Vascular diseases Flashcards
Where can disturbances in blood flow occur?
- depends on system of patent blood vessels and adequate perfusion pressure
- disturbance disrupts:
delivery of O2 and nutrients - removal of waste products
- return of blood to the heart
What occurs in arterial disorders?
- decreased blood flow to the tissue, impaired O2 and nutrient delivery
What occurs in venous disorders?
- interference with outflow of blood from capillaries
- interference with removal of tissue wastes and return of blood to heart
What are the factors that contribute to disturbance in blood flow?
- pathologic changes in vessel wall: atherosclerosis and vasculitis
- acute vessel obstruction due to thrombus, embolus, MI, or vasospasm (prinzmetals angina) - raynauds phenomenon
- abnormal vessel dilation: atretial aneurysms or varicose veins (valve disorder)
- compression of blood vessels by extravascular forces: edema or tumors
Basic constituents of blood vessels?
- tunica intima: innermost layer and lines the lumen
- tunica media: middle layer, smooth muscle and elastic fibers, responsible for vasodilation and constriction
- tunica adventitia: most superficial, dense irregular basement membrane, collagen fibers for strength
Process of platelet aggregation?
- platelets circulate in close proximity to vascular walls
- they don’t interact with endothelial cells which provide natural resistance to thrombosis
- may adhere in many inflammatory states
3 types of arteriosclerosis?
- atherosclerosis: plaque buildup of fat, cholesterol, or calcium
- moenckenberg medial calficific sclerosis: calcium deposits in muscular mdidle layer (tunica media), poorer dx
- arteriosclerosis: vessel wall thickening and luminal narrowing in small arteries and arterioles
common features of arteriosclerosis?
- stiffening of arterial vessels (HTN, widens pulse pressure - lose elasticity)
- thickening of arterial wall
- degenerative nature of the disease
difference b/t arterioscleroiss and atherosclerosis?
- arteriosclerosis: thickening and hardening of arterial walls
- loss of elasticity of medium or large vessels (lead to an aneurysm)
- atherosclerosis: specific form of arteriosclerosis caused by build up of fatty plaques and cholesterol in the arteries (have fatty streaks at age of 9)
Major complications of atherosclerosis, risk factors?
- responsible for 50% of all deaths in developed world
- major complications:
ischemic heart disease
stroke (CAD)
aneurysm
PVD - develops in response to vascular injury and involves inflammation and vessel remodeling
- RFs:
hypercholesterolemia
diabetes
smoking
HTN
obesity
family hx of early heart disease
clinical presentation of atherosclerosis?
- cardiac: CP/pressure (angina)
- sudden numbness or weakness in arms or legs, difficulty speaking or slurred speech, or drooping muscle in your face
- arteries in arms and legs: leg pain when walking (intermittent claudication)
- kidneys: High BP or kidney failure
- genitals: ED
- neuro: sudden numbness or weakness in arms or legs
- difficulty speaking or slurred speech
drooping muscles n face, TIA may progress to stroke
What is Carotid artery disease? What can this cause?
- vascular disease can block the carotid arteries to the brain and cause paralyzing strokes
- stroke is 3rd leading cause of death in US and the leading cause of perm diability among older Americans
- more than $50 billion spent annually on care of stroke pts
- without Afib, 90% come from ICA, the ICA is one of main arteries that feeds eyes and parts of the cerebral hemispheres
What is a TIA?
- transient episode of neuro dysfunction caused by loss of blood flow either focal brain, spinal cord or retinal without infarction (tissue death)
- called mini strokes
- can cause same sxs assoc with strokes
- can present as transient hemispheric event or monocular blindness (amaurosis fugax), aphasia, slurred speech (dysarthria) and mental confusion
- usually resolves in 24 hrs, stroke is more than 24 hrs and usually there is an embolus
- you want to aggressively tx a TIA
Carotids eval?
