Vascular Disease Flashcards
Define arteriosclerosis.
A broader term for a condition in which the arteries narrow and harden
Define atherosclerosis.
A specific kind of arteriosclerosis but it affects the intima of the large and medium sized arteries.
Name the three main forms of Arteriosclerosis
Monckenberg medial calcification
Arteriolosclerosis
Atherosclerosis
What is an aneurysm?
An abnormal, permanent dilation of a blood vessel
Name the types aneurysms.
Fusiform
Saccular
Rupturing/ Dissecting
Most common causes of aneurysms?
Atherosclerosis
Systemic hyperstension
What are the consequences of the formation of an embolism?
Rupture into peritoneal cavity or retroperitoneal tissue. Obstruction of a vessel. Ischemia . Embolism from atheroma or thrombus. Impinge adjacent structures. Erosion of vertebrae.
Define thrombosis.
Formation of a blood clot (thrombus) in a blood vessel, prevents blood from flowing normally.
What is a thrombus?
A blood clot that forms in a vessel and remains there.
What is an embolism?
A clot that travels form the site where it is formed to another location.
What are the two types of thrombosis?
Venous thrombosis
Arterial thrombosis
Characteristics of atherosclerosis?
Athermatous/atherosclerotic plaque deposits on the walls causing narrowing of the lumen.
What is atheroma/atheromatous plaque?
A localized collection of lipid and cholesterol with a fibrous cap.
How does the collection of atheromatous plaque become complicated?
Through rupturing and superadded thrombus.
Consequences of atherosclerosis?
Atheromatous plaques cause mechanical obstruction of blood flow and luminal narrowing.
A decreased flow and ischemia follows.
Decrease in tissue perfusion (distal tissues)
If the blood vessels are occluded, there is no blood flow and the result is infarction (coagulative tissue necrosis).
Non-modifiable risk factors of atherosclerosis?
Genetic abnormalities (Familial hyperchlesterolaemia)
Family history
Increasing age
Male gender
Modifiable risk factors of atherosclerosis?
Hyperlipidemia Hypertension Cigarette smoking & tobacco chewing Diabetes mellitus Vasculitis Diet Sedentary life style
Consequences of atherosclerosis?
Myocardial ischemia and infarction.
Stroke/CVA.
Peripheral vascular disease, gangrene.
Aneurysms, Gastrointestinal tract ischaemia.
Define Diabetes.
An abnormality in glucose metabolism due to either absent or improper utilization of insulin.
The microvascular consequences of retinopathy and nephropathy includes what?
Blindness and renal failure.
Which characteristics of diabetes provoke molecular mechanisms that alter the function and structure blood vessels?
Metabolic abnormalities->hyperglycaemia, free fatty acids, insulin resistance.
Describe the macrovasular pathology of diabetes.
Accelerated atherosclerosis (earlier onset, more severe, myocardial ischemia and infarction, stroke, peripheral vascular disease) Systemic hypertension (renal artery stenosis, diabetic nephropathy)
Describe the microvascular pathology of diabetes.
Diabetic nephropathy (nodular glomerulosclerosis, pyelonephritis, papillary necrosis, diffuse mesangial sclerosis) Peripheral neuropathy (glove and stocking distribution) Diabetic ocular pathology (cataracts, diabetic retinopathy, glaucoma, retinal detachment) Autononic neuropathy (delayed gastric enoptying, constipation)
Diabetic neuropathy: example of proprioception loss
Charcot joint deformity.
Diabetic neuropathy: motor loss causes…
Hammer toes and contracture
Define ischemia
Restriction of blood supply to tissue, causing a shortage of oxygen that is needed for cellular metabolism.
Define infarction
Tissue death (necrosis) due to inadequate blood supply to the affected areas. The resulting lesion is called an infarct.
Define cardiac output.
The amount of blood the heart pumps through the circulatory system in a minute.
Possible pathology of heart failure.
Leaks in the system.
Cardiac muscle weakness and failure.
Valve problems, obstruction or incompetence.
Electrical conduction, irregular rhythm.
Name the two pathological setting for myocardial ischaemia and infarction
Blockage of coronary artery/arteries (localised region of ischaemia and infarction; results in TRANSMURAL INFARCTION)
Global decrease inn blood flow (shock, results in subendocardial ischaemia and infarction in watershed zone)
What is the main risk factor for ischaemic heart disease?
Atherosclerosis.
Risk factors for myocardial ischaemia and infarction.
