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Cardio > Vascular Path > Flashcards

Vascular Path Flashcards

1
Q

Diagnosis?

Thick walled arteries and veins
Pulsitile tangle of worm like vessels
Can occur in the skin, GI tract, lungs and brian

A

Arteriovenous malformation

*Large AVMs shunt blood from A to V circulation, leading to high output cardiac failure

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2
Q

Diagnosis?

Focal dilation of an artery due to a defect in the media
Typically appear in Circle of Willis (pt presents with worst headache of their life with N/V, diplopia, loss of consciousness
Risk factors are HTN and smoking
Seen in polycystic kidney disease, Marfan, Ehlers-Danlos

A

Berry (saccular) aneurysm

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3
Q

Diagnosis?

Sceptic emboli from infective endocarditis
Extension of infectious process into the artery

A

Mycotic aneurysm

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4
Q

Diagnosis?

Young woman
String of beads angiography of renal arteries
Renovascular hypertension (epigastric bruits)

A

Fibromuscular dysplasia

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5
Q

Diagnosis?

Idiopathic HTN
Unmodifiable risk factors: age, genetics
Modifiable risk factors: stress, obesity, physical activity, salt consumption

A

Primary (essential) HTN

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6
Q

Diagnosis?

HTN due to
Renovascular disease
Endocrine disorder (primary hyperaldosteronism, Cushjing, pheochromocytoma)
Cardiovascular abnormality (coarctation of the aorta)

A

Secondary HTN

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7
Q

Diagnosis?

HTN with hypokalemia
Idiopathic or aldosterone secreting tumor or glomerulosa cells directly responsive to ACTH

A

Primary Hyperaldosteronism

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8
Q

Diagnosis?

HTN
Woman with round race, fat belly/neck/back, stretch marks
Pituitary tumor secreting ACTH or tumor secreting cortisol or paraneoplastic

A

Cushing syndrome

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9
Q

Diagnosis?

HTN
Paroxysms of HTN, tachy, palpitations, headache, diaphoresis, tremors
Urinary or plasma metanephrines elevated

A

Pheochromocytoma

*catecholamine secreting tumor

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10
Q

Some causes for renal artery stenosis that lead to HTN

A
  • Atherosclerosis
  • Fibromuscular dysplasia
  • Polycystic kidney disease, pylonephritis

*HTN decreases GFR leading to CKD

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11
Q

Diagnosis?

HTN in the upper extremities with hypotension in the lower extremities

A

Coarctation of the aorta

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12
Q

Affects of HTN on the heart and aorta (3)

A
  • Cardiac hypertrophy and chronic heart failure
  • Ischemic heart disease
  • Acute aortic dissection
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13
Q

Affects of HTN on the kidney

A

Renal dysfunction and failure

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14
Q

Affects of HTN on the brain and eye

A
  • Cerebrovascular hemorrhage, Stroke
  • Papilledema
  • Retinopathy
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15
Q

Leading causes of death in untreated HTN

A
  • 1/2 die from ischemic heart disease or CHF

- 1/3 die of stroke

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16
Q

Histologic changes or arteries in chronic HTN

A

Luminal narrowing due to homogenous pink (hyaline) thickening of vessel wall

*kidney will show this histology and be shrunken with a granular surface

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17
Q

BP reading in hypertensive crisis

A

Systolic >180 and/or Diastolic >120

*Hypertensive emergency occurs when there is end organ damage

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18
Q

Histologic changes of vessels in severe HTN

A

Concentric lamellations “onion skinning”

*kidney will show this histology and have numerous petechial hemorrhages

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19
Q

Diagnosis?

Myocardial infarct due to exogenous cocaine/caffeine, endogenous catecholamines, elevated thyroid hormones

A

Myocardial vessel vasospasm

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20
Q

Diagnosis?

Emotional distress causes sudden surge of catecholamines which leads to ischemic cardiomyopathy and sometimes death
Almost exclusively in elderly women

A

Takotsubo cardiomyopathy (broken heart syndrome)

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21
Q

Diagnosis?

