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CPR Exam 1 > Vascular Pathology > Flashcards

Vascular Pathology Flashcards

1
Q

How are arteries and veins connected?

A

By capillary beds, which have a low pressure

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2
Q

What is the problem with arteriovenous malformation?

A

Arteries and veins are connected by a tangle of worm-like vasculature

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3
Q

What does the arteriovenous malformation problem cause?

A

Causes a large shunt of blood form the arteries to the veins which leads to a high-output cardiac failure

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4
Q

What is a Berry aneurysm?

A

Focal abnormal dilation of an artery due to an underlying defect in the media

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5
Q

Where are berry aneurysms typically found?

A

Circle of Willis near major branch points

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6
Q

What are the risk factors for berry aneurysms?

A
  • HTN

- Smoking

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7
Q

What other diseases are berry aneurysms seen in?

A
  • Polycystic Kidney Disease
  • Marfan Syndrome
  • Ehlers Danlos Syndrome
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8
Q

How does a berry aneurysm rupture and what does it cause?

A
  • Ruptures due to increased intracranial pressure like during sex or passing stool
  • Most common cause of subarachnoid hemmorhage
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9
Q

What are some clinical features of a berry aneurysm?

A
  • Worst headache of their life
  • Neck pain
  • Vomiting
  • Double vision
  • Seizures
  • Loss of consciousness
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10
Q

What is a Mycotic aneurysm?

A

An aneurysm caused by an infected artery wall (from circulating organisms)

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11
Q

What is fibromuscular dysplasia?

A

A focal, irregular thickening in medium and large arteries

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12
Q

What arteries are affected by fibromuscular dysplasia?

A
  • Carotid
  • Renal
  • Splanchnic
  • Vertebral
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13
Q

What causes fibromuscular dysplasia? Who is most likely to develop it?

A
  • Due to a developmental issue

- First degree relatives have higher incidence and is more frequent in women

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14
Q

What does fibromuscular dysplasia look like on an angiography?

A

Beads on a string

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15
Q

What is primary hypertension?

A

Often idiopathic and is 90-95% of cases

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16
Q

What are the unmodifiable risks of primary hypertension?

A
  • Increased age

- Genetic factors

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17
Q

What are the modifiable risks of primary hypertension?

A
  • Stress
  • Obesity
  • Physical inactivity
  • Increased salt consumption
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18
Q

What are some kidney issues that cause secondary hypertension?

A
  • Renovascular disease
  • Renal artery stenosis
  • Polycystic kidney disease
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19
Q

What are some endocrine issues that cause secondary hypertension?

A
  • Primary aldosteronism
  • Cushing syndrome
  • Pheochromocytoma
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20
Q

What are some cardiovascular issues that cause secondary hypertension?

A
  • Coarctation of the aorta
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21
Q

What does renal artery stenosis cause? What will be the clinical sign?

A
  • Hypertension, decreased GFR, and chronic kidney disease

- Will hear an abdominal bruit

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22
Q

What does coarctation of the aorta cause? What will be the clinical sign?

A
  • It is a narrowing of the aorta

- Causes HTN in the UE’s and hypotension in the LE’s

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23
Q

What are the effects of hypertension on the heart or aorta?

A
  • Cardiac hypertrophy and CHF
  • Ischemic heart disease
  • Aortic dissection
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24
Q

What are the effects of hypertension on the kidneys?

A
  • Renal dysfunction and failure
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25
Q

What are the effects of hypertension on the brain and eyes?

A
  • Multi-infarct dementia and cerebrovascular hemorrhage/stroke
  • Increased intracranial pressure/papilledema
  • Retinopathy
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26
Q

What is hyaline arteriolosclerosis?

A
  • Generalized and severe in chronic HTN

- There is an increase in smooth muscle matrix synthesis and plasma protein leakage across damaged endothelium

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27
Q

What does hyaline arteriolosclerosis lead to?

A

Could lead to a hyaline nephrosclerosis causing an impairment of the renal blood supply and cause ischemic glomerulosclerosis

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28
Q

What is defined as a hypertensive crisis?

A
  • Systolic >180-200 OR

- Diastolic >120

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29
Q

What is a hypertensive emergency?

A

When there is a hypertensive crisis with end organ damage

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30
Q

What is hyperplastic arteriolosclerosis? When does it occur?

A
  • Smooth muscle forms concentric lamellations showing “onion skinning” (could be accompanied with fibrinoid deposits and vessel wall necrosis)
  • Occurs in severe HTN
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31
Q

What is atherosclerosis?

