Chapter 9 - Blood Vessels Pt. 2 Flashcards
What causes giant cell arteritis?
Idiopathic but T cell activity and autoimmune hypothesis
Giant cell arteritis involves what arteries?
Large and small arteries of the head (patchy involvement)
What artery is most commonly affected during giant cell arteritis (50% of cases)?
Ophthalmic artery
What are signs of ophthalmic artery involvement in giant cell arteritis?
Diplopia and/or sudden blindness
What is usually the quick treatment for giant cell arteritis?
Corticosteroids (especially to prevent blindness)
What kind of inflammation is present in giant cell arteritis?
Granulomatous
What is also known as the “pulseless disease”?
Takayasu arteritis
What form of arteritis is exclusively seen in the aortic arch and its branches?
Takayasu
Takayasu arteritis produces what kind of inflammation?
Granulomatous
What causes the loss or minimized pulse of Takayasu arteritis?
Narrowing of the lumen of branches off of the aortic arch
What arteries are affected by Takayasu arteritis?
Radial, carotid, renal, pulmonary
Takayasu arteritis is most common among what population?
Younger individuals
What are some results of Takayasu arteritis?
Various neurological defects and possibly visual disturbances
What kind of necrosis is seen with polyarteritis nodosa?
Transmural necrosis
What is polyarteritis nodosa?
System wide vasculitis of small and medium sized arteries
What can happen with polyarteritis nodosa?
Tissue atrophy, ischemia, infarction
Polyarteritis nodosa affects what tissues?
Kidneys, viscera, heart, liver, GI tract
What arteries are avoided by polyarteritis nodosa?
Pulmonary
Polyarteritis nodosa is most common among what population?
Young adults
What chronic infection is seen among 1/3 of polyarteritis nodosa cases?
Hepatitis B
Around what fraction of polyarteritis nodosa cases are said to be autoimmune or idiopathic in nature?
2/3
What is seen with polyarteritis nodosa of the renal artery?
Rapidly increasing blood pressure (renovascular hypertension)
What is seen with polyarteritis nodosa of the GI arteries?
Abdominal pain, blood stools
What is the treatment for polyarteritis nodosa?
Corticosteroids
What happens if polyarteritis nodosa is left untreated?
Fatal
What can be one of the first visual indications of polyarteritis nodosa?
Widespread vascular lesions
Segmental fibrinoid necrosis and thrombosis is seen among what widespread vascular condition?
Polyarteritis nodosa
The “rosary sign” is seen among what vascular condition?
Polyarteritis nodosa
Kawasaki disease primarily affects what population?
Pediatrics (80% under 4 years)
If a child has a heart attack, it is usually because of what condition?
Kawasaki disease
What is the fatality rate of Kawasaki related heart attacks in children?
Only 1%
How does CAD influence the prognosis of Kawasaki disease?
Patients without CAD recover fully
Severity of CAD determines prognosis
What is the cause of Kawasaki disease?
Idiopathic but suggestive of type IV hypersensitivity and possibly viral antigens, genetics
What gender and race are more likely to get Kawasaki disease?
Asian descent and males
What is unique about the fever associated with Kawasaki disease?
Unresponsive to ibuprofen or acetaminophen
What is the hallmark sign of Kawasaki disease?
Acute/persistent fever
What are the unique signs of the skin and tongue seen with Kawasaki disease?
Desquamation of extremities, strawberry tongue (oral erythema)
What type of hypersensitivity is seen with Wegener granulomatosis?
Type II
Wegener granulomatosis is seen in what locations?
Kidneys and upper/lower respiratory tracts
What is seen with Wegener granulomatosis?
Granulomas, systemic vasculitis of small/medium arteries, glomerulonephritis
What population is more likely to be affected by Wegener granulomatosis?
Middle aged (40 years old), males
What is the treatment for Wegener granulomatosis?
Immunosuppression
What lung condition is seen in 95% of cases of Wegener granulomatosis?
