Vascular System Flashcards
What causes HTN?
95% idiopathic: “essential HTN”
What positive affects are noted with a decrease in BP?
Deacreased risk of IHD, CHF, and stroke
Malignant HTN is considered thus by what BP range?
200/120: lethal within 2 years
What is early malignant HTN?
Papilledema, retinal hemorrhage
What is late malignatn HTN?
Renal failure
What is vascular injury?
Non-specific (stereotypical) response. Trauma, infxn, inflammation, immune reaciton
What are examples of endothelial activation?
Thrombosis, atherosclerosis
What are the 4 stages of vascular wall response to injury?
Endothelial injury/ dystunction
Smooth muscle cell recruitment
Growth of smooth muscle cell adn ECM
Irreversible intimal thickening (vessel stenosis = tissue ischemia)
What are the characteristics of arteriosclerosis?
“Hardening of the arteries”. Arterial thickening, deacersed elasticity
What is arterioLOsclerosis?
Small arteries/arterioles hardening (not arteriosclerosis). Possible ischemic injry (HTN, diabetes)
What is Monckeberg medial sclerosis?
Ca++ within tunica media. No stenosis: not clinically significant Age related, >50 years old.
What is the MC type of arteriosclerosis?
Atherosclerosis.
What are some features of arteriosclerosis?
Atheromas (plaques). Stenosis, aneurysm, dissection, thrombosis. Heart (CAD), brain, intestines, kidneys, legs.
What are some characteristics of hyaline arteriolosclerosis?
Benign HTN (chronic hemodynamic stress)
Prolonged DM
Luminal narrowing
Pink hyaline, Increased ECM
What are some characteristics of hyperplastic arteriolosclerosis?
Severe HTN
Luminal narrowing
“Onionskin appearance”
Kidney are most sensitive
What are some features of monckeberg medial sclerosis?
Dystrophic calcification
Idiopathic
Affects elderly
Incidental Dx: x-ray mammogram
99% of arteriosclerosis is….
Artherosclerosis
What is the #1 cause of morbidity and mortality in the US?
Atherosclerosis. CAD, MI, carotid atherosclerosis, stroke
Atheromas.
Where do atheromas protrude into?
Lumen, deacreasing flow (vascular stenosis)
Atheromas are prone to rupture, what happens with thsi?
Massive thrombosis,. Macrophages, lipids (foam cells), Ca++, dibris, MC cause of MI
What do atheromas weaken?
Tunic media -> aneurysm risk
What are foam cells?
Fat-laden macrophages
What do foam cells cause?
Possible blood flow obstuction (ischemia). CAD = 70% occlusion of coronary arteries
What are some hemodynamic distrubances that can cause atherosclerosis?
Turbulence.
Branch points or turbulent areas
What does chronic endothelial injury lead to?
Atherosclerosis
What are addtl risk factors for atherosclerosis?
Family Hx, increased age, males. Dyslipidemia, smoking, HTN, DM, stress, inflammation (C-reative protein), inactiity
What are the risk factors for MI?
Hyperlipidemia, HTN, smoking. Multiplicative: 2 of the risk factors = 4x risk, all 3 = 7x risk
What is metabolic syndrome?
Central obesity, HTN, insulin resistance, dyslipidemia, hypercoagulability/pro-inflammatory state (adipokines). Risk for cardiovascular disease
What are the consequences of atherosclerosis?
Stroke, AAA
MI, CHF
Peripheral vascular disease (PVD) -> gangrene
What is an aneurysm?
Local vascular dilations (ballooning).
What are some complications associated with an aneuryism?
Stasis -> thromboembolism
Thinned wall -> rupture/hemorrhage
What is a true aneurysm?
All 3 layers of a vessel of heart wall. Saccular aneurysm (one sided bulge), Fusiform aneurysm (both sides bulge)
What is a false aneurysm?
Defect in a vascular wall, extravascular hematoma. Communicates with lumen = pulsatile
Where do true aneurysms happen?
Aortic arch
Abdominal aorta
Iliac arteries
What are risk factors for aneurysms?
HTN/atherosclerosis: ischemia of tunica media
Marfan syndrome, Ehlers-Danlos syndrome
What is an abdominal aortic aneurysm (AAA)?
Dilation of > 50% of normal.
Where is the MC location for AAA?
Between renal and common iliac arteries
What are some features that facilitate AAA?
Degeneration and necrosis of media and ECM. Inflammation: macrophages, MMPSs
Decreased diffusion: thinning of wall
What are some risk factors for AAA?
Males, smoking, >50 years, caucasian, familial Hx. of AAA, atherosclerosis, HTN
With is the Dx for AAA?
Ultrasounds or CT
T/F
People with AAAs are okay to be adjusted
True,
Being extremely cautious with any HV adjusting.
What can be obstructed in an AAA considering the aorta
Kidneys, spinal cord, G.I., legs. Mass effect: may compress ureters.
If an AAA produces emboli, what is a great risk factor?
Tissue infarct
What happens in AAA with rupture?
Hemorrhage
T/F
90% of AAA are Fatal
False,
Only 50% are fatal
What is an aortic dissection?
