Vascular Disease Flashcards
What structures are affected by vascular disease?
- arteries: causing
- arteriosclerosis
- atherosclerosis
- veins: causing thrombosis and formation of varicosities
- all vessels:
- vasculitis
- radiation damage
- tumours
What happens to the vascular system as you get older?
- intima and media fibrose
- ground substance accumulates loosening arteries and making them bigger
- fragmentation of elastic lamellae (less elastic)
What characterises atherosclerosis?
- lipid deposition
- fibrosis
- chronic inflammation
What are the components of atherosclerosis?
- central nephrotic core
- lipid core
- fibrous cap on the surface
What are the risk factors for atherosclerosis?
- age: older
- sex: men > women
- hypertension
- hyperlipidaemia: in paricular LDL
- diabetes: more type 1
- smoking
- obesity
- non-active lifestyle
- low socio-economic status
- low birth weight
What are the possible complications of atherosclerosis?
- cerebral infarction which can cause stroke
- carotid atheroma can cause TIA/ cerebral infarct
- aortic aneurysms
- MI
- peripheral vascular disease
- gangrene
What is peripheral vascular disease?
- atheroma of distal aorta/iliac/femoral arteries
- causes ischaemia of lower limbs
What are the effects of peripheral vascular disease?
- intermittent claudication
- pain
- ulcers
- gangrene
What are aneurysms?
localised, permanent, abnormal dilatation of a blood vessel or the heart
What are true aneurysms?
- when it affects and occurs in the walls of the vessel
- saccular: bulging on one side
- fusiform: bulging on both sides
What are false aneurysms?
not affecting the entire wall, possible rupture in endothelia and blood clot buldging out towards adventitia
What vessel is most commonly affected by atherosclerotic aneurysms?
abdominal aorta distal to renal arteries
What is the morphology of atherosclerotic aneuryms?
- saccular/fusiform
- 15-25cm length
- wall diameter >50%
- commonly has mural thrombus contained
What are the clinical consequences of atherosclerotic aneurysms?
- thrombosis
- embolism
- rupture
- obstruction of a branch vessel resulting in ischemic injury
- impingement on adjacent structure
How do atherosclerotic aneurysms present themselves?
abdominal pulsating mass
What are risk factors specific to dissecting aortic aneurysms?
- men 40-60 with hypertension
- younger patients with systemic/localised abnormalities in connective tissue
What are risk factors specific to atherosclerotic aneurysms?
- men more than women
- smokers over 50
What is the morphology of dissecting aortic aneurysms?
- initiated with intimal tear and blood escaping from lumen into intimal layer
- most common in thoracic aorta and can spread upwards towards heart or downwards towards iliac/femoral arteries
What are the clinical symptoms of dissecting aortic aneurysms?
- sudden onset of excruciating pain
- begins anterior chest, radiates to back between scapulae, moving downward as dissection progresses
How do dissecting aortic aneurysms cause death?
rupture of dissection outward into pericardial, pleural or peritoneal cavities
What are berry aneurysms?
aneurysms in the circle of Willis
What do rupture of berry aneurysms cause?
sub-arachnoid haemorrhage
What are the risk factors specific to berry aneurysms?
- young people
- hypertensive
What are the risk factors specific to capillary micro-aneurysms?
- hypertension
- diabetes mellitus
