Vascular System Flashcards
1
Q
What causes HTN?
A
95% idiopathic: “essential HTN”
2
Q
What positive affects are noted with a decrease in BP?
A
Deacreased risk of IHD, CHF, and stroke
3
Q
Malignant HTN is considered thus by what BP range?
A
200/120: lethal within 2 years
4
Q
What is early malignant HTN?
A
Papilledema, retinal hemorrhage
5
Q
What is late malignatn HTN?
A
Renal failure
6
Q
What is vascular injury?
A
Non-specific (stereotypical) response. Trauma, infxn, inflammation, immune reaciton
7
Q
What are examples of endothelial activation?
A
Thrombosis, atherosclerosis
8
Q
What are the 4 stages of vascular wall response to injury?
A
Endothelial injury/ dystunction
Smooth muscle cell recruitment
Growth of smooth muscle cell adn ECM
Irreversible intimal thickening (vessel stenosis = tissue ischemia)
9
Q
What are the characteristics of arteriosclerosis?
A
“Hardening of the arteries”. Arterial thickening, deacersed elasticity
10
Q
What is arterioLOsclerosis?
A
Small arteries/arterioles hardening (not arteriosclerosis). Possible ischemic injry (HTN, diabetes)
11
Q
What is Monckeberg medial sclerosis?
A
Ca++ within tunica media. No stenosis: not clinically significant Age related, >50 years old.
12
Q
What is the MC type of arteriosclerosis?
A
Atherosclerosis.
13
Q
What are some features of arteriosclerosis?
A
Atheromas (plaques). Stenosis, aneurysm, dissection, thrombosis. Heart (CAD), brain, intestines, kidneys, legs.
14
Q
What are some characteristics of hyaline arteriolosclerosis?
A
Benign HTN (chronic hemodynamic stress)
Prolonged DM
Luminal narrowing
Pink hyaline, Increased ECM
15
Q
What are some characteristics of hyperplastic arteriolosclerosis?
A
Severe HTN
Luminal narrowing
“Onionskin appearance”
Kidney are most sensitive
16
Q
What are some features of monckeberg medial sclerosis?
A
Dystrophic calcification
Idiopathic
Affects elderly
Incidental Dx: x-ray mammogram
17
Q
99% of arteriosclerosis is….
A
Artherosclerosis
18
Q
What is the #1 cause of morbidity and mortality in the US?
A
Atherosclerosis. CAD, MI, carotid atherosclerosis, stroke
Atheromas.
19
Q
Where do atheromas protrude into?
A
Lumen, deacreasing flow (vascular stenosis)
20
Q
Atheromas are prone to rupture, what happens with thsi?
A
Massive thrombosis,. Macrophages, lipids (foam cells), Ca++, dibris, MC cause of MI
21
Q
What do atheromas weaken?
A
Tunic media -> aneurysm risk
22
Q
What are foam cells?
A
Fat-laden macrophages
23
Q
What do foam cells cause?
A
Possible blood flow obstuction (ischemia). CAD = 70% occlusion of coronary arteries
24
Q
What are some hemodynamic distrubances that can cause atherosclerosis?
A
Turbulence.
Branch points or turbulent areas
25
What does chronic endothelial injury lead to?
Atherosclerosis
26
What are addtl risk factors for atherosclerosis?
Family Hx, increased age, males. Dyslipidemia, smoking, HTN, DM, stress, inflammation (C-reative protein), inactiity
27
What are the risk factors for MI?
Hyperlipidemia, HTN, smoking. Multiplicative: 2 of the risk factors = 4x risk, all 3 = 7x risk
28
What is metabolic syndrome?
Central obesity, HTN, insulin resistance, dyslipidemia, hypercoagulability/pro-inflammatory state (adipokines). Risk for cardiovascular disease
29
What are the consequences of atherosclerosis?
Stroke, AAA
MI, CHF
Peripheral vascular disease (PVD) -> gangrene
30
What is an aneurysm?
Local vascular dilations (ballooning).
31
What are some complications associated with an aneuryism?
Stasis -> thromboembolism
| Thinned wall -> rupture/hemorrhage
32
What is a true aneurysm?
