Vascular Disease Flashcards
How may we classify vascular disease ? Give examples of such a classification.
By the type of vessel they affect.
ARTERIES
-Arteriosclerosis=
When arteries “become thick and stiff — sometimes restricting blood flow to your organs and tissues”. Atherosclerosis is a specific type of arteriosclerosis, involving build up of fatty substances.
VEINS
-Thrombosis=
Could be phlebothrombosis, i.e. thrombosis in a vein forms independently from the presence of inflammation of the vein or Thrombophlebitis i.e. vein inflammation related to a thrombus
-Formation of varicosities (swollen, distended, and knotted veins, usually in the subcutaneous tissues of a LL)
ALL VESSELS
- Vasculitis (inflammation)
- Radiation damage
- Tumours
Describe age-related vascular changes. Are these normal ?
- Fibrosis of intima and media
- Accumulation of ground substance
- Fragmentation of elastic lamellae
Yes, these are normal with increasing age.
Which kinds of vessels does atherosclerosis affect ? Identify its main characteristics.
Large and medium-sized elastic and muscular arteries
Lipid deposition, fibrosis and chronic inflammation
What is another name of atherosclerosis ?
Atheroma
Identify the main risk factors for atherosclerosis.
- Age
- Sex
- Hypertension
- Hyperlipidaemia (particularlyLDL)
- Diabetes
- Smoking
- Obesity
- Sedentary lifestyle
- Low socio-economic status
- Low birth-weight
Describe the morphology of atherosclerosis.
- Atheromatous (fibro-fatty, fibro-lipid) plaque • Patchy and raised white to yellow 0.3-1.5cm
- Core of lipid
- Fibrous cap (smooth muscle cells, macrophages, foam cells, lymphocytes)
- Necrotic center (cell debris, foam cell, cholesterol crystals)
Identify complications of Atherosclerosis.
- MI, cardiac failure
- Cerebral infarction
- Emboli causing transient ischaemic attacks or cerebral infarcts (due to the carotid atheroma)
- Aortic aneurysm (rupture would cause immediate death)
- Peripheral vascular disease with intermittent claudication
- Gangrene
Define peripheral vascular disease.
Atheroma of distal aorta/iliac/femoral arteries, usually causing ischaemia of lower limbs
What are the possible effects of peripheral vascular disease ?
- Intermittent claudication (pain in the leg that a person experiences when walking or exercising. The pain is intermittent and goes away when the person rests)
- Pain
- Ulcers
- Gangrene
Define aneurysm.
Localised, permanent, abnormal dilatation of blood vessel or the heart
Identify the main types of aneurysms.
- Atherosclerotic
- Dissecting aortic
- Berry
- Micro-aneurysms
- Syphilitic
- Mycotic
Where do atherosclerotic aneurysms usually occur ?
Usually abdominal aorta, distal to renal arteries
Describe the demographic distribution of atherosclerotic aneurysms (any over-affected groups ?).
Women
Describe the morphology of atherosclerotic aneurysms.
- saccular (resembling a sac) or fusiform (spindle-shaped)
- 15 to 25 cm in length
- Wall diameter > 50% of normal diameter
- frequently contains mural thrombus
Identify the main clinical consequences of atherosclerotic aneurysms.
- Thrombosis
- Embolism
- Rupture
- Obstruction of a branch vessel (ischemic injury)
- Impingement on an adjacent structure
How do atherosclerotic aneurysms present ?
Presents as an abdominal pulsating mass
To what extent is an atherosclerotic aneurysm repairable.
It can be repaired
Describe the demographic distribution of dissecting aortic aneurysms (any over-affected groups ?).
- Men x3 more than women
- Men 40 to 60 with hypertension
- Younger patients with systemic or localized abnormalities of connective tissue
Describe the morphology of a dissecting aortic aneurysm.
- usually initiates in tunica intima, 1-2 cm from aortic valve (blood accumulates between intima and media)
- dissection can extend
1) along the aorta retrograde toward the heart or
2) distally, sometimes into the iliac and femoral arteries
Identify a possible complication of dissecting aortic aneurysms.
Dissection travels upwards around pericardium, causing accumulation of
blood around pericardial sac (cardiac tamponade, can be fatal)
Identify the clinical symptoms of a dissecting aortic aneurysm.
The sudden onset of excruciating pain:
-beginning in the anterior chest, radiating to the back, between the scapulae, and moving downward as the dissection progresses (the pain can be confused with that of myocardial infarction)
What are the most common causes of death associated with dissecting aortic aneurysms ?
