Vascular disease Flashcards
Learning objectives
Classify vascular diseases
Describe the characteristics of atheroma and its complications
Define, classify and describe the types of aneurysm
Define varicose veins
Define vasculitis
Classify vascular tumours
Discuss vascular disease in different vessels
Arteries
Arteriosclerosis
Veins
Thrombosis
-Phlebothrombosis vs Thrombophlebitis
Formation of varicosities
All vessels
• Vasculitis (inflammation)
• Radiation damage
Tumours
Discuss age-related vascular changes
Fibrosis of intima and media
Accumulation of ground substance
Fragmentation of elastic lamellae
Discuss Atherosclerosis
Also known as atheroma
Affects large and medium-sized elastic and muscular arteries
Characterised by lipid deposition, fibrosis and chronic inflammation
What are the risk factors for atherosclerosis?
Age Sex Hypertension Hyperlipidaemia (particularlyLDL) Diabetes Smoking Obesity Sedentary lifestyle Low socio-economic status Low birth-weight
What is the morphology of atherosclerosis
• Atheromatous (fibro-fatty, fibro-lipid) plaque
- – Patchy and raised white to yellow 0.3-1.5cm
- – Core of lipid
- – Fibrous cap
What are some complications of atherosclerosis?
Cerebral infarction
Carotid atheroma - emboli causing transient ischaemic attacks/cerebral infarcts
Myocardial infarction, cardiac failure
Aortic aneurysms (rupture causes sudden death)
Peripheral vascular disease with intermittent claudication
Gangrene
Discuss peripheral vascular disease
Atheroma of distal aorta/iliac/femoral arteries
Causes ischaemia of lower limbs
Effects
- Intermittent claudication
- Pain
- Ulcers
- Gangrene
Discuss aneurysms
Localised, permanent, abnormal dilatation of
•blood vessel or the heart
Types: •– Atherosclerotic •– Dissecting •– Berry •– Micro-aneurysms •– Syphilitic •– Mycotic
Discuss atherosclerotic aneurysms
Usually abdominal aorta, distal to renal arteries
Women 50%
frequently contains mural thrombus
The clinical consequences
Thrombosis
Embolism
Rupture
Obstruction of a branch vessel
ischemic injury
Impingement on an adjacent structure
Presentation as an abdominal pulsating mass
Can be repaired
Discuss the occurrence of aortic aneurysms
Men x3 more than women aged 40 to 60 with hypertension
Younger patients with systemic or localized abnormalities of connective tissue
Morphology:
usually initiates with an intimal tear
1-2 cm from aortic valve
dissection can extend along the aorta retrograde toward the heart or
distally, sometimes into the iliac and femoral arteries
What are the clinical symptoms of aortic aneurysms?
• The sudden onset of excruciating pain,
beginning in the anterior chest, radiating to the back
•between the scapulae, and moving downward as the
•dissection progresses; the pain can be confused with
•that of myocardial infarction.
- The most common cause of death is rupture of
- the dissection outward into the pericardial,
- pleural, or peritoneal cavities.
What are Berry aneurysms
Aneurysms of the circle of Willis Young people Often hypertensive Associated with sub-arachnoid haemorrhage
Discuss capillary micro-aneurysms
Associated with
• Hypertension
• Diabetes mellitus
Small aneurysms of branches of middle cerebral artery
Associated with intra-cerebral haemorrhage
Discuss syphilitic and mycotic aneurysms
Syphilitic
• Usually affects thoracic aorta
Mycotic
• Wall of artery weakened by infection
• Bacteria or fungi
• Often in brain, secondary to embolism
Discuss varicose veins
Definition:
Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support
Risk factors: Age, sex, heredity, posture, obesity
•Venous valves incompetent and leads to stasis, congestion, oedema, pain, and thrombosis
• Lower limbs usually saphenous system
• Oesophageal varices
• Haemorrhoids
• Varicocele
What are the consequences of varicose veins?
- Cosmetic problems
- Aching in legs
- Stasis dermatitis
- Skin ulceration and bleeding
Discuss vasculitis
Inflammation and necrosis of blood vessels
Pathogenesis:
•Cell immune-mediated inflammation
•Deposition of immune complexes
•Direct attack by circulating antibodies
•Direct invasion of vascular walls by infectious pathogens •Often part of multi-system disease
What are the different types of vasculitis?
Giant-cell (temporal) arteritis
• > age 50, average onset age 70, women > men
• granulomatous inflammation of large to small-sized arteries
(temporal, vertebral and ophthalmic)
• Cord like nodular thickening
Takayasu arteritis (pulseless disease) • granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta) women age <30
Polyarteritis nodosa (PAN) • Medium small size muscular arteries of the kidneys, heart, liver, and gastrointestinal tract are involved • Fibrinoid necrosis could be fatal without steroid treatment
Kawasaki disease (children < age 4) •High fever, conjunctival and oral lesions. Self-limited
Discuss giant-cell (temporal) arteritis
- 6-12 months
- Could be self-limited
- Patchy lesion
- Throbbing temporal pain
- Malaise
- Fever
Discuss Takayasu arteritis
- Dizziness
- Visual disturbances
- Dyspnoea
- Intermittent claudication upper limbs
- Asymmetric BP
- Steroid treatment
Discuss Vascular Tumours
BENIGN Angioma Haemangioma • Juvenile (strawberry) Skin • Capillary (rubyspots) Skin, spleen, kidneys • Cavernous (portwinestains) Skin, spleen, liver, pancreas Lymphangioma • Capillary and Cavernous
MALIGNANT
Angiosarcoma
• Skin, soft tissue, breast, bone, liver and spleen
• Kaposi’s sarcoma: associated with HIV / AIDS
Angioproliferative tumour derived from endothelial cells
