Vascular Disease Flashcards
When does atherosclerosis begin?
early childhood
What are the stages of atherosclerosis?
1) prenatal/early childhood exposures
2) endothelial dysfunction
3) fatty streaks
4) fibrous plaques
5a) occlusive atherosclerotic plaques
5b) plaque rupture & thrombosis
What are fatty streaks?
accumulation of lipid (from lipid-laden macrophages and monocytes) and smooth muscle migration into the tunica intima
What happens in the case of:
- occlusive atherosclerotic plaques
- plaque rupture & thrombosis
occlusive atherosclerotic plaques - luminal obstruction and its associated symptoms of ischemia (angina + claudication)
plaque rupture & thrombosis - causes acute MI, coronary death, stroke
What are the major modifiable + nonmodifiable risk factors for coronary heart disease?
nonmodifiable
- age
- male
- family hx
modifiable
- HTN
- smoking
- hypercholesterolemia
What are therapies (Rx + procedural) for coronary heart disease?
Rx
- aspirin
- b-blockers
- ACE inhibitors
- statins
Procedural
- PCI angioplasty + stent
- CABG (grafting of arteries/veins)
Which therapy provides the greatest decrease in LDL levels and greatest reduction in coronary mortality?
statins
What are the 4 layers of the blood vessel anatomy (out->in)
endothelium
intima - contains IEL
media
adventitia - contains EEL + vasa vasorum
What is the difference between hyaline arteriosclerosis and hyperplastic arteriosclerosis?
Which one causes malignant hypertension?
hyaline arteriosclerosis - thickening of arteriolar wall due to collagen deposition
hyperplastic arteriosclerosis - thickened concentric smooth muscle layer with thickened basement membrane; AKA malignant HTN
What are the two types of aneurysms?
True - when ALL of the layers of the blood vessel are dilated, which results in an increased lumen size. This leads to increased wall stress, which can rupture.
False - when there is a tear of the arterial wall, which creates a collection of blood that is bound externally by adherent extravascular connective tissue (NOT a true dissection).
What are the causes of true dissection? (when ALL of the layers of the blood vessel are dilated)
Congenital/genetic disorders
Atherosclerosis
Marfan’s disease
Syphilis
CAMS
In what patients would you expect an abdominal aorta aneurysm?
What would you find on a physical examination?
How would you diagnose it?
What is the treatment?
M 40-60yo with chronic HTN
younger patient with CT dz
physical examination: pulsatile epigastric mass + abdominal bruit
Dx: ultrasound
Trmt: surgical repair graft
What is an aortic dissection? What is the difference between a type A and type B dissection?
In what patients is this most common?
Occurs when blood enters the vessel wall by breaking through the endothelial/subendothelial intimal layers and causes medial degeneration.
Type A
- type I - extensive dissection that involves proximal aorta
- type II - dissection that involves only the proximal aorta
Type B
- dissection that arises AFTER the great vessels (distally)
common in Marfan’s syndrome.
What is vasculitis? What are the 3 main types?
inflammation of blood vessels
Types:
Polyarteritis Nodosa (med + small arteries)
Temporal Arteritis (vessels of the head/neck)
Granulmoatous w. Polyangiitis
What is Polyarteritis Nodosa?
What is this common in? Are men more susceptible to this disease compared to women?
vasculitis of med+small arteries that result in small aneurysms that resemble beads on a rosary
30% of pts have HepB infection; men are 2x likely to get it than women
What is temporal arteritis?
What is this also known as?
damage to blood vessels that supply the head area, particularly the large or medium arteries that branch from the neck and supply the temporal area; cause of vasculitis is unknown
aka giant cell arteritis/Horton’s disease - presence of giant cells in the thick arterial wall
dx: Perinuclear pattern of antineutrophil cytoplasmic antibodies (p-ANCA)
What is granulomatosis w. polyangiitis?
What is this also known as?
vasculitis of small- and medium-size vessels in many organs that’s caused by an autoimmune attack by an abnormal antibody (ANCA)
aka Wegener’s granulomatosis
dx: ANCAs that react with the enzyme proteinase 3 (cANCA) in neutrophils
Which vascular neoplasm is more malignant: hemiangiomas or angiosarcomas?
angiosarcomas are malignant endothelial neoplasms which can metastases to distant sites
Hemiangiomas are self-involuting endothelial cells of blood vessels
Why may repeated sympathetic activation be atherogenic?
Why might people who have hyper-responsive emotional stimuli be more likely to develop HTN and atherosclerosis?
it increases BP + vasoconstriction, which may result in increased endothelial injury
these people have increased stress levels, which may result in an exaggerated catecholamine responses HR and BP in response to emotional stress.
Why might cigarette smoking be atherogenic?
nicotine can activate the sympathetic ganglia (NN receptors), resulting in increased HR, BP, which may result in increased endothelial injury