Blood enters the arterial wall “blood splays apart the laminar planes of the media to for a blood-filled channel inside the artic wall”
What are 2 types of aortic dissections?
Massive hemorrhage
Pericardial tamponade
What is the major risk factor for aortic dissection?
HTN: major risk factor, 90% of cases. Male 40-60 years. Adolescents/young adults with CT disorders (Marfans, Ehler-Danlos, Wilson disease)
T/F
Aortic dissection is commonly found in conjunction with substantial atherosclerosis
False,
Rare in presence of substantial athersclerosis (act as somewhat of a protection).
What is Wilson disease?
Autosomal recessive. Abnormal copper ion transpiration. Excessive copper accumulation.
What organs are affected by Wilson disease?
Liver: steatohepatitis
Brain: psychosis, parkinsonism
Eye: Kayser-Fleischer ring
What is pain like with aortic dissections?
Sudden & severe “treaing or stabbing”. Anterior chest, projects posteriorly between scapulae. Inferior radiation: progressive dissection.
What is a DDx for aortic dissections?
MI
What are complications associated with aortic dissections?
Depends on location
Type A: proximal
Type B: distal
What is vasculitis (vasculidites)
Inflammation of vascular wall
Local vessel destruction
MC in small arteries
Fever, malaise, myalgia, arthralgia, fatigue
What is infectious vasculitis?
Vascular invasion (e.g. Hep B)
What is non-infectious vasculitis?
Immune-mediated, ADRs. (e.g. SLE, penicillin)
What is are a few ancillary causes of vasculitis?
Irradiation, trauma (physical, chemical)
What is giant cell (temporal) arteritis?
MC vasculitis in older adults (> 50 years). Idiopathic, T cells, autoimmun ehypothesis
What vessels are involved in giant cell (temporal arteritis)?
Large and small arteries of head, patchy involvement (may involve an artery and not another very close to it)
- Temporal artery
- Ophthalmic artery: 50% diplopia/sudden blindness
- Vertebral artery & aorta (giant cell aortitis)
What are some features of giant cell (temporal) arteritis?
Facial pain, HA, pyrexia, vision distrubance. Granulomatous inflammation
What is the tx for giant cell (temporal) arteritis?
Corticosteroids
What is Takayasu arteritis?
“pulseless disease”. Granulomatous vasculitis (autoimmune hypothesis). Pronounced narrowing of lumen (aortic arch, branches off aortic arch,
What arteries are involved in Takayasu arteries?
Places where pulses are checked: radial, carotid, renal, pulmonary
What are some symtpoms/features of Takayasu arteritis?
Fatigue, fever, weight loss, pulmonary HTN
What is an example of the variety of neuro defects with Takayasu arteritis?
Visual disturbances (not as much as in temporal arteritis).
What age group is indicated in takayasu arteritis?
Younger individuals
What is polyarteritis nodosa (PAN)?
System-wide vasculitis, transmural necrosis (small and medium sized arteries).
What does PAN do to the vessels it affects?
Weakens walls -> aneurysm, hemorrhage, or ulceration. Tissue atrophy, ischemia, or infarction.
What tissues are MC affected by PAN?
Kidneys, viscera, heart, liver, GI (avoids pulmonary arteries oddly).
What are symptoms of PAN?
Episodic, widespread, constitutional. Weigth loss, fatigue, fever, malaise.
What age groups are MC affected by PAN?
Any age, but MC in young adults.
1/3 of anyone with PAN will have…
Chronic Hep B infxn (HBV antigen)
2/3 of anyone with PAN will ahve…
Idiopathic, automimmune hypothesis
How are myalgia and peripheral neuritis inolved in PAN?
Diffuse, motor defects
What artery is affected by PAN and causes rapid increase in BP (renovascular HTN)?
Renal artery
If someone has PAN and has abdominal pain, bloody stools (frank/obvious), what is happening?
PAN affecting GI arteries
What is the prognosis of PAN if untreated?
Fatal
What is the Tx for PAN?
Corticosteroids: 90% cure
What kind of dermatological features can be noted with PAN?
Widespread vascular lesions.
Segmental fibrinoid necrosis and thrombosis (biopsy)
What is kawasaki disease?
Pediatric vasculitis (80%
What % involvement is cardiovascular issues apart of kawasaki disease?
20%
What is the description of the damage of kawasaki disease?
Aneurysm or thromubs -> MI
T/F
Kawasaki disease is self limiting?
True
What determines the prognosis of Kawasaki?
Severity of CAD
Who recovers full from Kawasaki disease?
Patients without CAD
What tends to happen more often than not with aneurysms in kawasaki disease?
> 50% resolve within 2 years.
What is the cause of Kawaski diease?
Idiopathic, hypothesized type IV hypersens. Genetics + viral antigens. Rare, asian descent, males.
What is the hallmark of Kawasaki disease?
Actue/persistant fever. No response to ibuprofen or acetaminophen
What are some features of kawasaki disase?
Conjunctivitis, swollen extemities, cervical lymphadenopathy, desquamation of extremitites (de-squamous cell-ing), strawberry tongue (oral erythema)
What are the treatments for Kawasaki disease?
