Vascular Pathology Flashcards
What histological structure do arteries contain that veins do not?
Internal Elastic Membrane.
Arteries= Elastic
Veins= Distensible
At what level of systemic circulation is blood pressure mainly controlled?
Arterioles
What can cause arteriovenous malformations?
- Rupture of arterial aneurysm into adjacent vein
- Penetrating injury that pierces artery and vein
- Inflammatory necrosis
- Iatrogenic (gain vascular access)
Complications of AVM’s
Seizures
Hemorrhage
Neural Deficits if in brain
Describe a Berry Aneurysm
Aneurysm in the circle of Willis most commonly between anterior cerebral and anterior communicating arteries.
“Worst HA of your life”
Risk factors for a Saccular (Berry) Aneurysm
- HTN
- Smoking
- Polycystic Kidney Dz
- Marfan’s or Ehler-Danlos
Fibromuscular Dysplasia
Focal thickening of M/L arteries that creates a “beads on a string” angiography.
Commonly affects renal arteries. Epigastric abd bruit commonly present
2 most important receptors that control heart rate and contractility
B1- “1 heart” increases Inotropy and rate
M2- decreased HR and Inotropy
RAAS pathway
Macula Densa/JG cells sense low Na+ levels/Low Pressure
JG releases Renin converts angiotensinogen to angiotensin
Angiotensin–> Angiotensin II–> Aldosterone/vasoconstriciton–> resorbed Na and H2O
Primary HTN
most common
Modifiable factors: Diet, exercise, Salt consumption, stress
Non-modifiable: Age, genetics
What blood pressure defines HTN
140/90
Secondary HTN
caused by Kidney, Endocrine, or CV problems
3 causes of primary hyperaldosteronism
- Idiopathic
- Adrenal Adenoma
- Glucocorticoid suppression
Cushing DISEASE
Increased ACTH release causing Increased Cortisol
Cushing SYNDROME
Increased Cortisol caused by adrenal release; Independent of ACTH release
Pheochromocytoma
Catecholamine-releasing tumor.
HTN, Tachy, HA, diaphoresis, tremor.
Test urine for plasma metanephrines
Primary cause of Renal Artery Stenosis
Atheroslcerosis
Fibromuscular Dysplasia
Symptoms of Coartctation of the Aorta
HTN in UE with Hypotension in LE
Hyaline Arteriosclerosis vs. Hyperplastic Arteriosclerosis
Hyaline: Narrowing due to chronic HTN
Hyperplastic: Malignant HTN “onion skinning”
Hypertensive Crisis
Rapid increase in BP to >180/120
Renal failure, encephalopathy, HF, papilledema
3 types of Arteriosclerosis
- Arteriosclerosis due to HTN
- Atherosclerosis due to plaque
- Monckeburg medial sclerosis due to calcification (not clinically significant)
Major risk factors for the development of Atherosclerosis
Non-modifiable:
- Genetics
- FH
- Age (>40)
- Male
Modifiable:
- Hyperlipidemia
- Hypertension
- Smoking
- the betus
- Stress, obesity, hyperhomocysteinemia
How does Atherosclerosis occur?
Vascular Injury causes activation of endothelium that leads to pro coagulation, inflammation, SM hypertrophy, and increased ECM.
Happens between Internal elastic membrane and endothelium
Growth factors the cause smooth muscle proliferation and ECM deposition
- PDGF
- FGF
- TGF-a
3 bad outcomes from atherosclerotic plaque in a vessel
- Aneurysm and rupture
- Occlusion by thrombus
- Critical Stenosis
True vs. False Aneurysm
True: intact endothelium and outpouching of all layers (similar to true diverticulum)
False: defect in wall that causes a space between muscular intima and adventitia
Describe a dissection
Tear in intimate that causes blood to collect in a new space between endothelium and muscle intima
Marfan Syndrome
Defect in Fibrillin-1 gene Increased TGF-B causes elastic weakening MVP Arachnodactyly Lense subluxation
Ehlor Danlos Syndrome
Defect in collagen synthesis Hypermobile joints Berry Aneurysms Stretchy skin Poor wound healing
What can an infection with treponema pallidum cause in the CV system?
