, atherosclerosis, hypertension
How is AAA diagnosed?
Ultrasound or CT
Should we adjust someone who has signs of an abdominal aortic aneurysm?
High velocity lumbar adjustments should be largely avoided, but approach the situation with care because an AAA is very unstable.
Abdominal aortic aneurysms can also obstruct vessels branching off of the aorta to what locations?
Kidneys, spinal cord, GI tract, legs, could compress ureters
What percentage of ruptured abdominal aortic aneurysms are fatal?
50%
What is a major risk factor for aortic dissection?
Hypertension
Who is most at risk for an aortic dissection?
Males 40-60
Adolescents and young adults with what type of disorders are at risk for aortic dissections?
Connective tissue disorders like Marfan syndrome, Ehlers-Danlos, Wilson disease
What type of genetic pattern is seen with Wilson disease?
Autosomal recessive
What is the frequency of Wilson disease?
1:30,000
What is Wilson disease?
Abnormal copper ion transpiration leading to excessive copper accumulation
How is the liver affected by Wilson disease?
Steatohepatitis
How is the brain affected by Wilson disease?
Psychosis, Parkinsonism (the movement disorder, not Parkinson’s disease)
How does Wilson disease affect the eye?
Kayser-Fleischer ring
Pain with an aortic dissection can resemble what other condition?
Myocardial infarction
Where is pain felt with an aortic dissection?
Anterior chest, projects posteriorly between the scapulae
What type of aortic dissection is the most common and most severe?
Type A
Which type of aortic dissection is in the ascending aorta?
Type A
Which type of aortic dissection is seen in the left subclavian artery?
Type B
Vasculitis is most common in what kind of arteries?
Small arteries
What kind of infection could cause vasculitis?
Hepatitis B
SLE or penicillin could cause what type of vasculitis?
Non-infectious
What physical or chemical things could lead to vasculitis?
Irradiation or trauma
Vascular tumors can arise from what structures?
Endothelial cells, connective tissue or vessels
What most common type of vascular tumor?
Benign (example = hemangioma)
A Kaposi sarcoma is an example of what type of vascular tumor?
Fairly aggressive
An angiosarcoma is an example of what type of vascular tumor?
Rare and highly malignant sarcoma
What is a hemangioma?
Common benign vascular tumor affecting 1:200 newborns
What is the usual prognosis with hemangiomas?
Self-resolve with age, usually around 7 years
What virus is responsible for a Kaposi sarcoma?
Human herpesvirus 8 (HHV-8)
A Kaposi sarcoma is common among what group of people?
AIDS patients (1,000X more likely)
Kapsoi sarcomas are most likely where on the body?
Lower extremities
What is the term for the purple, pink, and red appearance of a Kaposi sarcoma?
Macule formation (purpura)
What is the prognosis of an angiosarcoma?
30% 5-year survival
Angiosarcomas are more common among what population?
Older adults
Where can angiosarcomas occur?
Anywhere on the body
What are the most common locations for angiosarcomas?
Skin, breast, liver
What present as risks for angiosarcomas?
Irradiation, foreign bodies
Endovascular stenting is common with what vascular condition (90% of cases)?
Coronary artery disease (CAD)
What is the purpose of endovascular stenting?
Preserve luminal patency
How can endovascular stenting affect the luminal wall layers?
Possible intimal hyperplasia
What is the purpose of vascular grafts?
Replace or bypass arteries
What is a limitation of vascular grafts?
Long-term vessel patency, thrombosis possible
