Hillard Vascular Pathology Part #2 Flashcards
1
Q
Differentiate the three types of arteriosclerosis?
A
- Arteriolosclerosis:
- effects small arteries and arterioles has hyaline and hyperplastic changes on histo
- Atherosclerosis:
- Gruel and hardening, atheromatous plaque formation
- Stenosis/occlusion of artery, plaque rupture, aneurysm
- Monckeberg medial sclerosis
- age related degeneration
- Calcification of muscular arteries and IEM
- No narrowing of lumen
- NOT clinically significant
2
Q
What causes Atherosclerosis?
A
- Coronary, cerebral, and peripheral vascular disease
3
Q
What are the non modifiable risk factors for atherosclerosis?
A
- Genetic abnormalities
- Family history
- Increasing age
- 40-60 5x higher risk
- Males
4
Q
How does estrogen play a role in atherosclerosis?
A
It is protective in premenopausal estrogenized women, however estrogen therapy post menopause is not protective
5
Q
Modifiable risk factors for atherosclerosis?
A
- Hyperlipidemia
- Htn
- Smoking
- Metabolic syndrome
- Lack exercise
- Competitive/stressful lifestyle
Synergistic effect
6
Q
What can help lower LDL?
A
- Diet higher in soluble fiber
- Statins
7
Q
How do you increase HDL?
A
- Exercise
- Moderate alcohol
8
Q
How does hyperhomocysteinemia impact cardiovascular system?
A
- Increase levels correlate to increased coronary atherosclerosis
- Increased peripheral vascular disease risk
- Increased stroke risk
9
Q
How does increased CRP impact cardiovascular system?
A
- Measures inflammation
- Increased by IL 6
- Correlates with increased CV disease risk
10
Q
Describe the activated state of endothelium
A
- Chronic endothelial injury/dysfunction increases expression of procoagulants, adhesion molecules, and proinflammatory factors
- Alters expression of chemokines, cytokines and growth factors
11
Q
Pathogenesis of atherosclerosis>
A
- LDL deposits in the intima of arteries
- Macrophages take in the lipid and foam cells are created
- GF’s are signaled such as TGF-a, PDGF, FGF resulting in proilferation of sm muscles and extracellular matrix
- These foam cells build up in the intima
12
Q
What re the three “outcomes” of progressive atherosclerotic disease?
A
- Aneurysm and rupture
- Occlusion by thrombus
- Critical stenosis
13
Q
How does atherosclerotic disease impact brain?
A
- Can lead to intracerebral hemorrhage
- Multiple silent strokes appearing as dementia
- Strokes
14
Q
How does atherosclerosis impact kidneys?
A
- Renal artery stenosis leading to developed HTN
- Chronic renal insufficiency leading to renal failure
15
Q
How does atherosclerosis impact GI system?
A
- Can lead to ischemic bowel and potentially rupture leading to sepsis
16
Q
Describe an aneurysm
A
- excessive localized abnormal dilation of blood vessel or ventricular wall
17
Q
True aneurysm vs false?
A
- True is an intact but thinned muscular wall at site of dilation
- False is a defect through the wall of vessel communicating with extravascular hematoma that communicates with the intravascular space
- “pulsating hematoma”
18
Q
What cardiac risks are associated with Marfan’s
A
Aortic aneurysm and aortic dissection
19
Q
What are the cardiovascular implications of Ehler’s Danlos syndrome?
A
- Vascular type (IV)
- rupture of large arteries
- MVP
- Mutation in COL3A1
20
Q
What is the most important risk factor for AAA?
A
atherosclerosis
21
Q
Describe a symptomatic AAA.
A
- Non ruptured:
- pain in abdomen and back
- Ruptured:
- severe acute pain
- pulsatile abdominal mass
- hypotension
22
Q
When is surgical bypass considered for an AAA?
A
>5cm
23
Q
Describe how the majority of AAA cases are presented?
A
- Majority are asx
- have pulsatile abdominal mass
- Incidental or during workup of PVD find on radiology
24
Q
What type of AAA responds well to steroids?
A
- IgG4 inflammatory type
25
What is the most important risk factor for thoracic aortic aneurysm?
