Robbins Ch 11 Vascular Pathology part 1 Flashcards
What part of the blood vessel is characterized as a single layer of endothelial cells sitting on a basement membrane underlaid by a thin layer of extracellular matrix?
Intima
What part of the blood vessel is characterized as concentric smooth muscle layers in arteries while it is disorganized in veins?
Media
In elastic arteries, what is there is a greater amount of to help change shape with the pulse?
In muscular arteries, what is there more of to allow the artery to change shape as the body need?
1) Elastin
2) Concentric smooth muscle layers
What does atherosclerosis mainly affect?
What does HTN mainly affect?
1) Elastic and muscular arteries
2) Small muscular arteries and arterioles
What are direct connections between arteries and veins that can be made surgically?
What does it provide vascular access for?
1) AV fistulas
2) Chronic hemodialysis
What are characterized by focal irregular thickenings in medium and large muscular arteries?
What classic appearance does it have?
What population is it seen most commonly in?
1) Fibromuscular dysplasia
2) String of beads
3) Young women
Vascular wall response to injury is always?
Intimal thickening
What are the relaxing factors involved in vascular injury?
What are the contracting factors?
1) NO, kinins, and prostaglandins
2) Endothelin, angiotensin II, and catecholamines
What cells are motile, acquire new biosynthetic capabilities, and move from the media to the intima?
Neointimal smooth muscle cells
Individual with a blood pressure above what are more at risk of atherosclerotic disease?
140/90
Hypertensive vascular disease will lead to?
Left ventricular hypertrophy
Most hypertensive vascular disease patients are asymptomatic until late in the course and 50% of untreated patients will die of?
Another 33% die from?
1) Ischemic heart disease or congestive heart failure
2) Stroke
What blood pressure is defined as malignant HTN?
BP > 200/120
What is seen when aldosterone causes the BP to rise by increasing Na+ reabsorption in the DCT?
Increased preload
What is the most common form of secondary HTN?
Aldosterone metabolism
Arterioles that show homogenous pink (“glassy”) thickening with associated luminal narrowing describes the morphology of?
Hyaline arteriolosclerosis
Hyaline arteriolosclerosis is due to excess hemodynamic stress that causes there to be?
More matrix deposition and plasma proteins to leak across the endothelial cell membrane
Diabetic microangiography lesions are that of?
Hyaline arteriolosclerosis
Vessels show concentric laminated (“onion skin”) thickening of the walls with luminal narrowing describes the morphology of?
Hyperplastic arterioles
When is estrogen therapy beneficial in treating atherosclerosis?
When is there no benefit from the therapy?
1) Younger postmenopausal women
2) Older postmenopausal women
What is the most common cause of left ventricular hypertrophy?
Chronic HTN
What is the best biomarker to look for inflammation?
C reactive protein (CRP)
In the pathogenesis of atherosclerosis, macrophages phagocytose lipids and become?
Foam cells
The two most important causes of endothelial dysfunction are?
1) Hemodynamic disturbances
2) Hypercholesterolemia
What are the dominant lipids in plaques?
Cholesterol and Cholesteryl esters
What creates a stable plaque?
What creates an unstable plaque?
1) Smooth muscle cells synthesize extracellular matrix (collagen)
2) Inflammatory cells in atheromas may increase breakdown of extracellular matrix components
What may fatty streaks evolve into?
Plaques
Atherosclerotic plaques are more likely to occur at places of?
Turbulent flow like branch points
What are the most commonly involved arteries for atherosclerotic plaque?
1) Lower abdominal aorta
2) Coronary arteries
3) Popliteal arteries
4) Internal carotid arteries
5) Circle of Willis
What occurs if an atheroma ruptures, ulcerates, or erodes?
Exposes highly thrombogenic substances such as tissue factor and leads to thrombosis
What is the point at which there is a 70% decrease in cross-sectional area?
Critical Stenosis
How do plaques that are responsible for myocardial infarction and other acute coronary syndromes present?
Often asymptomatic before the acute change
What destabilizes the mechanical integrity of the fibrous cap?
Plaque inflammation which is the net increase in collagen degradation and reduced collagen synthesis
What does a true aneurysm involve?
An attenuated but intact arterial wall or thinned ventricular wall of the heart
What is characterized as a defect in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space?
What type of aneurysm is it?
1) Pulsating hematoma
2) False aneurysm
What is defective in Marfan syndrome?
What does this lead to?
1) Fibrillin synthesis
2) Hyperactive TGFβ signaling which leads to cardiovascular abnormalities
What is defective in Loeys-Dietz syndrome?
What does this lead to?