A

Hardening of the arteries

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32
Q

What are the three types of atherosclerosis?

A
  1. Arteriolosclerosis
  2. Atherosclerosis
  3. Monckeberg medial sclerosis
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33
Q

What is arteriolosclerosis? What does it affect? What does it cause?

A
  • Hyaline and hyperplastic arteriolosclerosis
  • Affects small arteries or arterioles
  • Causes downstream ischemic injury
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34
Q

What is atherosclerosis? What does it cause?

A
  • Atheromatous plaque formation

- Causes stenosis/occlusion occurs; plaque rupture; aneurysm

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35
Q

What is Monckeberg medial sclerosis? Who does it affect?

A
  • Calcification of muscular arteries; specifically the internal elastic membrane
  • Is an age related degenerative process that does not cause narrowing of the lumen
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36
Q

What are the non modifiable risk factors of atherosclerosis?

A
  • Genetic: multifactorial inheritance
  • Increased age: 40-60 years old
  • Gender: women on birth control or other hormones have protective effect
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37
Q

What are the modifiable risk factors of atherosclerosis?

A
  • Hyperlipidemia
  • HTN
  • Smoking
  • Diabetes
  • Metabolic syndrome
  • Inflammation
  • Hyperhomocysteinemia
  • Lipoprotein A
  • Lack of exercise
  • Competitive/stressful lifestyle
  • Obesity
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38
Q

What is the pathogenesis of atherosclerosis?

A
  • Chronic endothelial injury occurs (like increased permeability or leukocyte adhesion)
  • Macrophages are activated and smooth muscle is recruited
  • Macrophages and smooth muscle cells engulf lipid causing fatty streaks
  • Smooth muscle proliferates, collagen and other extracellular matrix is deposited causing a fibrofatty atheroma
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39
Q

What are the growth factors that cause the smooth muscle proliferation in atherosclerosis?

A
  • PDGF
  • Fibroblast growth factor
  • TGF-a
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40
Q

What are patients most likely to suffer from as they get older with atherosclerosis?

A
  • Aneurysm and rupture of the vessel due to mural thrombosis, embolization, or wall weakening
  • Occlusion by thrombus due to plaque rupture, plaque erosion, plaque hemorrhage, mural thrombosis, or embolization
  • Critical stenosis due to progressive plaque growth
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41
Q

What is an aneurysm?

A
  • Excessive localized abnormal dilation of a blood vessel or ventricular wall
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42
Q

What is a true aneurysm?

A
  • Intact, but thinned, muscular wall at the site of dilation
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43
Q

What is a false aneurysm?

A
  • Defect through the wall of the vessel communicating with an extravascular hematoma that freely communicates with the intravascular space
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44
Q

What is an arterial dissection?

A
  • Occurs when blood enters a defect in an arterial wall and tunnels between its layers
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45
Q

What is the mutation in Marfan Syndrome?

A
  • FBN1 fibrillin gene
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46
Q

What does the mutation in Marfan Syndrome cause?

A
  • Causes an increased in TGF-B which results in elastic tissue weakening
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47
Q

What is the mutation in Ehlers Danlos syndrome?

A
  • Collagen
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48
Q

What is the clinical presentation of Ehlers Danlos syndrome?

A
  • Tall
  • Hyperelastic and fragile skin
  • Joint hypermobility
  • Lens subluxation
  • Abnormal wound healing
  • Widened scars, bruising
  • Mitral valve prolapse
  • Kyphoscoliosis in some areas
  • Rupture of colon, cornea, and large arteries
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49
Q

What is tertiary syphilis?

A

Sexually transmitted disease, spirochete T. pallidum

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50
Q

When does tertiary syphilis occur?

A

More than 5 years after primary infection

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51
Q

What does tertiary syphilis do?

A
  • Cause obliterative endarteritis of vasa vasorum which causes thoracic aneurysm
  • Aortic valve regurgitation can occur
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52
Q

Who are most likely to be seen with an abdominal aortic aneurysm?

A
  • Older white males who smoke
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53
Q

Where does the AAA occur?

A
  • Below the renal arteries and above the split
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54
Q

What does an asymptomatic AAA present with?

A
  • Pulsatile abdominal mass

- Incidental finding or during workup of PVD

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55
Q

What does a symptomatic AAA present with?

A
  • Nonruptured will have pain in the back and abdomen

- Ruptured will have severe acute pain, a pulsatile abdominal mass, and hypotension

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56
Q

What is the primary risk for a thoracic aortic aneurysm?

A
  • HTN
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57
Q

What are some other causes of thoracic aortic aneurysm?

