Exam 3: Vessels Flashcards
Narrowing of vessels can be due to ___, which is gradual, or ___, which is rapid
Atherosclerosis
Thromboembolism
Weakening of arteries can occur from __ or ___
Aneurysm (dilation)
Dissection (rupture)
Lumen
Interior of vessel
Arteriosclerosis
Hardening
Atherosclerosis
Atheromas
Aneurysm
Dilation of Artery
Varicosity
Dilation of vein
Dissection
Blood in vascular wall
Thrombus
Clot in vessel
____ walls are thicker
Arterial
___ have valves
Veins
Layers of vessels
Tunica intima
Tunica media
Tunica adventitia
Tunica intima
Endothelial cells
Internal elastic lamina
Tunica media
Smooth muscles
External elastic lamina
Tunica adventitia
CT
Nerves
Vessels
Blood supply to interior cells occurs via
Diffusion
Blood supply to exterior cells occurs by
Vasa vasorum
Most arteriosclerosis is
Atherosclerosis
1 cause of morbidity / mortality
Atherosclerosis
MC cause of MI
Thrombosis
Vascular resistance is regulated at level of
Arterioles
Site for edema and WBC diapedesis
Postcapillary venules
Functions of endothelial cells
Regulate thrombosis
Vasoreactivity
Regulates smooth muscle cell growth
Nitric oxide
Vasodilator
Endothelin
Vasoconstriction
Fibromuscular dysplasia
Local thickening of arterial wall
Fibromuscular dysplasia MC in
Young women
Renal artery
Ischemia increases ___ which increases ___
RAAS
BV
Lowest value for stage 1 HTN
130/80
Most people with long-term HTN will die from
Heart disease
Most likely cause of renovascular HTN
Fibromuscular dysplasia
Hypotension
<90/60
Hypertension
> 130/80
Organs most sensitive to HTN
Heart
Kidney
Eyes
Brain
Regulation of BP
Cardiac output
Peripheral vascular resistance
Increase in BP causes stretch and ____ released
ANP
Lowers BP
Low BP causes
RAAS activation
Increase BP
Silent killer
HTN
Essential HTN
90% of all HTN
Malignant HTN
> 180/120
1% of all cases
Malignant HTN causes
Papilledema
Retinal hemorrhage
Stoke
Renal failure
Papilledema
Increase in ICP causes microbleeds in retina
Pheochromocytoma
Neuroendocrine tumor
Abnormal chromaffin cells in adrenal medulla
Increase catecholamines secretion
Increase in catecholamines causes
SNS stimulation
Episodic spikes in BP
Endothelial injury causing thickening of intima is
Irreversible
Arteriolosclerosis
Hardening of small arteries due to chronic HTN or diabetes
Monckeberg Medial Sclerosis
Ca deposition into media
No stenosis = not significant
Atherosclerosis
Atheroma formation causing stenosis
Which form of arteriolosclerosis develops due to long-term DM
Hyaline
Hyaline arteriolosclerosis is ___ and due to ____ or DM
Pink
Benign HTN
Layered arteriolosclerosis is ____ and due to ___
Layered “onion-skin”
Severe HTN
Atherosclerosis weakens what layer?
