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CVS lll Flashcards

1
Q

Epi of Moenckberg Arteriosclerosis

A

: >50 yrs

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2
Q

loc of Moenckberg arterioscleoris

A

calcification of media, of small and
medium-sized muscular arterie

*no arterial flow obstruction

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3
Q

Macro-/Microscopic picture:
* Stiff, calcific “pipe-stem” arteries
* Ring-like calcifications in the media

Are the features of what type of Plaque?

A

Moenckeberg arteriosclerosis (Medial Calcific Sclerosis)

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4
Q

Etiology of Calciphylaxis (Vascualar calcinosis)

A

–> severe form of the media calcification
–> Association with renal failure & hyper-parathyroidism

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5
Q

patho of Calciphylaxis

A

1) Elevation of acute phase reactants
2) Marked giant-cell reaction in proximal arteries
3) Extension of calcification into distal vessels
4) Intima fibrosis→ Vessel’s obstruction → Ischaemia symptoms or progressive ischaemic gangrene
5) Frequently, vascular micro-thrombi
6) Occasionally, subcutaneous calcium deposits with panniculitis (inflammation of subcutaneous adipose tissue) and fat necrosis

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6
Q

The 2 forms of Arteriosclerosis

A

1) Hyaline Arteriosclerosis
2) Hyperplastic Arteriosclerosis

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7
Q

Atiology/association of arteriosclerosis

A

*Hyaline thickening or proliferative changes of
small arteries and arterioles (e.g. Kidneys)
*Associated w/ –> Hypertension or Diabetes Mellitus

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8
Q

patho of Hyaline arteriosclerosis

A
  • Hyaline thickening of arteriolar walls →
  • → Narrowing of the arteriolar lumen →
  • → Ischaemia
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9
Q

Histopathological features:
- Tubular atrophy, Interstitial fibrosis,
Glomerular alterations (mild hyalinosis to
sclerosis of glomeruli) and peri-glomerular
fibrosis
- Accumulation of pink, amorphous,
homogeneous material in the wall of small
arteries and arterioles
* “Benign nephrosclerosis” –> Long-standing
Hypertension

Are the features of what type of plaque?

A

Hyaline arteriosclerosis

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10
Q

Histopathological features:
- Concentric, laminated, “onion-skin”
thickening of the arteriolar walls –> narrowed lumen
- accompanied by necrotising arteriolitis
(intramural deposition of fibrinoid material
in arterioles with vascular necrosis and
inflammation) in malignant hypertension
* Malignant hypertension –> “Malignant
nephrosclerosis”

Are the features of what type of palque?

A

Hyperplastic plaque

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11
Q

Risk factors of Atherosclerosis

A

1) Age
2) Gender ( M > F) [increased
incidence in post-menopausal women]
3) Cigarette smoking
4) Hypertension
5) Diabetes Mellitus (Peripheral vascular occlusive
disease → Gangrene of the lower extremities)
6) Obesity, “type A” personality, hyper-uricaemia, hyper-homocysteinaemia
7) Hyper-cholesterolaemia

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12
Q

Atheroscleorsis: the formation of fibrous plaque or atheromas within the intima of the arteries.

At which anatomical site do these atheromas form?

A

1) Proximal portions of coronary arteries
2) Larger branches of carotid arteries
3) Circle of Willis
4) Large vessels of lower extremities
5) Renal and mesenteric arteries

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13
Q

Atherosclerosis are characterised by the formation of ?

A

Fatty streaks (Accumulation ofOxidised LDL within macrophages and SMCs, underneath the enothelial cells)

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14
Q

Macroscopic features of Fatty streaks?

A

Yellow elevations on the
internal surface of the vessel wall

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15
Q

patho of Atherosclerotic plaque

A

1) Death of foamy macrophages → Release of
intra-cytoplasmic lipid → Formation of lipid
debris
2) Proliferation of smooth muscle cells and
secretion of collagen + ECM proteins
→ Development of a fibrous cap over the
core (composed of oxidised lipid and inflammatory cells)

*fibrous cap –> bodies attempt to repaire the injured vessele wall by scaring
*Core –> plaque (oxidised LDL)

