Vascular Disease Flashcards
Arteriosclerosis
Hardening of the arteries
Response to injury: chronic inflammatory response to endothelial injury
Atheroma
Basic pathologic finding in a vessel with atherosclerosis
Fibrous cap: smooth muscle cells, macrophages, foam cells, lymphocytes, collage, elastin
Necrotic center: cell debris, cholesterol crystals, foam cells, calcium
Plaque rupture
Exposes platelet to basement membrane/necrotic components of cap, leads to development of thrombus
Monckeberg’s Medial Calcific Sclerosis
Calcific deposits in media of medium sized muscular arteries
Non-obstructive
No impact on patient’s well-being
Hypertension induced arteriosclerosis
Hyaline arteriosclerosis: arterioles, hemodynamic stress, plasma protein leakage into blood vessel.
See this in brain and kidneys, subtle ischemic changes over time
Hyperplastic arteriosclerosis: severe acute blood pressure elevation, onion skin concentric thickening (smooth muscle cells with thickened/reduplicated membranes), lumenal narrowing
Brain and kidneys are hit pretty hard
Aneurysm
Localized abnormal dilatation of blood vessel
False aneurysm
Injury to the wall of blood vessel and blood from the lumen is being caught by the adventitia, not full wall dilation
Looks like a hematoma on the vessel
Aneurysm pathogenesis
Poor intrinsic quality of connective tissue (Marfan’s, Ehler’s Danlo)
Weakened vascular wall through loss of SMC or inappropriate synthesis of ECM (ischemia, atherosclerosis, HTN, syphilis)
Altered balance of collagen degradation and synthesis (local inflammatory infiltrates, destructive proteolytic enzymes)
Cystic Medial Degeneration
Elastin fragmentation
Loss of smooth muscle cells leading to areas resembling “cystic” spaces
Can lead to aneurysms because wall is weak
AAA Pathogenesis
End result of multifactorial process leading to destruction of aortic wall connective tissue
Matrix metalloproteinasis play a key role
Smoking can upregulate function of matrix metalloproteinasis
Atherosclerosis (compresses media, compromised nutrient/waste diffusion)
Aortic Dissection
Blood splays apart laminar planes of media to form blood filled channel within the aortic wall
Aortic Dissection pathogenesis
HTN (pressure related mechanical or ischemic injury)
Connective tissue disorders
Bicuspid aortic valves
Aortic Dissection
Debakey I
Ascending and descending
Aortic Dissection
Debakey II
Ascending aorta
Need to be operated on immediately
Aortic Dissection
Debakey III
Descending aorta
