Vascular Path Flashcards
Diagnosis?
Thick walled arteries and veins
Pulsitile tangle of worm like vessels
Can occur in the skin, GI tract, lungs and brian
Arteriovenous malformation
*Large AVMs shunt blood from A to V circulation, leading to high output cardiac failure
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
Berry (saccular) aneurysm
Diagnosis?
Sceptic emboli from infective endocarditis
Extension of infectious process into the artery
Mycotic aneurysm
Diagnosis?
Young woman
String of beads angiography of renal arteries
Renovascular hypertension (epigastric bruits)
Fibromuscular dysplasia
Diagnosis?
Idiopathic HTN
Unmodifiable risk factors: age, genetics
Modifiable risk factors: stress, obesity, physical activity, salt consumption
Primary (essential) HTN
Diagnosis?
HTN due to
Renovascular disease
Endocrine disorder (primary hyperaldosteronism, Cushjing, pheochromocytoma)
Cardiovascular abnormality (coarctation of the aorta)
Secondary HTN
Diagnosis?
HTN with hypokalemia
Idiopathic or aldosterone secreting tumor or glomerulosa cells directly responsive to ACTH
Primary Hyperaldosteronism
Diagnosis?
HTN
Woman with round race, fat belly/neck/back, stretch marks
Pituitary tumor secreting ACTH or tumor secreting cortisol or paraneoplastic
Cushing syndrome
Diagnosis?
HTN
Paroxysms of HTN, tachy, palpitations, headache, diaphoresis, tremors
Urinary or plasma metanephrines elevated
Pheochromocytoma
*catecholamine secreting tumor
Some causes for renal artery stenosis that lead to HTN
- Atherosclerosis
- Fibromuscular dysplasia
- Polycystic kidney disease, pylonephritis
*HTN decreases GFR leading to CKD
Diagnosis?
HTN in the upper extremities with hypotension in the lower extremities
Coarctation of the aorta
Affects of HTN on the heart and aorta (3)
- Cardiac hypertrophy and chronic heart failure
- Ischemic heart disease
- Acute aortic dissection
Affects of HTN on the kidney
Renal dysfunction and failure
Affects of HTN on the brain and eye
- Cerebrovascular hemorrhage, Stroke
- Papilledema
- Retinopathy
Leading causes of death in untreated HTN
- 1/2 die from ischemic heart disease or CHF
- 1/3 die of stroke
Histologic changes or arteries in chronic HTN
Luminal narrowing due to homogenous pink (hyaline) thickening of vessel wall
*kidney will show this histology and be shrunken with a granular surface
BP reading in hypertensive crisis
Systolic >180 and/or Diastolic >120
*Hypertensive emergency occurs when there is end organ damage
Histologic changes of vessels in severe HTN
Concentric lamellations “onion skinning”
*kidney will show this histology and have numerous petechial hemorrhages
Diagnosis?
Myocardial infarct due to exogenous cocaine/caffeine, endogenous catecholamines, elevated thyroid hormones
Myocardial vessel vasospasm
Diagnosis?
Emotional distress causes sudden surge of catecholamines which leads to ischemic cardiomyopathy and sometimes death
Almost exclusively in elderly women
Takotsubo cardiomyopathy (broken heart syndrome)
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)
Superior vena cava syndrome
Diagnosis?
Marked lower extremity edema with distension of superficial lower abdominal veins
Classically due to neoplasm (HCC, renal cell carcinoma, DVT)
Inferior vena cava syndrome
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
Thrombophlebitis
*most serous complication is PE
Diagnosis?
Inflammation of lymphatic channels
Commonly caused by GAS
Lymphangitis
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)
Lymphedema
Vascular ectasias (blood vessel dilations):
Birth mark, most will regress
Nevus simplex
Vascular ectasias (blood vessel dilations):
Progressive ectasia of vascular plexus that persists into adulthood
Port-wine stain (nevus flammeus)
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)
Sturge-Weber syndrome
Diagnosis?
Permanent dilation of small vessels
Looks like spider
Spider telangectasia
Diagnosis?
Numerous telangectasias and AV malformations of the skin, mucous membranes, organs
Also presents with nosebleeds, GI bleeds and hematuria
Hereditary Hemorrhagic Telangectasia (Osler-Weber-Rendu disease)
*caused by mutation in TGF-B signaling pathway
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
All benign vascular tumors
Diagnosis?
Modified smooth muscle tumor
Subungal location, blueish color
Painful including with temp changes
Glomus tumor
*arise from glomus body, responsible for thermoregulation
Diagnosis?