Marked dilation of veins of the head, neck, chest wall and arms with cyanosis
Facial swelling and neurologic manifestations
Respiratory distress if pulm vessels compressed
Classically due to neoplasm (lung tumor, lymphoma)

A

Superior vena cava syndrome

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22
Q

Diagnosis?

Marked lower extremity edema with distension of superficial lower abdominal veins
Classically due to neoplasm (HCC, renal cell carcinoma, DVT)

A

Inferior vena cava syndrome

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23
Q

Diagnosis?

Venous thrombosis and inflammation, typically in the deep veins of the legs
Edema, cyanosis, erythema and pain
Due to prolonged inactivity/immobilization and hypercoagulable states

A

Thrombophlebitis

*most serous complication is PE

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24
Q

Diagnosis?

Inflammation of lymphatic channels
Commonly caused by GAS

A

Lymphangitis

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25
Q

Diagnosis?

Swelling caused by fluid buildup due to lymphatic blockage
Primary is congenital defect
Secondary occurs in previously normal lymphatic drainage (peau d’orange in breast cancer)

A

Lymphedema

26
Q

Vascular ectasias (blood vessel dilations):

Birth mark, most will regress

A

Nevus simplex

27
Q

Vascular ectasias (blood vessel dilations):

Progressive ectasia of vascular plexus that persists into adulthood

A

Port-wine stain (nevus flammeus)

28
Q

Vascular ectasias (blood vessel dilations):

Trigeminal nerve region port wine stain of face
Intellectual disability, neurological deficits
Leptomeningeal capillary-venous malformation
Skull radio-opacities
Eye abnormalities (glaucoma)

A

Sturge-Weber syndrome

29
Q

Diagnosis?

Permanent dilation of small vessels
Looks like spider

A

Spider telangectasia

30
Q

Diagnosis?

Numerous telangectasias and AV malformations of the skin, mucous membranes, organs
Also presents with nosebleeds, GI bleeds and hematuria

A

Hereditary Hemorrhagic Telangectasia (Osler-Weber-Rendu disease)

*caused by mutation in TGF-B signaling pathway

31
Q

Hemangiomas:

Capillary hemangioma: most common, small red spot

Strawberry hemangioma: present at birth and regress

Cavernous hemangioma: more likely to be in deep tissues and bleed

Pyogenic granuloma: oral, lobar capillary hemangioma common in pregnancy

A

All benign vascular tumors

32
Q

Diagnosis?

Modified smooth muscle tumor
Subungal location, blueish color
Painful including with temp changes

A

Glomus tumor

*arise from glomus body, responsible for thermoregulation

33
Q

Diagnosis?

Benign lymphatic neoplasm associated with Turner syndrome
Dilated spaces that do not contain RBCs
Present in the neck or axilla

A

Lymphangioma

*Simple lymphangioma or cystic hygroma

34
Q

Diagnosis?

Benign red papule
Caused by Bertonella bacilli (bacteria on silver stain)
Occur in immunocompromised (HIV, transplant)

A

Bacillary angiomatosis

35
Q

Diagnosis?

Angioproliferative disorder caused by HHV-8
Red-purple nodules or plaques
Patch stage => Plaque stage => Tumor stage

A

Kaposi sacroma

Types:

  • Classic - distal lower extremities, indolent
  • Endemic african - in african kids
  • Iatrogenic - immunosuppressant related (transplant pt)
  • AIDS associated - most common AIDS related malignancy
36
Q

Diagnosis?

Malignant vascular tumor
Risk factors: PVC (liver malignancy), lymphadema, radiation

A

Angiosarcoma

37
Q

Nonmodifiable risk factors for atherosclerosis

A
  • Genetic (multifactorial)
  • Family history
  • Age (40s-60s 5x risk, risk increases with age)
  • Male (estrogen protective)
38
Q

Modifiable risk factors for atherosclerosis

A
  • Hyperlipidemia (high LDL, low HDL)
  • HTN
  • Smoking
  • Diabetes
  • Obesity
  • Sedentary
  • Stress
  • Inflammation
  • Hyperhomocysteinemia
39
Q

Diagnosis of metabolic syndrome criteria

A

3/5

  • Abdominal obesity
  • Hypertriglyceridemia
  • Decreased HDL
  • HTN
  • Insulin resistance
40
Q

Pathogenesis of atherosclerosis

A

Endothelial injury =>
SM migration =>
Macrophage infiltration and uptake of LDL =>
Macrophage cytokine release attracts more =>
SM proliferation and ECM deposition (PDGF, FGF, TGF-a) =>
Intimal thickening and plaque formation

41
Q

Diagnosis and risk?

