CHAPTER 9 BLOOD VESSELS Flashcards
(179 cards)
1
Q
1 cause of morbidity and mortality in the U.S.
A
Vascular conditions
2
Q
Most vascular conditions are associated with _________?
A
Arteries
3
Q
What are the 2 main mechanisms of vascular disease?
A
- Narrowing or obstruction of lumen (e.g. atherosclerosis, thrombus, embolism)
- Weakening of the vessel walls causing dilation or rupture (e.g. abdominal aortic aneurysm)
4
Q
Arteriosclerosis is …
A
hardening of arteries (non-specific)
5
Q
Atherosclerosis is …
A
atheromas causing hardening of arteries
6
Q
Aneurysm is …
A
the ballooning of a vascular wall
7
Q
Dissection is …
A
the passage of blood through the layers of the walls
8
Q
Thrombus is …
A
blood clot within vessel wall
9
Q
Hypertension is …
A
Increase in arterial pressure (above 140/90)
10
Q
Varicosity is …
A
dilation of veins due to increased pressure
11
Q
DVT is …
A
blood clot in the calf, thigh or pelvis
12
Q
Angiosarcoma is …
A
a malignant neoplasm of endothelial cells
13
Q
What type of cell lines the normal cardiovascular system (CVS)?
A
Endothelial cells
14
Q
Characteristics of smooth muscle cells lining the CVS?
A
involuntary and non-striated
15
Q
What are larger, arterial or venous walls?
A
arterial
16
Q
Why are arterial walls larger?
A
to accommodate for pulsations and higher BP
17
Q
The 3 layers of vessel walls beginning with the inner layer are…
A
- Intima
- divided by an internal elastic lamina - Media
- divided by an external elastic lamina - Adventicia
18
Q
Blood supply to the vascular wall
A
Inner portion of Media- diffusion of blood from the lumen
Outer portion of Media- vasa vasorum
19
Q
Vascular pathway breakdown beginning with arteries…
A
Large elastic arteries,
Medium size muscular arteries,
Small arteries,
Arterioles,
-Capillary beds-
Postcapillary venules,
Collecting venules,
Progressively larger veins
20
Q
Where does vascular leakage (aka Edema) and leukocyte migration most commonly occur?
A
Postcapillary venules
21
Q
Vascular organization of veins is as follows…
A
Larger lumen and thin walls to accommodate low pressure
22
Q
Veins are more prone to…
A
Dilation, compression and penetration from metastasis or inflammation
23
Q
Vascular organization of lymphatic vessels…
A
Thin walled and lined with endothelial cells
24
Q
Lymphatic vessel functions are…
A
Drain lymph from interstitial fluid
Deliver lymph fluid to the lymph follicles and continuous monitoring of peripheral infections
25
What vessels may spread disease?
All vessels!
26
Function of endothelial cells lining vasculature...
Maintain non-thrombogenic interface b/w blood and vessel walls
Modulate inflammation and immunity
Regulate cell growth
*Functions vary by location*
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Trauma of endothelial cells may cause...
an upset to the anti-thrombogenic homeostatic balance
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What happens when trauma upsets the balance of endothelial cells lining vasculature and what is it associated with?
```
Endothelial activation- pro-inflammatory response "clotting"
Associated with:
-thrombosis
-atherosclerosis
-vascular lesions from HTN or diabetes
```
29
Are congenital anomalies symptomatic?
Rarely but important during surgical procedures!
30
3 notable congenital anomalies are...
1. Intracranial Berry Aneurysms- of the cerebral vessels (Circle of Willis), which are likely to rupture and may cause FATAL stroke
2. Arteriovenous (AV) Fistulas- that bypass the capillaries by connecting the arterial and venous systems, shunting blood past capillaries
3. Fibromuscular Dysplasias- cause vascular stenosis (ischemia) resulting from the thickening of arterial walls in medium and large arteries
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Most common of the 3 congenital anomalies?
Arteriovenous Fistulas
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Hypotension indicates...
Organ dysfunction (<90/60)
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Hypertension (HTN) indicates...
Vessel/End-organ damage, also is a risk for atherosclerosis
34
Regulation of BP is influenced by...