Aspirin, corticosteroids, CABG
What is Wegener granulomatosis?
Type II hypersensitivity. Necroptizing vasculitis -> ischemia
What is primarily involved with Wegener granulomatosis?
Kidneys, and upper/lower respiratory tracts: nose, nose/sinuses, trachea, lung
What are 3 major features of Wegener granulomatosis?
Granulomas
Sytemic vasculitis: small/medium arteries
Glomerulonephritis
What is the age group MC affected by Wegener granulomatosis?
Middle-aged (40- years old), males
What are some secondary features of Wegener granulomatosis?
Bilateral pneumonitis (95%0, couch, chest pain, hemoptysis, dyspnea Chronic sinusitis (90%)
What are some issue with renal disease associated with Wegener’s granulomatosis?
Hematuria, proteinuria, possible renal failure
What are some nasopharyngeal issues associated with Wegeners?
Inflammation/ulcers (75%). Rhinitis, sinusisits, nose bleeds
What is Thromboangiitis obliterans (Buerger disease)?
Medium-sized arteries. Inflammation, thrombosis -> vascular insufficiency.
What arteries are MC affected by Thromboangiitis obliterans?
Feet (tibial artery), hands (radial artery))
Who is most at risk for Thromboangiitis obliterans?
Heavy tobacco smokers: endothelial damage. Relieved with abstinence
What is MC affected by thromboangiitis obliterans?
Males, age 25-35 years
What kind of symptoms associated with ischemia is found in thromboangiitis obliterans?
Painful extremities, cyanosis/cold. Ulcerations, gangrene.
What are some symptoms of thromboangiitis obliterans?
Pain at rest
Exercise -> vascular claudication
Ulcerations and gangrene (amputation)
Possible Raynaud phenomenon.
What is raynaud phenomenon?
Exaggerated arteriole vasoconstriction. Pallor and cyanosis. Extremities: fingers, toes (nose, earlobes, lips).
T/F
Raynauds is a serious condition
False
Benign condition. Unless it’s chronic which can produce tissue atrophy - skin, CT, muscles.
When does raynaud onset?
Adolescent/young adults, MC in females
What is primary raynauds?
Cold and emotional, 5% of US
What is secondary raynauds?
Atherosclerosis, Buerger disease, Lupus (SLE), scleroderma, atherosclerosis
What is takotsubo cardiomyopathy?
“Broken heart syndrome” or “cardiac raynaud” or “stress cardiomyopathy”. Extreme psychological stress causing increased catecholamine production which may affect the coronary arteries, stimulating vasospasm increasing heart rate and contractility. Fatal arrythmia (V-fib). Possible cardiac ischemia -> MI
What is a veinous thrombosis?
Blood clot formation
What is a phlebitis?
Vein inflammation
What are the three conditions that make up 90% of venous diseases?
- Varicose veings
- Phlebothrombosis: venous thrombosis without previous inflammation (rare)
- Thrombophlebitis: venous thrombosis following inflammation (MC used term)
What are vericose veins?
Superficial veins: dilated and tortuous (Legs MC). INcreased intraluminal pressure. Dilation -> incompetent valves.
What are some features of vericose veins?
Congestion/edema, pain, thrombosis, ulceration.
What are some risks for vericose veings?
Obesity, genetics, pregnancy. MC a cosmetic concern
T/F
Vericose veins are high risk for the production of emboli?
False
No real association
What is thrombophlebitis?
Thrombosis and inflammation lOCALIZED CYANOSIS/ERYTHEMA, EDEMA, PAIN.
What is the major risk for thrombophlebitis?
Immobilization
Are DVTs involved in throbophlebitis?
DVTs (90% of all cases)
What are some other risks for throbophlebitis?
Recent surgery, pregnancy, obesity, immobilization, O.C., CHF, genetics
What is often produced with thrombophlebitis that causes fatality?
Possible pulmonary embolism. May be the 1st indication of thrombophlebitis
What is superior vena cava syndrome?
Compression or invasion of SVC. Bronchogenic carcinoma, mediastinal lymphoma congesting UE veings: edema (head, neck, arms)
What is inferior vena cava syndrome?
Compression or invasion of IVC
Hepatocellular carcinoma, renal cell carcinoma
Congestion of LE veins: edema, proteinuria
What is lymphedema?
Rare. Obstruction -> tissue expansion. Lymphatic obstuction -> inflammation.
What is primary congenital lymphatic abnormalities
Milroy disease (inherited). Hypoplasia or agenesis of lymph vessels
What is secondary obstruction of normal lymph vessels?
Neoplasia, infxn (filariasis), thrombosis, ribrosis (surgery)
What is Peau d’organge?
“Skin of an orange” acute lymphedema
What is the long-term consequence of lymphedema?
Brawny induration (hardening of the edemic tissues).
What tissues do vascular tumors originate from?
Endothelial cells
Connective tissue or vessels
MC benign
What is the MC benign vascular tumor?
Hemangioma
Occasionaly vascular tumors can be farily aggressive. What is the condition called?
Kaposi sarcoma
