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SS- Cardio > Vascular > Flashcards

Vascular Flashcards

1
Q

atherosclerosis

A

disease of arterial intimal thickening due to lipid accumulation, chronic inflammation, and repair
muscular and elastic arteries
contains: calcification, cholesterol clefts, necrotic core, fibrous cap

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2
Q

modifiable risk factors for athersclerosis

A

multiplicative

  1. smoking
  2. HTN
  3. obesity
  4. DM
  5. dyslipidemia
    also: inflammation (high CRP) and physical inactivity
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3
Q

atherosclerosis pathogenesis

A

injured endothelial cells and dysfunction-> increase permeability and leukocyte and platetlet adhesion-> accumulation of lipid in tunica intima-> monocyte recruitment-> foam cell-> recruit sm. muscle cells and T cells-> Sm. muscle cell proliferation and ECM deposition

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4
Q

How does hyperlipidemia contribute to atherogenesis?

A

high levels of cholesterol increases local reactive oxygen species causing membrane and mitochondrial damage and accelerate NO decay

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5
Q

foam cells formation

A

macrophages (sm. muscles too) take up modified LDL through scavenger receptors that lack feedback inhibition and are unable to degrade them
release GF, cytokines, chemokines

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6
Q

What is the role of inflammation in atherosclerosis?

A

cholesterol crystal and FFA activate inflammasome leading to activation of IL-1: recruits leukocytes
inflammatory cells breakdown ECM and result in unstable plaques
IL-1 and TNF-a: decrease superoxide dismutase, NO, PG

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7
Q

factors implicated in sm. muscle proliferation in atherosclerosis

A

PDGF, FGF, TGF-alpha

stabilizes plaques

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8
Q

neovascularization of later atherosclerosis

A

O2 can’t get through thickened artery

hemorrhage into plaque making it prone to rupture

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9
Q

internal elastic lamina

A

separates tunica intima and tunica media

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10
Q

arteriovenous fistula

A

direct connection between arteries and veins bypassing capillaries

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11
Q

fibromuscular dysplasia

A

focal irregular arterial wall thickening with intimal and medial hyperplasia and fibrosis leading to luminal stenosis
renal, carotid, splanchnic or vertebral arteries in young women

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12
Q

hyperplastic arterioloscerosis

A

concentric wall thickening due to smooth muscle hyperplasia and hypertrophy
onion skinning
cause: malignant HTN, scleroderma can cause similar look of large interlobar renal arteries, lupus

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13
Q

fibrinoid change/necrosis

A

leakage of plasma protein into wall with or without necrosis

cause: malignant HTN or vasculitis (esp. polyarteritis nodosa)

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14
Q

hyaline arteriolosclerosis

A

wall thickening due to leakage of plasma protein into wall and increased secretion of matrix by smooth muscle cells
cause: HTN, DM
differential should include amyloidosis (larger vessels) and fibrinoid change

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15
Q

medial calcific sclerosis

A

Monckeberg

degenerative calcification of internal elastic lamina spreading into tunica media

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16
Q

canakinumab

A

trial drug
anti-interleukin-1B Ab
Tx:unstable plaque in acute coronary syndrome

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17
Q

What makes a plaque unstable?

A

thin fibrous plaque: prone to rupture and release thrombogenic material form necrotic

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18
Q

colchicine

A

gout drug that can be used at low doses in athersclreosis

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19
Q

angiogram

A

shows lumen of vessels only

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20
Q

intravascular ultrasound

A

shows wall and lumen of vessels

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21
Q

mechanism of acute coronary syndrome

A

rupture of atherosclerotic plaque due to erosion of fibrous cap (usually thin) and release of thrombogenic material
ruptured plaques: large lipid core, thin cap, abundant inflammatory cells, calcification

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22
Q

erosion of atherosclerotic plaque

A
  1. oxidative stress and hypochlorous acid cause endothelial cell apoptosis producing TF
  2. modified LDL can induce MMP-14 -> MMP-2-> degradation of type IV collagen
  3. Lp-PLA2-> MCP-1, ICAM-1, VCAM-1 -> endothelial cells vasodilator less in response to NO and undergo apoptosis
  4. Lp-PLA2-> MCP-1 on macrophages-> IL-1beta
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23
Q

What causes atthersclerotic events?

A

up to 75% rupture
up to 25% erosion
most events are due to superimposed thrombosis

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24
Q

How do statins and aspirin prevent atherosclerotic event?