A
  • Syphilic aortitis
  • Connective tissue disease (marfan)
  • Vasculitis
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58
Q

What are some clinical symptoms of a thoracic aortic aneurysm?

A
  • Breathing difficulties (respiratory tree involved)
  • Dysphagia (esophagus involved)
  • Cough (recurrent laryngeal nerve involved)
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59
Q

What happens in an aortic dissection?

A
  • Intimal tear with blood filled channel separating the media
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60
Q

What can an aortic dissection progress to?

A
  • A rupture with excruciating pain in the anterior chest
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61
Q

What is the triad of an aortic dissection?

A
  • Thoracic pain
  • Pulse abnormalities
  • mediastinal widening on CXR
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62
Q

What are some causes of an aortic dissection?

A
  • HTN

- CT disorders (Marfan, Ehlers Danlos)

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63
Q

What is the most common type of aortic dissection?

A
  • Debakey I
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64
Q

What kind of vessels does Giant cell arteritis affect?

A

Large to small arteries in the head (temporal, vertebral, ophthalmic)

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65
Q

What are the symptoms for giant cell arterities?

A
  • Headache and flu like symptoms
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66
Q

Who is most likely seen with giant cell arteritis?

A
  • Older men (>50)
67
Q

What can occur if a diagnosis is not made in a reasonable time?

A
  • Vision loss can occur with ophthalmic artery involvement
68
Q

What Abs show up in giant cell arteritis?

A
  • Anti-smooth muscle

- Anti-endothelial

69
Q

What is Takayasu Arteritis?

A
  • A granulomatous autoimmune vasculitis of large to medium arteries
70
Q

What happens in takayasu arteritis?

A
  • There is a thickening of the aorta or major branch vessels
71
Q

Who does takayasu arteritis affect?

A
  • Middle age adults (<50)
72
Q

What are the clinical symptoms of takayasu arteritis?

A
  • Weakening of the UE pulses
  • Ocular disturbances
  • +/- fatigue
  • HTN
  • Fever
  • Weight loss
73
Q

What size vessels does polyarteritis nodosa affect?

A
  • Small to medium vessels
74
Q

Who is most likely to have PAN?

A

Young adults; 1/3 have HepB

75
Q

What do the vessels look like in PAN?

A
  • Shows necrotizing, segmental inflammation with infiltration of eosinophils, lymphocytes, neutrophils, and macrophages
76
Q

Which specific vessels does PAN affect?

A
  • Renal
  • Heart
  • Liver
  • GI tract
77
Q

What is the clinical presentation of PAN?

A
  • Rapidly accelerating HTN
  • Abdominal pain and bloody stools
  • Myalgias
  • Peripheral neuritis
78
Q

What can be used to cure PAN?

A
  • Immunosuppresion
79
Q

Who does Kawasaki Disease affect?

A

Illness in infancy or early

80
Q

What size vessels does kawasaki disease affect?

A

Large to medium vessels

81
Q

What is the trigger for kawasaki disease?

A
  • Viral infection

- Activated T cells and monocytes/macrophages

82
Q

What is the clinical presentation for kawasaki disease?

A
  • Febrile
  • Strawberry tongue
  • Conjunctivitis
  • erythema of palms and soles
  • Cervical lymphadenopathy
  • Genital rash
83
Q

What vessels does Churg-Strauss affect?

A
  • Small vessels
84
Q

How does Churg-Strauss affect the body?

A
  • Necrotizing vasculitis associated with asthma, hypereosinophilia, and lung infiltrates
85
Q

What does Churg-Strauss resemble? How is it different?

A
  • Inflammation resembles PAN but has addition of eosinophils and granulomas
86
Q

What organ systems are involved in Churg-Strauss?

A
  • Skin (palpable purpura)
  • GI tract bleeding
  • Renal disease
87
Q

How does Churg-Strauss affect the heart?

A
  • Cardiomyopathy/myocarditis and infarction; heart is involved in 60% of patients and may cause death in half with syndrome
88
Q

What size vessels does Wegener’s Granulomatosis affect?

A
  • Small to medium vessels
89
Q

Who does Wegener’s granulomatosis affect generally?

A
  • 40 yo males
90
Q

What is the immune reaction process of wegener’s granulomatosis?

A
  • T-cell mediated hypersensitivity due to inhaled environmental or microbial material
91
Q

Which ANCA is wegener’s granulomatosis positive for?

A

PR3-ANCA

92
Q

Which ANCA is Churg-Strauss positive for?

