The most common vascular diseases involve veins?
A gradual Narrowing/Obstruction of a Lumen is called _______
A Rapid Narrowing/Obstruction of a Lumen is called a _____
Vessel walls can weaken in which two ways?
Dilation (Aneurysm) or Rupture (Dissection)
What is the term for Hardening of the arteries? Is it specific?
Arteriosclerosis, No it is non specific
What is the term for the dilation of a vascular wall
What is the term for passage of blood through layers of wall
What is the term for a blood clot in a vessel
A varicosity is the dilation of an artery?
False, A Vein
What is the open interior of a vessel called?
What cells line a vessel
The smooth muscles in vessels are voluntarily controlled but non striated
False, they are involuntary
What are the layers of a Vessel from innermost to outermost?
Intima (Endothelia cells - Internal Elastic Lamina)
Media (smooth muscles - External Elastic Lamina)
Adventitia (CT, Nerves, Vessels)
The Intima and the Inner portion of the Media gets its blood supply via diffusion of blood from the lumen?
The Outer Media and Adventitia get its blood supply by diffusion of blood from the lumen
False, from vasa vasorum
The Following in the Correct Vascular Pathway
1) Large Elastic Arteries
2) Medium Sized Muscular Arteries
3) Small Arteries
5) Capillary Beds
6) Collecting Venules
7) Post Capillary Venules
8) Progressively Larger Veins
False #6 and #7 are switched Correct: 1) Large Elastic Arteries 2) Medium Sized Muscular Arteries 3) Small Arteries 4) Arterioles 5) Capillary Beds 6) Post Capillary Venules 7) Collecting Venules 8) Progressively Larger Veins
Which Structure in the vascular pathway provides vascular resistance (Blood Pressure Control)
Which structure in the vascular pathway is where edema and leukocyte emigration associated with inflammation begins
Because Veins have thinner walls they are prone to dilation/compression and penetration of tumors or the inflammatory process
Lymph Vessels are thin walled and lined by endothelium. They Drain lymph from intracellular fluid and eventually return it to the body via the thoracic duct.
False, from the interstitial fluid
Vascular Anomalies are very symptomatic
False, Rarely Symptomatic
Rupture of a Berry Aneurysm leads to an Epidural Hemorrhage
False a SUBDURAL hemorrhage
What Congenital Anomalie is a connection of arterial and venous systems that bypass capillaries?
Arteriovenous (AV) Fistula
What congenital Anomalie is a local thickening of medium/large artery walls that can lead to ischemia
Fibromuscular Dysplasia is caused by atherosclerosis and inflammation in a blood vessel and is most common in young adult females
False, it is a congenital condition (local thickening of medium/large artery walls that can lead to ischemia) that is NON Inflammatory and NON atherosclerotic
Hypotension can result in decreased perfusion and dysfunction. What is the value that is indicative of hypotension
Less than 90/60
Hypertension can result in damage to vessels and organs (associated with atherosclerosis). What is the value that is indicative of Hypertension?
More than 140/80
Blood pressure regulation is a function of what two factors?
Cardiac Output and Vascular Resistance
How do the kidneys effect vascular tone and blood volume?
Sodium control and the Renin-Angiotensin System
How do the adrenal glands effect Vascular tone and blood volume?
*increases sodium absorption
How does the heart have an effect on vascular tone and blood volume?
Atrial Natriuretic Peptide (ANP)
* inhibit sodium resorption leading to sodium excretion
An increase in BP causes the heart to stretch which causes the release of ANP. ANP causes a reduction in sodium resorption and vasodilation
A decrease in BP will activate the renin angiotensin system. This will cause vasodilation and sodium excretion
False, Activation of the renin angiotensin system will cause vasoconstriction and sodium resorption
What causes the release of ANP from the heart?
Stretch of the Heart wall in response to increased blood volume entering the Atrium
The overall Goal of ANP is to Decrease Blood pressure and the overall goal of Aldosterone and Renin is to Increase Blood pressure
what causes the renin angiotensin system to be activated
A drop in blood pressure in the kidneys
without treatment 30% of people with hypertension will die of Ischemic Heart Disease (MI) or Congestive Heart Failure (CHF) and 1/2 will die of stroke
False, 50% of MI or CHF
1/3 of Stroke
Hypertension can be characterized as having a BP of more than 130/80
False, more than 140/90
95% of Hypertension cases are Idiopathic but may result from an increase in Vascular resistance and a Decrease in sodium excretion
Which type of hypertension is lethal within 1-2 years and associated with Renal Failure and Retinal Hemorrhage (Papilledema)? what BP is it associated with?
Malignant HTN (>200/120)
Injury to vascular walls causes Endothelial activation that is pro-inflammatory, What are risks associated with this.
Thrombosis and Atherosclerosis may result
What occurs when a vessel wall is damaged?
