Misc. Vascular Pathologies

Question 1

What is myocardial vessel vasospasm?

(causes)

Answer 1

constriction of the coronary arteries

Causes:

• endogenous vasoactive substances -> epinephrine/norepinephrine (pheochromacytoma)
• exogenous vasoactive substances: cocaine, phenylephrine, caffiene
• hyperthyroidism
• autoantibodies/T cells in scleroderma

Question 2

What are complications of myocardial vessel vasospasm?

Answer 2

• ischemia
• infarct

Question 3

What is Takostubo cardiomyopathy?

Answer 3

“broken heart syndrome”

sudden release of catechomaines in respone to emotional distress -> myocardial vessel vasospasm

Question 4

What are varicose veins?

(cause)

Answer 4

abnormally dialated, tortuous veins

Cause:

-prolonged increased intraluminal pressure

Question 5

What factors increase risk of developing varicose veins?

Answer 5

• obesity
• pregnancy
• sedentary lifestyle
• prolonged standing (dependent posture)

Question 6

What are complications of varicose veins?

Answer 6

valvular incompetence ->

• stasis
• congestion
• edema
• pain
• ischemia of skin -> stasis dermatitis
• brawny skin changes

Question 7

What is vena cava syndrome and how does it present?

Answer 7

obstruciton of the vena cava

Superior vena cava syndrome:

• typically lung carcinoma or medistinal lymphoma
• dilation of vessels of neck, head, and anterior chest
• facial swelling
• neurologic symptoms
• s/x worsen with bending forward or laying down
• respiratory distress (if pulmonary vessels effected)

Inferior vena cava syndrome:

• hapatocellular carcinoma, renal cell carcinoma, thrombosis
• dilation of lower abdominal vessels
• lower extremity swelling

Question 8

What is thrombophlebitis?

Answer 8

venous thrombosis

• most common in deep veins, especially in legs
• uncommon in superficial veins

Question 9

What is the presentation of thrombophlebitis?

Answer 9

may be asymptomatic

symptomatic:

• edema
• erythema + warmth -> cyanosis + cool
• pain

Question 10

What is a complication of thrombophlebitis?

Answer 10

Pulmonary embolism (PE):

• detachment/fragmentation of thrombus which travels to the lungs and obstucts blood flow
• varies from asymptomatic -> dyspnea -> sudden death
• can be the first sign of previously asymptomatic thrombophlebitis

Paradoxical embolism:

• thrombus traverses patent foramen ovale, crossing into systemic circulation instead of normal pulmonary circulation
• can cause stroke

Question 11

What are risk factors for thrombophlebitis?

Answer 11

Virchow triad:

• Hypercoagulability: thrombophilia, estrogen, increased platelet adhesion
• Endothelial damage
• Venous stasis: prolonged inactivity/sedintary lifestyle/hospitalization

paraneoplastic hypercoagulability; mostly associated with mucin secreting pancreatic and lung adenocarcinomas -> migratory thrombophlebitis (Trousseau sign)

Question 12

What is a possible sign found on exam that could indicate thrombophelbitis?

Answer 12

Homan sign:

-pain with squeezing of calf or dorsiflexion of foot

**not always present, absence does not exclude thrombophlebitis

Question 13

What is lymphangitis?

(cause and presentaiton)

Answer 13

inflammation of the lymphatics

Cause:

-most commonly cause by group A β-hemolytic strep (S. pyogenes)

Presentation:

-subcutaneous painful, red streaks -> progress to LN (lymphadenitis)

Question 14

What is lymphedema?

(causes and presentation)

Answer 14

impaired lymph flow -> persistent edema

Causes:
-primary (genetic): Milroy disease; lymphatic agenesis/hypoplasia

-secondary: tumors, surgical removal of lymphatics, postradiation fibrosis, postinflammatory scarring

Presentation:

-edema (typically of associated limb)

Question 15

What is Peau d’orange?

Answer 15

skin change associated with breast cancer obstructing lymphatics

-skin resembles orange peel w/ pitting of hair follicles