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MD2 Ambulatory Care and Emergency Medicine > Vascular Pathology > Flashcards

Vascular Pathology Flashcards

1
Q

What are the likely potential causes of sudden collapse and death in a young adult?

A 
Fatal arrhythmia, related to hypertrophic cardiomyopathy
Myocarditis
Congenital coronary artery problem
Aortic root problem
Long QT syndrome
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2
Q

What are the possible causes of haemopericardium?

A 
Ruptured MI
Ruptured ventricular aneurysm
Aortic dissection
Pericarditis
Trauma
Cardiac malignancies
Ruptured coronary artery aneurysm
Post thrombolysis
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3
Q

How does haemopericardium cause death?

A

Cardiac tamponade

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4
Q

What are the main risk factors for aortic dissection?

A 
Hypertension
Marfans syndrome
Ehlers-Danlos syndrome
Hyperlipidaemia
Smoking
Big vessel vasculitis
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5
Q

What are the potential complications of aortic dissection?

A 
Severe internal bleeding > death
Organ damage
Stroke
Aortic valve damage > aortic regurgitation
Haemopericardium
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6
Q

What is the typical phenotype of a person with Marfan syndrome?

A

Tall
Skinny
Abnormal heart sounds: aortic dilatation and regurgitation
Mitral valve prolapse

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7
Q

What are the genetic features of Marfan syndrome?

A

Autosomal dominant
Up to 30% of cases sporadic
Great variation in clinical expression

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8
Q

What do the cardiovascular manifestations of Marfan syndrome include?

A

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

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9
Q

Which medication is a risk factor for subarachnoid haemorrhage?

A

OCP

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10
Q

Why should a CT head be done before a lumbar puncture?

A

If subarachnoid haemorrhage, lumbar puncture can cause coning due to sudden decrease in intracranial pressure

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11
Q

What are the causes of a subarachnoid haemorrhage?

A

Ruptured berry aneurysm

Ruptured arteriovenous aneurysm

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12
Q

What is the management for subarachnoid haemorrhage?

A

Transfer to neurosurgical facility
Blood pressure control
Analgesia
Find cause and definitive treatment

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13
Q

After a subarachnoid haemorrhage, what causes further brain damage, usually on day 5?

A

Ischaemia due to vasospasm of carotid arteries

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14
Q

What causes vasospasm post-subarachnoid haemorrhage?

A

Breakdown products of blood irritating vessels

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15
Q

What causes raised intracranial pressure after a post-subarachnoid haemorrhage vasospasm?

A

Oedema secondary to ischaemia

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16
Q

What are the risk factors for a subarachnoid haemorrhage?

A 
Smoking
Alcohol misuse
Hypertension
Bleeding disorders
Mycotic aneurysm
17
Q

Where are the most common sites for berry aneurysms?

A

Junction of posterior communicating artery with internal carotid artery
Junction of anterior communicating with anterior cerebral artery
Bifurcation of middle cerebral artery

18
Q

What are the presenting clinical features of a subarachnoid haemorrhage?

A

Thunderclap headache
Vomiting
Collapse
Late: seizures and coma

19
Q

What are the complications of a subarachnoid haemorrhage?

A

Rebleeding
Cerebral ischaemia due to vasospasm > permanent CNS deficit
Hydrocephalus
Hyponatraemia

20
Q

What proportion of patients with a subarachnoid haemorrhage die?

A

50%

21
Q

Name three other types of aneurysm that may occur in vessels supplying the CNS

A

Microaneurysm
Mycotic
Atherosclerotic

22
Q

What are the causes of thrombophilia?

A 
ACP resistance
Factor V Leiden
Prothrombin gene mutation
Protein C and S deficiency
Antithrombin deficiency
Some OCPs
Antiphospholipid syndrome
23
Q

What sorts of tests can be done to investigate thrombophilia?

A 
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
24
Q

What is vasculitis?

A

Inflammation of walls of blood vessels

25
Q

What can vasculitis be associated with?

A

Fibrinoid necrosis
Thrombosis
Perivascular haemorrhage
Leukocytoclasis

26
Q

What vessels can vasculitis affect?

A

Almost any

27
Q

What are the common constitutional symptoms of vasculitis?

A 
Fever
Weight loss
Malaise
Arthraligia
Myalgia
28
Q

What are the causes of vasculitis?

A 
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
29
Q

Which vessels are affected in large vessel vasculitides?

A

Aorta and major branches

30
Q

Which vasculitides predominantly affect large vessels?

A

Giant cell arteritis

Takayasu arteritis

31
Q

Which vessels are affected in medium vessel vasculitides?

A

Main visceral arteries

32
Q

Which vasculitides predominantly affect medium vessels?

A

Polarteritis nodosa

Kawasaki disease

33
Q

Which vessels are affected in small vessel vasculitides?

A

Small intraparenchymal arteries
Arterioles
Capillaries
Venules

34
Q

Which vasculitides are ANCA associated, and affect small vessels?

A

Microscopic polyangiitis
Granulomatosis with polyangiitis (Wegener’s)
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

35
Q

Which vasculitides are associated with immune complexes, and affect small vessels?

A

Anti-GBM disease
Cryoglobulinaemic vasculitis
IgA vasculitis (Henoch-Schonlein)
Hypocomplementemic urticarial vasculitis

36
Q

What are some examples of variable vessel vasculitis?

A

Behcet’s disease

Cogan’s syndrome

37
Q

What are some examples of single organ vasculitis?

A

Cutaneous leukocytoclastic angiitis
Primary CNS vasculitis
Isolated aortitis

38
Q

What are some examples of vasculitis associated with systemic disease?

A

Lupus
Rheumatoid
Sarcoid

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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