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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
What is atheroma
Arteriosclerosis of large and medium arteries characterised by hardening of arteries
26
What is thrombosis limited by
Fibrinolysis
27
What happens in normal thrombosis
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
Describe normal fibrinolysis
Plasma contains inactive proenzyme plasminogen, activated by tissue plasminogen activators secreted by endothelial cells -> plasmin Fragments fibrin to form fibrin degradation products
29
What factors convert plasminogen to plasmin
Xla xlla Tissue plasminogen activator Urokinase
30
When is a thrombus pathological
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
What initiates the intrinsic coagulation cascade
Vitamin k
32
What is involved in the extrinsic pathway
7a converts 10 to 10a
33
What predisposes to pathological thrombosis
Damage to vessel wall Stasis Change in blood character eg platelet increase, increases RBC, increased viscosity
34
What is most important for pathogical thrombosis in A) heart ventricles B) heart atrium C) valves
A) chamber wall damage B) stasis C) valve surface damage
35
What are the possible outcomes for a thrombus
``` Lydia Occulsion Organisation as recanalisation Propagation Detach and travel in circ ```
36
What is recanalisation
Growth of new vessels into thrombus development of vascular granulation tissue Fibroblasts invade and deposit collagen Fibrovascular granulation tissue develops
37
What are the consequences of a thrombosis embolism in an artery/left side of heart
``` Travels to Brain- stroke Leg- gangrene Mesenteric- bowel necrosis Renal- kidney infarct Splenic- spleen infarct ```
38
What are the consequences of a venous thrombo embolism
Pulmonary artery branch- small= peripheral lung infarct | Large= sudden death
39
What are 11 risk factors for VTE
``` 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
What are physical causes of a VTE
``` Thrombus Malignant tumour Fat and marrow Air Nitrogen Amniotic fluid ```
41
What does infarction mean
Term used to describe death of tissue due to lack of oxygen following abrupt cessation of the arterial supply or venous drainage
42
What are the cause of occulsion
Atheroma Atheroma plus thrombosis Atheroma with plaque fissure By embolus
43
What are the outcomes of infraction
Sudden death Death sure to complications during infarct healing Survival with infarct replaced by granulation tissue- scar
44
``` In an arterial infarct what happens after 0-12 hrs 12-24 24-72 3-14 days 14-21 days 21-51 days ```
``` 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
What is haemopericardium
Rupture of myocardium following an arterial infarct | Leads to acute valve failure
46
Give two examples of venous infarcts
Bowel (Volvulus or hernial strangulation) and testis (torsion)
47
What is the sequence of events after venous obstruction
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
Chest pain on exercise is called...
Stable angina
49
Where's is the most commend site of aortic aneurysm
Abdominal aorta just above bifurcation of iliac vessels
50
What and where is an intimal tear
Dissecting aneurysm, tunica media filled with blood Haemopericardium Stays near arch Renal arteries descending
51
What is a common cause of a sub arachnoid haemorrhage
Berry aneurysm
52
What types of stroke are there
Ischeamic Heamorrhagic Cortical necrosis
53
What is the problem with reperfusion after a stroke
Red blood cells extravasate and tissue fluid from blood enters brain - swelling
54
What is a predisposing factor for rupture of blood into lateral ventricles
Warfarin Hypotension Atherosclerosis
55
What is an ECG with a big Q wave indicative of
Recent myocardial infarction

CLS (12 decks)

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