A

statins: reduce lipid content, making more fibrous, decrease macrophages
may be anti-thromboic, pro-fibrinolytic, vasodilatory
aspirin: anti-platelet

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25
Q

What is the role of T cells in atherosclerotic plaques?

A
  1. secrete IFN-gamma that inhibits sm. muscle cells from making collagen required for fibrous cap
  2. boosts macrophage collagenases through its CD40 ligand
26
Q

What is the role of macrophages in atherosclerotic plaques?

A

overproduces MMP-1, MMp-8, MMP-13 that degrade collagen

27
Q

distribution of atherosclerosis

A
  1. lower abdominal aorta
  2. coronary arteries
  3. popliteal arteries
  4. internal carotid arteries
28
Q

Which coronary arteries are most likely to have acute coronary disease?

A
  1. LAD (1/2)
  2. RCA (1/3)
  3. LCX (1/6)
29
Q

atherosclerotic stenosis

A

early stages: remodeling of artery expands it outward and preserves lumen, eventually impinges on lumen

30
Q

critical stenosis

A

occlusion that produces tissue ischemia, 70% reduction of lumen cross section
Sx develop: angina on exertion
effects of occlusion depend on metabolic demand and arterial supply of tissue

31
Q

general categories of acute plaque changes

A
  1. rupture: releases thrombogenic plaque constituents into blood
  2. erosion: exposes subendothelial basement membrane to blood
  3. hemorrhage into atheroma: expanding its volume
32
Q

When are MI most likely?

A

6am-12pm
due to adrenergic stimulation associated with waking and rising
also intense emotional distress

33
Q

methotrexate use in atherosclerosis

A

inhibition of proliferation fibroblasts, sm. muscle cells, endothelial cells, lymphocytes that play a role in atherosclerosis

34
Q

thrombosis of coronary arteries in the young

A
  1. vasospasm (cocaine, amphetamines)
  2. lupus anticoagulant in young woman
    hypercoaguable states lead to VENOUS thrombosis
35
Q

atheroembolism

A

most likely in leg, renal, intestinal arteries from aorta

RARE in coronary arteries

36
Q

dissection

A

tear of tunica intimal letting luminal blood under high pressure into the tunica media making a second lumen

37
Q

ectasia

A

non-discrete, non-localized dilatation of blood vessel or duct

38
Q

fibrillin

A

extracellular glycoproteins essential for structuring elastin fibers

39
Q

Marfan syndrome

A

autosomal dominant
inherited disease of defective fibrillin (FBNI gene) and excess TGF-beta leading to tall thin body habits and cystic medionecrosis of ascending aortic (dissections)
Tx: beta-blockers

40
Q

Ehlers-Danlos

A

usually autosomal dominant
heterogeneous group of inherited disorders due to defects in synthesis or structure of fibrillar collagen
COL3A1 gene for type III collagen
spontaneous rupture of blood vessels and intestines

41
Q

aortic aneurysm

A

elderly, fam. Hx, white males
combination of atherosclerosis and predetermined degeneration of tunica media (increased MMP)
other causes: Marfan, infection, vasculitis
abdominal more common
Sx: usually none; back pain if leaking
Dx: imaging
Tx: stent, surgery (not until 5 cm)
complications: RUPTURE, thrombus, embolism, obstruction, aortoenteric fistula

42
Q

aortic dissection

A

late, middle age, men blacks
rarely obvious what causes it, medial dissection associated with cystic medial degeneration
Sx: tearing chest pain or between scapulae that moves as dissection progresses, with or without altered mental status (carotid), arm pain/weakness (subclavian), collapse (rupture into pericardium or left pleural cavity)
DX: CT, MRI, transesophageal echo
Tx: reduce BP, surgery

43
Q

giant cell arteritis

A

temporal arteritis
elderly, white, female, N. European Hx
Sx: headache, visual distrubance, jaw claudication, scalp tenderness
complication: blindness
inflammation: segmental, transmural, granulomatous, giant cells on internal elastic
membrane
innate and adaptive
PAMP-> dendritic cells (TLR-4) produce IL-12 and IL-18 (also IL-2, IL-6) -> up regulate Th1 cell production of IFN-gamma, Th17 (IL-1, IL-23) and release homing CCL19 and CCL21-> bind CCR7 receptor-> arrest of dendritic cells -> trapped in arterial wall
IFN-gamma-> VEGF and PDGF -> fibrosis and stenosis
MMP-2 and MMP-9: destroy elastin
Tx: anti-TNF and corticosteroids: suppress IL-1, IL-6, IL-17 (Th17)

