Devine Flashcards
What is the cause of increased pulse pressure in aging?
Pulse pressure is systolic blood pressure minus diastolic. It is widened in aging due to loss of elasticity of the aorta as might occur in atherosclerosis
What vessel is primarily responsible for increased blood pressure (and peripheral blood pressure regulation)?
The arteriole. It constricts to elevate pressure; dilates to lower pressure.
Endothelial cell properties and functions
Maintains permeability layer
Endothelial cell consequences of activation: endothelial dysfunction.
When activated, promotes thrombosis; modulates blood flow; activated endothelium is proinflammatory and promotes cell growth; endothelium oxidizes LDL cholesterol
Endothelial dysfunction
Consequence of prolonged activation. Hypercoagulable, atherogenic and impaired vasodilation. Endothelial dysfunction is a feature of hypertension and diabetes.
Varicosities; complications
Abnormally dilated, tortuous veins. Result in stasis/brown induration of legs, skin ulcers
Phlebitis; where is the most significant location and the risks associated with it?
Inflammation of a vein; usually associated with thrombus, ie thrombophlebitis. Deep veins of the legs are most significant due to source of pulmonary embolus
Define lymphangiitis. What is the usual cause?
Acute inflammation of lymph vessels; most commonly due to group A beta hemolytic streptococcus. Painful, subcutaneous red streak. Risk for sepsis (systemic response).
Define lymphedema and list causes
Edema due to malformation or obstruction of lymph channels. May be primary (hereditary malformation) or secondary to tumor, surgery, filarial (elephantisias, due to massive enlargement of an extremity).
What is the most serious complication of edema?
Complications include orange peel skin (peau d’orang) and angiosarcoma
Define AV malformation
Abdnormal communication between an artery and a vein, without intervening capillaries
What are the complications: AV malformation
May rupture/hemorrhage; may cause heart failure, rupture and hemorrhage
What are the major morphologic features and most frequent consequences of atherosclerosis?
Fatty streak: earliest arterial change; may be seen in infancy; no consequences
Atheroma/atheromatous plaque: fibrofatty plaque; at bifurcations; origins of branches. Intima thickened; lipid core.
Plaque may be soft (noncalcified) or hard (calcified). Fibrous cap is thick in stable plaque; thin in vulnerable plaque.
Narrowing of coronary artery produces angina; plaque change results in unstable angina and myocardial infarction.
Weakened artery wall (aorta) results in aneurysm.
What are specific consequences of atherosclerosis: Coronary arteries:
MI
What are specific consequences of atherosclerosis: Carotid & cerebral arteries
Strokes
What are specific consequences of atherosclerosis: Abdominal aorta
Aneurysm
What are specific consequences of atherosclerosis: Iliac, popliteal arteries
Gangrene of the leg
Describe the response to injury theory of atherogenesis
Chronic endothelial injury (key event)- may be injured by oxidized LDL, cigarette smoke, hypertension and others
Endothelial activation leads to platelet, leukocyte adhesion and emigration into subendothelium. Macrophages, smooth muscle cells, proliferation of ECM accumulate in subendothelium
Risk factors for atherosclerosis
Nonmodifiable: age, sex (males earlier than females); family history; familial hypercholesterolemia (LDL receptor defect and others)
Modifiable risk
Hyperlipidemia, especially hypercholesterolemia, especially LDL cholesterol (>130)
Hypertrigyceridemia
Hypertension
High carbohydrate intake
Diabetes mellitus
Cigarette smoking
Chronic inflammatory diseases such as rheumatoid arthritis
Renal insufficiency
Lesser: obesity; physical inactivity; type A personality
What factors lower risk for atherosclerosis?
HDL, the higher the better; higher than 40 OK; >60 very good
Lower LDL
No smoking
Regular exercise (30 min aerobic/day)
Good control of blood pressure; diabetes mellitus
Weight reduction if overweight
Alcohol in moderation
Describe, in sequence, retinal changes of atherosclerosis.
Hyaline thickening
Arteriovenous nicking
Copper wire arterioles
Silver wire arterioles
Know the categories of hypertension. What is the most common type?
Hypertension: blood pressure > 140/90 mmHg.