All 3 layers of a vessel of heart wall. Saccular aneurysm (one sided bulge), Fusiform aneurysm (both sides bulge)
33
What is a false aneurysm?
Defect in a vascular wall, extravascular hematoma. Communicates with lumen = pulsatile
34
Where do true aneurysms happen?
Aortic arch
Abdominal aorta
Iliac arteries
35
What are risk factors for aneurysms?
HTN/atherosclerosis: ischemia of tunica media
| Marfan syndrome, Ehlers-Danlos syndrome
36
What is an abdominal aortic aneurysm (AAA)?
Dilation of > 50% of normal.
37
Where is the MC location for AAA?
Between renal and common iliac arteries
38
What are some features that facilitate AAA?
Degeneration and necrosis of media and ECM. Inflammation: macrophages, MMPSs
Decreased diffusion: thinning of wall
39
What are some risk factors for AAA?
Males, smoking, >50 years, caucasian, familial Hx. of AAA, atherosclerosis, HTN
40
With is the Dx for AAA?
Ultrasounds or CT
41
T/F
People with AAAs are okay to be adjusted
True,
Being extremely cautious with any HV adjusting.
42
What can be obstructed in an AAA considering the aorta
Kidneys, spinal cord, G.I., legs. Mass effect: may compress ureters.
43
If an AAA produces emboli, what is a great risk factor?
Tissue infarct
44
What happens in AAA with rupture?
Hemorrhage
45
T/F
90% of AAA are Fatal
False,
Only 50% are fatal
46
What is an aortic dissection?
Blood enters the arterial wall "blood splays apart the laminar planes of the media to for a blood-filled channel inside the artic wall"
47
What are 2 types of aortic dissections?
Massive hemorrhage
| Pericardial tamponade
48
What is the major risk factor for aortic dissection?
HTN: major risk factor, 90% of cases. Male 40-60 years. Adolescents/young adults with CT disorders (Marfans, Ehler-Danlos, Wilson disease)
49
T/F
Aortic dissection is commonly found in conjunction with substantial atherosclerosis
False,
Rare in presence of substantial athersclerosis (act as somewhat of a protection).
50
What is Wilson disease?
Autosomal recessive. Abnormal copper ion transpiration. Excessive copper accumulation.
51
What organs are affected by Wilson disease?
Liver: steatohepatitis
Brain: psychosis, parkinsonism
Eye: Kayser-Fleischer ring
52
What is pain like with aortic dissections?
Sudden & severe "treaing or stabbing". Anterior chest, projects posteriorly between scapulae. Inferior radiation: progressive dissection.
53
What is a DDx for aortic dissections?
MI
54
What are complications associated with aortic dissections?
Depends on location
Type A: proximal
Type B: distal
55
What is vasculitis (vasculidites)
Inflammation of vascular wall
Local vessel destruction
MC in small arteries
Fever, malaise, myalgia, arthralgia, fatigue
56
What is infectious vasculitis?
Vascular invasion (e.g. Hep B)
57
What is non-infectious vasculitis?
Immune-mediated, ADRs. (e.g. SLE, penicillin)
58
What is are a few ancillary causes of vasculitis?
Irradiation, trauma (physical, chemical)
59
What is giant cell (temporal) arteritis?
MC vasculitis in older adults (> 50 years). Idiopathic, T cells, autoimmun ehypothesis
60
What vessels are involved in giant cell (temporal arteritis)?
Large and small arteries of head, patchy involvement (may involve an artery and not another very close to it)
1. Temporal artery
2. Ophthalmic artery: 50% diplopia/sudden blindness
3. Vertebral artery & aorta (giant cell aortitis)
61
What are some features of giant cell (temporal) arteritis?
Facial pain, HA, pyrexia, vision distrubance. Granulomatous inflammation
62
What is the tx for giant cell (temporal) arteritis?
Corticosteroids
63
What is Takayasu arteritis?
"pulseless disease". Granulomatous vasculitis (autoimmune hypothesis). Pronounced narrowing of lumen (aortic arch, branches off aortic arch,
64
What arteries are involved in Takayasu arteries?