44
Q

Takayasu arteritis

A

young East Asian females
cpture, hemopericardium (cardiac tamponade)
Sx: pulseless arm, arm claudication, subclavian or aortic bruit, aortic or major branches stenosis, angina
inflammation: segmental, transmural, necrotizing, loose granulomas (multinucleate giant cells)
complications: aortic dissection, rupture, hemopericardium (cardiac tamponade)
Tx: corticosteroids
poor prognosis

45
Q

polyarteritis nodosa

A

white, male, 40s
Sx: neuropathy (wrist or foot drop), renal failure, ACUTE ABDOMEN, cholecystitis, pancreatitis, angina pectoris, livedo reticularis
inflammation: segmental, transmural, nodular, FIBRINOID necrosis
SPARES LUNGS, lesions at DIFFERENT PHASES
complications: thrombosis, occlusion, rupture, aneurysm
NO Ab
prognosis: good with treatment

46
Q

Kawasaki disease

A

East Asian children
Sx: conjunctival injection, desquamtion rash, cervical lymphadenopathy, strawberry tongue, hand and foot erythema/ edema, fever
complications: coronary aneurysm, thrombosis, MI, sudden death
Tx: aspirin and IV immunoglobulin

47
Q

microscopic polyangiitis

A

hypersensitivity or leukocytoclastic vasculitis
all lesions SAME PHASE
necrotizing glomerulonephritis and pulmonary capillarities common
Ab: P-ANCA (MPO)
segmental, fibrinoid necrosis
Sx: hemoptysis, hematuria, proteinuria, bowel pain, bleeding, muscle pain/weakness, palpable purpura
Tx: corticosteroids, immunosuppression

48
Q

granulomatosis with polyangiitis

A

Wegner’s, white, 40’s
necrotizing granulomatous: arteries and veins in upper and lower respiratory tract and kidneys
GEOGRAPHIC with histiocytes
Ab: C-ANCA (proteinase-3)
Tx: corticosteroids, immunosuppression, rituximab

49
Q

Churg-Strauss syndrome

A

allergic granulomatosis with polyangitis

asthma, eosinophilia, vasculitis

50
Q

Buerger disease

A

young, male, smoker, Middle Eastern or South Asian
thrombosing faso-occlusive disease of arteries and veins of limbs
ischemic ulcers. gangrene moving distal to proximal
granulomas and giant cells
Tx: stop smoking and amputation

51
Q

peripheral arterial disease

A

common, elderly, men
chronic atherosclerotic occlusive disease of large and medium arteries, primarily legs
Sx: intermittent claudication (during exercise), pain at rest is severe
signs: lost pulses, bruits, pallor, skin/muscle atrophy, ulceration, necrosis
Dx: Hx and physical
Tx: exercise

52
Q

acute arterial occlusion

A

uncommon
thromboemboli mostly from heart
Sx: pain, pallor, paralysis, paresthesia, pulselessness in legs (arms and brain too)
Dx: Hx and physical
Tx: anticoagulation, thrombolytics, surgery, thromboectomy
SURGICAL EMERGNCY

53
Q

large vessel vasculitis

A
  1. Temporal (giant cell) arteritis
  2. Takayasu arteritis
    PULSELESS
54
Q

medium vessel vasculitis

A
  1. polyarteritis nodosa
  2. Kawasaki
  3. Buerger
    INFARCTION
55
Q

small vessel vasculitis

A
  1. granulomatosis with polyangitis (Wegner’s)
  2. microscopic polyangitis
  3. eosinophilic granulomatosis with polyangitis (Churg-Strauss)
  4. Henoch-Sconlein purpura
    PALPABLE PURPURA
56
Q

aneurysm

A

discrete localized dilatation of blood vessel (or heart)

57
Q

cysitc medial degeneration

A

loss of sm. muscle cells and plastic fibers in tunica media of large arteries
leads to: aneurysm

58
Q

Type A aortic dissection

A

ascending aorta with/without other parts of aorta
must have rapid Dx
Tx: anti hypertensives, surgery

59
Q

Type B aortic dissection

A

descending aorta alone

Tx: anti-hypertensives

60
Q

vasculitis

A

inflammation of blood vessels
most autoimmune
most common Sx: fever, myalgia, arthralgia, malaise
Dx: biopsy

61
Q

palpable purpura

A

erythematous tender skin nodules

62
Q

infectious vasculitis

A 
caused by :
1. fungal (Aspergillus)
2. bacterial (pseudomonas)
3. viral (CMV)
may cause mycotic aneurysm (even if not fungal)

SS- Cardio (16 decks)

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