* Cardiac output (HR + SV)
* Peripheral (vascular) resistance
* Kidneys, adrenals, and myocardium influence blood volume by regulating sodium balance
35
How do kidneys influence peripheral resistance and sodium balance?
Via the renin-angiotensin system
36
What stimulates the release of renin?
Hypotension
37
Renin stimulates...
Angiotensinogen
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Angiotensinogen stimulates...
Angiotensin I
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Angiotensin I stimulates...
Angiotensin II
40
Angiotensin II stimulates...
Smooth muscle contraction and aldosterone
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What does aldosterone stimulate?
increased re-absorption of sodium
42
What do BP medications influence?
The renin-angiotensin system
43
How does adrenal aldosterone influence the renin-angiotensin system?
By increasing sodium re-absorption (+H2O) and excreting potassium
44
How are natriuretic peptides stimulated?
Blood volume expansion
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What effect do natriuretic peptides have?
Inhibition of sodium re-absorption (Increased excretion) and vasodilation
46
Hypertension increases the risk of...
Atherosclerosis
47
Hypertension is classified as...
BP > 140/90
48
HTN results in?
Damage to vasculature and end oragns
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HTN is also know as the...
"Silent Killer"
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HTN is a substantial risk factor for developing?
* Atherosclerosis
* Coronary Artery Disease (CAD)
* Stroke
* Hypertensive heart disease (Heart failure)
* aortic dissection
* Multi-infarct dementia
* Renal failure
* Hypertensive retinopathy
51
How welll are the mechanisms HTN understood?
Poorly
52
Risk Factors for HTN?
Age, African Americans
53
Cardiovascular risk (CAD & Stroke) are primarily concerned with which measurement?
Systolic BP
54
Reduction of BP has shown to decrease the incidence of...
* Ischemic Heart Disease
* Congestive Heart Failure
* Stroke
55
Malignant HTN statistics?
* BP (200/120)
* 5% of HTN patients
* Fatal within 1-2 years if untreated
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Without Treatment of HTN what are the statistics of fatality?
* 50% die from Ischemic Heart Disease (IHD) or Congestive Heart Failure
* 33% die from stroke
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Vascular response to injury?
1. Recruitment of smooth muscle cells
2. Mitosis of smooth muscle cells
3. Thickening of Intima/elaboration of ECM
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Vascular response to injury may result in?
Vascular stenosis within lumen from smooth muscle proliferation
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Vascular wall (Endothelial activation) contributes to?
* Thrombosis
* Atherosclerosis
* Hypertensive vascular regions
60
Arteriosclerosis is...
The hardening of arteries, arterial wall thickening, and decreased vessel wall activity
61
What are the 3 patterns of arteriosclerosis?
1. ArterioLOsclerosis
2. Monckenberg Medial Sclerosis
3. Atherosclerosis
62
ArterioLOsclerosis is...
Ischemic injury from vessel wall thickening and luminal narrowing of SMALL ARTERIES and ARTERIOLES
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Monckenberg Medial Sclerosis is...
Calcific deposits in arteries that does NOT cause stenosis and is NOT clinically significant
MC >50 yrs old
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Leading cause of morbidity and mortality in the US
Atherosclerosis
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Atheromas (plaques) are...
Intimal lesions that protrude into the lumen and are the HALLMARK of this condition
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Atheromas consist of...
*Macrophages
*Debris
*Lipids
All covered by a fibrous plaque
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Atheroma weakens the underlying tunica media causing?
Dilation
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Rupture is also know as...
Thrombosis
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% of arterioclerosis that is comprised of atherosclerosis?
99%
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Phases of Athlerosclerosis...
* Pre-clinical phase
| * Clinical phase
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Pre-clinical phase
Usually young age involving:
* Fatty streak
* Fibrofatty plaque
* Advanced vulnerable plaque
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Clinical phase
Usually middle age to elderly involving:
* Aneurysm and rupture
* Occlusion by thrombus
* Critical stenosis
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Multiplicative risk factors for athlerosclerosis...
*Hyperlipidemia
*HTN
*Smoking
*Previous incidents:
2 previous incident= 4 x the risk
3 previous incidents = 7 x the risk
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Modifiable risk factors for atherosclerosis...