Smooth muscle and ECM in the vessel wall will grow causing Irreversible Intimal thickening
Thickening of the Tunica Media following vascular injury is irreversible
False, Thickening of the Tunica Intima is Irreversible
Which type of Arteriolosclerosis is associated with “onion skin” appearance
Hyaline Arteriolosclerosis is associated withe Severe Hypertension and Luminal Narrowing
False, is associated with Benign Hypertension, Luminal Narrowing and a Pink Hyaline thickening of the arteriolar walls
Hyperplastic Arteriolosclerosis is prominent in the kidney
Hyaline Arteriolosclerosis is common in people with prolonged Diabetes Mellitus
Atherosclerosis occurs in small arteries/arterioles and may cause downstream ischemic injuries
False, this is ArterioLOsclerosis
Monckeberg medical sclerosis is characterized by the presence of _______ in muscular arteries. and is most common in the elderly (>50)
What is the most common type of ARTeriosclerosis
Atherosclerosis is characterized by the presence of intimal lesions called atheromas which protrude into the lumen and are prone to rupture stenosis or thrombosis
ATHerosclerosis is the #1 cause of morbidity and mortality in the US
What is the difference between a true and a false aneuryism
A True aneurysm occurs when there is dilation of a vessel in which all three layers are involved
A False Aneurysm occurs when a wall defect results in a hematoma that communicates with the lumen (Pulsatile)
What is an Arterial Dissection?
When blood enters the vessel wall through a surface defect and pushes apart underlying layers
Abdominal Aortic Aneurysms occur most commonly between which two arteries?
Renal and Common iliac arteries
abdominal aortic aneurysm is characterized as dilation of greater than 50% of normal
adjusting is a contraindication for abdominal aortic aneurysms
what percentage of ruptured abdominal aortic aneurysms are fatal?
90% of aortic dissections are caused by what major risk factor?
Aortic Dissections occur in mainly which two age groups?
1) Men aged 40-60 with HTN (90% of cases)
2) Adolescents with CT disorders (Marfans,Wilsons, Ehlers-Danlos)
Substantial Atherosclerosis is a major cause of aortic Dissections
False, Aortic Dissections are rare in the presence of substantial atherosclerosis
The Most common and most severe aortic dissections occur in Type B location (distal to the left subclavian artery)
False, MC and Most Severe Aortic Dissections occur in Type A location ( Ascending Aorta)
When an Aortic Dissection occurs you will have sudden and sever “tearing/stabbing pain” that starts in the anterior chest, projects posteriorly between the scapulae
What may indicate that the Aortic Dissection is progressing?
Pain radiates inferiorly
Where do Type A Aortic Dissections occur?
Proximal Aorta (Ascending)
Where do Type B Aortic Dissections occur?
Distal Aorta (Beyond the left subclavian artery)
Most cases of vasculitis occur in large arteries
False, in Small arteries
What are the two main types of vasculitis? Which type is immune mediated?
Infectious and Non Infectious
(Non Infectious is Immune Mediated)
Which type of vasculitis may be caused by Hepatitis B?
Which type of vasculitis may be caused by Penicilin?
Non infectious Vasculitis
What is the most common type of Vasculitis in older adults (>50).
Giant Cell Arteritis
Which arteries are most involved in Giant Cell Arteritis
Large and Small Arteries of Head
- Temporal Artery, Ophthalmic Artery, Vertebral Artery and Aorta
Damage to which artery in Giant Cell Arteritis may commonly cause diplopia or sudden blindness
Classic Giant Cell Arteritis lesions exhibit what characteristics?
Patchy damage along vessel and granulomatous inflammation
What condition is a granulomatous vasculitis of medium sized and larger arteries characterized principally by ocular disturbances and marked weakening of the pulses in the upper extremity
Takayasu Arteritis “Pulseless Disease”
Takayasu Arteritis is most common among older adults
False, Younger Individuals (Less than 50)
Takayasu Arteritis occurs when there is pronounced Narrowing of the lumen in which structures?
The aortic arch and branches off the aortic arch
Which condition is characterized as systemic vasculitis of small or medium sized arteries. It typically involved renal and visceral vessels and spares pulmonary circulation
1/3 of patients with polyarteritis Nodosa have chronic _______ infections, the other 2/3 of cases are idiopathic
The symptoms of Polyarteritis Nodosa are chronic and specific. They include end organ damage, abdominal pain and bloody stools due to GI artery damage and rapid increase in BP due to Renal artery damage.
False, The symptoms are Episodic and Widespread
In Polyarteritis Nodosa damage to which artery may cause rapidly accelerating hypertension
Polyarteritis is typically fatal
True, although immunosuppression with corticosteroids can cure 90%
What age group does Kawasaki Disease occur in?
80% are less than 4
What are some symptoms of Kawasaki Disease?