Benign lymphatic neoplasm associated with Turner syndrome
Dilated spaces that do not contain RBCs
Present in the neck or axilla
Lymphangioma
*Simple lymphangioma or cystic hygroma
Diagnosis?
Benign red papule
Caused by Bertonella bacilli (bacteria on silver stain)
Occur in immunocompromised (HIV, transplant)
Bacillary angiomatosis
Diagnosis?
Angioproliferative disorder caused by HHV-8
Red-purple nodules or plaques
Patch stage => Plaque stage => Tumor stage
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
Diagnosis?
Malignant vascular tumor
Risk factors: PVC (liver malignancy), lymphadema, radiation
Angiosarcoma
Nonmodifiable risk factors for atherosclerosis
- Genetic (multifactorial)
- Family history
- Age (40s-60s 5x risk, risk increases with age)
- Male (estrogen protective)
Modifiable risk factors for atherosclerosis
- Hyperlipidemia (high LDL, low HDL)
- HTN
- Smoking
- Diabetes
- Obesity
- Sedentary
- Stress
- Inflammation
- Hyperhomocysteinemia
Diagnosis of metabolic syndrome criteria
3/5
- Abdominal obesity
- Hypertriglyceridemia
- Decreased HDL
- HTN
- Insulin resistance
Pathogenesis of atherosclerosis
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
Diagnosis and risk?
Tall lanky person with long extremities
Mutation in FBN1, increased TGF-B activity, weakens elastic tissue
Marfan
*risk of aortic aneurysm and dissection
Diagnosis and risk?
Hyperelastic skin
Joint hypermobility
Fragile skin and poor wound healing
Mutation in collagen 3 gene (COL5A1, COL5A2)
Ehlers Danlos syndrome
*risk of large artery rupture, MVP
Most important risk factor for AAA
Atherosclerosis
Aside from atherosclerosis, smoking, age and being male… what else can cause AAA?
IgG4 related disease
- inflammatory type with lymphoplasmatic inflammation\
- responds well to steroids
Most important risk factor for thoracic aortic aneurysm
HTN
*also may be caused by tertiary syphilis (obliteration of vasa vasorum)
Diagnosis?
Thoracic pain, pulse abnormalities, mediastinal widening on CXR
Aortic dissection
*casued by HTN and CT disorders (Marfan, Ehlers Danlos)
Most common location for aortic dissection
proximal to right brachiocephalic artery
*classified and Stanford Type A or DeBakey 1
Primary Reynaud’s phenomenon
Symmetric attack with spontaneous remission
Secondary Reynaud’s phenomenon
Asymmetric attack, increasing severity over time, due to another disease (SLE, scleroderma, Bergers vasculitis)
Vasculidities that involve the aorta and often have giant cells
Giant cell arteritis (temporal arteritis
Takayasu arteritis
Vasculitis where granulomas are required for diagnosis
Granulomatosis with polyangitis
*also has PR-3 ANCA (c-ANCA)
Vasculitis where eosinophilia is required for diagnosis
Churg-Strauss Syndrome
*also has MPO ANCA (p-ANCA)
Vasculitis where neutrophils are required for diagnosis
Behcet’s disease
How is restenosis prevented in baloon angioplasty with endovascular stenting?
Drug eluting stents
*coated in drug that prevents SM activation and proliferation
Vasculitis diagnosis?
Older adults
T-cell mediated
Headache, occular symptoms (potential vision loss)
Giant cell (temporal) arteritis
Vasculitis diagnosis?
Female <50 Autoimmune Granulomatous inflammation Weak upper extremity pulses Occular disturbances
Takayasu arteritis
Vasculitis diagnosis?
Associated with HBV Fibrinoid necrosis Affects renal vessels, GI tract, skin Spares the lungs Rapidly accelerating HTN
Polyarteritis nodosa
Vasculitis diagnosis?
Child <5 years old Conjunctivitis Rash Adenopathy (cervical lymphnodes) Strawberry toungue Hand and foot erythema/edema Fever
Kawasaki disease (mucocutaneous LN syndrome)
Vasculitis diagnosis?
Asthma Eosinophilia Palpable purpura GI bleeding Renal disease
Churg-Strauss (eosinophilic/allergic granulomatosis with polyangiitis)
*may give rise to cardiomyopathy/myocarditis =>death
Vasculitis diagnosis?
Necrotizing granulomatous vasculitis
Affects lungs, nose, kidneys
PR3-ANCA (c-ANCA)
Granulomatosis with polyangiitis (Wegener’s)
Vasculitis diagnosis?
Necrotizing vasculitis that involves capillaries, venules
Affects kidney, lung, nereves, GI tract (no nose)
MPO-ANCA (p-ANCA)
No immune complex deposition
Microscopic polyangiitis