Places where pulses are checked: radial, carotid, renal, pulmonary
65
What are some symtpoms/features of Takayasu arteritis?
Fatigue, fever, weight loss, pulmonary HTN
66
What is an example of the variety of neuro defects with Takayasu arteritis?
Visual disturbances (not as much as in temporal arteritis).
67
What age group is indicated in takayasu arteritis?
Younger individuals
68
What is polyarteritis nodosa (PAN)?
System-wide vasculitis, transmural necrosis (small and medium sized arteries).
69
What does PAN do to the vessels it affects?
Weakens walls -> aneurysm, hemorrhage, or ulceration. Tissue atrophy, ischemia, or infarction.
70
What tissues are MC affected by PAN?
Kidneys, viscera, heart, liver, GI (avoids pulmonary arteries oddly).
71
What are symptoms of PAN?
Episodic, widespread, constitutional. Weigth loss, fatigue, fever, malaise.
72
What age groups are MC affected by PAN?
Any age, but MC in young adults.
73
1/3 of anyone with PAN will have...
Chronic Hep B infxn (HBV antigen)
74
2/3 of anyone with PAN will ahve...
Idiopathic, automimmune hypothesis
75
How are myalgia and peripheral neuritis inolved in PAN?
Diffuse, motor defects
76
What artery is affected by PAN and causes rapid increase in BP (renovascular HTN)?
Renal artery
77
If someone has PAN and has abdominal pain, bloody stools (frank/obvious), what is happening?
PAN affecting GI arteries
78
What is the prognosis of PAN if untreated?
Fatal
79
What is the Tx for PAN?
Corticosteroids: 90% cure
80
What kind of dermatological features can be noted with PAN?
Widespread vascular lesions.
| Segmental fibrinoid necrosis and thrombosis (biopsy)
81
What is kawasaki disease?
Pediatric vasculitis (80%
82
What % involvement is cardiovascular issues apart of kawasaki disease?
20%
83
What is the description of the damage of kawasaki disease?
Aneurysm or thromubs -> MI
84
T/F
Kawasaki disease is self limiting?
True
85
What determines the prognosis of Kawasaki?
Severity of CAD
86
Who recovers full from Kawasaki disease?
Patients without CAD
87
What tends to happen more often than not with aneurysms in kawasaki disease?
>50% resolve within 2 years.
88
What is the cause of Kawaski diease?
Idiopathic, hypothesized type IV hypersens. Genetics + viral antigens. Rare, asian descent, males.
89
What is the hallmark of Kawasaki disease?
Actue/persistant fever. No response to ibuprofen or acetaminophen
90
What are some features of kawasaki disase?
Conjunctivitis, swollen extemities, cervical lymphadenopathy, desquamation of extremitites (de-squamous cell-ing), strawberry tongue (oral erythema)
91
What are the treatments for Kawasaki disease?
Aspirin, corticosteroids, CABG
92
What is Wegener granulomatosis?
Type II hypersensitivity. Necroptizing vasculitis -> ischemia
93
What is primarily involved with Wegener granulomatosis?
Kidneys, and upper/lower respiratory tracts: nose, nose/sinuses, trachea, lung
94
What are 3 major features of Wegener granulomatosis?
Granulomas
Sytemic vasculitis: small/medium arteries
Glomerulonephritis
95
What is the age group MC affected by Wegener granulomatosis?
Middle-aged (40- years old), males
96
What are some secondary features of Wegener granulomatosis?
```
Bilateral pneumonitis (95%0, couch, chest pain, hemoptysis, dyspnea
Chronic sinusitis (90%)
```
97
What are some issue with renal disease associated with Wegener's granulomatosis?
Hematuria, proteinuria, possible renal failure
98
What are some nasopharyngeal issues associated with Wegeners?
Inflammation/ulcers (75%). Rhinitis, sinusisits, nose bleeds
99
What is Thromboangiitis obliterans (Buerger disease)?
Medium-sized arteries. Inflammation, thrombosis -> vascular insufficiency.
100
What arteries are MC affected by Thromboangiitis obliterans?