Bilateral pneumonitis
How are the kidneys affected by Wegener granulomatosis?
Hematuria, proteinuria, possible renal failure
How is the nasopharyngeal area affected by Wegener granulomatosis?
Rhinitis, sinusitis, nose bleeds
What is another name for Buerger disease?
Thromboangiitis obliterans
What group of people are at risk for thromboangiitis obliterans?
Heavy tobacco smokers
Vascular insufficiency of what arteries and locations is seen with thromboangiitis obliterans?
Radial and tibial arteries, leading to cold feet and hands
What gender and age group are more at risk for thromboangiitis obliterans?
Males ages 25-35 years
What can result from the cold feet and hands due to ischemia seen with thromboangiitis obliterans?
Ulcerations, gangrene
What is unique about the pain felt with thromboangiitis obliterans?
Seen at rest
Raynaud phenomenon is possible with what vascular condition?
Thromboangiitis obliterans
Temporal region involvement is seen with what vascular condition?
Giant cell arteritis
What is the most common vasculitis in older adults?
Giant cell arteritis (temporal arteritis)
What kind of condition is Raynaud phenomenon?
Exaggerated arteriole vasoconstriction
What body parts are affected by Raynaud phenomenon?
Most commonly the fingers but also toes, nose, earlobes, lips
In chronic conditions, what can result from Raynaud phenomenon?
Atrophy of skin, connective tissue, and/or muscles
Who is more at risk for Raynaud phenomenon?
Adolescent/young adults, most commonly females
What are traditional triggers for primary Raynaud phenomenon?
Cold and emotional triggers (5% of the U.S.)
Raynaud phenomenon can be secondary to what other conditions?
Atherosclerosis, Buerger disease, Lupus, scleroderma
What condition is also known as “broken heart syndrome”, stress cardiomyopathy, or “cardiac Raynaud”?
Takotsubo cardiomyopathy
What is the location of exaggerated vasoconstriction of Takotsubo cardiomyopathy?
Coronary arteries
What is usually the cause of broken heart syndrome?
Psychological stress
What kinds of hormones are produced more heavily with cardiac Raynaud?
Catecholamine (stress hormones)
What occurs with Takotsubo cardiomyopathy?
Vasospasm, increased heart rate and contractility, fatal arrhythmia (ventricular fibrillation), possible ischemia and heart attack in severe cases
What is the term for venous inflammation?
Phlebitis
90% of venous disease fall into what three categories?
Varicose veins, phlebothrombosis, thrombophlebitis
What is phlebothrombosis?
Venous thrombosis without previous inflammation
What is thrombophlebitis?
Venous thrombosis following inflammation
What is the most common location of varicose veins?
Legs (lower extremities)
What are varicose veins?
Torturous dilation of superficial veins
What is the cause of varicose veins?
Increase in intraluminal pressure leading to dilation and then incompetent valves
What are the risks for varicose veins?
Obesity, genetics, pregnancy
What is the frequency per gender for varicose veins?
1/3 females, 1/5 males
Varicose veins is most commonly presenting what kind of concern?
Cosmetic (rarely pathological)
What is a risk factor for thrombophlebitis?
Immobilization (examples: recent surgery, pregnancy, obsesity), congestive heart failure, genetics, any pro-thrombotic medication, oral contraceptive
What condition is involved with 90% of all thrombophlebitis cases?
Deep vein thrombosis
What could be the first indication of thrombophlebitis?
Pulmonary embolism
What test can be used to diagnosis thrombophlebitis?
Dorsiflexion of the foot (Homan sign)
What is important to note with the Homan sign?
Could produce clot or embolism (only about 50% sensitive to thrombophlebitis)
What are signs of superior vena cava syndrome?
Congested upper extremity veins, edema in head, neck, and arms
What conditions are associated with superior vena cava syndrome?
Bronchogenic carcinoma, mediastinal lymphoma
What conditions are associated with inferior vena cava syndrome?
Hepatocellular carcinoma, renal cell carcinoma
What are some signs of inferior vena cava syndrome?
