Vascular Disease Flashcards
Why is it that blood vessel walls may become thicker as age increases?
Fibrotic tissue build up leading to higher chance of atherosclerosis
List some complications of atherosclerosis.
Aortic aneurysms Peripheral vascular disease with intermittent claudication Myocardial infarction Carotid atheroma Cerebral infarction
What is the most common type of aneurysm?
Abdominal aortic (normally distal to renal arteries)
What part of the aorta does a syphilitic aneurysm affect?
Thoracic aorta
What is a mycotic aorta?
Bacteria or fungi related, infection weakens the artery wall, often site of infection is the brain, secondary to embolism
What can result from varicose veins?
Stasis Congestion Oedema Pain Thrombosis Haemorrhoids
What is vasculitis?
Inflammation and necrosis of blood vessels
Name the 4 most common types of vasculitis.
Giant-cell (temporal) arteritis (>50) Takayasu arteritis (pulseless disease) (women
Fibrosis of intimate and media, accumulation of ground substance and fragmentation of elastic lamellae are all ……. related vascular changes.
Age
What is the difference between atheroma and atherosclerosis?
There is no difference
What type of vessel does atherosclerosis target?
Medium to large elastic and muscular ARTERIES
What three factors characterise atherosclerosis?
Lipid deposition
Fibrosis
Chronic inflammation
List some risk factors of atherosclerosis.
Age Sex Hypertension Hyperlipidaemia (esp. LDL) Diabetes Smoking Obesity Sedentary lifestyle Low socio-economic status Low birth weight
What does an atheromatous plaque consist of?
Necrotic centre containing core of lipid
Fibrous cap
Raised 0.3 - 1.5cm into artery
What are some of the effects of peripheral vascular disease?
Intermittent claudication Pain Ulcers Gangrene Ischaemia of lower limbs Atheroma of: - distal aorta - femoral arteries - iliac arteries
What are the 6 types of aneurysm?
Atherosclerotic Dissecting Berry Capillary micro-aneurysm Syphilitic Mycotic
Which type of person is most likely to develop an atherosclerotic aneurysm?
Over 50 year old male who is a smoker
What are the general characteristics of an atherosclerotic aneurysm?
Saccular (sac like) or fusiform (spindle like)
15 - 25cm in length
Wall diameter > 50%
Frequently contains mural thrombus (in artery walls)
What are some clinical consequences of an atherosclerotic aneurysm?
Thrombosis Embolism Rupture Obstruction of a branch vessel Impingement on adjacent structure
Which type of person is most likely to develop an dissecting aneurysm?
40 - 60 year old male with hypertension
OR
Younger patients with systemic or localised abnormalities of connective tissue
Where does the initial intimal tear usually originate in a dissecting aneurysm?
1 - 2cm from the aortic valve
What the main clinical symptom of dissecting aneurysm?
Sudden onset of excruciating pain
Where does pain associated with dissecting aneurysm originate and where does it spread to?
Begins in the anterior chest, radiates to the back, between the scapulae and moves inferiorly as dissection progresses
What is the pain from dissecting aneurysm commonly confused with?
That of MI
What is the most common cause of death relating to dissecting aneurysm?
Rupture of the dissection outwards into the PERICARDIAL, PERITONEAL or PLEURAL cavities
Where do berry aneurysms occur?
Circle of Willis (anastomosis that supplies blood to the brain and surrounding structures)
What age group are most frequently affected by berry aneurysms?
Young people
What type of haemorrhage are berry aneurysms commonly associated with?
Sub-arachnoid haemorrhage
What two conditions are capillary micro-aneurysms associated with?
Hypertension
Diabetes mellitus
In the branches of which artery do capillary micro-aneurysms occur?
Middle cerebral artery
What type of haemorrhage are capillary micro-aneurysms commonly associated with?
Intra-cerebral haemorrhage
Which vessel is usually affected by syphilitic aneurysms?
Thoracic aorta
What is a mycotic aneurysm normally secondary to and where does it commonly form?
Secondary to embolism
Forms in the brain
How does a mycotic aneurysm form?
Wall of artery weakened by infection, allowing infiltration of bacteria and/or fungi
Define varicose veins and state how they are produced.
Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support
What are the 5 risk factors associated with varicose veins?
Age Sex Heredity Posture Obesity
Where do varicose veins commonly arise?
Saphenous system in the lower limbs
Oesophageal varices
Haemorrhoids (anus)
Varicocele (spermatic cord)
What problems are caused by varicose veins?
Cosmetic problems
Aching in legs
Stasis dermatitis (skin inflammation)
Skin ulceration and bleeding
What is vasculitis?
Inflammation and necrosis of blood vessels
What type of inflammation causes vasculitis?
Immune mediated
List 3 other pathogenesis factors of vasculitis.
Deposition of immune complexes
Direct attack by circulating antibodies
Direct invasion of vascular walls by infectious pathogens
Name the 4 main types of vasculitis.
Giant cell (temporal) arteritis Takayasu arteritis (pulseless disease) Polyarteritis nodosa (PAN) Kawasaki disease
What is arteritis?
Inflammation of artery walls
What type of person is most likely to develop temporal/giant cell arteritis?
Over 50, ideally 70 year old female
Which arteries are affected in temporal arteritis?
Large to small sized arteries - temporal, vertebral and ophthalmic
What type of person is most likely to develop Takayasu arteritis?
Under 30 years of age female
Which arteries are affected in Takayasu arteritis?
Medium to large sized arteries - those of the upper limb and the arch of aorta
Which arteries are affected in PAN?
Medium to small size muscular arteries of the kidneys, heart, liver and gastrointestinal tract
Fibrinoid necrosis is potentially fatal without the correct treatment. What must be administered to reduce the risk of mortality?
Steroids
What symptoms and signs are typical of Kawasaki disease?
High fever
Conjunctival and oral lesions
Which age group is Kawasaki disease most prevalent in?
Children < aged 4
What is the treatment for Takayasu arteritis?
Steroids
What are the two names given to benign vascular tumours?
Angioma
Haemangioma
What are the 4 best know benign vascular tumours and which region of the vasculature does each affect?
Capillary (ruby spots):
skin, spleen, kidneys
Juvenile (strawberry):
skin
Cavernous (port wine stains):
skin, spleen, liver, pancreas
(known as a lymphangioma)
Capillary and Cavernous
What is a malignant vascular tumour known as?
Angiosarcoma
What is Kaposi’s sarcoma associated with?
HIV/AIDS (derived from endothelial cells)
Which regions of the vasculature is it possible for an angiosarcoma to arise?
Skin Soft tissue Breast Bone Liver Spleen
