Vascular Pathology Flashcards
What are the likely potential causes of sudden collapse and death in a young adult?
Fatal arrhythmia, related to hypertrophic cardiomyopathy Myocarditis Congenital coronary artery problem Aortic root problem Long QT syndrome
What are the possible causes of haemopericardium?
Ruptured MI Ruptured ventricular aneurysm Aortic dissection Pericarditis Trauma Cardiac malignancies Ruptured coronary artery aneurysm Post thrombolysis
How does haemopericardium cause death?
Cardiac tamponade
What are the main risk factors for aortic dissection?
Hypertension Marfans syndrome Ehlers-Danlos syndrome Hyperlipidaemia Smoking Big vessel vasculitis
What are the potential complications of aortic dissection?
Severe internal bleeding > death Organ damage Stroke Aortic valve damage > aortic regurgitation Haemopericardium
What is the typical phenotype of a person with Marfan syndrome?
Tall
Skinny
Abnormal heart sounds: aortic dilatation and regurgitation
Mitral valve prolapse
What are the genetic features of Marfan syndrome?
Autosomal dominant
Up to 30% of cases sporadic
Great variation in clinical expression
What do the cardiovascular manifestations of Marfan syndrome include?
Mitral valve prolapse
- Asymptomatic
- Mitral competence with/without ruptured chordae
- Arrhythmias and sudden death
- Predisposition to infective endocarditis
Cystic medionecrosis = cystic medial degeneration of aorta
- Aortic dissection
- Annuloaortic ectasia and aortic regurgitation
Which medication is a risk factor for subarachnoid haemorrhage?
OCP
Why should a CT head be done before a lumbar puncture?
If subarachnoid haemorrhage, lumbar puncture can cause coning due to sudden decrease in intracranial pressure
What are the causes of a subarachnoid haemorrhage?
Ruptured berry aneurysm
Ruptured arteriovenous aneurysm
What is the management for subarachnoid haemorrhage?
Transfer to neurosurgical facility
Blood pressure control
Analgesia
Find cause and definitive treatment
After a subarachnoid haemorrhage, what causes further brain damage, usually on day 5?
Ischaemia due to vasospasm of carotid arteries
What causes vasospasm post-subarachnoid haemorrhage?
Breakdown products of blood irritating vessels
What causes raised intracranial pressure after a post-subarachnoid haemorrhage vasospasm?
Oedema secondary to ischaemia
What are the risk factors for a subarachnoid haemorrhage?
Smoking Alcohol misuse Hypertension Bleeding disorders Mycotic aneurysm
Where are the most common sites for berry aneurysms?
Junction of posterior communicating artery with internal carotid artery
Junction of anterior communicating with anterior cerebral artery
Bifurcation of middle cerebral artery
What are the presenting clinical features of a subarachnoid haemorrhage?
Thunderclap headache
Vomiting
Collapse
Late: seizures and coma
What are the complications of a subarachnoid haemorrhage?
Rebleeding
Cerebral ischaemia due to vasospasm > permanent CNS deficit
Hydrocephalus
Hyponatraemia
What proportion of patients with a subarachnoid haemorrhage die?
50%
Name three other types of aneurysm that may occur in vessels supplying the CNS
Microaneurysm
Mycotic
Atherosclerotic
What are the causes of thrombophilia?
ACP resistance Factor V Leiden Prothrombin gene mutation Protein C and S deficiency Antithrombin deficiency Some OCPs Antiphospholipid syndrome
What sorts of tests can be done to investigate thrombophilia?
FBC Blood film Coagulation profile - Prothrombin time (PT) - Thrombin time - APTT - Fibrinogen APC resistance test Lupus anticoagulant Abs Anticardiolipin Abs Assays for - Antithrombin deficiency - Protein C and S deficiency
What is vasculitis?
Inflammation of walls of blood vessels
What can vasculitis be associated with?
Fibrinoid necrosis
Thrombosis
Perivascular haemorrhage
Leukocytoclasis
What vessels can vasculitis affect?
Almost any
What are the common constitutional symptoms of vasculitis?
Fever Weight loss Malaise Arthraligia Myalgia
What are the causes of vasculitis?
Immune - Deposition of circulating immune complexes - Seeding of Ag in vascular bed > in situ formation of immune complexes Infection - Direct invasion - Immune mediated Radiation Toxins and drugs
Which vessels are affected in large vessel vasculitides?
Aorta and major branches
Which vasculitides predominantly affect large vessels?
Giant cell arteritis
Takayasu arteritis
Which vessels are affected in medium vessel vasculitides?
Main visceral arteries
Which vasculitides predominantly affect medium vessels?
Polarteritis nodosa
Kawasaki disease
Which vessels are affected in small vessel vasculitides?
Small intraparenchymal arteries
Arterioles
Capillaries
Venules
Which vasculitides are ANCA associated, and affect small vessels?
Microscopic polyangiitis
Granulomatosis with polyangiitis (Wegener’s)
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Which vasculitides are associated with immune complexes, and affect small vessels?
Anti-GBM disease
Cryoglobulinaemic vasculitis
IgA vasculitis (Henoch-Schonlein)
Hypocomplementemic urticarial vasculitis
What are some examples of variable vessel vasculitis?
Behcet’s disease
Cogan’s syndrome
What are some examples of single organ vasculitis?
Cutaneous leukocytoclastic angiitis
Primary CNS vasculitis
Isolated aortitis
What are some examples of vasculitis associated with systemic disease?
Lupus
Rheumatoid
Sarcoid