*Acute/Persistent Fever (No response to Acetominophen) Conjunctivitis Swollen Extremities Strawberry Red Tongue (oral erythema) Desquamative Rash Cervical Lymph Node Enlargement
What three specific findings are associated with Wegener Granulomatosis
1) Granulomas of lung/upper respiratory tract
2) Systemic Vasculitis of small/medium vessels
Wegener Granulomatosis is a type 3 hypersensitivity reaction
False, Type 2
What are the classic symptoms of Wegener granulomatosis
Bilaterial Pneumonitis (95%) - cough, chest pain,dyspnea Chronic Sinusitis (90%) Nasopharyngeal Inflamation/Ulcers (75%) - nosebleed Renal Disease (80%)
If Wegener Granulomatosis goes untreated it is 80% lethal after 1 year
Wegener Granulomatosis is a necrotizing vasculitis characterized by granulomas, glomerulonephritis and vasculitis of vessels only in the lungs
False, Systemic Vasculitis
Buerger disease (Thromboangiitis obliterans) is almost exclusively found in which population
What disease is characterized by vascular insufficiency and gangrene of the extremities.
Buerger Disease (Thromboangiitis obliterans)
In Buerger Disease (Thromboangiitis obliterans) which medium sized arteries will become damaged leading to vascular insufficiency in the Feet? Hands?
Feet - Tibial Artery
Hands - Radial Artery
What are some symptoms associated with Buerger Disease (Thromboangiitis obliterans)
Pain even at rest
Ulceration and Gangrene of Extremities
Foot Pain induced with exercise (claudication)
Raynaud Phenomenon is most common in males and onset it in adolescence
Primary Raynaud Phenomenon is caused by Cold and Emotions and effects 5% of the US. Secondary Raynaud Phenomenon is the result of some other condition (atherosclerosis, Beurger disease, Lupus or scleroderma)
Raynaud Phenomenon results from ________ in the extremities (particularly fingers, toes, nose, lips and earlobes).
Restricted blood flow in raynauds phenomenon causes Pallor or ______ that shows a “red-white-and-blue” color change from proximal to distal
What is the term for Venous Inflammation
Varicose Veins and Phlebothrombosis/thrombophlebitis account for 90% of venous diseases
Phlebothrombosis is venous thrombosis following inflammation
False, that is Thrombophlebitis
What is the difference between Phlebothrombosis and Thrombophlebitis
Phlebothrombosis is venous thrombosis (clot) without previous inflammation
Thrombophlebitis is venous thrombosis following inflammation
What are varicose veins
abnormally dilated and tortuous veins created by increased intraluminal pressures and dilation that render valves incompetent
Varicose veins occur most often in the deep veins of the leg which are at risk for embolism
False, Varicose veins occur in the superficial veins (most commonly in legs) and embolism is rare. The most common concern is cosmetic
What are some side effects associated with varicose veins?
congestion/edema, pain, decreased wound healing (ulcerations),
90% of thrombophlebitis cases are a Deep vein thrombosis
what are some risk factors for thrombophlebitis
immobilization, post surgery, obesity, pregnancy,
pulmonary embolism is a serious and common clinical complication of DVT
True, this is often the first indication
Superior Vena Cava syndrome is caused by compression or invasion of the super vena cava and will result in congestion of Lower Extremity veins
False, will result in congestion of Upper Extremity Veins
Congestion of Lower Extremity veins will be caused by Inferior Vena Cava Syndrome
Primary Lymphedema is caused by a congenital lymphatic abnormality such as Milroy’s Disease
Secondary Lymphedema is caused by obstruction of previously normal lymph vessels by something such as infection, thrombosis or fibrosis
Primary Lymphedema is more common than Secondary
False, Primary (congenital) is much less common than Secondary (infectious)
What is Lymphedema
Obstruction of lymph vessels causes edema and tissue expansion
What condition is peau d’orange associated with
is it associated with Chronic Lymphedema
If you have a patient with a subcutaneous red, painful streak on their leg what are you thinking is wrong?
They have Lymphangitis which is an acute inflammatory process caused by bacterial infection of the lymph vessel, the red streak you see is the inflamed lymph vessel/nodes
most vascular tumors are malignant
False, most are benign
Benign - Hemangioma (Common)
Fairly Agressive - Kaposi Sarcoma (Rare)
Highly Malignant - Angiosarcoma (Very Rare)
What tissues can vascular neoplasms arise from?
Endothelium or supporting blood vessels and connective tissue
A Hemangioma is a common benign tumor usually seen in newborns caused by local capillary growth. It usually appears on superficial tissues and resolves with age.
75-90% resolve by age 7
Which condition is a vascular neoplasm opportunistic infection associated with aids that is caused by HHV-8
Kaposi Sarcoma is 100 times more likely among aids patients
False, 1000 times more likely
what are the characteristics of kaposi sarcoma
Macules (pupura) - which are red-purple skin plaques or nodules most common in the lower extremity. They grown and spread proximally
Angiosarcomas are extremely variable and range from A well differentiated angiosarcoma that may resemble a hemangioma to a highly invasive anaplastic angiosarcoma
What are hepatic angiosarcomas associated with
Known carcinogens such as arsenic , PVC, Irradiation and lymphedema
angiosarcomas can have a long latency period
What condition is endovascular stenting used in 90% of procedures. What is the purpose of an endovasclar stent
Coronary Artery Disease
- purpose - to preserve luminal patency
What veins are commonly used for vascular grafts?
Great Saphenous vein (50% at 10 years)
INternal Mammary Artery (90% at 10 years)