A

MPO-ANCA

93
Q

What size of vessels does Bechet’s disease affect?

A
  • Small to medium
94
Q

What are the clinical signs of Bechet’s disease?

A
  • Oral aphthous ulcers
  • Genital ulcers
  • Uveitis
95
Q

Which HLA is associated with Bechets?

A

HLA-B51

96
Q

What is required for diagnosis with Bechet’s disease?

A
  • Neutrophilic vasculitis
97
Q

What is Bechet’s disease treated with?

A
  • Steroids and TNF antagonists
98
Q

What size of vessels does Buerger Disease (thromboangiitis obliterans) affect?

A
  • Acute and chronic vasculitis of small and medium vessels
99
Q

Which arteries specifically does Buerger disease affect?

A
  • Tibial and radial arteries (hands and feet)
100
Q

Who is Buerger disease most prevalent in?

A
  • Heavy smokers <35 years old
101
Q

Where is buerger disease most seen?

A
  • HLA haplotypes in Israel, India, and Japan
102
Q

What is the progression of the buerger disease?

A
  • Thrombosis
  • Vascular insufficiency
  • Tissue death
103
Q

What is raynaud’s phenomenon?

A
  • Vasospasm of small arteries
104
Q

What causes raynaud’s phenomenon?

A
  • Cold or emotion
105
Q

Why is raynaud’s phenomenon called “red, white, and blue”?

A

There is proximal vasodilation, central vasoconstriction, and distal cyanosis

106
Q

What is primary raynaud’s phenomenon?

A
  • Symmetric involvement of digits
  • Occurs in young women
  • Episodic with sporadic remission
107
Q

What is secondary raynaud’s phenomenon?

A
  • Asymmetric involvement of digits
  • Is a component of another disease like SLE, scleroderma, or thromboangiitis obliterans
  • Worsens with time
108
Q

What is a myocardial vessel vasospasm?

A

Excessive vasoconstriction of myocardial arteries or arterioles which may cause ischemia or infarct

109
Q

What are some causes of myocardial vascular contraction?

A
  1. High levels of vasoactive mediators (cocaine, increased caffeine intake, epi or NE)
  2. Elevated thyroid hormones
  3. Autoantibodies and T cells in scleroderma
110
Q

What is takotsubo cardiomyopathy?

A
  • AKA broken heart syndrome

- Emotional distress causes a surge of catecholamines

111
Q

What causes varicose veins?

A

Sustained intraluminal pressure causing valvular incompetence

112
Q

How does stasis dermatitis occur?

A

Caused by stasis, congestion, thrombus, edema, pain, and ischemia

113
Q

What is the most common cause of portal hypertension?

A

Cirrhosis

114
Q

What does portal hypertension lead to?

A
  • Esophageal varices
  • Splenomegaly
  • Hemorrhoids
  • Distended superficial abdominal veins
115
Q

What are some causes of superior vena cava syndrome?

A
  • Lung carcinomas
  • Lymphomas
  • Aneurysms
  • AV fistula
  • Fibrosis
116
Q

What do obstructions in superior vena cava syndrome cause?

A
  • Marked dilations of the veins in the head, neck, chest wall, and arms with cyanosis
  • Facial swelling and neurologic manifestations
117
Q

What can happen with involvement of the pulmonary vessels in SVC syndrome?

A
  • Respiratory distress
118
Q

What causes inferior vena cava syndrome?

A
  • Hepatocellular carcinoma, renal cell carcinoma or thrombosis (DVT)
119
Q

What do obstructions in inferior vena cava syndrome cause?

A
  • Marked lower extremity edema

- Distention of superficial lower gastric veins

120
Q

What is lymphangitis?

A

Inflammation of the lymphatic channels

121
Q

What infection can cause lymphangitis?

A
  • Acute inflammation by group A B-hemolytic strep
122
Q

What are clinical signs of lymphangitis?

A
  • Painful, red streaks

- Enlargement of draining lymph nodes

123
Q

What is primary lymphedema?

A
  • A congenital defect; familial milroy disease
124
Q

What is secondary lymphedema?

A
  • Blockage of normal lymphatics
125
Q

What can cause secondary lymphedema?

A
  • Malignant tumor, surgical procedures, and post-irradiation fibrosis
  • Skin will look like an orange peel
126
Q

What is nevus simplex?

A
  • A simple birthmark seen on the forehead, eye, nose, and upper lip
  • Most regress on their own
127
Q

How common is a nevus simplex?

A
  • 40-70% of infants have one
128
Q

What is a port wine stain?

