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CLS > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

What is arteriolosclerosis

A

Thickening and hardening of wall of arteriole

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2
Q

What’s is arteriopath

A

Widespread disease of arteries

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3
Q

What are the three steps in hypertensive arteriosclerosis

A

1) hypertrophy of media
2) fibroelastic thickening of intima
3) elastic lamina replication

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4
Q

What are the stages in hypertensive arteriolosclerosis

A

Replacement of wall structures by amorphous hyaline material
Basement membrane how material = no smooth muscle
Perfusion failure and loss of function.

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5
Q

What are the consequences of hypertension

A

Reduction in vessel lumen
Reduced blood flow
Ischaemia
Increased rigidity ( loss of elasticity and contractility)
Unresponsive to normal vessel control agents ( vasodilators)

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6
Q

Where does atheroma not occur

A

Heart circ

Venous circ

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7
Q

What’ is atheroma initially a disease of

A

Tunica intima

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8
Q

What are the general four stages in development of an atheroma

A

Fatty stream
Lipid plaque
Fibrolipid plaque
Complicated atheroma

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9
Q

Explain a fatty streak

A

Smooth endothelial surface is damaged
LDLs enter intima through damaged area
Lipids are phagocytosed by macrophages

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10
Q

What is a the lipid plaque

A

Lipid released but macrophages
Macrophages secrete cytokines stimulating myofibroblasts to secret collagen
Early damage to elastic lamina and media

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11
Q

What is a fibrosis is plaque

A

Collagen covers lipid plaque
Media thins with replacement of muscle with collagen
Vessels susceptible to stretch

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12
Q

What is complicated atheroma

A

Lipids in intima become calcified and surfaces of fibrolipid plaque ulcerates exposing collagen with fibrin causes thrombosis
Activated coagulation cascade

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13
Q

What are the complications of atheroma

A

Expansion of intima - reduction in size of lumen = decreased blood flow and ischaemia
Ulceration of atheromatous intima- predisposition to thrombus formation and vessel occlusion
Plaque fissure- formation and haemorrhage
Aneurysm- thinning and stretching due to decreased muscle and elastic fibres

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14
Q

What does atheroma cause in coronary arteries

A

Angina

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15
Q

What does atheroma cause in leg arteries

A

Intermittent claudication (limp)

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16
Q

What does atheroma cause in mesenteric arteries

A

Ischaemic colitis (irritation and swelling)

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17
Q

What does atheroma cause in cerebral and vertebral arteries

A

TIA

or stroke

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18
Q

What is an aneurysm

A

Abnormal permanent focal dilation of an artery

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19
Q

What is aneurysm due to

A

Atrophy of media, muscle and elastic fibres replaced by collagen, collagen not capable of recoil, with each systolic pulse wall of artery stretches and thins

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20
Q

What types of aneurysms are there

A 
Syphilitic- arch of aorta 
Developmental- cerebral vessels 
Dissecting- thoracic aorta 
Mycotic- endocarditis 
Bacterial septicaemia 
Infection of arterial wall
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21
Q

What are lifestyle risk factors for atheroma

A 
Smoking 
Physical inactivity
Obesity
Unhealthy high salt diet
Excess alcohol
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22
Q

What treatable non- lifestyle risk factors are there for atheroma

A 
Hypertension
High cholesteroleamia 
High lipideamia 
Diabetes
Kidney dysfunction
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23
Q

What fixed risk factors are there for atheroma

A 
Family history 
Make 
Male baldness
Early menopause
Age 
Ethnicity (India pakinstan Bangladesh and Sri Lanka)
24
Q

What is thrombosis

A

Normal mechanism to prevent bleeding when a vessel wall is breached, solid mass d blood constituents ( fibrin and platelets) which have aggregated together in flowing blood in the lumen of a blood vessel

25
Q

What is atheroma

A

Arteriosclerosis of large and medium arteries characterised by hardening of arteries

26
Q

What is thrombosis limited by

A

Fibrinolysis

27
Q

What happens in normal thrombosis

A

Vessel wall breached (damage/stasis/ change in blood)
Circulating platelet aggregates
Platelets release factors which trigger coagulation cascade
Fibrinogen converted to insoluble fibrin
Bind together platelets and entrapped red blood cells

