Hillard Vascular Pathology Part #2 Flashcards
Differentiate the three types of arteriosclerosis?
- 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
What causes Atherosclerosis?
- Coronary, cerebral, and peripheral vascular disease
What are the non modifiable risk factors for atherosclerosis?
- Genetic abnormalities
- Family history
- Increasing age
- 40-60 5x higher risk
- Males
How does estrogen play a role in atherosclerosis?
It is protective in premenopausal estrogenized women, however estrogen therapy post menopause is not protective
Modifiable risk factors for atherosclerosis?
- Hyperlipidemia
- Htn
- Smoking
- Metabolic syndrome
- Lack exercise
- Competitive/stressful lifestyle
Synergistic effect
What can help lower LDL?
- Diet higher in soluble fiber
- Statins
How do you increase HDL?
- Exercise
- Moderate alcohol
How does hyperhomocysteinemia impact cardiovascular system?
- Increase levels correlate to increased coronary atherosclerosis
- Increased peripheral vascular disease risk
- Increased stroke risk
How does increased CRP impact cardiovascular system?
- Measures inflammation
- Increased by IL 6
- Correlates with increased CV disease risk
Describe the activated state of endothelium
- Chronic endothelial injury/dysfunction increases expression of procoagulants, adhesion molecules, and proinflammatory factors
- Alters expression of chemokines, cytokines and growth factors
Pathogenesis of atherosclerosis>
- 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
What re the three “outcomes” of progressive atherosclerotic disease?
- Aneurysm and rupture
- Occlusion by thrombus
- Critical stenosis
How does atherosclerotic disease impact brain?
- Can lead to intracerebral hemorrhage
- Multiple silent strokes appearing as dementia
- Strokes
How does atherosclerosis impact kidneys?
- Renal artery stenosis leading to developed HTN
- Chronic renal insufficiency leading to renal failure
How does atherosclerosis impact GI system?
- Can lead to ischemic bowel and potentially rupture leading to sepsis
Describe an aneurysm
- excessive localized abnormal dilation of blood vessel or ventricular wall
True aneurysm vs false?
- 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”
What cardiac risks are associated with Marfan’s
Aortic aneurysm and aortic dissection
What are the cardiovascular implications of Ehler’s Danlos syndrome?
- Vascular type (IV)
- rupture of large arteries
- MVP
- Mutation in COL3A1
What is the most important risk factor for AAA?
atherosclerosis
Describe a symptomatic AAA.
- Non ruptured:
- pain in abdomen and back
- Ruptured:
- severe acute pain
- pulsatile abdominal mass
- hypotension
When is surgical bypass considered for an AAA?
>5cm
Describe how the majority of AAA cases are presented?
- Majority are asx
- have pulsatile abdominal mass
- Incidental or during workup of PVD find on radiology
What type of AAA responds well to steroids?
- IgG4 inflammatory type
What is the most important risk factor for thoracic aortic aneurysm?
- Hypertension #1
- Syphilitic aortitis
- CTD
- Vasculitis
What are the clinical symptoms of thoracic aortic aneurysm?
- Asymptomatic until rupture
- Breathing difficulties
- Respiratory treeBreathing difficulties Esophagus dysphagiaRecurrent laryngeal nerve cough
Tertiary syphilis impact on CV system?
- Obliterative endarteritis of vasa vasorum leading to thoracic aneurysm
- Aortic valve regurgitation can also occur
How does aortic dissection present? (Triad)
- Sharp ripping tearing thoracic pain
- Mediastinal widening on CXR
- Pulse abnormalities
Causes of aortic dissection?
- Htn
- CTD
What is the most common type of aortic dissection?
- ascending aorta next to left common carotid artery DeBakey Type I
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
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
What type of immune mediated response is giant cell arteritis?
T cell mediated
Polyarteritis nodosa (PAN) is associated with what disease?
HBV
How will PAN present?
- Fibrinoid necrosis with vasculitis on biopsy
*
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
Granulomatosis with polyangiitis?
- +/- necrotizing renal pathology
- Associated with PR3 ANCA (c-ANCA)
- Males 40 yo
- Vasculitis of respiratory tract
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
Look for key to granulomatosis with polyangiitis key hallmark on histo
40 min in
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
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
Primary Raynaud’s phenomenon?
- Symmetric involvement of digits
- young women
- episodic and spontaneous remission
What is meant by red white and blue in Reynold’s phenomenon?
- Proximal vasodilation (Red)
- Central vasoconstriction (white)
- Distal cyanosis (blue)
Secondary Raynaud’s phenomenon?
- Asymmetric involvement of digits
- Component of another arterial disease
- Worsens with time
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
What happens to the organ systems in Microscopic polyangiitis?
- Hematuria & Proteinuria (nephritis)
- Hemoptysis
- Cutaneous purpura
- muslce weakness
- Bowel pain/bleeding
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
What is CABG?
- Coronary artery bypass grafting
- Internal mammary artery or great sapenous vein are used to bypass atherosclerotic heart vessels