* Hypercholesteremia (high LDL)
* Smoking
* HTN
* Diabetes
* Inflammation (c-reactive protein)
* Stress
* Sedentary lifestyle
* Low level of HDL's
* Metabolic syndrome
76
Response to injury hypothesis of atherosclerosis...
Suggest that chronic inflammation of the endothelial cells causes atherosclerosis
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How do smooth muscle cells contribute to atherosclosis?
By migrating into the lesion
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Are aneurysms congenital or aquired?
Both
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True and False aneurysms...
True - involve ALL 3 layers of a vessel
False - defect in vascular wall leading to extravascular hematoma
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What are arterial dissections?
The result of blood entering the vascular wall of an artery creating a hematoma that dissects the layers of a vessel
81
Can aneurysms and dissections both cause stasis, thrombosis, or ruptures?
Yes
82
Types of aneurysms and dissections:
* True aneurysm "saccular" - one sided (commonly contain thrombus)
* True aneurysm "fusiform" - two sided (typically involved with aortic arch, AAA, and iliac arteries)
* False aneurysm (causes hematoma)
* Dissection(Tear within Intima)
86
Unmodifiable risk factors for atherosclerosis..
* Age
* Gender
* Genetics
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When is an AAA considered abnormal?
When dilation is greater than 50%
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When is an AAA considered surgical?
When dilation is greater than 5 cm
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What causes an AAA?
Result of ECM degradation from the inflammation assc. with atherlosclerotic arteries
90
Is an AAA a contraindication to chiropractic adjusting?
Yes!
91
How is an AAA best evaluated?
Ultrasound or CT
92
Risk factors for AAA?
* Males
* Smokers
* >50 yrs old
* Hypercholesteremia
* Familial history of AAA
* HTN
* Atherosclerosis
93
Concerns with an AAA?
*May cause obstruction of vessels branching from aorta (ischemia)
involving (Kidneys, Legs, Spinal Cord, GI Tract)
* May cause emboli abdominal mass that cause compression of organs
* May lead to massive hemorrhage (FATAL)
94
Risk of hemorrhage from AAA is associated with?
Size of aneurysm:
4-5 cm = 1% chance/yr
5-6 cm = 11% chance/yr
>6 cm = 25% chance/yr
95
% of AAA surgeries that are fatal?
50%
96
An aortic dissection is...
When blood splays apart the laminar planes of the media from the blood filled channel within the aortic wall
97
Result of aortic dissection is?
Massive hemorrhage or pericardial tamponade
98
Most significant risk factor for aortic dissection?
HTN
99
Aortic dissections typically occur in...
* Males age 40-60 yrs with HTN
| * Adolescents/young adults with a CT disorder such as Marfans or Ehler-Danlos syndrome
100
Where are the most common and most dangerous lesions in an aortic dissection?
Proximal
101
Are aortic dissection usual or unusual in the presence of sustained atherosclerosis?
Unusual
102
Symptoms of an aortic dissection?
Sudden and severe tearing and stabbing in the anterior chest projection posterior area b/w shoulder blades
As the dissection progresses in may radiate downward
103
Can an aortic dissection be confused with an MI?
Yes
104
Complications depending on the location of an aortic dissection are categorized into what types?
Type I & II are the most common and most dangerous involving the ASCENDING AORTA
Type III are less common and less severe and begin DISTAL TO THE SUBCLAVIAN ARTERY
105
What is Vasculitis?
A destructive inflammatory disease of the vessels
106
About how many types of Vasculitis is there?
20 and ALL cause vascular destruction from inflammation
107
Commonly assc. symptoms with Vasculits?
* Fever
* Malaise
* Myalgia
* Arthralgia
108
Symptoms of Vasculitis are assc. with?
* Immune-mediated inflammation
* Direct vascular invasion of infectious pathogen!!!!!!
* Irradiation
* Physical trauma
* Toxins
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Immune complexes assc. with vasculitis may be the result of?
* Drug hypersensitivity
| * Secondary reaction to infection
110
Giant cell Arteritis is also know as?
Temporal Arteritis
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MC form of Vasculitis in elderly?
Giant cell "Temporal" Arteritis
112
Cause of Giant Cell "Temporal" Arteritis?