Tertiary Syphillis can cause:
Aortitis
destruction of vasa vasorum (obliterative endarteritis)
Leads to Thoracic aortic aneurysm and Aortic valve regurge
Number one cause of AAA
Atherosclerosis
Remember the number one cause of Thoracic aortic aneurysm is HTN
What demographic should AAA be on the differential for?
Smokers and men >50y with abdominal pain, hypotension
What diameter is the threshold for a non ruptured AAA to consider surgery
5cm
4 causes of a thoracic aortic aneurysm
- HTN
- Syphilis
- CT disorders (Marfan’s, Ehler-Danlos)
- Temporal and Takayasu Arteritis
Triad of findings to consider an Aortic Dissection
- Thoracic pain
- Pulse abnormal
- Mediastinal widening
Describe the Debakey dissection types
Debakey I: Includes the aortic arch, ascending, and descending (most common)
Debakey II: Ascending aorta only
Debakey III: descending aorta only
Temporal Arteritis
- Older >50y
- Unilateral HA
- Potential vision loss
- Anti-endothelial Ab
- Start Steroids right away
Takayasu Arteritis
- Younger
- “Pulseless” Disease
- Fever, Myalgia, Arthritis, Vision issues, Night sweats
- Mononuclear infiltrates
PAN
- Hep B association
- Type III HS (Immune-complexes)
- Black stool
- Malignant HTN
Kawasaki Disease
- Infants and children (most common acquired heart disease in children)
- Conjunctivitis
- Fever
- Coronary Aneurysm
- Strawberry tongue
- Give Aspirin to the kid
Churg-Strauss Syndrome
Eosinophilic Granulomatosis
- Asthma, hypereosinophilia, lung infiltrates
- MPO-ANCA
- Can cause cardiomyopathy/myocarditis and infarction
Wegner’s Disease
- PR3-ANCA
- Sinusitis
- Saddle nose
- Nasal Perforation
- Glomerulonephritis
- Cavitary Lung granulomas
Behcet’s Disease
Becky gives blowjobs and gets cum in her eye on a B-51 plane
Genital and mouth ulcers, uveitis
HLA-B51
Buerger Disease
Acute and Chronic thrombosis in tibial and arterial arteries.
Smokers <35y
Raynauds Phenomenon
Vasospasm of small arteries
Primary: Symmetric involvement of digits with spontaneous remission
Secondary: Asymmetric involvement with progression
Myocardial Vessel Vasospasm
Excessie vasoconstriction of coronary vessels Caused by: 1. cocaine, caffeine 2. Epinephrine/NE release 3. Elevated thyroid hormones 4. Autoimmune
Takotsubo Cardiomyopathy
“Broken Heart Syndrome”
Myocardial vessel vasospasm caused by emotional distress that leads to a surge of catecholamines
Varicose Veins
Stasis and congestion in superficial veins caused by valvular incompetence.
Can lead to stasis dermatitis
Vena Cava Syndromes
Obstruction of the SVC or IVC by neoplasms or thrombi causes dilation of veins. Can cause swelling, distention, and edema
Lymphangitis
inflammation of lymphatic channels
Most commonly caused by Group A B-hemolytic strep
Describe Peau d’ orange sign
draining lymphatics of skin overlying breast cancer cells shows a pitting edema
Nevus Simplex
Birth mark that regresses over time
Port-wine stain
angioectasia that usually persists into adulthood
Sturge-Weber Syndrome
Trigeminal port wine nevi accompanied by mental retardation, seizures, and skull radio-opacities
What is the most common benign tumor of infancy and childhood?
Hemangiomas
Most common type of Hemangioma
Capillary Hemangioma found on skin, membranes, or viscera
Strawberry Hemangioma
Present at birth, usually regress
Cavernous Hemangioma
Dilated vascular channels making an indistinct lesion
Pyogenic Granuloma
Pregnancy tumor often in oral mucosa
What diseases are Cavernous lymphangiomas associated with?
Turner Syndrome
Down’s
Klinefelter
What skin finding is associated with Catscratch Disease?
Bacillary Angiomatosis: benign, red papules
