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Clinical Medicine - Cardiology > Vascular Disease, Disease of the Aorta, and Peripheral Vascular Disease > Flashcards

Vascular Disease, Disease of the Aorta, and Peripheral Vascular Disease Flashcards

1
Q

Blood vessel diseases are common and important. What medical consequences do they have?

A

High morbidity and mortality
—more morbidity and mortality than any other
High cost
Often preventable w/ life style modifications
Often treatable if IDed early

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2
Q

Which vessels are most affected by vascular disease?

A

Arteries&raquo_space;> Veins
Smaller arteries&raquo_space;> bigger arteries
–smaller artery disease is often not recognized until later, where as bigger artery disease is more dramatic

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3
Q

What is the composition of a normal artery from inside to outside?

A

Single layer of endothelial cells in sub endothelial connective tissue

Internal elastic lamina - a dense elastic membrane that separates the ECs from the media

Smooth mm cells in layers of the media lamina

Surrounded by its lamina adventitia

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4
Q

What is the intima?

A

thin columnar ring of active endothelial cells on a dense and “pliable” basement membrane (the internal elastic lamina)

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5
Q

What is the media?

A

Layers of smooth mm in a metabolically active ECM composed of elastin, collagen, and glycosaminoglycans (where the action happens)

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6
Q

What is the adventitia?

A

Supportive fibrous tissue with nerves and blood vessels (vasoasorum)

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7
Q

What are the three types of arteries?

A

Large or elastic

Medium (or muscular or distributive)

Small arteries or arterioles

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8
Q

What are the characteristic features of large and medium arteries?

A

Vasa vasorum (vessels of the vessels) coring into the outer 1/2 - 2/3 of the media

A well defined external elastic lamina

Adventia (external to media) consisting of connective tissue with nerve fibers and the vasa vasorum

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9
Q

Describe the characteristics of the different types of veins

A

Veins are low pressure system conduits with thin walls

Large veins - intima, media, adventitia
Medium - have less adventitia
Venules - progressively less adventitia
Post cap venules - still less adventitia

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10
Q

Important structural features and functions of capillaries

A

Endothelial cells
Encircling pericytes
Thin walled

Function in gas exchange and nutrient exchange

Collective total CSA is massive

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11
Q

Arteries function as conduits. What are they conduits for?

A

Supply

  • nutrients
  • oxygen
  • immuno-chemicals and cells for healing and growth
  • pharmacologic agents

Bring

  • infection
  • inflammation
  • cancer
  • toxins
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12
Q

Arterial disease results in altered …

A

architecture

function

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13
Q

Atherosclerosis affects which vessels?

A

elastic and muscular arteries (large and medium vessels) like the aorta

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14
Q

Hypertension affects which vessels?

A

small muscular arteries and arterioles (capacitance vessels)

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15
Q

Aortic dissection

  • what changes are seen in the aorta?
  • what happens?
A
  • Structural weakness of the vessel wall
  • Loss of smooth mm cell or insufficient ECM
  • Blood enters the wall and separates the various layers
  • Causes rupture and/or obstruction of vessels branching off the aorta
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16
Q

Aortic aneurysm

  • which layers are involved?
  • result from?
  • cause?
A

AN ABNORMAL BULGE IN THE VESSEL

Involve the entire thickness of the wall

  • Result from the same structural weakness as dissections: loss of smooth mm cells or insufficient ECM
  • Can be caused by: ischemia, genetic defects, defective matrix remodeling, trauma
  • Cause rupture, thrombosis, and embolization
  • Can predispose to dissection
17
Q

Most pathology of the aorta will fit in one of the the following categories:

A

aneurysm
dissection
obstruction
aortitis (inflammation)

18
Q

LaPlace’s Law

  • what does it say
  • what does this imply
A

A principle of physic that the tension on the wall of sphere is the:

  • product of the pressure times the radius of the chamber
  • is inversely related to thickness of the wall

The bigger the balloon’s radius gets as the pressure increases within, the greater the wall tension and the thinner the wall gets This increases the likelihood of rupture

19
Q

Common causes of aortic aneurysms are factors that …

Examples

A

WEAKEN the aortic walls

Atherosclerosis
HTN
Infections such as TB, syphilis, strep, staph
Trauma
Congenital defects
Marfans
Ehlers-Danlos
ETC
20
Q

Aneurysms can be classified in various ways. What are these different ways?

A

Mechanism of dilation
Gross appearance
Location

21
Q

What are the different classes of aneurysms according to the schema that classifies them according to mechanism of dilation?

A

True aneurysm - all three layers are involved

Pseudo-aneurysm - localized dissection - adventitia is not included in plaque formation
–BULDGE DUE TO CLOT FORMATION WITHIN THE INTACT ADVENTITIA

22
Q

What are the different classes of aneurysms according to the schema that classifies them according to gross appearance?

A

Fusiform (like crescent shaped) - entire circumference of segment of vessel is enlarged

Saccular - side bulge (a cup-de-sac)

23
Q

What are the different classes of aneurysms according to the schema that classifies them according to location?

A 
Ascending aortic (thoracic) atherosclerotic
Arch (thoracic)
Descending (often continuous w/ infra diaphragmatic aneurysm and are called thoracoabdominal aortic aneurysms)
24
Q

Atherosclerotic aneurysms

  • where?
  • risk factors?
A

Arch and the abdominal aorta

Risk factors

  • cigarettes (smoking is strongest risk factors for abd aortic aneurysm)
  • aging
  • diabetes
  • HTN
  • dyslipidemia
25
Q

What would you expect to see on radiography of someone that has an aneurysm?

A

Widened mediastinum

Shift of midline structures (e.g. trachea)

26
Q

Aneurysms are defined by their size (depending on location). What are the sizes?

A

> 3.1 cm at aortic annulus

> 4.5 cm at aortic root

> 3.6 cm at ascending aorta

27
Q

What is a typical presentation of an ascending thoracic aortic aneurysm?

A

Usually asymptomatic and discovered incidentally

Occasionally chest pain

Compression of local structures

Aortic regurgitation

28
Q

What are the complications of an ascending thoracic aortic aneurysm?

A

Chronic aortic regurgitation

  • LVH
  • CHF

Dissection

Rupture (size dependent)

29
Q

Tx of an ascending thoracic aortic aneurysm?

A

Control HTN
B-blockers
Serial imaging to assess progression
Surgery (> 5.5, > 4.5 Marfans, bicuspid aortic valve)

30
Q

Descending thoracic aortic aneurysm

  • usually associated with …
  • chronic what?
  • surgery when diameter > ?
A
  • usually associated with atherosclerosis
  • chronic aortic dissection
  • surgery when diameter > 6.0 cm
31
Q

Clinical manifestations of abdominal aortic aneurysm

A

Often asymptomatic

Back/flank or abd pain (expanding, inflamed, leaking)

Lower extremity claudication

Distal embolization

32
Q

Abd aortic aneurysm complications

A
  • peripheral embolization of adherent thrombus
  • rupture risk strongly related to size and rate of expansion
  • treat vascular risk factors and assess for underlying CAD

Clinical Medicine - Cardiology (11 decks)

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