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CPR Midterm > Vascular Path > Flashcards

Vascular Path Flashcards

1
Q

causes of 2* HTN

A

any cardio, renal, and endocrine dx
=inc cardiac output +inc vasoconstriction= inc BP

a. Renal disease:polycystic disease, renal cell carcinoma (RCC), chronic renal failure, glomerulonephritis, renal artery
stenosis and fibromuscular dysplasia
b. Adrenocortical hyperfunction:congenital adrenal hyperplasia, adrenal tumors
c. Adrenal medullary hyperfunction: pheochromocytoma
d. Thyroid dysfunction: myxedema)
e. Pituitary dysfunction: acromegaly
f. Cardiovascular disease: coarctation of the aorta, polyarteritis nodosa
g. Pregnancy: eclampsia and pre-eclampsia
h. Neurologic disease:↑ intracranial pressure
i. Medications and drugs: glucocorticoids, cyclosporine, sympathomimetics, cocaine

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2
Q

describe hypertnsion (HTN)

A

sustained BP >139 systolic or > 89 diastolic
M>F, Afro-Am, smokers, obesity
90% primary (essential HTN/ unknown cause- linked to calories, salt or alcohol)
10% secondary (adrenal/renal cause)

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3
Q

HTN: increased risk for

A

eye (blindness), heart (LVH, IHD/MI, CHF, aortic dissection),
renal (ESRD), & brain (stroke)
INCREASE RISK OF ATHEROSCLEROSIS

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4
Q

(2) hitso pathologic features of HTN

A

Hyaline arteriolosclerosis- protein leaks
hyperplastic arteriolosclerosis- onion-skin
INCREASE RISK OF ATHEROSCLEROSIS

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5
Q

describe iodiopathic/primary/essential HTN

A

genetic + environmental causes ( linked to calories, salt or alcohol)
90% HTN cases
defects in renal homeostasis + vasoconstriction + defects in smooth muscle= inc cardiac output and inc peripheral resistance= HTN

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6
Q

(4) hormones maintaining BP homeostasis

A

renin- renal (increases BP)
angiotensinogen- hepatic (increases BP)
aldosterone- adrenal (increases BP)
ANP- cardiac (decreases BP)

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7
Q

Aortic Dissection: types

A 
bad= proximal aorta=risk of  rupture into the pericardial sac with cardiac tamponade and harm to coronary or cerebral vessels
Type A (DI/DII): med/surgical
emergency (poor prognosis);
Type B (DIII): distal dissections= better prognosis
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8
Q

high risk for aortic dissection

A
  • Connective tissue diseases (Marfan, Ehlers-Danlos= cystic medial degeneration)
  • hypertension (Hypertrophy of the vasa vasorum)
  • complication of arterial cannulation ( loss of smooth muscle)
  • pregnancy
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9
Q

Aortic Dissection

A 
Intimal tear, dissection into media (middle/outer
third), thru adventitia HMG into chest, abdominal,
or pericardial sac (poor prognosis);
false channel (better prognosis)
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10
Q

Hyaline Arteriolosclerosis

A 
Hyaline protein deposits, narrowed
endothelial cell damage: 
DM, HTN (decades), elderly
• endothelial cell dysfunction: plasma protein leakage/inc. SM cell & ECM synthesis
• a/w Nephrosclerosis  Renal Failure
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11
Q

Hyperplastic Arteriolosclerosis

A

Laminated “onion-skin” lesions
smooth muscle proliferation) obliterates lumen
Causes: fibrinoid nectosis, “flea bitten” kidney
• Life-threatening organ damage: brain, kidneys, heart medical emergency

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12
Q

Atherosclerosis

A

Affects elastic and muscular arteries
• Progressive accumulation of
lipid/lipid debris, smooth muscle cells, extracellular matrix, T-lymphocytes, macrophages/foam
cells in the intima
• Encroaches on the media &
adventitia (Atheroma) narrowing of the lumen (e.g., IHD, thrombus)
chronic inflammation

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13
Q

Atherosclerosis: modifiable risk factors

A

-Hypercholesterolemia(HC)/ Hyperlipidemia(HL) (Most important cause)
– HTN (major risk factor)
– DM (inc. HC/HL)
– Cigarette Smoking (inc. CRP)

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14
Q

steps in Pathogenesis of Atherosclerosis

A
  1. endothelial cell injury/dysfunction
  2. increase permeablility
  3. cytokine release and leukocyte/monocyte/macrophage emigration
  4. smooth muscle proliferation
  5. engulf lipid
  6. fatty streak
  7. ECM deposition
  8. fibrofatty atheroma
  9. plaque
  10. intimal ischemia
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15
Q

Elevated serum levels of CRP

A 
Inflammation marker
Risk Factor:
-  Atherosclerosis
- Acute Myocardial Infarction
- Stroke
- Peripheral arterial disease
- Sudden cardiac death
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16
Q

Atheromas: Thick vs Thin Fibrous Cap

A

Thin Fibrous Cap: Increase Risk of

Acute Coronary Thrombosis (AMI)

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17
Q

saccular aneurysms

A
  1. Saccular- spherical outpouchings
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18
Q

fusiform aneurysms

A
  1. Fusiform- diffuse, long, circumferential dilation
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19
Q

What are the two most important causes of aortic aneurysms?