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16
Q

The 3 Hallmarks of Chronic inflammation

A
  1. Persistent injury (endothelial damage from
    aforementioned risk factors)
  2. On-going inflammation (macrophages and
    lymphocytes)
  3. Repair with scarring (formation of a fibrous
    cap)
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17
Q

Plaque stability depends on the —————- and ————— in the fibrous cap

A

1) No. of SM
*smooth muscles –> Protective effect
2) Inflammaotry cells
*have Destablising effect

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18
Q

Plaque stability depends on the numbers of smooth muscle and inflammatory cells in the fibrous cap. Explain

A

1) Inflammatory cells have destabilising effect,
since:
* Produce MMPs → Digestion of fibrous cap
* Induce smooth muscle cells’ apoptosis

2) Smooth muscle cells have protective effect,
since:
* Produce fibrous cap → Plaque stabilisation
* Produce TIMPs → Inhibition of MMPs’ action

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19
Q

Stable plaques vs Unstable plaques

A

1) Stable plaques:
- Few inflammatory cells but Many smooth muscle cells
* Thick fibrous cap –> Resistant to rupture
* Slow growth → Gradual Stenosis of the lumen

2) Unstable “vulnerable” plaques:
* Inflammatory cells > Smooth muscle cells
* Thin fibrous cap → Acute rupture →
Thrombosis and/or Embolism

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20
Q

Atherosclerosis Complications related to plaques

A

1) Myocardial infarction (MI)
2) Ischaemic stroke
3) Rupture of aneurysm –> thrombous formation –> Embolisation
4) Stable Angina

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21
Q

Virchow’s Triade

A

1. Endothelial Injury
a. Atherosclerosis
b. Vasculitis
c. Trauma
2.Abnormal blood flow:
a. Turbulence
b. Stasis
3.Hypercoagulability:
a. Too many blood cells
b. Coagulation factor defects

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22
Q

Types of Aneurysm

A

1) Atherosclerotic
2) Aneurysms due to cystic medial necrosis
3) Berry aneurysms
4) Syphilitic (luetic) aneurysm
5) Dissecting aneurysm
6) Arterio-venous fistula

