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MED233 Cardiovascular > Vascular Pathology 1 - HTN Vascular Disease, Athero, Aneurysms, Dissection > Flashcards

Vascular Pathology 1 - HTN Vascular Disease, Athero, Aneurysms, Dissection Flashcards

1
Q

What layer do high pressure arteries have that low pressure veins don’t?

A

Internal elastic lamina

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2
Q

What is a berry aneurysm? What its rupture cause?

A

Found in Circle of Willis.
AD PCKD
Rupture = Fatal subarachnoid hemorrhage

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3
Q

What is an AV fistula?

A

artery&raquo_space; vein.

Commonly due to a developmental defect. May lead to rupture and hemorrhage or to high-output cardiac failure.

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4
Q

What is fibromuscular dysplasia?

A

Focal thickening of intima and media of med-lg muscluar arteries. Results in stenosis.

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5
Q

What stimuli induce changes in endothelial cell function?

What is the ultimate result?

A

Stimuli: turbulent blood flow, HTN, complement, bacterial products, viruses, hypoxia, acidosis, tobacco smoke.
Leads to an ACTIVATED STATE

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6
Q

When stimuli are consistently present, the prolonged activated state can lead to ENDOTHELIAL DYSFUNCTION characterized by what three things?

A

1) Procoagulation
2) Proinflammation
3) Smooth muscle stimulation

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7
Q

What is the stereotypical response to vascular injury?

A

Intimal Thickening.

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8
Q

How does intimal thickening occur and what is a potential problem with intimal thickning?

A

Caused by smooth muscle cells from media migrating to the intima and elaborating ECM.
When intima is thickened, potentially AFFECTS BLOOD FLOW.

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9
Q

What are risk factors for essential HTN?

A

High sodium intake, obesity, stress, smoking, sedentary lifestyle

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10
Q

What normally causes secondary HTN?

A

Renal or endocrine disorder

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11
Q

What maintains blood volume and vascular tone?

A

RAS

*Know RAS, aldosterone, ANP function

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12
Q

What vascular morphologic changes occur in HTN?

A

Hyaline Arteriosclerosis
Hyperplastic Arteriosclerosis

Both result in lumen narrowing

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13
Q

What is Hyaline Arteriosclerosis?

A

Increased smooth muscle matrix synthesis.&raquo_space;
» Plasma proteins leak across damaged endothelium.&raquo_space;
» PINK (hyaline) thickening of vessel wall and associated lumen narrowing

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14
Q

What is Hyperplastic Arteriosclerosis?

A

Occurs in severe HTN.

Smooth muscles for concentric lamellations (ONION SKINNING) that result in lumen narrowing.

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15
Q

Onion skinning is associated with what?

A

The vascular morphologic change associated with Hyperplastic Arteriosclerosis during severe HTN.

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16
Q

What are the three constitutional risk factors associated with atherosclerosis?

A

Family hx
Age
Gender

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17
Q

What are the four major modifiable risk factors associated with atherosclerosis?

A 
Hyperlipidemia (esp LDL)
HTN
Smoking
DM
(other: inflammation, hyperhomocystinemia, metabolic syndrome)
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18
Q

What is the pathogenesis of atherosclerosis?

A

Chronic injury to endothelium, leading to CHRONIC INFLAMMATION and repair of tissue.

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19
Q

What covers the necrotic core (cell debri, cholesterol crystals, foam cells, calcium) of an atheromatous plaque

A

Fibrofatty atheroma (soft) with FATTY STREAKS. Covered by fibrous cap (dense collagen fibers, smooth muscle cells, marcophages, foam cells, etc.).

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20
Q

*What is the most common location of atherosclerotic lesions associated with hemodynamic turbulence?

A

**Openings of exiting vessels, branch points, posterior abdominal aorta.

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21
Q

What are the predominant lipids in atheromatous plaques?

A

Cholesterol and cholesterol esters.

22
Q

What secretes IL-1 and why in the inflammatory processes of pathogenesis of atherosclerosis?

A

Accumulation of cholesterol crystals in macrophages is recognized by inflammasomes and secrete IL-1

23
Q

What surrounds the necrotic core of an atheromatous plaque?

