Vascular Disease Flashcards by sami sh

How may we classify vascular disease ? Give examples of such a classification.

By the type of vessel they affect.

ARTERIES
-Arteriosclerosis=
When arteries “become thick and stiff — sometimes restricting blood flow to your organs and tissues”. Atherosclerosis is a specific type of arteriosclerosis, involving build up of fatty substances.

VEINS
-Thrombosis=
Could be phlebothrombosis, i.e. thrombosis in a vein forms independently from the presence of inflammation of the vein or Thrombophlebitis i.e. vein inflammation related to a thrombus
-Formation of varicosities (swollen, distended, and knotted veins, usually in the subcutaneous tissues of a LL)

ALL VESSELS

Vasculitis (inflammation)
Radiation damage
Tumours

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Describe age-related vascular changes. Are these normal ?

Fibrosis of intima and media
Accumulation of ground substance
Fragmentation of elastic lamellae

Yes, these are normal with increasing age.

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Which kinds of vessels does atherosclerosis affect ? Identify its main characteristics.

Large and medium-sized elastic and muscular arteries

Lipid deposition, fibrosis and chronic inflammation

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What is another name of atherosclerosis ?

Atheroma

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Identify the main risk factors for atherosclerosis.

Age
Sex
Hypertension
Hyperlipidaemia (particularlyLDL)
Diabetes
Smoking
Obesity
Sedentary lifestyle
Low socio-economic status
Low birth-weight

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Describe the morphology of atherosclerosis.

Atheromatous (fibro-fatty, fibro-lipid) plaque • Patchy and raised white to yellow 0.3-1.5cm
Core of lipid
Fibrous cap (smooth muscle cells, macrophages, foam cells, lymphocytes)
Necrotic center (cell debris, foam cell, cholesterol crystals)

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Identify complications of Atherosclerosis.

MI, cardiac failure
Cerebral infarction
Emboli causing transient ischaemic attacks or cerebral infarcts (due to the carotid atheroma)
Aortic aneurysm (rupture would cause immediate death)
Peripheral vascular disease with intermittent claudication
Gangrene

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Define peripheral vascular disease.

Atheroma of distal aorta/iliac/femoral arteries, usually causing ischaemia of lower limbs

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What are the possible effects of peripheral vascular disease ?

Intermittent claudication (pain in the leg that a person experiences when walking or exercising. The pain is intermittent and goes away when the person rests)
Pain
Ulcers
Gangrene

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Define aneurysm.

Localised, permanent, abnormal dilatation of blood vessel or the heart

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Identify the main types of aneurysms.

Atherosclerotic
Dissecting aortic
Berry
Micro-aneurysms
Syphilitic
Mycotic

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Where do atherosclerotic aneurysms usually occur ?

Usually abdominal aorta, distal to renal arteries

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Describe the demographic distribution of atherosclerotic aneurysms (any over-affected groups ?).

Women

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Describe the morphology of atherosclerotic aneurysms.

saccular (resembling a sac) or fusiform (spindle-shaped)
15 to 25 cm in length
Wall diameter > 50% of normal diameter
frequently contains mural thrombus

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Identify the main clinical consequences of atherosclerotic aneurysms.

Thrombosis
Embolism
Rupture
Obstruction of a branch vessel (ischemic injury)
Impingement on an adjacent structure

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How do atherosclerotic aneurysms present ?

Presents as an abdominal pulsating mass

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To what extent is an atherosclerotic aneurysm repairable.

It can be repaired

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Describe the demographic distribution of dissecting aortic aneurysms (any over-affected groups ?).

Men x3 more than women
Men 40 to 60 with hypertension
Younger patients with systemic or localized abnormalities of connective tissue

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Describe the morphology of a dissecting aortic aneurysm.

usually initiates in tunica intima, 1-2 cm from aortic valve (blood accumulates between intima and media)
dissection can extend
1) along the aorta retrograde toward the heart or
2) distally, sometimes into the iliac and femoral arteries

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Identify a possible complication of dissecting aortic aneurysms.

Dissection travels upwards around pericardium, causing accumulation of
blood around pericardial sac (cardiac tamponade, can be fatal)

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Identify the clinical symptoms of a dissecting aortic aneurysm.

The sudden onset of excruciating pain:
-beginning in the anterior chest, radiating to the back, between the scapulae, and moving downward as the dissection progresses (the pain can be confused with that of myocardial infarction)

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What are the most common causes of death associated with dissecting aortic aneurysms ?