Tunica media
Foam cells
Fat laden macrophages
CAD =
70% occlusion of coronary arteries
Which is MC to be associated with inflammation
Unstable atherosclerotic plaque
Hemodynamic stress occurs at
Branch points or areas of turbulence
Claudication
Pain in legs due to peripheral vascular disease
Worse with physical activity
3 MI risk factors
Hyperlipidemia
HTN
Smoking
Any 2 of the 3 risk factors for MI increases risk
4X
All 3 risk factors for MI increases risk
7X
Metabolic syndrome aka
Syndrome X
Metabolic syndrome diagnosis
Any 3 of 5 criteria
Central obesity HTN Insulin resistance Dyslipidemia Pro-inflammatory state
Localized dilation of artery
Aneurysm
True aneurysm
All 3 layers affected
False aneurysm
Defect in inner wall
Extravascular hematoma
Risk factors for aneurysm
HTN Trauma Marfans Ehlers-Danlos Syphilis
Abdominal aortic aneurysm
Aorta dilated > 50%
Normal aorta dilated 3 cm, AAA dilated to
5 cm
AAA is _____ to adjusting
Contraindication
If AAA ruptured, ___ fatal
50%
Min criteria for AAA risk of rupture
5-6 cm
___ are most susceptible to compression from AAA
Ureters
Consequences of aortic dissection
Hemorrhage
Vascular occlusion
Pericardial tamponade
Aortic dissection MC in
Males, > 50 yo
Most cases of aortic dissection occur in present of
HTN
Earlier onset of aortic dissections can be due to
Marfan
Ehlers-danlos
Wilson disease
“Tearing or stabbing” and anterior chest pain describes
Aortic dissection
Type A aortic dissection
Ascending aorta
MC and most severe
Type B aortic dissection
Distal to left subclavian A
Less common
Less severe
Thoracic aortic dissection can be due to
HTN (40-60 years)
Marfan (younger)
Pericardial tamponade
Fluid accumulates in pericardium
Pericardial tamponade prevents
Ventricular expansion
Pericardial tamponade is an
Emergency- cardiogenic shock
Wilson Disease
Abnormal copper transport
Excessive copper accumulates in Wilson Disease and damages…
Liver = steatohepatitis Brain = psychosis, Parkinsonism Eyes= kayser-fleischer rings
Warning signs of dissection
Sudden, Severe, Sustained
Neck pain (suboccipital)
HA
Vertigo
5 Ds and 3 Ds of brainstem ischemia
Diplopia Dizziness Drop attacks Dysarthria Dysphagia
Numbness
Nausea
Nystagmus
Vessel wall inflammation
Vasculitis
Infectious vasculitis can be caused by
Hep b
Syphilis
Immune mediated vasculitis can be due to
Lupus
PAN
Immune mediated vasculitis is what type hypersensitivity?
Type 3
Temporal arteritis aka
Giant cell arteritis
Temporal arteritis (Autoimmune vasculitis) can be due to what 3 vessels?
Temporal artery
Ophthalmic artery
Vertebral artery and aorta
Temporal arteritis involves
Granulomas
Temporal arteritis treatment
Corticosteroids
Symptoms of temporal arteritis
Facial pain HA Diplopia Blindness Fever
Blindness in temporal arteritis is due to what artery
Ophthalmic artery
Takayasu arteritis aka
Pulseless disease
Takayasu arteritis is an autoimmune vasculitis that involves what vessels
Aortic arch and vessels branching from that
- radial artery
- Carotid artery
Takayasu arteritis MC in
Younger <50 yo
Systemic autoimmune vasculitis that occurs in medium sized arteries
Polyarteritis nodosa
PAN produces what characteristic sign?
Rosary Sign
2 MC and lethal arteries affected in PAN
Renal A
Coronary A
PAN spares
Pulmonary arteries
PAN is ___ and involves fatigue, fever, malaise, weight loss
Episodic
PAN MC in
Young adults
2/3 autoimmune
1/3 post hep B infection
PAN treated with
Corticosteroids
PAN can be __ if untreated
Fatal
Segmental fibrinoid necrosis and purpura characteristic of
PAN
Kawasaki Disease
Pediatric vasculitis
80% of Kawasaki Disease are in what population
<4 years
___ and ___ are primary concern with Kawasaki Disease
CAD and MI
Strawberry tongue characteristic of
Kawasaki Disease
Treatment for Kawasaki disease
Aspirin
Corticosteroids
CABG surgery
Kawasaki disease is rare and idiopathic, but observed in
Asians
Males
Kawasaki disease has acute onset and is
Self limiting
Reye syndrome damages
Liver and brain
Reye Syndrome can be due to
Viral infection (flu or chickenpox) Aspirin
Reye syndrome MC ages
4-12