A

Zone of inflammatory and smooth muscle cells.

24
Q

**What are the most common sites of invovlement in atherosclerosis?

A

**Abdominal aorta > coronary arteries > popliteal arteries > internal carotid arteries > Circle of Willis

25
Q

What are complications of atherosclerotic plaques?

A

Rupture and ulceration (leading to thrombosis)
Hemorrhage (following plaque rupture)
Embolism (following plaque rupture)» cholesterol clefts
Aneurysm formation

26
Q

What is critical stenosis?

A

When 70% of the arterial lumen is occluded, leading to ISCHEMIA DOWNSTREAM.

27
Q

What factors can cause some plaques to be more prone to rupture?

A
  • Fibrous cap continually regenerated/remodeled
  • Increased inflammation in plaque (inhibits cap reqynthesis&raquo_space; less collegen&raquo_space; weaker)
  • Physical stress dt BP chagne or vasoconstriction
28
Q

What the difference between a true v. false aneurysm.

A

True - INTACT, but thinned muscular wall at site of dilation

False - defect THROUGH the wall of vessel or heart, communicating with extravascular hematoma

29
Q

What is an aneurysm?

A

Abnormal dilation of vessel or heart.

30
Q

What are the two types of true aneurysms?

A

Saccular - one side bulges

Fusiform - entire diameter/both sides enlarge

31
Q

What is a dissection?

A

Extravasation of blood through intima, forming an intramural hematoma.

32
Q

Marfan Syndrome is associated with what?

A

Aneurysm due to defective vascular wall CT (dt defective fibrillin synthesis).

33
Q

What is tertiary syphilis associated with?

A

Ischemia of the outer media of thoracic aorta

34
Q

What three things weaken the vascular wall by ischemia, possibly leading to aneurysm? Which two are most common?

A

Ischemia of Outer Media: **HTN and Tertiary Syphilis

Ischemia of Inner Media: **atherosclerosis

35
Q

What is the final result of both ischemic medial damage and Marfan Syndrome?

A

Cystic Medial Degeneration (elastin degredation)

36
Q

What is Cystic Medial Degeneration?

A

Loss of vascular wall elastic tissue or ineffective elastin synthesis leading to CMD, with visible disruption/disorganization of elastin filaments and increased ground substance.

Elastin is no longer highly ordered.

37
Q

Common Iliac Arteries are associated with what?

A

Abdominal Aortic Aneurysm

38
Q

What demographic are AAAs most common in?

A

Men, smokers, 60s

39
Q

A 65yoM, smoker, presents with an AAA. What is the common presentation of this?

A

Pulsating mass in the abdomen.

40
Q

What causes AAA?

A

Severe atherosclerosis of the aorta, covered by mural thrombus.

41
Q

When should an aneurysm be surgically managed?

A

When it is greater than 5cm in diameter.

42
Q

What causes a Thoracic Aortic Aneurysm?

A

Severe HTN.

Less commonly, Marfan Syndrome- congenitla defect of CT synthesis.

43
Q

What does Thoracic Aortic Aneurysm common present with?

A

Impingement of lower respiratory tree, esophagus, or recurrent laryngeal nerves.
Aortic valvular insufficiency.
Rupture.

44
Q

A 45yoM has severe chest pain, radiating to the back between scapulae. Think what?

A

Aortic dissection/Dissecting hematoma

45
Q

A patient has Marfan Syndrome. Think:

A

Aortic Dissection

Cystic medial degeneration&raquo_space; ANEURYSM (i.e. Thoracic Aortic Aneurysm)

46
Q

What is the primary risk factor for aortic dissection?

What makes someone more at risk?

A

HTN!

Male, 40-60yo, hypertensive. Marfan

47
Q

Where is the most common location for a dissection? What type?

A

Ascending aorta - Type A Dissection

48
Q

What is the most common cause of death for both Type A and B Dissections?

A

Rupture

49
Q

How is type A dissection treated?

A

Anti-hypertensive therapy and surgical repair of the intimal tear.

50
Q

What are the 2 most important causes of aortic aneurysms?

A

HTN and atherosclerosis.

MED233 Cardiovascular (18 decks)

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