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CPR Exam 1 > Vascular Structure/Function, Vascular Anomalies, and Vascular Response to Injury > Flashcards

Vascular Structure/Function, Vascular Anomalies, and Vascular Response to Injury Flashcards

1
Q

There are 3 concentric layers to a blood vessel. What are they?

A

Intima
Media
Adventitia

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2
Q

Describe the 3 layers of blood vessels (intima, media, and adventitia). Make sure to mention differences in arteries vs. veins.

A

Intima = single layer of endothelial cells

Media:

  • arteries = well organized concentric layers of smooth muscle
  • veins = haphazard

Adventitia = external to media, often separated from media by wide external elastic lamina

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3
Q

What layer separates intimate from media?

A

Internal elastic lamina

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4
Q

What are the 3 types of arteries?

A

Elastic arteries
Muscular arteries
Arterioles

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5
Q

Describe elastic arteries. What are they predominantly made up of and how does this affect its function?

A

They have a high elastin content which allows expansion during systole and recoil during diastole

Propels blood toward organs

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6
Q

How are elastic arteries affected by age?

A

Increasing age leads to less compliance leading to increased blood pressure

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7
Q

Describe muscular arteries.

A

Circumferentially oriented smooth muscle

Arteriolar smooth muscle contraction = vasoconstriction
relaxation = vasodilation

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8
Q

Describe arterioles.

A

Principal point of physiologic RESISTANCE to blood flow

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9
Q

How do you calculate resistance?

A

Resistance to fluid flow is INVERSELY proportional to 4th power of diameter

R ~ nL/r^4

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10
Q

What is vasa vasorum?

A

“vessels of the vessels”, small arterioles supply O2 to outer media of large arteries

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11
Q

Where might you see Large Elastic Arteries?

A

Aorta and its major branches (common carotid, iliac, pulm art)

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12
Q

Where might you see Medium Sized Muscular Arteries?

A

Smaller branches of the aorta (coronary and renal)

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13
Q

Where might you see Arterioles?

A

Within tissues and organs

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14
Q

Describe capillaries.

A

Diameter of an RBC, no media, pericytes (resemble smooth muscle cells)

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15
Q

Describe veins. How are they structured compared to arteries?

A

Most inflammatory reactions, vascular leakage, and leukocyte exudation

Larger lumens, thinner and less organized walls; contains about 2/3 of total blood volume

Less rigid = susceptible to dilation and compression, as well as infiltration by tumors and inflamm. processes

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16
Q

What are venous valves?

A

Valves in the extremities to prevent venous reverse flow due to gravity

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17
Q

Describe lymphatics. How are they structures? What is their function?

A

Thin walled, lined by specialized endothelium

Return intestinal tissue fluid and inflammatory cells to bloodstream

Transport bacteria and other materials
Tumor cells = pathway for disease dissemination

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18
Q

What are the pressure differences between arteries and veins?

A

Arteries have a HIGH pressure system

Veins have a LOW pressure system

19
Q

What are the 3 vascular anomalies?

A

Aneurysms
Arteriovenous malformation (AVM)
Fibromuscular dysplasia

20
Q

What are aneurysms? When do they occur?

A

Localized abnormal dilation of blood vessel or the heart

Not present at birth, but develop over time due to underlying defect in the media of vessel

21
Q

What are arteriovenous malformations (AVMs)?

A

Tangle, worm-like vascular channels with prominent PULSATILE arteriovenous shunting with high blood flow

Arteriovenous shunting = arteries –> veins WITHOUT intervening capillaries

22
Q

What can AVMs ultimately lead to?

A

Large or multiple AVMs may shunt blood from arterial to venous circulation, forces heart to pump additional volume leading to high-output cardiac failure

23
Q

What is fibromuscular dysplasia? When does this occur?

A

Focal irregular thickening in medium and large muscular arteries (renal, carotid, splanchnic, and vertebral vessels)

Usually developmental defect, but can arise form trauma, etc.

24
Q

What is HTN a consequence of?

A

Increase tone in small muscular arteries and arterioles

25
Q

What is the defining characteristic of a berry aneurysm?

A

“The WORST headache I’ve ever had”

26
Q

Where do Berry aneurysms typically occur, what part of this area is the most common site? What disease could they be characteristic of?

