Vasculitides Flashcards Preview

Cardiology > Vasculitides > Flashcards

Flashcards in Vasculitides Deck (21):
1

Layers of vessels

Tunica Intima
Tunica Media
Tunica Adventitia

2

Typical symptoms

Organ ischemia (via thrombosis and inflammation- healing/ fibrosis)

3

Large vessel vasculitides

Affects Aorta/ Carotid

Giant Cell (Temporal)- most common (seen in females > 50)
Takayasu (Asian females < 50)

4

Giant cell arteritis

Seen in females >50
Generally affects branches of carotid artery
Headache (temporal))
Visual disturbance
Jaw claudication
Polymyalgia rheumatica (flue like symptoms with myalgia)
Elevated ESR
Granulomatous vasculitis- inflamed vessel wall with giant cell and intimal fibrosis

5

Biopsy of giant cell

Need to take a large sample, because it is "segmental" in the way it affects
Negative biopsy doesn't exclude giant cell arteritis, because it may be affecting a different area

6

Giant cell

Large cells with multiple nuclei

7

Treatment for giant cell arteritis

Corticosteroids- immediately when suspected
Because of high risk of irreversible blindness

8

Takayasu Arteritis

Similar to giant cell with a few exceptions:
- Adults <50 (typically young asian females)
- Affects aortic arch branch points (rather than more distal carotid artery)

9

Takayasa arteritis- treatment

Also corticosteroids

(think of Takayasu as part of the spectrum of giant cell arteritis)

10

Medium-vessel vasculitis

Affects muscular arteries (e.g. renal)
Polyarteritis Nodosa
Kawasaki
Buerger

11

Polyarteritis Nodosa

Necrotizing vasculitis
Involves most organs (but not lung)
Presents in young adults (renal- HTN, mesenteric- abdominal pain, neuro probs, skin probs)
Generally HBsAg +

12

Polyarteritis nodosa- histology

String of pearls appearance on imaging
Typically see transmural inflammation with fibrinoid necrosis (very pink on histology)- seen in vasculitis and malignant HTN
"Nodosa" because it appears like nodes after fibrosis occurs
Lesions are in different stages of healing (aneurysm- early lesions, fibrosis- late lesions)

13

Polyarteritis nodosa- tx

Corticosteroids or cyclophosphamide
Fatal if not treated

14

Kawasaki

Affects Asian children < 4
Looks like infection (fever, conjunctivitis, erythema in palms and soles, enlarged cervical lymph nodes)
Preferentially affects coronary arteries (can cause thrombosis and aneurysm)

15

Kawasaki- Tx

Aspirin- prevent thrombus formation in coronary arteries (important to distinguish that they do not have a viral illness)
IVIG
Disease is self limited

16

Buerger

Necrotizing- ulcerations and autoamputation
High association with smoking
Raynaud phenomenon seen in these patients

17

Small vessel vasculitis

Affects arterioles, capillaries, and venules
Wegener granulomatosis
Microscopic polyangiitis
Churg-Strauss

18

Wegener Granulomatosis "C"

Affects middle-aged mem
Involves nasopharynx, lungs, and kidneys
Patients present with rapidly progressing glomerulonephritis and hemoptysis
Necrotizing granulomas
c-ANCA positive
Cyclophosphamide & corticosteroids is the tx

19

Microscopic Polyangiitis

Similar to Wegner, but do not see:
No nasopharyngeal involvement (only affects lung and kidneys)
No granulomas seen
See p-ANCA not c-ANCA
Tx is the same as Wegner (cyclophosphamide and corticosteroids)

20

Churg-Strauss

p-ANCA +
Necrotixing granulomatous vasculitis with EOSINOPHILS
Typically have hx of asthma
Affects multiple organs: lungs and heart

21

Henoch Schonlein Purpura

Most common vasculitis in kids
PALPABLE purpura on buttocks and leg (because of inflammation)
GI pain and bleeding
Hematuria (IgA nephropathy)
Usually occurs following an upper respiratory tract infection- because of excess production of IgA
Generally self-limited