Rupture of the dissection outward into the pericardial, pleural, or peritoneal cavities

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Where do berry aneurysms usually occur ?

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Circle of Willis

Describe the demographic distribution of Berry aneurysms (any over-affected groups ?).

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Young people

Often hypertensive

What is an event which is associated with Berry aneurysms.

Associated with Subarachnoid haemorrhage (if they rupture)

Where do capillary micro-aneurysms usually occur ?

Branches of middle cerebral artery

Describe the demographic distribution of capillary micro-aneurysms (any over-affected groups ?).

Patients with hypertension or diabetes mellitus

What is an event which is associated with capillary micro-aneurysms.

Associated with intra-cerebral haemorrhage

Where do syphilitic aneurysms usually occur ? Why do they occur ?

Usually affects thoracic aorta | Occur resulting from tertiary syphilitic aortitis

What are the main characteristics of Mycotic aneurysms ?

* Wall of artery weakened by infection (due to bacteria or fungi) * Often in brain, secondary to embolism

Define varicose veins.

- Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support. - Venous valves become incompetent and leads to stasis, congestion, oedema, pain, and thrombosis

What are risk factors for varicose veins ?

Age, sex, heredity, posture, obesity

Where do varicose veins most often occur ? Where else may they occur ?

- Usually, in lower limbs (saphenous system) - Oesophageal - Haemorrhoids (in or around rectum) - Varicocele (scrotal swelling)

What are clinical issues associated with varicose veins ?

* Cosmetic problems * Aching in legs * Stasis dermatitis * Skin ulceration and bleeding

Define vasculitis.

Inflammation and necrosis of blood vessels

Explain the pathogenesis of vasculitis.

•Cell immune-mediated inflammation → Deposition of immune complexes → Direct attack by circulating antibodies (against own vessels) OR Direct invasion of vascular walls by infectious pathogens

True or False: Vasculitis is often part of multi-system disease.

True

List the main types of vasculitis.

1) Giant-cell (temporal) arteritis 2) Takayasu arteritis (pulseless disease) 3) Polyarteritis nodosa (PAN) 4) Kawasaki disease (children < age 4)

Describe the demographic distribution of giant-cell (temporal) arteritis.

> age 50 (average onset age 70) | Women > men

Explain the main features of giant-cell temporal arteritis.

* granulomatous inflammation of large to small-sized arteries (temporal, vertebral and ophthalmic) * Cord like nodular thickening

Describe the demographic distribution of Takayasu arteritis (pulseless disease).

Particularly women aged <30

Explain the main features of Takayasu arteritis (pulseless disease).

Granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta)

Explain the main features of Polyarteritis nodosa (PAN).

- Medium small size muscular arteries of the kidneys, heart, liver, and gastrointestinal tract are involved - Fibrinoid necrosis could be fatal without steroid treatment

Describe the demographic distribution of Kawasaki disease.

Children < age 4

Explain the main features of Kawasaki disease.

High fever, conjunctival and oral lesions. Self-limited

What is the general duration of giant-cell temporal arteritis.

6-12 months

To what extent is giant-cell temporal arteritis self-limited ?

Could be self-limited

What are the main symptoms of giant-cell temporal arteritis ?

* Patchy lesion * Throbbing temporal pain * Malaise * Fever

What are the main symptoms of Takayasu arteritis ?

* Dizziness * Visual disturbances * Dyspnoea * Intermittent claudication upper limbs * Asymmetric BP

How is Takayasu arteritis treated ?

Steroid treatment

What is the term for benign vascular tumour ?

Angioma

What is the term for malignant vascular tumour ?

Angiosarcoma

Identify the main types of angiomas, and state where each is usually found.

1) Haemangioma (proliferation of blood vessels) - Juvenile (=stawberry), often happens on the skin (disappears by itself) - Capillary (=ruby spots), can be in skin, spleen, kidneys - Cavernous (=port wine stains), can be on skin, spleen, liver, pancreas 2) Lymphangioma (proliferation of lymphatics) - Capillary - Cavernous

Identify the main types of angiosarcomas, and state where each is usually found.

In general Angiosarcoma seen in skin, soft tissue, breast, bone, liver and spleen -E.g. Kaposi’s sarcoma specifically, in skin and mucosal surfaces

What is so special about Kaposi's sarcoma ?

It is associated with HIV/AIDS.

Vascular Disease Flashcards

(55 cards)