Vascular Disease

Question 1

What are the three general forms of arteriosclerosis?

Answer 1

• Atherosclerosis
• Monckeberg’s Medial Calcific Sclerosis
• HTN-induced arteriosclerosis

Question 2

Atherosclerosis predominantly involves which arteries?

Answer 2

Elastic arteries (aorta, carotids, iliacs)
Muscular arteries (popliteal, coronary, renal, mesenteric)

Question 3

Modifiable Causes of Atherosclerosis

Answer 3

Hypertension
Hyperlipidemia
Cigarette Smoking
Diabetes
Inflammation

Question 4

Non-Modifiable Causes of Atherosclerosis

Answer 4

Age
Male Gender
Family History
Genetics

Question 5

Atherosclerosis is a chronic inflammatory response of the arterial wall to…

Answer 5

Endothelial injury

Question 6

Describe the basic structure of an atheroma

Answer 6

Fibrous cap and a necrotic core formed int the intima between the IEL and the endothelium

Question 7

What is the fibrous cap of an atheroma composed of?

Answer 7

Collagen, smooth muscle, foam cells, proteoglycans, elastin, ECM

Question 8

What is the necrotic core of an atheroma composed of?

Answer 8

Cell debris, cholesterol (LDL), macrophages (foam cells), calcium deposition

Question 9

What are some complications of atheromatous plaques?

Answer 9

Rupture/ulceration/erosion
Emboli
Hemorrhage
Weakened media leading to aneurysm
Calcification
Lumen occlusion
Thrombosus

Question 10

What is Monckeberg’s Medial Calcific Sclerosis

Answer 10

Calcium deposition in the media, leading to hardening of the artery. Typically occurs in medium sized arteries

Question 11

Does Monckeberg’s Medial Calcific Sclerosis cause any pathology?

Answer 11

No obstruction of the lumen

Question 12

List the two types of HTN-induced arteriosclerosis

Answer 12

Hyaline arteriosclerosis

Hyperplastic arteriosclerosis

Question 13

Hyaline Arteriosclerosis

What causes it? What happens? How does it appear on histology?

Answer 13

Longstanding HTN causing hemodynamic stress on the blood vessels. Allows plasma proteins to leak into the blood vessel walls. Give the vessels a PINK appearance. Can lead to narrowing of the lumen, which could cause ischemic injuries over time

Question 14

Hyperplastic Arteriosclerosis

What causes it? What is the response? What is the appearance on histology?

Answer 14

Caused by severe acute blood pressure elevations, leading to endothelial injury.
Smooth muscle responds by duplicating and replicating, leading to luminal narrowing. Onion skin appearance on histology.

Question 15

List some reasons for the formation of aneurysms

Answer 15

Atherosclerosis - weakening of the wall and less smooth muscle can lead to wall dilatation

Genetic abnormalities (Marfan’s syndrome - defective fibrillin; Ehlers Danlos Syndrome - defective type III collagen)

Altered balance of collagen deposition and synthesis (inflammation)

Trauma

Question 16

What is Cystic Medial Degeneration?

Answer 16

Degeneration of elastin, leading to areas devoid of smooth muscle and elastin

Question 17

What is the major cause of AAAs?

Answer 17

Atherosclerosis

Compression of the media leads to degeneration and necrosis, weakening the vessel wall and leading to an aneurysm

Question 18

Where are AAAs located?

Answer 18

Infrarenal

Above aortic bifurcation

Question 19

What are the classic clinical findings of AAA? Who is likely to get it?

Answer 19

Male smokers over the age of 50

Pulsatile abdominal mass

Question 20

Complications of AAA

Answer 20

Compression of other structures
Obstruction
Embolism
Rupture (think about treatment to avoid rupture when it grows above 5 cm)

Question 21

Which STD could cause vascular disease later in life?

Answer 21

Syphilis.
In tertiary syphilis, the vaso vasorum is injured and the aortic wall becomes ischemic. Has a tree bark appearance and may dilate due to weakening of the wall

Question 22

Aortic Dissection

Describe the main 3 classifications

Answer 22

DeBakey I - involving proximal and distal aorta
DeBakey II - involving proximal aorta only
DeBakey III - involving distal aorta only

Question 23

What is the biggest risk factor for aortic dissection?

Answer 23

HTN
Causes narrowing of the lumen of the vaso vasorum and degenerative changes of the media. We don’t know exactly what causes the intimal tear leading to aortic dissection.
Connective tissue disorders and bicuspid aortic valves are also commonly associated with dissection.

Question 24

What does aortic dissection commonly present as?

Answer 24

Stabbing pain in the chest

Radiates to the back

Question 25

Treatment of Aortic Dissections

Answer 25

Requires surgery if dissection involves the proximal aorta. If DeBakey III, then need to control HTN to prevent further endothelial injury