A

HTN+atherosclerosis

other Risk: CT dx: Marfan (fibrillin), Scurvy, Ehler-Danlos; Matrix Metalloprotease (MMP)

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20
Q

What are the two most common locations for aortic aneurysms?

A

Below the renal arteries and above the bifurcation of the aorta. They may be fusiform or saccular, up to 15 cm in diameter and up to 25 cm in length. They are often accompanied by smaller aneurysms of the iliac arteries.

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21
Q

describe inflammatory aneurysms

A

Fibrosis; lymphocytes, marcophages, giant cells

Microbes infect plaque

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22
Q

describe mycotic aneurysms

A

invades Vasa vasorum= ischemia

Obliterative endarteritis

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23
Q

endarteritis

A

inflammation of the inner lining of an artery

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24
Q

Obliterative endarteritis

A

Obliterative endarteritis- severe proliferating inflammation of the inner lining of an arterythat results in an occlusion of the lumen of the artery

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25
Dissections:
Intimal tear within the wall of a blood vessel, which allows blood to separate the wall layers Massive hemorrhage
26
Aortic dissection: Types A/B
Type A: Debakey 1- ascending + descending aorta Type A: Debakey 2- ascending aorta Type B: Debakey 3- descending aorta (*worst= closest to aortic valve)
27
Non-infectious Vasculitis:
``` Inflammation of vessel walls Thick, nodular Distrupts elastic lamina 1) Positive for immune complex deposition, 2) Antineutrophil cytoplasmic antibodies (ANCA), 3) Antiendothelial cell antibodiess ```
28
what Non-infectious Vasculitis | affect Large vessels: aorta, extremities, head, neck (2)
``` Giant cell (temporal) arteritis Takayasu arteritis ```
29
what Non-infectious Vasculitis affect Medium vessels: visceral (2)
Polyarteritis nodosa | Kawasaki disease
30
what Non-infectious Vasculitis affect Small vessels: arterioles, venules capillaries (4)
Microscopic polyangiitis Wegner granulomatosis Churg-Strauss syndrome Henoch-Schonlein Purpura
31
what Non-infectious Vasculitis affect Small/med a, extremity veins, nerves (1)
Thromboangiitis obliterans (Buerger disease)
32
what Non-infectious Vasculitis: Segmental, thrombosing inflammation of small and medium sized arteries, esp. the tibial and radial arteries
Thromboangiitis obliterans (buerger disease)
33
what Non-infectious Vasculitis: Systemic vasculitis of small and med sized arteries, esp the renal and visceral vessels, spares pulmonary vessels
Polyarteritis nodosa
34
what Non-infectious Vasculitis: Necrotizing or granulomatous vasculitis of small to medium vessels, esp. in the lungs and upper airway
Wegner granulomatosis
35
what Non-infectious Vasculitis: Granulomatous vasculitis of medium and large arteries with ocular problems and weakening of the pulses in the upper extremities (2)
Takayasu arteritis (female50yo)
36
what Non-infectious Vasculitis: Arteritis of large to medium vessels, predilection for coronary arteries
Kasasaki disease
37
what Non-infectious Vasculitis: Small vessel vasculitis mediated by IgA immune complexes
Henoch Schonlein purpura
38
what Non-infectious Vasculitis: Necrotizing vasculitis of capillaries, arterioles and venules
Microscopic polyangiitis
39
describe Giant cell (temporal) arteritis
Large vessels: aorta, extremities, head, neck Granulomatous inflamm. Intimal fibrosis Tcells, multinucl. Giant cells Temporal artery Ophthalmic artery >50yo Polymyalgia rheumatica
40
describe Takayasu arteritis
Large vessels: aorta, extremities, head, neck Granulomatous inflamm. Reduced BP, weak pulse <50yo Aorta arch (transmural) Japanese women
41
describe Polyarteritis nodosa
Medium vessels: visceral Necrotizing inflamm Histo: Fibrinoid necrosis, lesions at varying stages, "string of pearls" healing Multiple organs Renal arteries, mesenteric, spares pulmonary vessels Chronic HBV
42
describe Kawasaki disease
Medium vessels: visceral Arteritis, mucocutaneous lymph node sx Erythema/Desquamative rash (Conjunctiva, oral cavity, Hands/feet) Tx: Aspirin and gamma globulin Causes: coronary artery aneurysm, heart/lung block Histo: inflammatory cell infiltrates Asian children Coronary artery
43
Microscopic polyangiitis
