Week 3 - CVS Flashcards
Leg ulcers, Vasculitis, Vein disorders
What is the major complication of DVT
Pulmonary embolism
-thrombus in leg veins can get separated to form an embolus which gets carried into heart via IVC –> pulmonary circulation –> blocks major vessel –> infarction
What is a major complication of giant cell arteritis?
Visual loss –> optic nerve ischaemia
True or False?
Polyarteritis Nodosa is not ANCA+
True
What is a significant complication of polyarteritis nodosa?
acute renal failure
What are clinical manifestations of DVT?
- oedema
- heat
- tenderness
- redness
- swelling
- cyanosis
- pain –> clinical exam = Homan Sign (forced dorsiflexion of foot causing pain behind knee)
Differentiate between thrombophlebitis + phlebothrombosis
Thrombophlebitis = venous thrombosis formation causing inflammation and pain
Phlebothrombosis = venous thrombosis formation in absence of inflammation
What is hyperhomocysteinemia? And what are common causes?
- increased levels of homocysteine in the body
- may predispose to arterial thrombosis and venous thromboembolism due to injury of vascular endothelial cells (inflammation)
*common causes = acquired deficiencies (FOLATE/B12)
What is Virchow’s Triad?
- BV injury
- Hypercoagulability
- Stasis
Why does tortuous dilation occur in superficial veins and not deep veins?
- deep veins are supported by muscle/fascia, whereas superficial veins are not
- when reversal of blood flow occurs from deep –> superficial, vessels dilate and become tortuous (VARICOSE VEINS)
What is the pathogenesis of varicose veins?
- normally, muscles (calf) push venous blood back to heart
- blood travels from superficial veins –> deep veins –> heart (with backflow prevented by valves)
- in congenital valve conditions/immobilisation causing decreased muscle activity –> accumulation of blood due to lack of activity of the muscle pump –> blood falls back and pools (reversal of flow) –> this high pressure blood goes back from deep to superficial veins –> superficial vessels have no support from muscles/fascia –> develop tortuous dilatation (VARICOSE VEINS)
True or False?
Pulmonary embolism is a common complication of varicose veins
False
-v. rare as blood clot does not go back to deep then to heart due to reversal of flow in varicose veins
What are varicose veins?
- tortuous superficial veins due to increase pressure and weak wall (reversal of flow)
- congenital or acquired (obesity, pregnancy, long-standing jobs, immobilisation, etc.)
- valve defect in deep veins of lower limbs
Clinically, what is the most common disorder of veins?
Varicose veins
What is pyogenic granuloma?
- moist growth over wound resulting from excess formation of granulation tissue
- commonly on gingiva or palmar surfaces of fingers
- NOT a true tumour
What is takayasu arteritis?
- similar granulomatous vasculitis to giant cell arteritis but in younger patients (<50yrs)
- severe obstruction of major vessels –> pulseless disease
What is giant cell arteritis typically referred to as?
Temporal arteritis
-typically affects temporal artery
What is the commonest cause of organ ischaemia/infarction in all lifestyle disorders (i.e. DM, HTN, etc.) and its 2 types?
Arteriolosclerosis - microangiopathy
- Hyaline –> DM
- deposition of proteins in the BV wall - Hyperplastic –> HTN
- proliferation of smooth muscle fibres
What is the common laboratory finding in immune-mediated vasculitis?
ANCA+ –> Anti-Neutrophil Cytoplasmic Antibody
-formation of Abs which react with cytoplasm of neutrophils which then cause damage to the BV
What are the 2 large arteries?
Aorta & Pulmonary artery
What is arteriosclerosis?
hardening of ANY artery
- atherosclerosis
- arteriolosclerosis
- monkeberg medial sclerosis
True or false? All medium (muscular) arteries are named according to location
True - i.e. renal, cerebral, iliac, etc
Which arteries hold the majority of blood
Arterioles
- capacitance vessels
- function to maintain BP
What are the features of infectious ulcers?
- irregular, non-specific
- usually multiple
- associated with lymphadenitis
What are the causes of infectious ulcers?
simple strep/staph infections –> TB, Treponema, etc
What are the features of malignant ulcers?
A-asymmetry B-border irregularity C-colour change D-diameter > 6mm E-evolving
- irregular, punched out, caving or with tumour
- frequently painless
- lymph nodes, spreading, metastasis, cancer cachexia (wt. loss, etc.)
What are the causes of malignant ulcers?
- UV rays
- idiopathic
What are the features of neuropathic ulcers?