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23
Q

loc of Atherosclerotic aneurysm

A

Abdominal aorta

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24
Q

Epi of Atherosclerotic Aneurysm

A

Men and smokers

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25
patho of Atherosclerotic aneuryms
1) Excess ECM degradation by the inflammatory infiltrates in atherosclerotic arteries and the destructive proteolytic enzymes at these sites Impairment of the diffusion of nutrients and wastes between vascular lumen and wall * **Direct compression on the media** * → **Degeneration and necrosis → Wall thinning**
26
CM of Cystic medial Degeneration
Proximal aortic aneurysm → Aortic dissection and rupture; Aortic incompetence; Mitral valve prolapse; Peripheral artery aneurysms
27
loc of cystic medial degeneration
aortic root
28
- loss of elastic laminae - loss of smooth muscle cells, with replacement by pools of proteoglycan matrix Are the histopatho of what type of aneurysm?
Cystic medial degeneration
29
loc of Berry Aneurysm
Vessels of Willis’ circle
30
patho of Berry Aneurysm
: Development at sites of congenital medial weakness (bifurcation of cerebral arteries)
31
Assocation of Berry Aneurysm?
adult polycystic kidney disease
32
Macroscopic picture: Small, **saccular lesions** Are the features of what type of Aneurysm?
Berry Aneurysm
33
complications of Berry Aneurysm?
**subarachnoid haemorrhage**, after aneurysm’s rupture
34
Macroscopic picture: Characteristic **“tree-bark”** appearance <> Multiple **gelatinous plaques**, separated by **stellate scars** and vertical furrows Are the features of what type of Aneurysm?
Syphilitic (Leutic) Aneurysm
35
Complications of Syphilitic (leutic) aneyurysm?
1) Obliterative endarteritis of the **vasa vasorum** and necrosis of the **media** 2) **Dilatation of the ascending aorta** → Widening of the aortic valve commissures → Aortic valve insufficiency
36
causes of Dissecting Aneurysm
1) Hypertension, 2) cystic medial necrosis
37
patho of Dissecting Aneurysm
Longitudinal intraluminal tear in the **wall of the ascending aorta** → Second arterial lumen within the media
38
Clinical picture of dissecting Aneurysm
Severe, tearing chest pain, radiating through to the back
39
DD of Dissecting Aneurysm
Myocardial infarction
40
complications of Dissecting Aneurysm
Aortic rupture → Haemo-pericardium and cardiac tamponade
41
the Two vasculitic syndromes that affect **elastic arteries**
1) Takayasu disease 2) Giant-cell arteritis
42
Two vasculitic syndromes affect **muscular arteries**?
1) Polyarteritis nodosa 2) Kawasaki disease
43
complications of Arterio-venous Fistula
1) Ischaemic changes (due to diversion of blood) 2) Ballooning and aneurysm formation (↑ venous pressure) 3) High-output cardiac failure (hypervolaemia)
44
risk factors of Varicose veins of Extremities
1) Familial predisposition 2) Prolonged standing 3) Obesity 4) Pregnancy (Compression of the inferior vena cava)
45
loc of Varicose veins of extremities
Superficial veins of the upper and lower leg
46
Microscopic Findings: 1) Fibrosis **beneath the endothelium** and in the wall 2) **Secondary elastosis and loss of muscle** 3) Possible occurrence of calcificatin Are the features of what type of aneurysm?
Varicose veins of Extremities
47
clinical features of Varicose veins of extremities
1) Pain or cramping 2) Tingling or burning sensations 3) Heaviness or tiredness 4) Lower extremity stasis and congestion 5) Thrombosis 6) Oedema
48
complications of Varicose veins of Exremities
1) **Persistent oedema** → Secondary ischaemic changes (such as: **stasis dermatitis and ulcerations**) 2) **Ulcerations** with poor wound healing and superimposed infections → **Chronic varicose ulcers**
49
patho of Oesophagaeal varices
Liver Cirrhosis, Portal vein obstruction, Hepatic vein thrombosis --> portal vein hyepertension --> Opening of porto-systemic shunts --> Increased blood flow into veins at: 1) Gastro-Oesoph. Junction --> Oesophageal varices 2) Rectum --> Haemorrhoids 3) Peri-umbilical veins of abdominal wall --> **“Caput medusae”**
50
cause of Heamorrhoids
1) Pregnancy 2) Straining during defecation
51
patho of Haemorrhoids
Prolonged pelvic vascular congestion
52
venous thrombus is aka?
Phlebo-thrombosis
53
loc of Venous thrombosis?
Deep veins of the lower extremities
54
predisposing factors of Venous Thrombosis
* Venous circulatory stasis or partially obstructed venous return (cardiac failure, pregnancy, prolonged bed rest, varicose veins) * Thrombo-Embolism → Pulmonary infarct
55
venous Thrombosis associated w/ Inflammation?
Thrombo-Phlebitis
56
clinical features of Thrombo-Phlebitis
1) Minimal/marked **oedema of the extremity** 2) Purulent Thrombo-Phlebitis: Marked **chills and high temperature**
57
Macroscopic findings: * Superficial veins (e.g. saphenous vein) * Acutely inflamed and tender vein * Redness of the overlying skin * Thrombosis limited to the superficial veins --> Little oedema Are the features of what type of Aneurysm
THROMBO-PHLEBITIS
58
