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
