Blood Vessels Flashcards by Denisse Tiangco

Mutations in ENaC leading to inc tubular resorption by aldosterone

Liddle syndrome

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Mechanisms of Essential Hypertension (4)

1 Reduced renal sodium ex
2 Inc vascular resistance
3 Genetics
4 Environment

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Benign hypertension
Homo pink hyaline with thickening of arteriolar wall
Sometimes with nephrosclerosis

Hyaline arteriolosclerosis

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Typical severe hypertension
Onionskin concentric laminated thickening and luminal narrowing
Necrotizing arteriolosclerosis

Hyperplastic arteriolosclerosis

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Hardening of arteries

Arteriolosclerosis

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Calcific deposits in muscular arteries
Older than 50
Do not encroach lumen not clinicially
significant

Monckeberg medial sclerosis

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Presence of intimal lesions atheromas

Atherosclerosis

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Strongly and independently predict risk of MI stroke PAD SCD even in healthy

CRP level

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Atheroma development

Endothelial injury -> endothelial dysfunction and mac and smooth muscle activation ->mac and smooth ms engulf lipid -> smooth ms prolif collagen, ECM, lipid deposition

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Minute yellow plaque macules that coalesce into elongated lesions made up of lipid filled foamy mac but do not cause significant flow disturbance
Forms as early as <1 yr

Fatty streak

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Most involved vessels in atherosclerotic plaque formation:

Infrarenal abdominal aorta > coronary arteries > popliteal arteries > ICA > circle of Willis

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Atherosclerotic plaque 3 principal components:

1 cells (smooth muscle or foam cell, mac and T lymphocytes)
2 ECM (collagen, elastic fibers, proteoglycan)
3 intracellular and extracellular lipid

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When plaque exposes highly thrombogenic constituents

Plaque rupture/fissuring

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Thrombogenic subendothelial membrane exposed to blood

Erosion/ulceration

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Expansion of volume by plaque

Hemorrhage into atheroma

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Plaque inflammation induces

collagen degradation

reduced collagen synthesis

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True aneurysms

Involve all three layers of artery

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False aneurysm

Pseudoaneurysm

Wall defect becoming extravascular hematoma communicating with intravascular space (pulsating)

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Pressured blood enters arterial wall through defect and pushes apart underlying layers

Arterial dissection

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Discrete outpouchings 5-20cm with thrombus

Saccular

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Circumferential dilations up to 20cm involving aortic arch, abd aorta and iliac arteries

Fusiform

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Aneurysms occur bec (4)

1 inadequate abnormal CT synthesis
2 excessive CT degradation
3 loss of smooth muscle cell or change in smooth muscle cell synthetic phenotype

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Abnormal sequestration of tgf b in wall leading to dilation and dysregulating signalling and loss of elastic tissue

Marfan syndrome

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scaffolding protein defective in Marfan

fibrillin

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Mutation in tgf b result in

1 defective elastin | 2 defective collagen synthesis

Type IV Ehrlos Danlos results fr

Defective Type III collagen synthesis with aneurysm skin ligament blood vessel

``` Narrowing of aortic vasa vasorum fr sys HTN and ischemia Smooth muscle cell loss Aortic degenerative changes (fibrosis) Inadequate ECM synthesis Inc amorphous proteoglycan ```

Cystic medial degeneration

Most important causes of aneurysm (2)

1 atherosclerosis | 2 hypertension

Factor in abdominal aneurysm

Atherosclerosis

Ascending aortic aneurysms

Hypertension

Embolization of septic embolus fr infective endocarditis Extension of suppurative process Direct infection of wall

Mycotic aneurysm

Tertiary syphilis has predilection for

Vasa vasorum of ascending THORACIC aorta

Immune response to spirochetes attacking thoracic aorta

Obliterative endarteritis

Men Smokers More than 50 Plaques compromising diffusion of nutrients and waste bet lumen and wall compressing media leading to necrosis and thinning

Abdominal Aortic Aneurysm AAA

Distinct subtype of with dense periaortic fibrosis with lymphoplasmacytic inflammation mac giant cell

Inflammatory AAA

Risk of aneurysm rupture is determined by

Size

Never bursts

AAA =4cm diameter

4-5cm

1% chance rupture

5-6cm

11% per year

>6cm

25%

AAA Managed surgically

> 5cm

``` Encroachment of mediastinal structure Cough fr irritation of recurrent Pain by erosion of bone Cardiac from valvular insuff or narrowing of ostia Aortic rupture ```

Thoracic Aortic Aneurysm

Blood splays apart laminar planes of media forming blood-filled channel within wall

Aortic dissection

Dissecting hematoma reenters lumen of aorta through second distal intimal tear creating second vascular channel

Double barreled aorta | Chronic dissection

Ascending aorta isolated

DeBakey II | Proximal Type A dissection

Ascending aorta with descending aorta

Debakey I | Proximal Type A

Beyond sublavian

Debakey type III | Distal Type B

Sudden excruciating tearing stabbing pain beginning on ant chest radiating between scapula moving downward as tearing progresses

Aortic dissection

Most common cause of death in AD

Rupture of dissection into pericadial, pleural and peritoneal cavity

Pathogenic mechanisms of vasculitis (2)

1 immune mediated | 2 direct vascular invasion by pathogen

Mech underlying non infectious vasculitis (4)

1 immune complex 2 antineutrophil cytoplasmic antibodies (ANCA) 3 anti-endothelial cell ab 4 autoreactive T cell

Antibody production assoc in drug hypersensitivity vasculitis (penicillin) infection vasculitis

Immune complex assoc vasculitis

ANCAs (antineutrophilic cytoplasmic antibodies) against enzymes of granules Diagnostic markers that mirror severity