1) TGFβ receptor mutations
2) Hyperactive TGFβ signaling which leads to cardiovascular abnormalities
Why is the balance of collagen degradation and synthesis altered by inflammation and associated proteases?
Increased MMPs and/or decreased TIMPs
What is characterized by ischemia of the medial media which leads to aortic changes with smooth muscle cell loss leading to scarring, lack of matrix synthesis and production of amorphous ground substance?
Cystic medial degeneration
What is characteristic of late-stage syphilis?
What does tertiary syphilis lead to?
1) Obliterative endarteritis
2) Thoracic aortic aneurysm
What is the greatest risk factor for Abdominal Aortic Aneurysm?
What is it for ascending aortic aneurysm?
1) Atherosclerosis
2) HTN
What population is most affected by AAA?
Where does it commonly occur?
1) Male smokers > 50 yo
2) Below renal arteries above iliac bifurcation
How do inflammatory AAA commonly present?
Younger patients who present with back pain
Immunoglobulin G4 (IgG4)-related disease AAA responds well to?
Steroid therapy
What size is an AAA at risk of rupture?
6 cm = 25% / year
What noticeable sign and symptom is seen with thoracic aortic aneurysm?
What is it due to?
What is this called?
1) Chronic cough
2) Recurrent laryngeal nerve palsy
3) Ortner syndrome
What is the major risk factor for aortic dissection?
HTN
What type of aortic dissection is more dangerous?
What does it invovle?
1) Proximal lesion (Type A)
2) Ascending aorta
Where does the Distal lesion (Type B) of aortic dissection occur?
When does it involve the ascending aorta?
1) Distal to the subclavian artery
2) Never
What is the most common cause of death from aortic dissection?
Rupture into pericardial, pleural or peritoneal cavities
The clinical manifestations of aortic dissections include?
1) Cardiac tamponade
2) Aortic insufficiency
3) Widened mediastinum
What antibodies are seen with Microscopic Polyangiitis and Churg-Strauss Syndrome?
What are seen with Wegener’s granulomatosis (polyangiitis)?
1) p-ANCA = MPO-ANCA
2) c-ANCA = PR3-ANCA
Immune Complex Associated Vasculitis is associated with antibodies directed against?
Drugs or streptokinase
Kawasaki disease has antibodies to?
It is the leading cause of?
What is the Tx for it?
1) Endothelial cells
2) Acquired heart disease in kids
3) Aspirin
What is the most common form of vasculitis among adults over 50 in the United States and Europe?
Giant Cell (Temporal) Arteritis
Why is Giant Cell (Temporal) Arteritis a medical emergency?
Permanent blindness
What is characterized by severe luminal narrowing of great vessel branches?
What clinical feature does it lead to?
What does it classically involve?
1) Takayasu Arteritis
2) Weakening of pulses in UE
3) Aortic arch
Because the clinical features and histology are very similar between Giant Cell Arteritis and Takayasu Arteritis, the diagnosis is usually made based on?
1) patients < 50 years = Takayasu Arteritis
2) patients > 50 years = giant cell arteritis/aortitis
30% of patients with polyarteritis nodosa (PAN) have a vasculitis attributable to immune complexes composed of?
What does PAN spare?
What population is it most common in?
1) HBsAg and HBsAb
2) Pulmonary circulation
3) Young adults
How are the lesions characterized in microscopic polyangiitis?
What is found in 90% of patients?
What is also commonly seen?
1) All lesions are the same stage and distributed widely
2) Necrotizing glomerulonephritis
3) Pulmonary capillaritis
What is Churg-Strauss Syndrome associated with?
What is it characteristically accompanied by?
1) Asthma
2) Granulomas and eosinophils
The triad of Oral aphthous ulcers, Genital ulcers, and Uveitis is diagnostic of?
What is the most likely cause of mortality due to this disorder?
1) Behcet disease
2) Rupture of vascular aneurysms
Granulomatosis with Polyangiitis (Wegener Granulomatosis) resembles what condition?
PAN but with respiratory involvement
Thromboangiitis Obliterans (Buerger Disease) involves what arteries?
What population is affected?
1) Tibial and radial arteries
2) Heavy smokers younger than 35 yo
What will classically show red, white, and blue changes from most proximal to most distal of the extremities?
What do the red and blue color changes mean?
1) Raynaud Phenomenon
2) Red is vasodilation, blue is vasoconstriction
Which type of Raynaud’s affects the extremities asymmetrically?
Symmetrically?
1) Secondary
2) Primary
Greater than 20 minutes of vasoconstriction in a coronary artery can lead to?
MI
What may we see with myocardial vessel vasospasm?
Contraction band necrosis
