Vascular Disease Flashcards
What is vascular disease of the arteries?
atherosclerosis
What is vascular disease of the veins?
Phlebothrombosis
Thrombophlebitis
What can cause vascular disease in all vessels?
Vasculitis
Radiation damage
Tumours
What are the main age related vascular changes?
Fibrosis of intimacy and media
Accumulation of ground substance
Fragmentation of elastic lamellae
What is ground substance?
amorphous gel-like substance in the extracellular space that contains all components of the extracellular matrix except for fibrous materials such as collagen and elastin
What vessels does atherosclerosis affect?
large and medium sized muscular and elastic arteries
What are the characteristics of atherosclerosis?
lipid deposition
fibrosis
chronic inflammation
What are the main risk factors of atherosclerosis/vascular disease?
Unmodifiable: Age, Sex, Genetics
Modifiable: hypertension, hyperlipideamia, diabetes, smoking, obesity, sedentary lifestyle
What is the morphology of an atheromatous plaque?
Patchy and raised white to yellow
Core of lipid
Fibrous cap
What is peripheral vascular disease?
atheroma of distal aorta/iliac/femoral arteries
What does peripheral vascular disease cause?
ischaemia of the lower limbs
What are the effects of peripheral vascular disease?
Intermittent claudication (pain in calf while exercising)
Pain
Ulcers
Gangrene
What is an aneurysm?
Localised, permanent, abnormal dilation of a blood vessel or the heart
What are the main types of aneurysm?
Atherosclerotic Dissecting Berry Micro-aneurysms Syphilitic Mycotic
Where are atherosclerotic aneurysms usually found?
abdominal aorta distal to renal arteries
Who are atherosclerotic aneurysms more common in?
Men
What is the morphology of atherosclerotic aneurysms
Saccular or fusiform (more common)
15-25cm in length
Wall diameter exceeds 50%
Frequently contains mural thrombus
How are atherosclerotic aneurysms diagnosed?
ultrasound
What are the clinical features of atherosclerotic aneurysms
Thrombosis Embolism Rupture Obstruction of a branch vessel (ischaemic injury) Impingement on an adjacent structure
What is the presentation of atherosclerotic aneurysms
abdominal pulsating mass
Who are dissecting aortic aneurysms more likely in?
x3 more likely in men than women aged 40-60 with hypertension
Younger patients with systemic or localised abnormalities of CT
Morphology of dissecting aortic aneurysms
1-2cm from aortic valve
Dissection can extend along aorta in retrograde OR distally sometimes into iliac and femoral arteries
Clinical symptoms of dissecting aortic aneurysms
Sudden onset of excruciating chest pain
Begins the in anterior chest radiating to the back between the scapulae and moving downward as the dissection progresses; the pain can be confused with that of MI
What is the most common cause of death in dissecting aortic aneurysms
Rupture of the dissection outward into the pericardial, pleural or peritoneal cavities
Where are berry aneurysms found?
Circle of Willis in the brain
Who are berry aneurysms most likely to occur in?
Younger people
Often hypertensive
What are berry aneurysms associated with?
sub-arachnoid haemmorhage
What are capillary micro-aneurysms associated with?
hypertension
diabetes mellitus
intra-cerebral haemorrhage
What are capillary micro-aneurysms?
small aneurysms of branches of the middle vertebral artery
What do syphilitic aneurysms affect?
thoracic aorta
What occurs in mycotic aneurysms
Wall of artery weakened by infection
Bacteria or fungi
Often occur in the brain, secondary to embolism
What are varicose veins?
abnormally dilated, tortuous veins produced by prolonged, increased intralumninal pressure and loss of vessel wall support
Risk factors for varicose veins
Age, sex, heredity, posture, obesity
What does venous valve incompetence lead to?
stasis congestion oedema pain thrombosis
Where do varicose veins occur?
lower limbs in saphenous system oesophageal varicies haemorrhoids varicocele (bag that holds testicles) cosmetic problems
What are the signs of varicose veins?
aching in legs
stasis dermatisis
skin ulceration and bleeding§
What is vasculitis?
inflammation and necrosis of blood vessels
What is the pathogenesis of vasculitis?
Cell immune-mediated inflammation Deposition of immune complexes Direct attack by circulating antibodies Direct invasion of vascular walls by infectious pathogens Often part of multi system disease
who is at risk of giant-cell (temporal) arteritis?
Older than 50
Average age of onset is 80
More common in women than men
What is giant-cell (temporal) arteritis?
Granulomatous inflammation of large to small sized arteries (temporal, vertebral and ophthalmic)
What is takayasu arteritis?
Granulomatous vasculitis of medium and large arteries of upper limb (and arch of the aorta)
Who is takayasu arteritis common in?
Women under 30
Where does polyarteritis nodosa (PAN) occur?
medium small size muscular arteries of the kidneys, heart, liver and GIT
What is polyarteritis nodosa (PAN)?
Fibroid necrosis which could be fatal without steroid treatment
What are the symptoms of Kawasaki disease?
High fever
conjunctival and oral lesions
Who do Kawasaki disease occur in?
Children under 4
What are the symptoms of takaysau arteritis
Dizziness Visual disturbances Dyspnoea intermittent claudication of the upper limbs Asymmetric BP
What is the treatment of takaysau arteritis?
steroid treatment?
What are the 3 main types of benign vascular tumour?
- Angioma
- Haemangioma
- Lymphangioma
What are the main types of haemangioma
Juvenile (strawberry) - skin
Capillary (ruby spots) - skin, spleen, kidneys
Cavernous (port wine stains) - skin, spleen, liver, pancreas
What are the types of lymphangioma
Capillary
Cavernous
What are the types of malignant vascular tumour?
Angiosarcoma
Antiproliferative tumour derived from endothelial cells
What type of sarcoma is associated with AIDS/HIV
Kaposi’s sarcoma
Where can an angiosarcoma be found?
Skin Soft tissue Breast Bone Liver Spleen
