Vasculitis Flashcards Preview

Cardio > Vasculitis > Flashcards

Flashcards in Vasculitis Deck (39):
1

What is vasculitis?

Heterogeneous group of disorders that all have inflammation of the blood vessel walls in common

2

What is the problem with vascular damage?

It causes end organ damage

3

How do the vasculitides present?

With fever/myalgias/arthralgias/malaise, then organ specific signs and symptoms

4

Infectious vasculitis

Direct invasion of vessel wall by pathogens that result in inflammation.

5

Fungal causes of vasculitis

Aspergillus, mucor

6

Bacterial causes of vasculitis

Treponema pallidum, legionella, pseudomonas.

Rickettsia rickettsiae

7

Non-infectious vasculitis

Not known to be caused by direct invasion of the vessel wall, perhaps immune mediated. q

8

Why is it important to distinguish infectious/noninfectious vasculitis?

Because for noninfectious, immunosuppression could exacerbate infectious. Also know that noninfectous vasculitis can be precipitated by an infectious process.

9

Important vasculitis classifications

Large medium small variable vessel vasculitis

10

Medium vessels are...

Main visceral arteries, veins and their initial branches.

11

Small vessels are..

intraparenchymal arteries, arterioles, capillaries, venules, and veins

12

If a disease is classified as large vessel, or whatever, can it affect other vessels?

Yes.

13

Some immunological mechanisms that can initiate non-infectious vasculitides

SLE: Dna-antiDNA complexes
Polyarteritis nodosa: HepBag and AB complexes
Streptokinase/penicillin are antigenic
Antiendothelial cell antibodies may predispose to kawasaki disease

14

ANCA

Anti-neutrophil cytoplasmic antibody. Circulating that react with cytoplasmic antigens in neutrophils and endothelial cells. cytoplasmic anca is now Proteinase 3 anca (PR3anca). Perinuclear anca is now MPO-anca (myeloperoxidase).

15

Blindness in giant cell arteritis due to

Infection of small vessels ,even though GCA is a large artery disease.

16

Two major variants of LVV

Giant Cell Arteritis (>50)
Takayasu Arteritis (<50)

Histopathologically indistinguishable -- granulomatous

17

Granuloma characteristics

Has giant cells, epithelioid macrophages and a collar of lymphocytes

18

How to diagnose GCA

Temporal artery biopsy.

19

Does a negative biopsy rule out GCA?

No. Start steroids

20

Biopsy appearance for GCA

Intimal thickening with granulomatous inflammation. IEL fragmentation with elastic stain.

21

Where does takayasu arteritis present

Left subclavian, left common carotid, brachiocephalic artery

22

How to diagnose?

Can't do biopsy because of the vessels involved. Signs of limb ischemia, decreased pulse at brachial arteries, blood pressure difference between arms, subclavian bruits

23

Patients with Takayasu?

80-90% females. Under 40.

24

How to treat takayasu arteritis?

Glucocorticoids early, vascular surgery later.

25

Medium vessel vasculitis onset compared to LVV

Onset in more acute and necrotizing than in LVV.

26

Two major categories of MVV

Polyarteritis nodosa
Kawasaki's disease

27

Polyarteritis nodosa

Necrotizing vasculitis of medium to small arteries (ONLY!). Often leads to inflammatory aneurysms or rupture

28

Most commonly involved arteries in polyarteritis nodosa?

Renal arteries. causing hypertension and ischemic nephropathy But not glomerular capillaries. So no glomerulonephritis

29

What set of arteries does PAN usually spare?

Pulmonary circulation

30

Symptoms of PAN

Malaise fever weightloss, hypertension, abdominal pain/melena, diffuse muscular aches and pains.

31

How to treat PAN?

Corticosteroids and cyclophosphamide

32

Is PAN assoiciated with ANCA?

NO! 30 % have hep B

33

Biopsy findings in PAN

Begins as a segmental transmural inflammation with neutrophil predominance. Later, fibrinoid necrosis (bright pink) comprised of deposits of immune complexes.Lots of fibrin too. Finally chronic inflammation and scarring. All stages of activity present within the same vessel!

34

Kawasaki disease

Medium size arteries. Is associated with mucocutaneous lymph node syndrome and is found in infants and young childnre. Acute febrile and self limited illness. But has predelection for coronoarry arteries.

35

How does Kawaksaki disease happen?

Autoantibodies to endothelial and smooth muscle cells

36

Signs and symptoms

Fever and mucocutaneous lymph node senydome. Conjuctnival injection oral mucositis with strawberry ongue and cracked red lips. Accompanied by a skin rask and edema of hands and feet. Cerbival lymph node enalrgement.

37

How many people w/ KD develop cardiac sequellar?

20% if untreated. Can cause coronary artery ectasia leading to aneurysms and can cause rupture or thrombosis causing MI.

38

How to treat KD

ASPIRIN!!! This is super high yield.

39

Not doing small vessels because

I'm lazy!