Reye syndrome is a
Medical emergency
May be rapidly fatal
Reye syndrome can cause
Encephalopathy
Hepatic steatosis
Wegener granulomatosis aka
Granulomatosis with polyangiitis
Kidneys and respiratory tract vasculitis
Wegener granulomatosis
GPA commonly affects
Sinuses
Trachea
Lungs
Kidneys
GPA MC in
Males
If untreated, GPA is ___ lethal in 1 year
80%
Treatment for GPA
Immunosuppression
Symptoms of Wegener
Pneumonitis Sinusitis Kidney damage Nasopharyngeal inflammation/ulcers Fever Rash
Thromboangiitis obliterans aka
Buerger Disease
Buerger disease components
Raynaud
Vascular claudication
Ulceration
Gangrene
Tobacco smoke causes
Buerger disease
Vascular insufficiency common in ___ and ___ in Buerger Disease
Tibial artery
Radial artery
Buerger MC in
Males 3X
Age 20-40
Symptoms of buerger disease
Cold, cyanotic extremities
Vascular claudication
Raynaud phenomenon
Exaggerated arterioles vasoconstriction
Primary raynaud
Idiopathic
Cold or strong emotions
Secondary raynaud
Atherosclerosis
SLE
Buerger disease
Systemic sclerosis
Obliterative vasculitis
Buerger disease
Raynaud MC in
11% females
8% males
Adolescent or young adults
Takotsubo cardiomyopathy aka
Broken heart syndrome
Stress-induced cardiomyopathy
Extreme psychological stress causing catecholamine release
Takotsubo cardiomyopathy
Phlebothrombosis
Venous thrombosis
Absence of inflammation
Thrombophlebitis
Venous thrombosis
Inflammation
Varicose veins
Superficial veins are dilated and tortuous
MC in legs
Phlebitis
Venous inflammation
Risk for varicose veins
Obesity
Genetics
Pregnancy
High heels
Regarding varicose veins, increase in pressure causes ____ which causes ____
Vasodilation
Incompetent valves
Insufficient venous return causing discoloration, thinning of skin, and edema
Stasis dermatitis
Venous eczema
Most cases of thrombophlebitis
DVT
SVC syndrome
SVC compressed or invaded
Common “invaders” in SVC syndrome
Lung CA
Mediastinal lymphoma
Congested UE veins
SVC syndrome
IVC Syndrome
IVC compressed or invaded
IVC syndrome can be due to
Liver Ca
Renal Ca
Pregnancy
Congested LE veins
IVC Syndrome
Lymphedema
Lymphatic obstruction
-intestinal fluid accumulates
Lymphedema MC from
Infection or inflammation
Primary lymphedema
Congenital malformation
-Milroy disease
Milroy Disease
Inherited hypoplasia/agenesis of lymph vessels
Secondary lymphedema
Destruction of previously normal vessel
-tumors, infection (filariasis), surgery (mastectomy)
Signs of lymphedema
Peau D’orange
Brawny Induration
Peau d’orange
Skin of orange
Skin tethered by sweat ducts
Brawny induration
Hardening of skin due to chronic lymphedema
Lymphangitis
Acute inflammation of lymphatic channel
Lymphangitis can be due to
Bacterial infection
Painful red streaks
Vascular tumors are often from transformed
Endothelial cells
CT
Vessel walls
MC vascular tumor
Hemangioma
Occasionally, vascular tumors can be fairly aggressive and be called
Kaposi sarcoma
Rare highly malignant vascular tumor sarcoma
Angiosarcoma
Hemangioma
Benign tumor of capillary endothelial
- well differentiated
- well localized
In Hemangiomas, malignant transformation is ____ and usually self resolve by age ___
VERY RARE
Age 7
AIDS defining disease
Kaposi sarcoma
Kaposi sarcoma caused by
Kaposi sarcoma herpesvirus (KSHV)
KSHV transmission
Sex or oral secretions
MC HIV related malignancy
Kaposi sarcoma
Signs of kaposi sarcoma
Macules (purpura)
MC LE
Eventually back, face, mouth, genitals, GI, lungs
Malignancy of vascular endothelial
Angiosarcoma
angiosarcoma MC in
Older adults
Anaplastic angiosarcomas spread widely via
Lymph nodes
MC location of angiosarcoma
Skin
Breast
Liver
Soft tissues
Malignancy of lymphatic endothelial
Kaposi sarcoma
Early angiosarcoma
Small
Red
Late angiosarcoma
Large
Red-tan
Endovascular stenting
Preserves luminal patency
- holds down flaps
- limits vasospasm
Common treatment for CAD
Endovascular stenting
Grafts
Replace or bypass arteries
Synthetic graft
Increase risk of thrombosis
Autologous graft
Great saphenous vein (50% at 10 years)
Internal mammary artery (90% at 10 years)
Risk for angiosarcoma
PVC industry