Feet (tibial artery), hands (radial artery))
101
Who is most at risk for Thromboangiitis obliterans?
Heavy tobacco smokers: endothelial damage. Relieved with abstinence
102
What is MC affected by thromboangiitis obliterans?
Males, age 25-35 years
103
What kind of symptoms associated with ischemia is found in thromboangiitis obliterans?
Painful extremities, cyanosis/cold. Ulcerations, gangrene.
104
What are some symptoms of thromboangiitis obliterans?
Pain at rest
Exercise -> vascular claudication
Ulcerations and gangrene (amputation)
Possible Raynaud phenomenon.
105
What is raynaud phenomenon?
Exaggerated arteriole vasoconstriction. Pallor and cyanosis. Extremities: fingers, toes (nose, earlobes, lips).
106
T/F
Raynauds is a serious condition
False
Benign condition. Unless it's chronic which can produce tissue atrophy - skin, CT, muscles.
107
When does raynaud onset?
Adolescent/young adults, MC in females
108
What is primary raynauds?
Cold and emotional, 5% of US
109
What is secondary raynauds?
Atherosclerosis, Buerger disease, Lupus (SLE), scleroderma, atherosclerosis
110
What is takotsubo cardiomyopathy?
"Broken heart syndrome" or "cardiac raynaud" or "stress cardiomyopathy". Extreme psychological stress causing increased catecholamine production which may affect the coronary arteries, stimulating vasospasm increasing heart rate and contractility. Fatal arrythmia (V-fib). Possible cardiac ischemia -> MI
111
What is a veinous thrombosis?
Blood clot formation
112
What is a phlebitis?
Vein inflammation
113
What are the three conditions that make up 90% of venous diseases?
1. Varicose veings
2. Phlebothrombosis: venous thrombosis without previous inflammation (rare)
3. Thrombophlebitis: venous thrombosis following inflammation (MC used term)
114
What are vericose veins?
Superficial veins: dilated and tortuous (Legs MC). INcreased intraluminal pressure. Dilation -> incompetent valves.
115
What are some features of vericose veins?
Congestion/edema, pain, thrombosis, ulceration.
116
What are some risks for vericose veings?
Obesity, genetics, pregnancy. MC a cosmetic concern
117
T/F
Vericose veins are high risk for the production of emboli?
False
No real association
118
What is thrombophlebitis?
Thrombosis and inflammation lOCALIZED CYANOSIS/ERYTHEMA, EDEMA, PAIN.
119
What is the major risk for thrombophlebitis?
Immobilization
120
Are DVTs involved in throbophlebitis?
DVTs (90% of all cases)
121
What are some other risks for throbophlebitis?
Recent surgery, pregnancy, obesity, immobilization, O.C., CHF, genetics
122
What is often produced with thrombophlebitis that causes fatality?
Possible pulmonary embolism. May be the 1st indication of thrombophlebitis
123
What is superior vena cava syndrome?
Compression or invasion of SVC. Bronchogenic carcinoma, mediastinal lymphoma congesting UE veings: edema (head, neck, arms)
124
What is inferior vena cava syndrome?
Compression or invasion of IVC
Hepatocellular carcinoma, renal cell carcinoma
Congestion of LE veins: edema, proteinuria
125
What is lymphedema?
Rare. Obstruction -> tissue expansion. Lymphatic obstuction -> inflammation.
126
What is primary congenital lymphatic abnormalities
Milroy disease (inherited). Hypoplasia or agenesis of lymph vessels
127
What is secondary obstruction of normal lymph vessels?
Neoplasia, infxn (filariasis), thrombosis, ribrosis (surgery)
128
What is Peau d'organge?
"Skin of an orange" acute lymphedema
129
What is the long-term consequence of lymphedema?
Brawny induration (hardening of the edemic tissues).
130
What tissues do vascular tumors originate from?
Endothelial cells
Connective tissue or vessels
MC benign
131
What is the MC benign vascular tumor?
Hemangioma
132
Occasionaly vascular tumors can be farily aggressive. What is the condition called?
Kaposi sarcoma