* Hypertension #1
* Syphilitic aortitis
* CTD
* Vasculitis
26
What are the clinical symptoms of thoracic aortic aneurysm?
* Asymptomatic until rupture
* Breathing difficulties
* Respiratory treeBreathing difficulties Esophagus dysphagiaRecurrent laryngeal nerve cough
27
Tertiary syphilis impact on CV system?
* Obliterative endarteritis of vasa vasorum leading to thoracic aneurysm
* Aortic valve regurgitation can also occur
28
How does aortic dissection present? (Triad)
* Sharp ripping tearing thoracic pain
* Mediastinal widening on CXR
* Pulse abnormalities
29
Causes of aortic dissection?
* Htn
* CTD
30
What is the most common type of aortic dissection?
* ascending aorta next to left common carotid artery DeBakey Type I
31
Gian cell (temoral) arteritis what is it how does it present?
* Most common vasculitis in older adults
* Affects large arteries in the head
* headache, facial pain, **ocular symptoms**
32
How does Takayasu arteritis present and what is it?
* Granulomatous autoimmune vasculitis of large to medium arteries
* Thickening of the aorta and major branch vessels
* **Age \<50 and females**
* **Weakening of UE pulses & ocular disturbances**
33
What type of immune mediated response is giant cell arteritis?
T cell mediated
34
Polyarteritis nodosa (PAN) is associated with what disease?
HBV
35
How will PAN present?
* Fibrinoid necrosis with vasculitis on biopsy
*
36
Kawasaki Disease?
* Illness of infancy or early childhood
* Arteitis of large to medium vessels
* Infectious viral trigger
* Febrile illness, strawberry tongue, conjunctivitis, erythema of palms soles, cervical LAD and genital rash
37
Granulomatosis with polyangiitis?
* +/- necrotizing renal pathology
* Associated with **PR3 ANCA (c-ANCA)**
* Males 40 yo
* Vasculitis of respiratory tract
38
Churg Strauss Syndrome (allergic granulomatosis and angiitis) presentation?
* small vessel vasculitis associated with asthma hypereosinophilia lung infiltrates
* Palpable purpura, GI tract bleeding & renal disease
* Cardiomyopathy/myocarditis and infarction
* Heart involved in 60% patients and accounts for half of deaths
39
Look for key to granulomatosis with polyangiitis key hallmark on histo
40 min in
40
Bechet's Disease presentation
* Classic triad of oral apthous ulcers, genital ulcers, and uveitis
* Presents with arthritis, skin involvement, lung, GI and CNS
* **Neutrophilic vasculitis**
* Assoc. with HLA-B51
41
Thromboangiitis obliterans (Buerger Disease), who does it affect, what causes it, what arteries does it impact?
* **Heavy smokers \<35**
* Delayed hsn rxn or toxic reation to cigarette process
* Thrombosis →Vascular insufficiency → Tissue death
* Acute and chronic vasculitis of small and med vessels particularly tibial and radial arteries
42
Primary Raynaud's phenomenon?
* Symmetric involvement of digits
* young women
* episodic and spontaneous remission
43
What is meant by red white and blue in Reynold's phenomenon?
* Proximal vasodilation (Red)
* Central vasoconstriction (white)
* Distal cyanosis (blue)
44
Secondary Raynaud's phenomenon?
* Asymmetric involvement of digits
* Component of another arterial disease
* Worsens with time
45
What is microscopic poolyangiitis?
* Necrotizing vasculitis of small vessels particularly capillaries and venules
* Uniform stage of disease in all vessels
* Affects any organ system especially kidney lung
* Associated MPO-ANCA
* No significant immunoglobulin deposition
46
What happens to the organ systems in Microscopic polyangiitis?
* Hematuria & Proteinuria (nephritis)
* Hemoptysis
* Cutaneous purpura
* muslce weakness
* Bowel pain/bleeding
47
What are the risks associated with balloon angioplasty with endovascular stenting? How do we overcome this?
* Compression can rupture the occluding plaque
* Abrupt reclosure can result from thrombosis and spasm
* Use drug eluting stent which releases anti proliferative drugs to block smooth muscle activation
48
What is CABG?
* Coronary artery bypass grafting
* Internal mammary artery or great sapenous vein are used to bypass atherosclerotic heart vessels