Tobacco smoking
Alcohol
Hypertension
Obesity
Explanation of why demand increases?
Ventricular hypertrophy
Pregnancy
Exercise
High altitude
Explanation of low supply?
Global ischaemia-cardiac failure, shock
Coronary artery occlusion
What is the function of cardiac valves?
Prevents retrograde flow of blood.
Complications of myocardial infarction?
Death Arrhythmias Contractile dysfunction and cardiogenic shock Myocardial rupture Vulvar dysfunction Ventricular aneurysm Pericarditis Rupture and tamponade Progressive heart failure
Clinical presentation of myocardial ischaemia and infarction
Stable angina pectoris
Unstable angina pectoris
Myocardial infarction
Management of myocardial ischaemia
Prevention Nitroglycerin under tongue Aspirin Other drugs Surgical treatment->stents, angioplasty, arthrectomy bypass
What is rheumatic fever?
An acute, immunological mediated multisystem inflammatory disease following an infection with Group A B (beta) haemdytic streptococcal infection.
What process does rheumatic fever involve?
The immunological process of the unmasking of antigens and an antibody-antigen cross reactivity
Which bodily structures does rheumatic fever affect?
Involves the heart, skin and joints.
During phase of rheumatic fever is acute rheumatic carditis a frequent manifestation?
The active phase of rheumatic fever.
What are the two cardiac manifestation following rheumatic fever?
Acute rheumatic pancarditis
Chronic rheumatic heart disease.
What are the risk factors involved in Rheumatic heart disease?
Low socio-economic status
Overcrowded living conditions
Poor nutrition
Delays in seeking medical attention
High prevalence of Group A B (beta) haemolytic streptococci in the community
Possible predisposing genetic influence in some persons.
What is the endocardium?
Includes the cadiac valves, chordea tendinae and the lining endocardium.
Define infective endocarditis.
The colonization/infection of the endocardium by infective organisms.
Results in the formation of bulky, friable vegetations.
What type of organism is most responsible for infective endocarditis?
Bacterial infections.
Origin of infective endocarditis.
Poor dental hygiene Long term haemodialysis Systemic sepsis Recent surgery or non-surgical invasive procedure Localized suppurative inflammation IV drug use
Cause of Acute bacterial infective endocarditis.
Viruluent organisms, like staphylococcus aureus
Effect of acute bacterial infective endocarditis on valves.
Normal valve or a damaged valve may be involved.
Describe the vegetations in acute bacterial infective endocarditis.
At lines of valve closure
At edges of defect
Large and Friable
Easily dislodged and embolise
What do the vegetations linked to acute bacterial infective endocarditis consist of?
Fibrin, proliferating bacteria and suppurative inflammation.
Clinical features of acute bacterial infective endocarditis.
Rapid onset Fever Rigors Malaise Chest pain Shortness of breath Rapid fatigue Rapid death
What type of organisms cause subacute bacterial infective endocarditis?
Low virulence organisms like streptococcal viridans gorup of bacteria.
What is the condition of the valves involved in subacute bacterial infective endocarditis?
Damaged valves
E.g. rheumatic valvulitis, or previous infective endocarditis.
Can subacute bacterial infective endocarditis involve prosthetic valves?
Yes
Can also edges of intracardiac congenital defects or iatrogenic defects
Describe the vegetations associated with subacute bacterial infective endocarditis.
At lines of valve closure
At edges of defect
Large and friable (smaller than acute)
Easily dislodged and embolise
Which cells are associated with the vegetations of subacute bacterial infective endocarditis?
Fibrin and bacteria
Clinical features of subacute bacterial infective endocarditis.
Slower onset Fever Malaise Fatigue Loss of weight Clubbing Murmers Low mortality
What are the complications of infective endocarditis?
Ring abscesses (erodes into underlying myocardium
Systemic embolization (brain abscesses, splenic and renal infarction, septic infarcts)
Right side pulmonary septic infarcts
Valve/chordae rupture
Septicaemia
Immune complex formation
Other term for congestion in cardiac terms?
Backward failure
Other term for reduced output?
Forward failure
Most common causes of cardiac failure?
Ischaemic heart disease
Hypertension
Valvular heart disease
Chronic lung disease
Classifications of cardiac failure
Right sided failure (right ventricular)
Left sided failure (left ventricular)
Biventricular failure
Which circulation system does blood back up into in the case of left sided heart failure?
The pulmonary circulation
Which circulation system does blood back up into in the case of right sided heart failure?
The systemic circulation