Microscopic findings: * Oedematous venous wall * Irregular ulceration of the intima * Chronic inflammatory infiltrates in the media * Deposition of fibrous tissue in the adventitia & media Are the features of what type of aneurysm
Thrombo-phlebitis
59
Factors favouring intravenous thrombosis → Pulmonary embolism:
1) Neoplasms 2) Cardiac disease 3) Venous stasis from any cause 4) Infection in the immediate area of veins 5) Trauma 6) Vasospasm 7) Intimal injury 8) Increased coagulability 9) Immobilisation of the limbs
60
Long-term (after several years) complications of Thrombo-Phlebitis
Statis ulcer
61
Macroscopic features: * Cutaneous pigmentation * Brawny (strapping) oedema * Dermal and subcutaneous fibrosis * Extensive secondary varicosities * Ulceration of the skin in the lower 1/3 of the leg Are the features of what type of Atheroma?
Statis ulcer
62
Thromangiitis obliterans is aka?
Buerger’s disease
63
casue of Thrombangiitis obliterans
Rare thrombotic and inflammatory disease of the arteries and veins of unknown aetiology
64
epi of Thrombangiitis obliterans
young men (20-35 yrs) , heaving smokerts
65
clinical features of Thrombangiitis obliterans
painful ischaemic disease → Gangrene
66
Macroscopic findings: - **Inflam. of small- to mediumsized arteries, especially of the lower extremities**, with extension to the adjacent veins and nerves Microscopic findings: * **Panarteritis**, often in association with thrombosis * Endothelial proliferation and peri-arterial fibrosis * Extension of the inflammatory process through the entire vessel wall to the adjacent peri-vascular tissues and involvement of peri-neurial stroma * Partial and incomplete recanalisation of thrombi → Results in numerous small vascular channels passing through the remaining fibrous tissue Are the features of what type of condition?
THROMANGIITIS OBLITERANS
67
clinical features of Lympahngitis
* Red, painful subcutaneous streaks * Tender enlargement of draining lymph nodes (acute lymphadenitis)
68
cause of Secondary obstructive Lymphoedema
1) Tumours 2) Surgical procedures (e.g. axillary lymph nodes in radical mastectomy) 3) Post-radiation fibrosis 4) Lymphatic Filariasis (parasite Wuchereria bancrofti) → Elephantiasis 4) Post-inflammatory thrombosis and scarring
69
patho of Lymphodema
* Lymphoedema → Increase of the hydrostatic pressure in the lymph vessels distal to the obstruction → **Oedema** * Chronic oedema → Deposition of ECM and fibrosis → **Brawny induration or a “peau d’orange” appearance of the overlying skin** * Inadequate tissue perfusion → **Skin ulceration** * Rupture of dilated lymphatics, after obstruction by an infiltrating tumour → **Milky accumulations of lymph in various spaces** (chylous ascites, chylothorax, chylo-pericardium)
70
Primary Lymphoedema occurs as?
1) Isolated congenital defect (Simple Congenital Lymphoedema) or 2) Familial Milroy disease (Heredofamilial Congenital Lymphoedema), resulting from agenesis or hypoplasia of lymphatics
71
causes of secondary hypertension
**1) Chronic renal disease** (diabetic nephropathy, obstructive uropathy, chronic glomerulonephritis, etc. ▪ Reno-vascular disease (renal artery stenosis), **Adult polycystic kidney disease,Acute glomerulonephritis ,polyarteritis nodosa** **2) Coarctation of the aorta** **3) Endocrine diseases**: ▪ Cushing’s syndrome ▪ Conn’s syndrome ▪ Phaeochromocytoma ▪ Acromegaly **3) Drugs**: Steroids, oral contraceptives, NSAID **4) Pregnancy** (pre-eclampsia)
72
clinical features of Pheochromocytoma
1) random sever hypertension 2) Headache 3) sweating 4) heart palpitation
73
clinical manifestaions of Acromegaly
cardiovascular problems: 1) hypertension 2) HF 3) Cardiomegaly 4) Edema 5) Dyspnea
74
clinical features of hypertension
**1) Retinopathy** **2) Cerebral haemorrhage (“haemorrhagic stroke”**) -->due to rupture of tiny CharcotBouchard aneurysms; the latter develop as a result of weakening of arteriolar wall **3) Atherosclerosis** (Cerebral infarct, Ischaemic Heart Disease) **4) Subarachnoid haemorrhag**e --> due to rupture of a Berry aneurysm; the latter as a result of combined hypertension and atherosclerosis in genetically predisposed cerebral vessels **5) Aortic dilatation** → Aortic dissection 6) Pressure overload → Left Ventricular Hypertrophy (LVH) → **Heart Failure** **7) Renal Failure**
75
effect of hypertension on vessles
1) Large and medium-sized arteries: --> **Acceleration of atherosclerosis** 2) Small arteries (arterioles): --> **Hyaline Arteriolosclerosis** (Deposition of pink hyaline material in the walls of arterioles → Narrowing of lumen → Decreased blood flow → Ischaemia of the corresponding tissues/organs) **--> Hyperplastic Arteriolosclerosis** (Characteristic, but not limited to malignant /accelerated hypertension --> Hyperplasia of the intima and internal elastic layer and hypertrophy of the media → **Onionskin appearance** with progressive narrowing of the lumen → Ischaemia of the corresponding tissues/organs

Pathology (11 decks)

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