Vascular Disease Flashcards
Age-related Vascular Changes
Fibrosis of intima and media
Accumulation of ground substance
Fragmentation of elastic lamellae
Atherosclerosis
Also known as atheroma
Affects large and medium-sized elastic and muscular arteries
Characterised by lipid deposition, fibrosis and chronic inflammation
Risk Factors
Age Sex Hypertension Hyperlipidaemia(particularlyLDL) Diabetes Smoking Obesity Sedentarylifestyle Lowsocio-economicstatus Lowbirth-weight
Morphology
- Atheromatous (fibro-fatty, fibro-lipid) plaque •– Patchy and raised white to yellow 0.3-1.5cm
- – Core of lipid
Peripheral Vascular Disease
Atheroma of distal aorta/iliac/femoral arteries Causes ischaemia of lower limbs Effects Intermittent claudication Pain Ulcers Gangrene
Aneurysms
Localised, permanent, abnormal dilatation of •blood vessel or the heart Types: •– Atherosclerotic •– Dissecting •– Berry •– Micro-aneurysms •– Syphilitic •– Mycotic
Atherosclerotic aneurysms
Usually abdominal aorta, distal to renal arteries
Women 50%
frequently contains mural thrombus
Atherosclerotic aneurysms, the clinical consequences
Thrombosis Embolism Rupture Obstruction of a branch vessel ischemic injury Impingement on an adjacent structure Presentation as an abdominal pulsating mass Can be repaired
Dissecting Aortic Aneurysms
Men x3 more than women aged 40 to 60 with hypertension
Younger patients with systemic or localized abnormalities of connective tissue
Dissecting Aortic Aneurysms morphology
usually initiates with an intimal tear
1-2 cm from aortic valve
dissection can extend along the aorta retrograde toward the heart or
distally, sometimes into the iliac and femoral arteries
Dissecting Aortic Aneurysms - clinical symptoms
• 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.
• The most common cause of death is rupture of •the dissection outward into the pericardial,
•pleural, or peritoneal cavities.
Berry Aneurysms
Aneurysms of the circle of Willis Young people Often hypertensive Associated with sub-arachnoid haemorrhage
Capillary Micro-aneurysms
Associatedwith
• Hypertension
• Diabetes mellitus
Small aneurysms of branches of middle cerebral artery
Associated with intra-cerebral haemorrhage
Syphilitic
• Usually affects thoracic aorta
Mycotic
- Wall of artery weakened by infection
- Bacteria or fungi
- Often in brain, secondary to embolism
Varicose veins
Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support
Varicose veins - Risk factors
Age, sex, heredity, posture, obesity
after effects of varicose veins
- Venous valves incompetent and leads to stasis, congestion, oedema, pain, and thrombosis
- Lower limbs usually saphenous system
- Oesophageal varices
- Haemorrhoids
- Varicocele
Vasculitis
Inflammation and necrosis of blood vessels
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
Giant-cell (temporal) arteritis
• > age 50, average onset age 70, women > men
• granulomatous inflammation of large to small-sized arteries
(temporal, vertebral and ophthalmic)
• Cord like nodular thickening
Takayasu arteritis (pulseless disease)
granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta) women age <30
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
Kawasaki disease (children < age 4)
•High fever, conjunctival and oral lesions. Self-limited
Giant-cell (temporal) arteritis
- 6-12 months
- Could be self-limited
- Patchy lesion
- Throbbing temporal pain
- Malaise
- Fever
Takayasu arteritis
- Dizziness
- Visualdisturbances
- Dyspnoea
- Intermittent claudication upper limbs
- Asymmetric BP
- Steroidtreatment
Vascular Tumours
Benign Angioma Haemangioma Juvenile (strawberry) Skin Capillary (rubyspots) Skin, spleen, kidneys Cavernous (portwinestains) Skin, spleen, liver, pancreas Lymphangioma Capillary and Cavernous
Vascular Tumours
• Malignant
Angiosarcoma
• Skin, soft tissue, breast, bone, liver and spleen
• Kaposi’s sarcoma: associated with HIV / AIDS
Angioproliferative tumour derived from endothelial cells