Vascular Abnormalities Flashcards
Both arteries and veins are made of what 3 main layers?
Intima
Media
Adventitia
What do arteries have that veins do not in their walls?
Elastic fibers
Arterial system is ____ pressure and the Venous system is ____ pressure
Arterial system = high pressure
Venous system = low pressure
At what level in the Arterial system is the blood pressure controlled?
Arteriole
What are Arteriovenous Malformations?
Thick-walled arteries that connect directly to Thick-walled veins and SKIP capillaries
What do Arteriovenous Malformations look like?
Tangle of worm-like vascular channels with pulsatile Arteriovenous shunting
What can large Arteriovenous Malformations result in?
High output cardiac failure due to the heart having to pump additional volume!
What is and where are Berry (saccular) Aneurysms usually found?
Abnormal dilation of an artery due to a defect in the media layer
– usually found in circle of willis at major branch point
Where in the circle of willis is the most common site for a Berry Aneurysm?
Near the anterior cerebral artery branch point
What are 2 risk factors and 3 syndromes that put you at risk for a Berry Aneurysm?
Risk factors - smoking and HTN
- Polycystic kidney disease, Marfans and Ehlers Danlos Syndromes
If a Berry Aneurysm ruptures, what will the symptoms be?
(subarachnoid hemorrhage)
= worst headache ever; N/V, double vision, neck pain, seizures, loss of consciousness
What is a Mycotic Aneurysm and what are 3 potential causes?
Infected arterial wall Aneurysm
ex. From septic emboli, circulating organisms, adjacent bacterial infection
What is Fibromuscular Dysplasia?
Focal, irregular thickening in medium/large muscular arteries
What arteries does Fibromuscular Dysplasia commonly affect and in what population?
RENAL arteries in young women with 1st degree relatives affected as well
What will Fibromuscular Dysplasia look like on angiography?
String of beads
If Fibromuscular Dysplasia affects the renal arteries, what will result?
Renovascular hypertension and abdominal bruit
Renovascular hypertenion with an abdominal bruit is likely due to what vascular abnormality?
Fibromuscular Dysplasia
“string of beads” on angiography?
Fibromuscular Dysplasia
A subarachnoid hemorrhage can be due to a rupture of what vascular abnormality?
Berry Aneurysm in the circle of willis
High output cardiac failure can be a result of what vascular abnormality?
Arteriovenous Malformation
What is blood pressure dependent on?
Cardiac output X Peripheral resistance
With low BP what occurs?
- Kidney releases Renin
- Renin (+) angiotensin 2
- Causes Vasoconstriction and Aldosterone release
- Salt and water retention
With high BP what occurs?
- Heart releases atrial natriuretic peptide
= vasodilation and decreased salt and water retention
Primary Hypertension is likely due to what idiopathic factors?
Age, genetics
Stress, obesity, increased salt consumption
Hypertension is a major risk factor for what conditions?
Atherosclerosis and end organ damage
Findings if primary hyperaldosteronism is causing secondary HTN?
Hypertension with HYPOkalemia
Cushing syndrome can cause secondary HTN. What will be elevated and what physical exam findings will be present?
- Elevated Cortisol
= Moon face, buffalo hump, purple striae and central obesity
A Pheochromocytoma is an adrenal gland tumor. What does it cause to be released?
Catecholamines - epinephrine and norepinephrine
Symptoms of a Pheochromocytoma?
Paroxysms (sudden attacks) of secondary HTN
- Tachycardia, sweating and tremors
What will be elevated in the urine or plasma with a Pheochromocytoma that is causing secondary HTN?
Metanephrines
– breakdown product of catecholamines
(norepinephrine and epinephrine)
What are 2 possible causes of Renal A. stenosis?
Atherosclerosis
Fibromuscular Dysplasia
What will the findings be (4) with Renal A. Stenosis?
Secondary HTN
DECREASED GFR
Abdominal bruit
Chronic kidney disease
The adult form of coarctation of the aorta can cause secondary HTN. What will the findings be?
UE HTN
LE hypotension
What can HTN cause in the heart?
Cardiac hypertrophy
Heart failure
Ischemic heart disease
What can HTN cause in the CNS/eye?
Stroke
Increased intracranial pressure
Papilledema = swelling of optic disc
What 2 types of Arteriolosclerosis can result from chronic/severe HTN?
Hyaline
Hyperplastic
Hyaline Arteriolosclerosis
Hyaline thickening of vessel wall –> luminal narrow
How will Hyaline Arteriolosclerosis look?
Homogenous pink
– granular surface
Hyperplastic Arteriolosclerosis
Smooth muscle forms concentric lamellations –> luminal narrowing
How will Hyperplastic Arteriolosclerosis look?
Onion skinning
– petechial hemorrhages
Smooth muscle forms concentric lamellations that causes luminal narrowing in response to severe HTN
Hyperplastic Arteriolosclerosis
Hyaline thickening of vessel wall that causes luminal narrowing in response to chronic HTN
Hyaline Arteriolosclerosis
What classifies a Hypertensive Crisis?
Rapid increase of BP:
- Systolic > 180-200
- Diastolic > 120
What classifies a Hypertensive Emergency?
Hypertensive crisis + end organ damage
