Vascular specifically Flashcards
What are the 5 main causes of vascular disease?
Gradual obstruction (Atherosclerosis/arteriolosclerosis) Sudden obstruction (thrombosis, embolus) Aneurysm/dissection Vasculitis Extrinsic vascular compression
What type of vessel is most often atherosclerotic?
Larger vessels (aorta, medium/large arteries)
What is meant by “essential” HTN?
Basically, nobody knows the precipitating factor…which also means nobody knows how to cure (treat)
What percentage of HTN cases are deemed “essential”?
95%
What is a big risk of a diabetic with HTN?
Both arteries and arterioles become obstructed
Arteriolosclerosis is a non-bypassable disease
What is the most common cause of life-threatening vascular events?
Sudden luminal occlusion
What is the most common cause of sudden luminal occlusion?
Unstable atheromatous plaques
What is always considered the source of an embolus?
Heart until proven otherwise
Besides thrombosis/embolus what else can cause a sudden occlusion?
A dissection can occlude orifices of exiting arteries (think about an aortic dissection)
What is the typical site of a DVT?
Iliofemoral veins
What are some general causes of DVT?
Surgery/trauma/sepsis
Congenital/acquired hypercoagulable state
What is the concern of a DVT?
PE and sudden death
How can a DVT be screened for?
D-dimer
CT angiography
What can cause a bowel infarct or Budd-Chiari syndrome?
Splanchnic venous thrombosis
What is almost always the underlying cause of unexplainable thrombi in atypical locations (mesenteric, portal, hepatic, cerebral)?
Congenital/acquired systemic hypercoagulable state
What are the two primary causes of wall weakening leading to an aneurysm?
Atherosclerosis
HTN
Besides HTN and atherosclerosis, what else can lead to a weakened wall and eventually an aneurysm?
Inherited connective tissue disease (Marfan’s)
Vasculitis (Takayasu’s and giant cell)
Connective tissue/autoimmune diseases
Infection of aortic/arterial wall
Where is atherosclerosis most likely to cause an aneurysm in smokers?
Infra-renal abdominal aorta
Where is HTN most likely to cause an aneurysm?
Ascending aorta
What are the concerns with an aneurysm?
Rupture
Exsanquination (fancy word for draining)
What type of aortic dissection involves the descending aorta and/or the aortic arch?
Type B
What does a type A aortic dissection involve?
Ascending aorta +/- distal aorta
What is the most likely pre-disposing factor in a patient over 40 with an aortic dissection?
HTN
What is the most likely pre-disposing factor in a patient under 40 with an aortic dissection?
Inherited connective tissue disorder (Marfan’s)
What arteries can be occluded by an aortic dissection?
Coronary Arch vessels Celiac Mesenteric Renal
Besides arterial occlusion, what are other possible complications of an aortic dissection?
Rupture into pericardial sac or left thorax
Acute aortic valve regurgitation/CHF
What does ANCA stand for?
Anti-Neutrophil Cytoplasmic Antibody
Are ANCA-associated vasculitides bad?
Very bad, high mortality
Very aggressive visceral vasculitic disease
What are two non-adult causes of vasculitis?
Henoch-Schnolein Purpura (IgA-related vasculitis) Kawasaki disease (risk of coronary vasculitis)
What is most commonly affected in vasculitis of middle-aged/elderly?
External carotid
What is the usual cause of vasculitis in middle-aged/elderly?
Giant cell (temporal) arteritis
What is a risk of vasculitis of middle-aged/elderly?
Vision loss
How is external carotid vasculitis diagnosed?
Temporal artery biopsy
How is external carotid vasculitis treated?
Corticosteroids (it is an immune response)
What are two examples of ANCA-associated vasculitides?
Wegener's (Anti-PR3 Abs; c-ANCA) Microscopic polyangiitis (Anti-myeloperoxidase Abs; pANCA)
Besides Wegener’s and Microscopic Polyangiitis, what are some other examples of life-threatening vasculitis in adults?
Goodpasture’s syndrome
SLE
Polyarteritis Nodosa (PN)
Churg-Strauss syndrome
What is the differential with a pulmonary-renal syndrome?
ANCA-associated vasculitis
Goodpasture’s
SLE
What should be done if suspicion of Wegener’s or pulmonary-renal syndrome?
CXR or chest CT
What is the most common benign form of a vascular neoplasm?
Hemangioma
Where is a hemangioma most likely to form?
Skin (cherry/purple papules)
Besides the skin, where else might a hemangioma form?
Any visceral organ but usually liver, spleen, or soft tissue
What is a pyogenic granuloma?
Capillary hemangioma secondary to trauma
Rapidly growing and friable (crumbles?)
What are lymphangiomas?
Benign vascular neoplasms in the neck/axilla of children
What is a glomus tumor?
Glomus cell proliferation associated with vascular channels
Where are glomus tumors and are they noticed?
In the distal digits
They are PAINFUL
What form of benign vascular neoplasm is associated with a cat scratch species (Bartonella infection)?
Bacillary angiomatosis
What are vascular ecstasies?
Descrete lesions with dilated pre-existing vessels resembling hemangioma but a flat/non-papular
Sturge-Weber syndrome is an extreme form
What is a systemic vascular ecstasia syndrome with risk of serious bleeding?
Osler-Weber-Rendu (hereditary hemorrhagic telangiectasia)
What are arteriovenous malformations?
Tangled mass of arteries and veins without an intervening capillary bed
What is the risk of arteriovenous malformations?
High output heart failure
In brain, a rupture with fatal cerebral hemorrhage
What forms from a penetrating vascular injury?
An arteriovenous fistula
What are examples of low-grade malignant vascular neoplasms?
Kaposi’s sarcoma
Epitheliod hemangioendothelioma
What does a Kaposi’s sarcoma affect?
Skin +/- visceral involvement
What infections are Kaposi’s sarcoma associated with?
HHV-8
HIV
Where does an epitheloid hemangioendothelioma form?
Normally liver or soft tissue
What is an example of a high-grade malignant sarcoma?
Angiosarcoma
Where is an angiosarcoma likely to form in the elderly?
Skin of head/neck
What does an angiosarcoma look like?
An aggressive reddish/purple lesion in skin
What chronic diseases has an increased risk of developing an angiosarcoma?
Chronic lymphedema
Stewart-Treves Syndrome
Who has Stewart-Treves syndrome?
Post-mastectomy/radiation/axillary dissection patients