28
Q

Describe normal fibrinolysis

A

Plasma contains inactive proenzyme plasminogen, activated by tissue plasminogen activators secreted by endothelial cells -> plasmin
Fragments fibrin to form fibrin degradation products

29
Q

What factors convert plasminogen to plasmin

A

Xla xlla
Tissue plasminogen activator
Urokinase

30
Q

When is a thrombus pathological

A

When it enlarges beyond vessel healing requirements and continues to grow
Beyond a certain size and rate of development intrinsic fibrinolytic system is incapable of controlling size, is fibrinolysis fails thrombus grows by accretion

31
Q

What initiates the intrinsic coagulation cascade

A

Vitamin k

32
Q

What is involved in the extrinsic pathway

A

7a converts 10 to 10a

33
Q

What predisposes to pathological thrombosis

A

Damage to vessel wall
Stasis
Change in blood character eg platelet increase, increases RBC, increased viscosity

34
Q

What is most important for pathogical thrombosis in
A) heart ventricles
B) heart atrium
C) valves

A

A) chamber wall damage
B) stasis
C) valve surface damage

35
Q

What are the possible outcomes for a thrombus

A 
Lydia
Occulsion
Organisation as recanalisation
Propagation
Detach and travel in circ
36
Q

What is recanalisation

A

Growth of new vessels into thrombus
development of vascular granulation tissue
Fibroblasts invade and deposit collagen
Fibrovascular granulation tissue develops

37
Q

What are the consequences of a thrombosis embolism in an artery/left side of heart

A 
Travels to 
Brain- stroke 
Leg- gangrene 
Mesenteric- bowel necrosis
Renal- kidney infarct
Splenic- spleen infarct
38
Q

What are the consequences of a venous thrombo embolism

A

Pulmonary artery branch- small= peripheral lung infarct

Large= sudden death

39
Q

What are 11 risk factors for VTE

A 
Active cancer treatment 
Over 60
Dehydration
Known thrombophilias
Obesity 
Medical comorbidity 
Family history 
Hormone replacement therapy 
Oestrogen containing contraceptive therapy 
Varicose veins 
Pregnancy or
40
Q

What are physical causes of a VTE

A 
Thrombus 
Malignant tumour
Fat and marrow 
Air
Nitrogen 
Amniotic fluid
41
Q

What does infarction mean

A

Term used to describe death of tissue due to lack of oxygen following abrupt cessation of the arterial supply or venous drainage

42
Q

What are the cause of occulsion

A

Atheroma
Atheroma plus thrombosis
Atheroma with plaque fissure
By embolus

43
Q

What are the outcomes of infraction

A

Sudden death
Death sure to complications during infarct healing
Survival with infarct replaced by granulation tissue- scar

44
Q 
In an arterial infarct what happens after
0-12 hrs
12-24
24-72
3-14 days
14-21 days
21-51 days
A 
Invisible early cell death
Necrotic muscle fibres- eosinophilic
Acute inflammatory reaction 
Macrophagic removal of debris and vascular granulation tissue formation 
Fibrous granulation tissue
Scar formation and cicatrisation
45
Q

What is haemopericardium

A

Rupture of myocardium following an arterial infarct

Leads to acute valve failure

46
Q

Give two examples of venous infarcts

A

Bowel (Volvulus or hernial strangulation) and testis (torsion)

47
Q

What is the sequence of events after venous obstruction

A

Tissues venules Capps become engorged with blood
Pressure in venules and Capps increased so that they may rupture or cause hypoxia
Tissues become congested and necrotic

48
Q

Chest pain on exercise is called…

A

Stable angina

49
Q

Where’s is the most commend site of aortic aneurysm

A

Abdominal aorta just above bifurcation of iliac vessels

50
Q

What and where is an intimal tear

A

Dissecting aneurysm, tunica media filled with blood
Haemopericardium
Stays near arch
Renal arteries descending

51
Q

What is a common cause of a sub arachnoid haemorrhage

A

Berry aneurysm

52
Q

What types of stroke are there

A

Ischeamic
Heamorrhagic
Cortical necrosis

53
Q

What is the problem with reperfusion after a stroke

A

Red blood cells extravasate and tissue fluid from blood enters brain - swelling

54
Q

What is a predisposing factor for rupture of blood into lateral ventricles

A

Warfarin
Hypotension
Atherosclerosis

55
Q

What is an ECG with a big Q wave indicative of

A

Recent myocardial infarction

CLS (12 decks)

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