A

Circle of Willis
90% of berry aneurysms found near major branch points of the ANTERIOR circulation

AD polycystic kidney disease

27
Q

What is most clinically significant of berry aneurysms?

A

It is the most frequency cause of subarachnoid hemorrhage

1/3 of ruptures associated with acute increases in intracranial pressure

28
Q

How can mycotic aneurysms arise? Can you give me an example of when you may get a mycotic aneurysm?

A

Embolization of a septic embolus, usually complication of infective endocarditis

Extension of adjacent suppurative process

Circulating organisms directly infecting the arterial wall

EX: Pts with cardiac disease may get these aneurysms

29
Q

What are fusiform and giant aneurysms?

A

Fusiform aneurysms bulge from all sides of an artery and do not have a neck (unlike berry)

Giant aneurysms will involve more than one artery and be over 2.5 cm wide

30
Q

How can AVMs form?

A

Result from rupture of an arterial aneurysm into adjacent vein

Penetrating injuries that pierce arteries and veins

Inflammatory necrosis of adjacent vessels

31
Q

When is an AV fistula useful?

A

Surgically generated AV fistulas provide vascular access for chronic hemodialysis.

Joining the artery and vein together makes the vein stronger by thickening it due to the high pressure system of the artery. It also provides better access to the blood as it will get taken from the vein, cleaned, and put directly back into the artery.

32
Q

What is fibromuscular dysplasia?

A

Focal IRREGULAR thickening in medium and large muscular arteries (renal, carotid, splanchnic, and vertebral vessels)

Can develop aneurysms that may rupture

33
Q

What is the cause of fibromuscular dysplasia? In who is it most likely seen?

A

Unknown, probably developmental

Young women
First degree relatives have increased incidence

34
Q

What conditions may arise form fibromuscular dysplasia?

A

Medial and intimal hyperplasia leading to luminal stenosis

Renovascular HTN due to fibromuscular dysplasia of renal arteries

35
Q

What is the marked appearance of fibromuscular dysplasia? What imaging is needed to confirm dx?

A

String of beads

Seen in Angiography - needed

36
Q

Describe the normal expression of vascular endothelial cells.

A

Non-thrombogenic surface = maintains blood in fluid state

Modulate medial smooth muscle tone = influence vascular resistance

Metabolize hormones (angiotensin)
Regulate inflammation
Affect growth of other cell types (esp smooth muscle cells)
37
Q

What is endothelial activation? Explain in detail.

A

When an injury (turbulent flow, HTN, cigarette smoke, lipid products, etc) leads to change in expression of endothelial cells.

Increased expression of procoagulants, adhesion molecules, and pro inflammatory factors

Altered expression of chemokine, cytokines, and growth factors

38
Q

What is the initial event following vascular injury?

A

Endothelial activation

39
Q

What is endothelial dysfunction?

A

Alteration in phenotype of endothelial cells leading to pro inflammatory and prothrombogenic states

Initiation of thrombus formation, atherosclerosis, and vascular lesion of HTN

40
Q

Describe the conditions that vascular smooth muscle cells are responsible for.

A

Vascular Repair and atherosclerosis

41
Q

What is the function of vascular smooth muscle cells?

A

Ability to proliferate
Synthesize collagen, elastin, and proteoglycans
Elaborate growth factors and cytokines
Vasoconstriction/vasodilation

42
Q

What is intimal thickening?

A

Stereotypical response of vessel wall to any insult/injury

43
Q

Describe the process of intimal thickening.

A

Associated with endothelial cell dysfunction or loss
Stimulates smooth muscle cell recruitment and proliferation and associated matrix synthesis

Neointimal smooth muscle cells are motile, undergo cell division, acquire new biosynthetic capabilities

They can return to nonproliferative state with normalization of endothelial layer

The healing response results in intimal thickening that may impede blood flow

44
Q

In a step wise fashion, describe the response to vascular injury.

A
  1. Recruitment of smooth muscle cells or smooth muscle precursor cells to intimal
  2. Smooth muscle cell mitosis
  3. Elaboration of extracellular matrix

CPR Exam 1 (11 decks)

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