Tall lanky person with long extremities
Mutation in FBN1, increased TGF-B activity, weakens elastic tissue

A

Marfan

*risk of aortic aneurysm and dissection

42
Q

Diagnosis and risk?

Hyperelastic skin
Joint hypermobility
Fragile skin and poor wound healing
Mutation in collagen 3 gene (COL5A1, COL5A2)

A

Ehlers Danlos syndrome

*risk of large artery rupture, MVP

43
Q

Most important risk factor for AAA

A

Atherosclerosis

44
Q

Aside from atherosclerosis, smoking, age and being male… what else can cause AAA?

A

IgG4 related disease

  • inflammatory type with lymphoplasmatic inflammation\
  • responds well to steroids
45
Q

Most important risk factor for thoracic aortic aneurysm

A

HTN

*also may be caused by tertiary syphilis (obliteration of vasa vasorum)

46
Q

Diagnosis?

Thoracic pain, pulse abnormalities, mediastinal widening on CXR

A

Aortic dissection

*casued by HTN and CT disorders (Marfan, Ehlers Danlos)

47
Q

Most common location for aortic dissection

A

proximal to right brachiocephalic artery

*classified and Stanford Type A or DeBakey 1

48
Q

Primary Reynaud’s phenomenon

A

Symmetric attack with spontaneous remission

49
Q

Secondary Reynaud’s phenomenon

A

Asymmetric attack, increasing severity over time, due to another disease (SLE, scleroderma, Bergers vasculitis)

50
Q

Vasculidities that involve the aorta and often have giant cells

A

Giant cell arteritis (temporal arteritis

Takayasu arteritis

51
Q

Vasculitis where granulomas are required for diagnosis

A

Granulomatosis with polyangitis

*also has PR-3 ANCA (c-ANCA)

52
Q

Vasculitis where eosinophilia is required for diagnosis

A

Churg-Strauss Syndrome

*also has MPO ANCA (p-ANCA)

53
Q

Vasculitis where neutrophils are required for diagnosis

A

Behcet’s disease

54
Q

How is restenosis prevented in baloon angioplasty with endovascular stenting?

A

Drug eluting stents

*coated in drug that prevents SM activation and proliferation

55
Q

Vasculitis diagnosis?

Older adults
T-cell mediated
Headache, occular symptoms (potential vision loss)

A

Giant cell (temporal) arteritis

56
Q

Vasculitis diagnosis?

Female <50
Autoimmune
Granulomatous inflammation
Weak upper extremity pulses
Occular disturbances
A

Takayasu arteritis

57
Q

Vasculitis diagnosis?

Associated with HBV
Fibrinoid necrosis
Affects renal vessels, GI tract, skin
Spares the lungs
Rapidly accelerating HTN
A

Polyarteritis nodosa

58
Q

Vasculitis diagnosis?

Child <5 years old
Conjunctivitis
Rash
Adenopathy (cervical lymphnodes)
Strawberry toungue
Hand and foot erythema/edema
Fever
A

Kawasaki disease (mucocutaneous LN syndrome)

59
Q

Vasculitis diagnosis?

Asthma
Eosinophilia
Palpable purpura
GI bleeding
Renal disease
A

Churg-Strauss (eosinophilic/allergic granulomatosis with polyangiitis)

*may give rise to cardiomyopathy/myocarditis =>death

60
Q

Vasculitis diagnosis?

Necrotizing granulomatous vasculitis
Affects lungs, nose, kidneys
PR3-ANCA (c-ANCA)

A

Granulomatosis with polyangiitis (Wegener’s)

61
Q

Vasculitis diagnosis?

Necrotizing vasculitis that involves capillaries, venules
Affects kidney, lung, nereves, GI tract (no nose)
MPO-ANCA (p-ANCA)
No immune complex deposition

A

Microscopic polyangiitis

Cardio (18 decks)

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