Vascular pathology part 2 (atherosclerosis) Flashcards
Describe the differences between athero, arterio, & Monckberg medial calcific- sclerosis (SIMPLE definitions) i.e. size or vessel & type of blockage
Atherosclerosis = Plaques obstruct blood flow (large-med arteries)
Arteriosclerosis = Narrowed arterioles due to thickened vessel walls (small arteries)
Monckberg medial calcific sclerosis = non-obstructive calcification of the media of muscular (medium) arteries
Describe the make up of an intimal plaque in atherosclerosis
a necrotic lipid core (cholesterol) with a fibromuscular cap that undergoes dystrophic calcification
What are some risk factors for atherosclerosis?
(Modifiable/lifestyle):
- Hypertension
- Hypercholesterolemia
- Smoking
- Diabetes
(Nonmodifiable):
- Age
- Gender (males)
- Genetics
Describe the pathogenesis/formation of atherosclerotic plaques
- damaged endothelium leaks lipids into the intima
- Lipids are oxidized & eaten by macrophages turning them into foam cells (Fatty streaks)
- The inflammation & healing due to the damage leads to deposition of ECM & proliferation of smooth muscle which trap the foam cells forming plaques
- damaged endothelium leaks lipids into the intima
- Lipids are oxidized & eaten by macrophages turning them into foam cells (Fatty streaks)
- The inflammation & healing due to the damage leads to deposition of ECM & proliferation of smooth muscle which trap the foam cells forming plaques
This describes the process of which condition?
Atherosclerosis
Complications of atherosclerosis:
Atherosclerosis of popliteal artery leads to ______
Peripheral vascular disease
Complications of atherosclerosis:
Atherosclerosis of Coronary artery leads to ______
Angina
Complications of atherosclerosis:
Atherosclerosis of mesenteric arteries leads to ______
Ischemic bowel disease
Complications of atherosclerosis:
Atherosclerotic plaque rupture results in
MI (Coronary artery)
Stroke (Middle cerebral artery)
Complications of atherosclerosis:
Atherosclerotic plaque rupture with embolization results in
Atherosclerotic emboli characterized by crystals within the embolus
Complications of atherosclerosis:
Atherosclerosis leading to weakened vessel wall can result in
Aneurysm (abdominal aorta)
Describe the pathogenesis of hyaline arteriosclerosis (causes & what happens)
Caused by long-standing Benign hypertension or diabetes, it’s when proteins leak into the vessel wall causing it to thicken (very pink on microscopy)
What is a consequence of hyalin arteriosclerosis (leads to a major organ failure!)
The thickened arteriole has less caliber (smaller lumen) causing ischemia this results in:
- Glomerular scarring (arteriolonephrosclerosis) that can progress to renal failure
Describe the pathogenesis of hyperplastic arteriosclerosis (causes & what happens)
Due to malignant hypertension, it causes hyperplasia of the arterioles giving it an “onion skin” appearance & reduced vessel caliber (smaller lumen) causing ischemia:
- Can lead to fibrinoid necrosis of the vessel wall with hemorrhage (renal failure with “flea bitten” appearance)
Due to malignant hypertension, it causes hyperplasia of the arterioles giving it an “onion skin” appearance & reduced vessel caliber (smaller lumen) causing ischemia:
- Can lead to fibrinoid necrosis of the vessel wall with hemorrhage (renal failure with “flea bitten” appearance)
pathogenesis of hyperplastic arteriosclerosis
The thickened arteriole has less caliber (smaller lumen) causing ischemia this results in:
- Glomerular scarring (arteriolonephrosclerosis) that can progress to renal failure
consequence of hyalin arteriosclerosis
What’s the condition? (sclerosis type)
Hyperplastic arteriosclerosis
Describe the pathogenesis of Mockeberg medial calcification (what is it?)
Non-obstructive calcification of the media layer of muscular/medium sized arteries (Not clinically sig) you can see it on x-ray or mammography
What is the condition? (sclerosis type)
Mockeberg medial calcific sclerosis
What’s the condition
Mockeberg medial calcific sclerosis via mammogram
Describe what an aortic dissection is & what usually causes it & what’s the leading cause of death?
Usually due to Hypertension (older) or defective CT (i.e Marfan’s younger) which leads to an intimal tear with dissection through the media layer of the aorta the consequent leading COD is cardiac tamponade
Patient with long-standing hypertension presents with a sharp tearing pain that radiates to the back
1. What’s the likely diagnosis?
- Aortic dissection
Complications of aortic dissection:
- Pericardiac tamponade (Most common cause of death)
- Rupture with fatal hemorrhage
- Obstruction of branching arteries coronary or renal causing end organ ischemia
How does hypertension in older patients lead to aortic dissection?
The hypertension causes hyaline arteriosclerosis of the vasa vasorum which reduces blood flow to the media of the aorta (atrophy) weakening it eventually causing dissection
Describe what infection is classically seen in thoracic aneurysm
Patient with atherosclerosis classically has tertiary syphilis leading to endarteritis of the vasa vasorum (luminal narrowing of aorta) & atrophy giving aorta a tree bark app
What gives the aorta a tree bark appearance?
Atherosclerosis & syphilis infection combine to cause endarteritis of the vasa vasorum (luminal narrowing of aorta) & atrophy
Describe the causes of an aortic abdominal aneurysm
A balloon-like dilation of the abdominal aorta that usually arises below the renal arteries & above the aortic bifurcation
What are the arteries most commonly involved in atherosclerosis?
** Abdominal aorta
Coronary arteries
Popliteal arteries
Descending thoracic aorta
Internal carotid artery
Atherosclerosis
A 80 yr old male smoker presents to the clinic for flank pain. Upon examination hypotension & a pulsatile mass are noted. Judging by the size & history of discomfort the mass has likely been growing over time. What is the diagnosis?
Abdominal aortic aneurysm