Idiopathic (Unknown)
113
Symptoms of Giant Cell "Temporal" Arteritis?
* Tenderness to palpation
* Thickening of artery
* Headache
* Fever
* Diplopia (Double vision)
* BLINDNESS
114
Average age of onset of Giant Cell "Temporal" Arteritis?
55 yrs old
115
Type of inflammation that can be assc. with Giant Cell "Temporal" Arteritis?
Granulatomous inflammation
116
What is used to prevent blindness in Giant Cell "Temporal" Arteritis?
Corticosteroids
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What is Polyarteritis Nodosa?
System wide vascultis
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What arteries are affected in Polyarteritis Nodosa?
Small and medium sized arteries
119
1/3 of patients with Polyarteritis Nodosa have this type of infection?
Chronic Hepatitis B Infection = HBV antigens deposited within affected vessels
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Cause of Polyarteritis Nodosa in the remaining 2/3 of patients?
Idiopathic
121
What arteries does Polyarteritis Nodosa favor?
* Renal
* Heart
* Liver
* Visceral
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What arteries does Polyarteritis Nodosa AVOID?
Pulmonary arteries
123
Polyarteritis Nodosa is FATAL if untreated due to?
* Aneurysm
* Rupture
* Hemorrhage
* Ulceration
* Infarction
* Atrophy
124
Polyarteritis Nodosa is treated with?
Corticosteroids/Cyclophosphamide
125
Paroxysmal (sudden reoccurrence or intensification of symptoms) conditional symptoms of Polyarteritis Nodosa?
* Weight loss
* Fatigue
* Fever
126
Classic presentation of Polyarteritis Nodosa?
* Rapid increase in BP
* Abdominal pain
* Bloody stools
Renal and GI tract involvement
May also have MYALGIA and PERIPHERAL NUERITIS
127
Who does Polyarteritis Nodosa primarily affect?
Young adults
128
Why is it important as a D.C. to visual areas of patients that they may not commonly see such as the back of legs and thorax?
Because there may be visual clues of organ dysfunction the patient is unaware of
129
Immunosuppression results in _____ % remission or cure of Polyarteritis Nodosa?
90%
130
What is Kawasaki disease?
Vasculitis in children (Idiopathic and self limiting "Genetic")
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Kawasaki disease is MC in?
Boys (80% under 4 yrs of age)
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What is the MC cause of coronary artery disease in children?
Kawasaki disease
133
What is Kawasaki disease thought to be assc. with?
Viral infection
134
Hallmark of Kawasaki disease?
ACUTE PERSISTENT FEVER
| Does NOT respond to ibuprofen or acetaminophine
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Symptoms of Kawasaki disease?
* Conjunctivitis
* Swollen extremities
* Cervical lymphadenopathy
* STAWBERRY TONGUE (Rare)
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Thrombangitiis Obliterans is also known as?
Buerger's Disease
137
What is Thrombangitiis Obliterans "Buerger's Disease"?
Focal inflammation of medium sized arteries in hands and feet
(Tibial and Radial arteries)
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Thrombangitiis Obliterans "Buerger's Disease" is MC in males or females and typically occurs at what age?
Males with average age on onset of 35 yrs old
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Thrombangitiis Obliterans "Buerger's Disease" leads to...
Vascular insufficiency (Thrombosis)
140
Symptoms for Thrombangitiis Obliterans "Buerger's Disease"?
* Painful, cyanotic and cold extremeties
* May cause Gangrene or Ulcerations
* Pain may occur at rest due to vascular insufficiency
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Is it true that Thrombangitiis Obliterans "Buerger's Disease" in smokers may be relieved if smoking is ceased?
Yes, True!
142
Is Raynaud's Phenomenon a disease or a clinical finding?
Clinical finding
143
What is Raynaud's Phenomenon the result of?
Exaggerated central and local vasoconstriction in the hands and feet causing pallor or cyanosis
144
Stimuli for Raynaud's Phenomenon?
Cold and emotional triggers
145
Raynaud's Phenomenon is MC in?
Females and Adolescent young adults
146
Is Raynaud's Phenomenon benign?
Yes, except in the most severe cases
147
Chronicity in Raynaud's Phenomenon leads to?