A
  • A progressive ectasia of vascular plexus

- Persists into adulthood

129
Q

What is Sturge-Weber syndrome?

A
  • A trigeminal nerve facial port wine nevi
130
Q

What are some other clinical symptoms of Sturge-Weber syndrome?

A
  • Mental retardation
  • Seizures
  • Hemiplegia
  • Skull radio-opacities
  • Glaucoma
131
Q

What is vascular telangiectasia?

A
  • Permanent dilation of small vessels and capillaries forming a discrete lesion
132
Q

Where do vascular telangiectasias most likely occur?

A
  • Seen most on face, neck, and upper chest
133
Q

What induces vascular telangiectasias?

A
  • Increased circulating estrogen (pregnancy, liver disease)
134
Q

What causes hereditary hemorrhagic telangiectasia?

A
  • AD mutation of TGF-B signaling
135
Q

What does hereditary hemorrhagic telangiectasia look like clinically?

A
  • Abnormal blood vessel formation in skin, mucous membranes, and organs
136
Q

What are hemangiomas?

A
  • Common benign vascular tumor found on head or neck

- Most common benign tumor of childhood

137
Q

What is a capillary hemangioma?

A
  • Most common

- Involves the skin, mucous membranes, and viscera

138
Q

What does a capillary hemangioma look like?

A
  • Red spot; thin walled cap, tightly packed together
139
Q

What is a strawberry hemangioma?

A
  • Specific type of capillary hemangioma

- Present at birth but regresses

140
Q

What is a cavernous hemangioma?

A
  • Irregular dilated vascular channels making a lesion with an indistinct border
  • More likely to involve deep tissue and bleed
141
Q

Describe a pyogenic granuloma?

A
  • Rapidly growing
  • Found in oral mucosa or on finger
  • Granuloma gravidarum is PG of pregnancy and involves the gingiva of pregnant women
142
Q

What is a glomus tumor?

A
  • A mesenchymal tumor of modified smooth muscle cells arising from glomus body
143
Q

Where does a glomus tumor arise?

A
  • Can occur anywhere but most likely to occur in fingers

- Will present as blue and painful (esp in temp change)

144
Q

What is a lymphangioma?

A
  • A benign, lymphatic neoplasm
145
Q

What is a simple lymphangioma?

A
  • Involves head and neck with axillary predilection
146
Q

What is a cavernous lymphangioma?

A
  • Involves the neck or axilla in children

- Often seen in turner syndrome or other developmental syndromes

147
Q

What is bacillary angiomatosis?

A
  • A reactive vascular proliferation to gram neg bartonella bacilli
148
Q

Who is a bacillary angiomatosis most likely seen in?

A
  • Occurs in immunocompromised (HIV, transplant)
149
Q

What is a bacillary angiomatosis treated with?

A

Antibiotics

150
Q

What causes kaposi sarcoma?

A
  • HHV8
151
Q

How many types of kaposi sarcoma are there? What are they?

A
  1. Classic (sporadic)
  2. Endemic
  3. Iatrogenic
  4. AIDS associated
152
Q

What is the classic type of kaposi sarcoma?

A
  • Affects mediterranean, Eastern European, or middle eastern men
  • Affects distal LE
153
Q

What is the endemic type of kaposi sarcoma?

A
  • Affects african children (<10) and has lymph node involvement
154
Q

What is the iatrogenic type of kaposi sarcoma?

A
  • Related to T cell immunosuppression in transplant patients
155
Q

What is the AIDS type of kaposi sarcoma?

A
  • Most common type in US and most common type of AIDS related illness
  • Disseminates widely and has an aggressive course
156
Q

What is an angiosarcoma?

A
  • A malignant vascular tumor that is locally invasive
157
Q

What are some specific risk factors of angiosarcomas?

A
  • Liver– arsenic, thorotrast, PVC
  • Lymphedema with axillary lymph node dissection –> lymphangiosarcoma
  • Radiation for carcinoma
158
Q

What does a balloon angioplasty do?

A
  • Compress but can rupture occluding plaque
159
Q

What occurs in coronary metallic stents?

A
  • Could cause endothelial injury (causing immediate thrombus)
  • Antithrombotic meds are given prior to procedure
160
Q

What is given to reduce the restenosis?

A
  • Drug-eluting stents
161
Q

What are the types of vascular grafts?

A
  • Synthetic

- Autologous

162
Q

What are vascular grafts used for?

A
  • Used to release vessel occlusion or bypass
163
Q

When are synthetic grafts used?

A
  • Used only for large vessels like AAA

CPR Exam 1 (21 decks)

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