- clean, caving, callus
- punched-out ulcers, deep caving
- frequently painless - absent or weak pulses
- often with surrounding calluses (hyperkeratosis)
- probing/debriding –> brisk bleeding (arteries still intact)
- occur typically on pressure points
- may have impaired sensation + diminished positional sense or 2-point discrimination –> typical of nerve damage from DM in particular
What is the cause of neuropathic ulcers?
- due to lack of sensation (nerve fibre damage)
- happens in regions exposed to constant pressure
- no pain felt by patient
What are the features of arterial leg ulcers?
- dry, dark, painful (gangrenous)
- cold, pale, absent or weak pulses
- irregular, clear border
- pale granulation - does NOT bleed on touch
- painful (nocturnal) –> partly relieved by dependency
- skin –> shiny, loss of hair (atrophy)
What is etiology of arterial leg ulcers?
- due to block in the artery
- ATHEROSCLEROSIS
What are the features of venous leg ulcers?
- large, irregular, shallow
- wet, oedematous, oozing
- moist granulating base –> bleeds on touch
- surrounding eczematous stasis dermatitis (woody oedema)
- mild pain –> relieved by elevation (helps venous drainage)
- compression bandages helpful
What is the pathogenesis of the stasis dermatitis (woody oedema) in venous leg ulcers?
-due to accumulation of excretory waste products from venous pooling causing inflammation and infection to surrounding skin
What is the etiology of venous leg ulcers?
- commonest = varicose veins
- due to lack of venous drainage –> obstruction to venous flow –> stasis of blood
True or False?
Diabetes can cause venous leg ulcers
False
-can only cause arterial, neuropathic and infectious ulcers
Where are venous leg ulcers typically found?
COMMONEST
-gaiter region (above lateral/medial malleolus)
What is Raynaud’s phenomenon vs. Raynaud’s disease?
-both are vasoconstriction of digital arteries resulting in alternating areas of pallor and cyanosis in digits
Disease = primary (i.e. no other associated disorders)
- hyperactive BV
- cold/emotional trigger
- increase in young women
- normal microscopy
Phenomenon = secondary to other BV disorders
-immune vasculitis, SLE, Buerger’s disease, atherosclerosis, etc
What is Kaposi sarcoma?
- malignant tumour of BVs –> angiosarcoma
- common in HIV pts. –> terminal stages of AIDS
- caused by HHV-8
Many types:
- classic KS
- endemic African KS
- transplant-associated
- common HIV-associated
What is Buerger’s disease?
- thromboangitis obliterans (totally blocking arteries)
- segmental inflammation with thrombosis of small/medium arteries
- strong association with smoking
- severe, painful peripheral gangrene
What is Wegner’s granulomatosis?
- rare vasculitis of small BVs
- granulomatous inflammation around BVs
- typically affects lung
- antiproteinase-3
What is polyarteritis nodosa?
- systemic necrotising vasculitis
- renal NOT lungs
- nodule formation over arteries
- leads to severe gangrenous death of tissue
- acute fever, myalgia, arthralgia, malaise, rash, wt. loss
- neuropathy, KIDNEY FAILURE
- produces necrotic ulcers (DDx. for leg ulcers)
What is giant cell arteritis?
- granulomatous inflammation of medium and large arteries
- leads to fragmentation of internal elastic lamina with giant cells and thrombosis
- clinically presents as painful, thickened, nodular temporal arteries
- segmental involvement –> doesn’t involve whole BV wall thickness
- usually pts. >50
What is the etiology of DVT?
Virchow’s Triad
True or False?
Oral contraceptives are a risk factor for DVT
True
-can produce a hypercoagulable state
What are the clinical complications of varicose veins?
- stasis dermatitis
- ulcers
What is monkeberg medial sclerosis?
- medial calcific sclerosis
- intimal and media fibrosis and calcification (no obstruction)
What is the pathogenesis of DVT?
Virchow’s triad factors cause thrombosis –> typically in lower legs due to increased blood stagnation –> obstruction –> stasis
Apart from varicose veins in lower limbs, where else should it be noted for vein dilation to occur?
- eosophageal varices
- haemorrhoids
Is DVT usually unilateral or bilateral?
Unilateral
What are the risk factors for DVT?
- immobility
- surgery/trauma
- increased oestrogens (OCP/preg.)
- medical condtions –> cancer, heart failure, nephrotic syndrome, autoimmune disorders
- other –> age, varicose veins, FHx., PMHx., congenital, smoking, obesity