Rupture of the dissection outward into the pericardial, pleural, or peritoneal cavities
Where do berry aneurysms usually occur ?
Circle of Willis
Describe the demographic distribution of Berry aneurysms (any over-affected groups ?).
Young people
Often hypertensive
What is an event which is associated with Berry aneurysms.
Associated with Subarachnoid haemorrhage (if they rupture)
Where do capillary micro-aneurysms usually occur ?
Branches of middle cerebral artery
Describe the demographic distribution of capillary micro-aneurysms (any over-affected groups ?).
Patients with hypertension or diabetes mellitus
What is an event which is associated with capillary micro-aneurysms.
Associated with intra-cerebral haemorrhage
Where do syphilitic aneurysms usually occur ? Why do they occur ?
Usually affects thoracic aorta
Occur resulting from tertiary syphilitic aortitis
What are the main characteristics of Mycotic aneurysms ?
- Wall of artery weakened by infection (due to bacteria or fungi)
- Often in brain, secondary to embolism
Define varicose veins.
- Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support.
- Venous valves become incompetent and leads to stasis, congestion, oedema, pain, and thrombosis
What are risk factors for varicose veins ?
Age, sex, heredity, posture, obesity
Where do varicose veins most often occur ? Where else may they occur ?
- Usually, in lower limbs (saphenous system)
- Oesophageal
- Haemorrhoids (in or around rectum)
- Varicocele (scrotal swelling)
What are clinical issues associated with varicose veins ?
- Cosmetic problems
- Aching in legs
- Stasis dermatitis
- Skin ulceration and bleeding
Define vasculitis.
Inflammation and necrosis of blood vessels
Explain the pathogenesis of vasculitis.
•Cell immune-mediated inflammation → Deposition of immune complexes → Direct attack by circulating antibodies (against own vessels)
OR Direct invasion of vascular walls by infectious pathogens
True or False: Vasculitis is often part of multi-system disease.
True
List the main types of vasculitis.
1) Giant-cell (temporal) arteritis
2) Takayasu arteritis (pulseless disease)
3) Polyarteritis nodosa (PAN)
4) Kawasaki disease (children < age 4)
Describe the demographic distribution of giant-cell (temporal) arteritis.
> age 50 (average onset age 70)
Women > men
Explain the main features of giant-cell temporal arteritis.
- granulomatous inflammation of large to small-sized arteries (temporal, vertebral and ophthalmic)
- Cord like nodular thickening
Describe the demographic distribution of Takayasu arteritis (pulseless disease).
Particularly women aged <30
Explain the main features of Takayasu arteritis (pulseless disease).
Granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta)
Explain the main features of Polyarteritis nodosa (PAN).
- Medium small size muscular arteries of the kidneys, heart, liver, and gastrointestinal tract are involved
- Fibrinoid necrosis could be fatal without steroid treatment
Describe the demographic distribution of Kawasaki disease.
Children < age 4
Explain the main features of Kawasaki disease.
High fever, conjunctival and oral lesions. Self-limited
What is the general duration of giant-cell temporal arteritis.
6-12 months
To what extent is giant-cell temporal arteritis self-limited ?
Could be self-limited
What are the main symptoms of giant-cell temporal arteritis ?
- Patchy lesion
- Throbbing temporal pain
- Malaise
- Fever
What are the main symptoms of Takayasu arteritis ?
- Dizziness
- Visual disturbances
- Dyspnoea
- Intermittent claudication upper limbs
- Asymmetric BP
How is Takayasu arteritis treated ?
Steroid treatment
What is the term for benign vascular tumour ?
Angioma
What is the term for malignant vascular tumour ?
Angiosarcoma
Identify the main types of angiomas, and state where each is usually found.
1) Haemangioma (proliferation of blood vessels)
- Juvenile (=stawberry), often happens on the skin (disappears by itself)
- Capillary (=ruby spots), can be in skin, spleen, kidneys
- Cavernous (=port wine stains), can be on skin, spleen, liver, pancreas
2) Lymphangioma (proliferation of lymphatics)
- Capillary
- Cavernous
Identify the main types of angiosarcomas, and state where each is usually found.
In general Angiosarcoma seen in skin, soft tissue, breast, bone, liver and spleen
-E.g. Kaposi’s sarcoma specifically, in skin and mucosal surfaces
What is so special about Kaposi’s sarcoma ?
It is associated with HIV/AIDS.