ATROPHY of associated skin, CT, and musculature
148
Raynaud's Phenomenon may be secondary to these diseases?
* Atherosclerosis
* Buerger's Disease
* Lupus (SLE)
* Scleroderma
149
Phlebitis is?
Venous inflammation
150
Thrombosis is?
Blood clot
151
Phlebothrombosis is?
Phlebitis clot without previous inflammation
152
Thrombophlebitis is?
Phlebitis from a thrombosis following inflammation
153
What 3 venous conditions comprise 90% of venous diseases?
1. Vericose veins
2. Phlebothrombosis
3. Thrombophlebitis
154
Varicose veins is?
Superficial veins that are dilated and tortous (MC in legs)
155
Varicose veins are the result of?
Increased intramural vascular pressure---- which leads to dilation--which creates incompetent valves----ending with loss of vascular wall support
156
Are Varicose veins more prominent in men or women?
WOMEN 33%
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Risk factor for Varicose veins?
Obesity
158
Symptoms of Varicose veins?
* Pain
* Edema
* Swelling
* Thrombosis formation
* Ulceration
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As a result of varicose veins?
* Poor wound healing
| * Cosmetic effects
160
Thrombophlebitis is?
Thrombosis and inflammation of deep veins of the legs
161
In Thrombophlebitis, Deep Vein Thrombosis (DVT) is MC in what % of cases?
90%
162
Symptoms of Thrombophlebitis?
* Rubor- redness
* Dolor- pain
* Calor- heat
* Edema- blood leaked into interstitial spaces
* Cyanosis- bluish color skin due to lack of oxygen
163
Risk factors for Thrombophlebitis?
* Recent surgery
* Pregnancy
* Obesity
* Immobilization (stasis)
* ORAL CONTRACEPTIVES
* CHF
* Genetics
164
Can be a complication of Thrombophlebitis?
Pulmonary embolism (may occlude pulmonary artery)
165
Lymphadema is?
A lymphatic obstruction that leads to inflammation which leads to a greater obstruction creating a viscous cycle
166
Lymphedema leads to...
* MALIGNANCY (Tendency for conditions to get progressively worse)
* INFECTIONS
167
Primary cause of Lymphedema?
CONGENITAL- defects in lymphatic system resulting from hypoplasia or agenesis of lymph vessels
*Extremely uncommon!
168
Secondary cause of Lymphedema?
Build-up of fluid and pressure behind an obstruction
169
Possible causes of obstructions leading to Lymphedema?
* Neoplasms
* Scar tissue post-surgery
* Irradiation scarring
* Previous inflammation scarring
* Thrombosis(Clot)
170
Skin conditions assc. with Lymphedema?
* Peau D'orange - Skin takes the appearance of an orange peel
* Brawny Induration- Hardening of the skin
171
Lymphangitis is?
Acute inflammation of the lymphatic vessels (Bacterial seeding)
172
Hallmark of Lymphangitis?
Red streaks (Rare)
173
Vascular Tumors are typically benign or malignant?
Benign Hemangioma - abnormal build-up of blood vessels in the skin or internal organs
174
An occasionally fairly aggressive condition assc. with benign Vascular tumors?
Kaposi Sarcoma- cancerous tumor of the CT assc. with AIDS
175
A rare but highly malignant type of Vascular Tumor?
Angiosarcoma- a malignant neoplasm of endothelial cells that line the walls of vessels
176
Vascular tumors arise from?
Endothelial cells and surrounding CT and blood vessels
177
A Hemangioma is?
A common tumor made up of an abnormal INCREASED NUMBER OF BLOOD VESSELS in skin or internal organs that has CAPILLARY INVOLVEMENT
178
How common are Hemangiomas?
Fairly common
| 1:1,200 Newborns (7% of all benign tumors at birth)
179
Where will you typically find Hemangiomas?
Superficial and localized
| *Usually on head and face
180
Can Hemangiomas resolve themselves?
Yes, typically 75-90% solve by 7 yrs old
181
A previously rare skin tumor associated with gay men and AIDS?
Kaposi Sarcoma
182
Kaposi Sarcoma (KS) is caused by?
HHV-8
183
Would HHV-8 infected individuals be symptomatic without being immuno-suppressed?
No, they are usually asymptomatic