Small vessels: arterioles, venules capillaries Necrotizing vasculitis, p-ANCAs (MPO-ANCA) Histo: All lesions are of same age; Fragmented, apoptotic neut Tx: Immunosuppression glomerulonephritis and pulmonary capillaries
44
Wegner granulomatosis
Small vessels: arterioles, venules capillaries Granulomatous inflamm., Necrotizing vasculitis, c-ANCAs Respiratory tract (lungs+nasal+pharynx), glomerulonephritis
45
Churg-Strauss syndrome
Small vessels: arterioles, venules capillaries Eosinophil-rich, Granulomatous inflamm., Necrotizing vasculitis p-ANCAs Respiratory tract Asthma Blood eosinophil
46
Henoch-Schonlein Purpura
Small vessels: arterioles, venules capillaries IgA immune complex deposition Palpable purpura, hematuria Children, follows URI
47
Thromboangiitis obliterans (Buerger disease)
Small/med a, extremity veins, nerves Segmental, thrombosing inflamm., fibrous tissue, Leads to vascular insufficency Histo: Occluding thrombus & microabscesses Ulceration & gangrene Autoamputation of digits Cigarettes Arteries in extremities (UE/radial; LE tibial) digits
48
Infectious vasculitis
1) Bacterial (pseudomonas), 2) Fungal (mucor; aspergillus) by vascular/hemato spread
49
Raynaud phenomenon
recurrent vasospasm of the fingers and toes and usually occurs in response to stress or cold exposure reduced blood= white/blue
50
Hemangioma
benign vascular tumor vessels filled with blood 3 types (capillary, cavernous, pyogenic) Histo: organized, lobular architecture. Each lobule consists of small vessels
51
Bacillary angiomatosis (bartonella)
benign vascular proliferation involving the skin, bone, brain, and other organs Gross: Red papules or nodules Histo: PMN inflammation & capillary proliferation -gram negative bacilli Bartonella on Warthin-Starry stain Risk: immunocompromised patients, also causes: cat-scratch fever & trench fever -Tx w/ Abx’s
52
Kaposi sarcoma
Intermediate grade malignant tumors: Locally invasive Risk: AIDS (herpesvirus type 8), east. European males, transplants Gross: - Red-purple patches, macules, papules, plaques or nodules Morph: - nodular, Sheets of plump, proliferating spindle cells Dilated irregular endothelial cell-lined vascular spaces with interspersed lymphocytes, plasma cells, and macrophages Tx: excision,radiation,chemo Rx (good prognosis)
53
Angiosarcoma
malignant: aggressive tumor Proliferation of endothelial cells (cell marker CD31) breast, skin, liver Gross: Aggressive, poorly demarcated, variegated, fleshy masses Histo: dense clumps of Atypical cells lining vascular lumen Risk: older adults, PVC, arsenic (5 yr survival= 30%)
54
Syphilitic Aneurysm
Untreated 3* syphilis, treponema pallidum Histo: "tree bark" intima Enlarged heart Causes thoracic aortic aneurysm Obliterative endarteritis of vasa vasorum
55
HOW IS VASCULITIS DIAGNOSED?
``` Biopsy—surgical removal of a small piece of tissue for inspection under a microscope Angiography—a type of X-ray to look for abnormalities of blood vessels Blood tests (+ANCA) ```
56
effects of Antineutrophil cytoplasmic antibodies (ANCA):
Leads to vascular injury | Autoantibodies cause autoimmune swelling and inflammation of blood vessels
57
C-ANCA (anti-proteinase-3/PR3-ANCA)
Attacks in cytoplasm Neutrophil azurophillic granules Increase PMN activity Intracellular components Microbial peptides (polyangiitis)
58
P-ANCA (anti-myeloperoxidase/MPO-ANCA)
Attacks near nucleus Lysosomal granules Forms Oxygen free radials Microbial antigens Infection Endotoxins autoantibodies
59
Proliferative restenosis
Proliferative restenosis- metabolic syndrome = inc risk for coronary atherosclerosis Tx: angioplasty: place stent with paclitaxel to limit smooth muscle hyperplasia
60
Risk factors for atherosclerosis in pulmonary vasculature: (*different than systemic risk factors*)
emphysema and fibrosis (obstructive and restrictive dx's)
61
Raynaud phenomenon
recurrent vasospasm of the fingers and toes and usually occurs in response to stress or cold exposure reduced blood= white/blue
62
varices
abnormally dilated vessel with a tortuous path | Caused by blocked venous drainage
63
phlebothrombosis vs Thrombophlebitis
``` phlebothrombosis= blood clot in a vein without inflammation. Thrombophlebitis = inflammation of a vein with a clot ```
64
Lymphangitis
inflammation or an infection of the lymphatic channels that occurs as a result of infection at a site distal to the channel. Caused by acute streptococcal infection of the skin
65
lymphedema
lymphatic obstruction localized fluid retention and tissue swelling caused by a compromised lymphatic system Develops over time Causes: infection, cellulitis