Congestion of lower extremity veins, edema, proteinuria
Which form of lymphedema is congenital?
Primary
What is another name for congenital lymphedema?
Milroy disease
What can cause secondary lymphedema?
Neoplasia, infection (filariasis), thrombosis, fibrosis (surgery)
What appearance of the skin is associated with acute lymphedema?
Peau d’orange
What skin appearance is seen with chronic lymphedema?
Brawny induration (hardening of the skin)
What pattern is seen with lymphangitis?
Inflammation following the course of the lymphatic channel externally seen on the skin
What type of infection may be allowed with lymphangitis?
Bacterial infection (sepsis)
Vascular tumors originate from what cells or tissues?
Endothelial cells, connective tissue or vessels
Most vascular diseases involve what vascular structures?
Arteries
What is the term for when there is passage of blood through layers of a vascular wall?
Dissection
Which have thicker walls: arteries or veins?
Arteries (therefore increased blood pressure and pulsations)
What makes up the tunica intima?
Endothelial cells
What makes up the tunica media?
Smooth muscle
What makes up the tunica adventitia?
Connective tissue, nerves, vessels
How is the blood supply to the interior of a blood vessel wall given?
Diffusion of blood from lumen (tunica intima and inner portion of the tunica media)
How is the blood supply to the exterior of a blood vessel wall given?
Vasa vasorum (outer tunica media and tunica adventitia)
What is the order from smallest to largest of artery-based vessels?
Capillary beds, arterioles, small arteries, medium-sized muscular arteries, large elastic arteries
What is the order from the smallest to largest of vein-based vessels?
Capillary beds, postcapillary venules, collecting venules, progressively larger veins
Activation of what part of the vascular vessel wall via vascular lesions or thrombosis is pro-inflammatory?
Endothelial lining
What is the function of the endothelial cells?
Regulate vasoreactivity by NO & endothelin
Regulate cell growth
When are vascular anomalies relevant?
During surgery
What is a Berry aneurysm?
Dilation of cerebral vessels that rupture and lead to subarachnoid hemorrhage
What is an arteriovenous (AV) fistula?
Connection of arterial and venous systems that bypass capillaries
What is fibromuscular dysplasia?
Local thickening of medium/large artery walls that leads to ischemia (non-atherosclerotic and non-inflammatory)
Fibromuscular dysplasia is more common with what gender?
Females
What level of blood pressure is characteristic of hypotension?
Below 90/60
What level of blood pressure is characteristic of hypertension?
> 140/80
What does blood pressure regulate?
Cardiac output (heart rate + stroke volume) Vascular resistance
Sodium and the renin-angiotensin system help regulate vascular tone and blood volume in what organs?
Kidneys
Aldosterone helps regulate blood volume and vascular tone in what area?
Adrenals
Atrial natriuretic peptide (ANP) helps regulate vascular tone and blood volume in what organ?
Heart
How does atrial natriuretic affect the heart and blood pressure?
Stretches heart and decreases blood pressure (reduced sodium resorption)
Is ANP a vasodilator or vasoconstrictor?
Vasodilator
How does the renin-angiotensin system affect blood pressure?
Increases it (sodium resorption and blood volume increased)
Does the renin-angiotensin system act as a vasodilator or vasoconstrictor?
Vasoconstrictor
The kidney can produce what substances that initiate vasodilation and decrease blood pressure?
Prostaglandins and NO
What blood pressure level is indicative of malignant hypertension and is a hypertensive emergency?
Systolic over 200 or diastolic over 120
What are general treatment recommendations for hypertension?
Healthier diet, quit smoking, exercise, medication
Without treatment, 50% of those with hypertension will die from what complication?
Ischemic heart disease (myocardial infection)
Without treatment, 1/3 of those with hypertension will die from what complication?
Stroke
What percentage of US adults have hypertension?
25%
Why is hypertension called the “silent killer”?
Asymptomatic until almost deadly
