vascular disease Flashcards
what does atherosclerosis effect?
arteries
what does thrombosis effect?
veins
what will vasculitis (inflammation) and radiation damage effect?
all vessels
age related vascular changes?
- fibrosis of intimate and media
- accumulation of ground substances
- fragmentation of elastic lamellae
what can age related changes be mistaken for?
aneurysms
atherosclerosis?
- also known as atheroma
- affects large and medium sized elastic and muscular arteries
characteristics of atherosclerosis?
necrotic lipid deposition fibrosis and chronic inflammation
risk factors of atherosclerosis?
- age
- sex
- hypertension
- hyperlipideamia
- diabetes
- smoking
- obesity
- sedentary life
- low birth weight
- low socioeconomic status
what are complications that may arise from atherosclerosis? from head to toe
- cerebral infarction
- carotid atheroma (emboli)
- MI
- aortic aneurysms (rupture causes sudden death)
- peripheral vascular disease with intermittent claudication (particularly with diabetics)
- gangrene
morphology of atherosclerosis?
- atheromatous (fibre fatty, fibre lipid) plaque
- patchy and raised white to yellow
- core of lipid
- fibrous cap
what will the fibrous cap of the atheromatous contain?
- smooth muscle cells
- collagen
- macrophages
- foam cells
- lymphocytes
- elastin
- proteoglycans
- neurovascularised
what will the necrotic centre of the atheromatous contain?
- cell debris
- cholesterol crystals
- foam cells
- calcium
what will peripheral vascular disease cause?
- pain
- ulcers
- gangrene
- intermittent claudication
what does peripheral vascular disease cause?
ischaemia of lower limbs
what is peripheral vascular disease?
atheroma of distal aorta/ iliac/ femoral arteries
what are aneurysms?
localised, permanent, abnormal dilation of blood vessels or the heart
what are the different types of aneurysms?
- atherosclerotic
- dissecting
- berry
- micro aneurysms
- syphilitic
- mycotic
describe atherosclerotic aneurysms?
- usually happens in the abdominal aorta, distal to the renal arteries
- more common in men than women
- and smokers, aged over 50
morphology of atherosclerotic aneurysms?
- saccular or fusiform
- 15 to 25cm in length
- wall diameter > 50%
- frequently contains mural thrombus
clinical consequences of atherosclerotic aneurysms?
- thrombus
- embolism
- rupture
- obstruction of a branch vessel (ischameic injury)
- impingement of an adjacent structure
how does atherosclerotic aneurysms present?
as an abdominal pulsating mass
who is most prone to dissecting aortic aneurysms?
- men x3 more likely than women aged 40 to 60 with hypertension
- younger patients with systemic or localised abnormalities of connective tissue
morphology of dissecting aneurysms?
- usually initiates with an intimal tear
- 1-2cm from aortic valve
- dissection can extend along the aorta retrograde towards the heart or distally, sometimes into the iliac and femoral arteries
where can blood go if the dissecting aortic aneurysms leaks?
pericardial sac
clinical symptoms of aortic aneurysms?
- the sudden onset of excruciating pain
- beginning in the anterior chest, radiating to the back between the scapula and moving downwards as the dissection progresses
what can the pain of an aortic aneurysm be confused with?
MI
most common cause of death with dissecting aortic aneurysms?
rupture of the dissection outwards into the pericardial, pleural or peritoneal cavities
where would a berry aneurysm be found?
circle of willis
- most commonly seen in the anterior cerebral artery
who is most at risk of berry aneurysms?
young people with hypertension
what are berry aneurysms often associated with?
subarachnoid haemorrhage
what are capillary micro aneurysms associated with?
- hypertension
- diabetes mellitus
what are capillary micro aneurysms associated with?
intra cerebral haemorrhage
where will you most commonly see a capillary micro aneurysm?
small aneurysms of branches of middle cerebral artery
syphilitic aneurysms?
usually effects the thoracic aorta
mycotic aneurysms?
- wall of artery weakened by infection
- caused by bacteria or fungus
- often in brain or secondary to embolism
varicose veins?
abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support
risk factors of varicose veins?
age
sex
heredity
posture
obesity
what can varicose veins cause?
- cosmetic problems
- aching in legs
- stasis dermatitis
- skin ulceration and bleeding
what is vasculitis?
inflammation and necrosis of blood vessels
pathogenesis of vasculitis?
- cell immune-mediated inflammation
- deposition of immune complexes
- direct attack by circulating antibodies
- invasion of vascular walls by infectious pathogens
- often part of a multi system disease
what happens to the venous valve in varicose veins?
it becomes incompetent and leads to stasis, congestion, oedema, pain and thrombosis.
what can varicose veins lead to?
- oesophageal varices (in patients with portal hypertension)
- haemorrhoids
- varicocele (plaque around testes in men , can cause infertility)
what are the 4 different types of vasculitis?
1- giant cell (temporal) arteritis
2- takayasu arteritis (pulseless disease)
3- polyarteritis nodosa (PAN)
4- Kawasaki disease (children < age 4)
what are the 3 different types of haemangioma?
1- juvenile (strawberry) - effects skin
2- capillary (ruby spots) - effects skin, spleen, kidneys
3-cavernous (port wine stains) - effects skin, spleen, liver, pancreas
what are the different types of vascular tumours?
angioma
heamangioma
lympahngioma
what are the 2 different malignant vascular tumours?
angiosarcoma
Kaposi’s sarcoma
kaposi’s sarcoma?
- associated with HIV/AIDS
- this is an angioproliferative tumour derived from endothelial cells of blood vessels (it will look brown/purple on the skin)
where will angiosarcomas effect?
skin
soft tissue
breast
bone
liver
spleen
who will giant cell (temporal) arteritis effect?
> age 50, average onset is age 70 and women are more prone than men.
who will takayasu arteritis (pulseless disease) effect?
when <30
what is giant cell arteritis?
granulomatous inflammation of large to small sized arteries (in the temporal, vertebral and ophthalmic arteries)
- it is cord like nodular thicking
- patchy lesion
- throbbing temporal pain
- malaise
- fever
what is Takaysu arteritis?
granulomatous vasculitis of medium and large arteries of upper limbs and aortic arch.
- very rarely you’ll feel the pulse in the limbs because of the narrowing of the vessels coming out of the aortic arch especially the subclavian
signs of takayasu arteritis?
how to treat?
- dizziness
- visual disturbances
- dyspnea
- intermittent claudication upper limbs
- asymmetric BP
- give steroid treatment
what is polyarteritis nodosa (PAN)?
MEDIUM SMALL SIZE MUSCULAR ARTERIES OF THE KIDEYS, HEART, LIVER AND GI TRACT ARE INVOLVED.
- FIBRINOID NECROSIS COULD BE FATAL WITHOUT steroid TREATMENT
what would you see Kawasaki disease?
- a higher fever, conjunctival and oral lesions.
- self limiting.