- PE (bruits)
- duplex: 50% in sx and 80% in asx require intervention, at least one other to confirm
- MRA
- CTA
- angiography: gold std but risks are stroke or bleeding pluse high cost (not really worth it)
- only 10% of stroke pts have had TIA prior
- asx bruits are present in 5% of pop over 50, bruits are not dx of sig stenosis (only 23% have more than 50% stenosis)
When do you tx pts with carotid occlusion?
- asx pts with CAS of more than 80% will benefit from surgery assuming teh surgeon has complication rate of less than 2%, prophylactic operation
What is rheumatic fever?
- inflamm disease following strep pyogenes - strep pharyngitis
- believed to be caused by ab cross reactivity
- usually develops 2-4 weeks after a group A strep infection
- usually appears in children b/t ages of 6 and 15 with only 20% of first time attacks occurring in adults
- named because of similarity in presentation to rhematism
Major manifestations of rheumatic fever?
- migratory arthritis: predom involving large joints
- carditis and valvulitis (pancarditis): myocarditis which can manifest as CHF with SOB
pericarditis with a rub, new heart murmur - CNS involvement
- erythema marginatum
- sydenham’s chorea (rapid movements withou purpose of the face and arms occurring late in the disease)
Minor criteria for dx Rheumatic fever?
- fever of: 100.8-102
- arthralgia: joint pain without swelling
- elev ESR or CRP
- leukocytosis
- EKG showing heart block such as prolong PR interval (can’t be included if carditis present as major sx)
- previous episode of rheumatic fever
Modified Jones criteria for dx of rheumatic fever?
- 2 major criteria
- one major + 2 minor
- exceptions:
chorea
indolent carditis
(these are auto considered dx)
Tx of rheumatic fever?
- anti-inflamm: ASA - be careful in children - Reyes
- NSAIDs: ibuprofen for moderate to severe inflammatory reaction, corticosteroids
- abx
- PCN or clarithro or Zpack
- HF:
ACEI, diuretics, BBs, corticosteroids (inflammation - pericarditis)
What is an aortic aneurysm?
- bulges in weak areas of the aorta’s wall
- it can develop anywhere along the aorta (90% develop in abdominal aorta, most common cause is atherosclerosis), can develop in arteries at back of kneew (popliteal arteries)
What is an aortic dissection?
- separation of the layers of its walls
- inner lining of aortic wall tears
- artery wall detiorates and usually asscd with high BP
- both dissection and aneurysm can be immediately fatal, but they usually take years to develop
What kind of conditions do you see TAAs in?
- less than 10% of aortic aneurysms
- may be secondary to collagen vascular diseases:
marfans or ehlers-danlos syndrome
Thoracoabdominal aneurysms? Classification?
- traumatic occur at ligamentum arteriosum - just beyond the left subclavian artery, occurs from from rapid deceleration accidents (MVAs, and Falls)
- TAAA:
I (L) subclavian to renal arteries
II (L) subclavian to iliac bifurcation
III: midthoracic to infrarenal
IV: distal thoracic to infrarenal
Clinical presentation/tx of TAAs?
- most are asx
- sx can have all of the following sxs:
substernal, back or abd pain
dyspnea, stridor or brassy cough (trachea pressure), dysphagia (pressure on esophagus), hoarseness (pressure on recurrent laryngeal nerve), neck and arm edema from SVC compression
** start BBs and call a surgeon
Characteristics of AAA, who is it common in?
- 10th leading cause of death in men over 50
- over 90% originate below renal arteries
- present in 5-8% of men older than 65 and incidence has 3x in past 30 years
- routine U/S screening of high risk groups has decreased mortality by 53%, half of all newly detected aneurysms are less than 5 cm and 2/3 will eventually need surgical repair
screening for AAA?
- abdominal US is highly sensitive and specific screening test for AAA
- one time screening recommended in men ages 65-75 who have ever smoked
- one time screening for men 65-75 who have never smoked but who have first degree relative who required repair of an AAA or died of ruptured AAA