66
define angiitis & vasculitis
inflammation of blood vessel walls Thick, nodular Disrupts elastic lamina
67
What are the complications of hypertension?
Heart – concentric LV hypertrophy → LV dilatation → congestive heart failure, arrhythmias • Blood vessels – arteriosclerosis → myocardial infarction, peripheral vascular disease, Aortic dissection • Kidneys – ↓ GFR → chronic renal failure • Brain – stroke (due to atherosclerosis) and intracerebral hemorrhage (due to Charcot-Bouchard microaneurysms) • Retina - retinopathy → blindness
68
What are the risk factors for atherosclerotic cardiovascular disease?
Age, Sex (Male), Family history and genetic abnormalities, Post-menopausal females (decreased estrogen) Hyperlipidemia, Hypertension, Diabetes Smoking, Obesity, Inactivity, Stress, Alcohol Genetic: rare single gene defects of aldosterone or Na+ channels. Polymorphisms at multiple sites are much more common, but not well defined.
69
“Response to Injury” Hypothesis: pathogenesis of atherosclerosis
atherosclerosis is an aberrant chronic inflammatory response: All five cell types in an atherosclerotic plaque are capable of liberating mediators that have a role in the disease progression. These interact with the ECM and induce the formation of the thick fibrous cap with the lipid core.
70
What are complications of atherosclerotic disease?
myocardial infarction/ischemic heart disease, strokes, aortic aneurysms, and peripheral vascular disease (distal lower extremity gangrene). In addition, rupture of an atherosclerotic plaque may cause thrombus formation and occlusion of a vessel.
71
Which inflammatory marker in the serum correlates with the risk of ischemic heart disease and is important in the overall risk stratification of patients?
Serum C-reactive protein (CRP)
72
What population is most at risk for the development of an abdominal aortic aneurysm?
Male, smokers, > 50 years of age, atherosclerosis, HTN
73
What is the incidence of abdominal aortic aneurysms?
<5% in males over 60 even with close to 100% aortic atherosclerosis in that population
74
What determines the risk of rupture of an abdominal aortic aneurysm?
The risk of rupture is directly related to the size of the aneurysm. negligible risk if < 4cm, 1% per year if between 4-5cm, 11% per year if between 5-6 cm, and 25% per year if > 6 cm. Surgical treatment (prosthetic grafts) are usually recommended if the AAA is 5cm or greater in diameter
75
What is the mortality of abdominal aortic aneurysm surgery with and without rupture?
Operative mortality for un-ruptured aneurysms is approximately 5% and emergency surgery after rupture has a mortality rate >50%
76
What is the mortality of a ruptured abdominal aortic aneurysm?
Mortality is about 50% for emergency surgery to repair a ruptured AAA, whereas it is only 5% operative mortality for unruptured AAA
77
Describe the clinical features (sx) of temporal arteritis?
fever, fatigue, weight loss; facial pain and headache, especially along the course of the superficial temporal artery, which is often painful to palpation. Ocular symptoms, associated with involvement of the ophthalmic artery, appear abruptly in 50% of patients, and include diplopia to complete vision loss.
78
What are (3) TYPES OF Hemangiomas (common benign vascular tumors) and what are their histologic features?
1. Capillary hemangiomas of of skin, subcutaneous tissues, mucosa, liver, spleen or kidneys, which are un-encapsulated aggregates of closely packed thin walled capillaries. These lesions frequently regress spontaneously to variable degrees. 2. Cavernous hemangiomas with infiltrative growth of large, dilated vascular channels into deeper structures; they do not tend to regress. and 3. Pyogenic granulomas which are pedunculated skin nodules of proliferating capillaries with extensive edema and inflammation.
79
What are the diagnostic criteria of Kawasaki disease
1. Bilateral non-exudativet conjunctival injection 2. Changes of the mucosa of the oropharynx, including infected pharynx, infected and/or dry fissured lips, strawberry tongue 3. Changes of the peripheral extremities, such as edema and/or erythema of the hands or feet, desquamation, usually beginning periungually 4. Rash, primarily truncal, polymorphous but nonvesicular 5. Cervical adenopathy

CPR Midterm (15 decks)

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