Essential – most common; multifactoral pathogenesis
Secondary (120/80 < 140/90), hypertension, and malignant hypertension (>160/120)
What are the two major categories of effects implicated in the pathogenesis of essential hypertension.
Reduced sodium and water excretion
Vascular constriction
What environmental factors contribute to essential hypertension?
Environmental factors: obesity (insulin increased); stress, smoking; physical inactivity; high sodium-low potassium intake
Name some hereditary causes of dysregulation of sodium.
Liddle syndrome: increased renal tubular reabsorption of sodium
Bartter syndrome : defect in chloride resorption leads to increased serum sodium; BP normal
Define malignant hypertension. What are the retinal changes?
Blood pressure rapidly rises to greater than 160/120; risk of immediate death: renal failure; Cerebral edema (headache, stupor); papilledema, retinal hemorrhages; cotton wool spots
Describe the morphology and the complications of hypertension.
Morphology: arteriole changes – hyaline arteriolosclerosis (“benign” hypertension); hyperplastic arteriolosclerosis
Complications of hypertension
Renal failure
Stroke
Myocardial infarction
Congestive heart failure
Hypertensive retinopathy
Narrowing of arterioles Hemorrhages Cotton wool spots (infarcts of nerves) Macular star Papilledema
Define aneurysm. What are the types, associated with locations and causes?
Dilation of an artery- fusiform or saccular
Syphilic aneurysm: thoracic aorta
Berry aneurysm (Circle of Willis) : hypertension + smoking
Abdominal aortic aneurysm: atherosclerosis + smoking- below kidneys; more common in males over 50. Prone to rupture resulting in death.
Aortic dissections
Wall of an artery is split longitudinally by blood accumulating between the layers.
Aortic dissection/dissecting aneurysm of the thoracic aorta is due to hypertension; Marfan’s disease. Cystic medial degeneration (necrosis) of elastic tissue permits dissection
Clinical: sudden, excruciating pain in anterior chest radiates to back and moves downward. Fatal, due to vessel rupture, without treatment
What infections cause vasculitis?
Syphilis; meningococcemia (Neisseria meningitides); Rocky Mountain spotted fever; aspergillus
Most manifest as a rash. Some (syphilis) lead to aneurysm, rupture or occlusion (aspergillus).
Define Behçet disease
Vasculitis that involves the mucosa; uveitis
Thrombosis, aneurysms, hemorrhages
Aphthous ulcers of mucosa
Describe Raynaud phenomenon. List causes
Pallor/cyanosis of hands, feet, nose, ears on exposure to cold
Causes: primary, young women; secondary: autoimmune disease, eg Lupus, Scleroderma; Cryoglobulinemia (increased IgM)
What are the two microscopic types of hemangiomas? Which is most common in
infants? Which does not regress?
Capillary hemangioma. Juvenile/strawberry, most common on skin of head/neck; regresses spontaneously
Cavernous: Deep; larger vascular channels; does not regress
What is the nature and location of the “pregnancy tumor”? What is the same lesion called at other locations?
Granuloma pyogenicum. Occurs at the gum line of pregnant women or elsewhere. Bleeds, rapid growth of granulation (reactive proliferation) tissue.
What are two types of lymphangiomas?
Simple, capillary
Cystic hygroma: occurs in neck, axilla
What are the features of port wine stain including the pathology? Describe Sturge-Weber syndrome
Dilated – ecstatic vascular channels. Most commonly involves the face; does not regress. Sturge-Weber involves trigeminal distribution and is associated with vascular malformation w/in the eye that leads to glaucoma, cataract.
What are telangiectasias? What are associations of : common telangiectasias?
Dilated small blood vessels. Commonly due to sun-damage of skin; radiation
Spider telangiectasia (“angioma”)?
Spider shape; chest; due to excess estrogen, eg liver failure
What are the causes and clinical features of Bacillary angiomatosis and Kaposi sarcoma?
Both occur in HIV. Bacillary angiomatosis due to infection with Bartonella- treat with antibiotics; KS due to Herpes virus 8
What is the nature and what are three clinical scenarios in which angiosarcoma occurs?
Angiosarcoma is aggressively malignant, usually fatal, metastasizes early
Arises in:
chronic lymphedema, eg following mastectomy
liver in polyvinyl chloride occupational exposure
radiation exposure