ANCA vasculitis

Neutrophil azurophilic granule sharing homology of bacterial peptides Assoc with

Antiproteinase-3 PR3 ANCA Wegener granulomatosis

Lysosomal granule involving free radical generation Induced by PTU assoc with

Anti-myeloperoxidase (MPO-ANCA) P-ANCA Microscopic polyangiitis Churg Strauss syndrome

ANCA Vasculitis are pauci immune bec

They do not contain antibody-complement in lesions

Most common form of vasculitis in elderly

Giant cell Temporal arteritis

Granulomatous inflammation of large to small sized arteries supplying head Temporal Vertebral Opthalmic Aorta

Giant cell Temporal arteritis

Giant cell arteritis is caused by

T cell mediated immune response to vessel wall antigen TNF and endothelial cell antibody MHCII Responds to steroids

Patchy nodular granulomatous inflamm in inner media on INTERNAL ELASTIC MEMBRANE multinucleated giant cell fragmentation of IEL

Giant cell temporal arteritis

Giant cell dx tx

Biopsy histology Corticosteroids TNF

granulomatous vasculitis of medium and large arteries with transmural scarring and thickening of aorta (pulseless) Ocular disurbance Weakening of pulse in UE Less than 50, autoimmune etiology

Takayasu arteritis

Takayasu classically affects

aortic arch and arch vessel 50% pulmonary artery, renal coronary

Systemic vasculitis of small and medium muscular artery involving renal and visceral vessel sparing pulmonary circulation Assoc with chronic hep B Segmental transmural necrosis, inflammation and thrombosis Kidney heart liver

PAN

Acute phase transmural inflammation infiltrate neutrophils and mononuclear cells accompanied by All stages of activity in PAN COEXIST

Fibrinoid necrosis and thrombosis

Rapidly accelerating HTN with renal involvement Abdominal pain bloody stool Diffuse muscular ache and pain Peripheral neuritis of motor nerves Renal major cause of death

PAN

Arteritis of large and medium vessel with involvement of coronary artery causing aneurysms and MI Infectious trigger Delayed type hypersensitivity Cytokine and B cell activation

Kawasaki Disease

Transmural inflammation with less fibrinoid necrosis and accompanying aneurysm

Kawasaki

``` Conjunctival oral erythema Blistering edema of hands Erythema of palms and soles Desquamative rash Cervical LN enlargement (mucocutaneous LN) CV sequelae ```

Kawasaki

Necrotizing vasculitis affecting capillaries, small arterioles and venules characterized by segmental fibrinoid necrosis of media with focal transmural necrosis lesion Also called hypersensitivity or leukocytoclastic vasculitis

Microscopic polyangitis All lesions of the same age Pauci immune

``` 90% nec glomerulonephritis Pulmonary capilitis Hemoptysis Hematuria Proteinuria Abd pain Bleeding ```

Microscopic polyangitis

Wegener Granulomatosis triad:

Granuloma of lung URT Vasculitis small to med in lungs Glomerulonephritis

PR3 ANCA + Like PAN but with pulmo sx Nec granulomatous vasc with surrounding fibroblast prolif MAN 40 yrs with bilateral pneumonitis nodule and cavitary lesion, mucosal ulcer, renal disease Mort of 80% 1 yr

Wegener Granulomatosis

Wegener tx

Rituximab anti b cell cyclophosphamide Steroid

Allergic granulomatosis and angiitis Small vessel necrosis assoc with asthma, allergic rhinitis, lung infiltrate and eosinophil perivascular infiltration MPO ANCA+ Granuloma and eosnophil

Churg Strauss syndrome

``` Heavy smoker Before 35yrs Cold induced Raynaud phenomenon Instep claudication Superficial nodular phlebitis (venous inflamm) Gangrene of extremities ``` Sharply segmental acute and chronic transmural vasc of medium sized and small arteries with microabscess

Thromboangiitis obliterans | Buerger disease

Ischemic dilated myopathy assoc with emotional duress from cardiac raynaud

Takotsubo cardiomyopathy | Broken heart syndrome

Evanescent thrombosis in diff vascular beds at diff times from hypercoagulable states

Trousseau syndrome Migratory thrombophlebitis Pancreatic cancer

DVT risk factors

``` CHF pregnancy OCP Obesity Malignancy Post op immob ```

Common serious clinical complication of DVT

Pulmonary embolism

First manifestation of thrombophlebitis

Pulmonary embolus

Neoplasm bronchogenic ca or mediastinal lymphoma obstructing SVC Dilation of veins of head neck arms and lungs with cyanosis and respi distress

SVC syndrome

IVC result from

Compression or invasion of IVC by renal or HCC

Familial disease of agenesis or hypoplasia of lymphatics

Milroy | Heredofamilial congenital lymphedema

Permanent dilation of preexisting small vessels in skin and mucous membrane forming discrete red lesions

Telangectasia

Most common form of vascular ectasia

Nevus flammeus birthmark

Lesions on childhood thickening skin surface and do not fade with time occuring on distribution of trigeminal nerve assoc w Sturge Webber (encephalotrigeminal angiomatosis)

Port wine stain

AD by mutation of genes encoding TGF B | Dilated cap and veins and rupture

Hereditary hemorrhagic telangiectasia (Osler Weber Rendu disease)

Cavernous hemangiomas constitute a component of

von Hippel Lindau disease vasc lesions on cerebellum brainstem retina pancreas liver

Benign painful tumors from smooth muscle cells of glomus bodies involved in thermoregulation

Glomus tumors

Vascular proliferation in immunocompromised hosts caused by G- of Bartonella family Cats Homeless

Bacillary angiomatosis

vascular neoplasm by KSHV or HHV8 most common in AIDS

Kaposi sarcoma

Blood Vessels Flashcards

(92 cards)