Cardiovascular Diseases Pathology Lecture

Front 1

what is arteriosclerosis?

Back 1

- "hardening of the arteries" secondary to arterial wall thickening

Front 2

what is arteriolosclerosis?
what diseases are assoc w/ it?
is there a pathological lumen narrowing?

Back 2

- basically arteriosclerosis process but specific to small arteries & arterioles
- assoc w/ HTN & diabetes mellitus
- of coarse there is

Front 3

what is medial calcific sclerosis?
is there a pathological lumen narrowing?

Back 3

- calcification of media
- nope, not this time

Front 4

what is another name for medial calcific sclerosis?

Back 4

Monckeberg sclerosis

Front 5

what is atherosclerosis?
is there a pathological lumen narrowing?

Back 5

- basically arteriosclerosis process but specific to med to large arteries
- fo sho there is

Front 6

where do you see changes in the intima of large to med sized arteries?

Back 6

atherosclerosis

Front 7

what do the lesions in artherosclerosis look like?

Back 7

- atheromas (raised lesion) or plaques
- the lesions are lipid deposits in the intima covered by a fibrous cap

Front 8

what are 3 complications of atherosclerosis?

Back 8

- atheromas or plaques protrude in to lumen and...
- can obstruct-->ischemia-->MI
- can rupture-->thrombosis
- can weaken underlying media-->aneurysm

Front 9

what are the risk factors for atherosclerosis?

(hint: 4 nonmodifiable and 5 modifiable)

Back 9

NON-MODIFIABLE
- inc age
- male
- family hx
- genetic disorder
MODIFIABLE
- Hyperlipidemia (inc LDL)
- HTN
- ciggs
- diabetes
- C-reactive protein & inflamm

Front 10

What kind of change do you observe in the intima of atherosclerotic arteries?
What is earliest sign in intima suggesting atherosclerosis?

Back 10

- yellowish discoloration (fat) or white lesions (collagen fibrous cap)
- first sign is fatty yellow streaks w/n intima

Front 11

atherosclerosis pathogenesis list?
(just have basic understanding of these)

Back 11

- chronic endothelial injury
- accum of lipoproteins (LDL) w/n lumen
- monocyte adhesion to endothelium
- plt adhesion
- factor release
- SM cell proliferation (can secrete collagen which accum)
- ECM prod
- lipid accum in cells

Front 12

if in the thoracic aorta, where do atherosclerotic plaques/lesions generally hang out?

Back 12

-(in the dorsal part) often around intercostal artery projections

Front 13

collagen depostion in atherosclerosis causes what?

Back 13

- a raised intima into lumen (fibrous caps)

Front 14

where is common site for plaque buildup in abdominal aorta leading to thrombus or aneurysm?

Back 14

- right before bifurcation of iliac arteries

Front 15

are plaques more commonly found in the thoracic aorta or the abdominal aorta?

Back 15

- abdominal aorta
- both the dorsal & ventral parts
- numerous plagues can be found
- plaques more prone to ulcerate

Front 16

what would happen if a thrombus in abdominal aorta right before bifurcation of iliac arteries embolized?

Back 16

- it would probably move to leg and become lodged in an artery causing ishemia, possibly gangrene

Front 17

what does an aneurysm look like pathologically?

Back 17

- wide, cracked valleys
- causing a weakening or thinning of media

Front 18

If the pathogenesis of an aneurysm were as follows, where would you expect the location of the aneurysm?
1. atherosclerosis-->
2. syphilis-->
3. dissecting secondary to cystic medial nedcrosis-->
4. congenital (Berry)-->

Back 18

1. abdominal aorta
2. thoracic aorta
3. variable but prob in thoracic aorta
4. cerebral arteries

Front 19

most likely epidemiology of AAA (abdominal aorta aneurysm)?

Back 19

>50 male

Front 20

most common site of AAA?

Back 20

- below renal arteries & above bifurcation

Front 21

2 types of morphology for AAA? which is more common?

Back 21

Fusiform - diffuse elongated widening in arterial wall (most common)
Saccular - outpouching of portion of wall (less artery involved)

Front 22

3 complications of aneurysm?

Back 22

- obstruction
- rupture
- embolism

Front 23

what would kidney look like if wasnt receiving enough blood due to arteriolosclerosis? what could have caused this?

Back 23

- kidney surface would not be smooth. it would look granular
- HTN

Front 24

Thoracic Aortic Aneurysm morphology?

Back 24

- Saccular (spherical outpouching)
- obliterative endarteritis
- patchy loss of elastic fibers in media
- wrinkling "tree bark" of intima

Front 25

3 complications of Thoracic Aortic Aneurysm?

Back 25

- aortic valvular ring dilatation
- aortic insufficiency
- congenital heart failure

Front 26

Thoracic Aortic Aneurysms common in?

Back 26

- ascending aorta
- aortic arch

Front 27

what are the 2 etiologies & epidemiology of Aortic Dissection?

Back 27

1. HTN [90%] - (40-60 yo. men)
2. Conn Tiss abnormality - (younger)
---> due to Marfan Syn
---> due to cystic medial degeneration

Front 28

where do most aortic dissections begin? where can they appear?

Back 28

- ascending aorta
- basically anywhere in aorta

Front 29

Aortic Dissection morphology?

Back 29

intima tear-->blood into media-->extends proximally & distally

Front 30

2 main complications of Aortic Dissection?

Back 30

1. massive catastophic hemmorhage (hemothorax)
2. rupture into pericardium (cardiac tamponade)

Front 31

is Aortic Dissection assoc w/ atherosclerosis?

Back 31

-hell no, aortic dissection is normally thoracic region where as atherosclerosis is normally in abdominal aorta

Front 32

most common site of Berry aneurysm?

Back 32

anterior communicating artery

Front 33

a berry aneurysm rupture is assoc w/?

Back 33

subarrachnoid hemorrhage

Front 34

there is a higher incidence of of berry aneurysms in what type of pt?

Back 34

one w/ polycystic kidney dx

Front 35

what is vasculitis?

Back 35

- inflamm of vessel walls

Front 36

sx of vasculitis?

Back 36

fever, myalgia, arthralgias, malaise

Front 37

causes of vasculitis?

Back 37

- immune mediated or direct invasion by pathogen
- can be infectious or non-infectious

Front 38

examples of non-infectious vasculitis? (list abs you would expect to find)

Back 38

1. SLE (antiDNA ab)
2. Wegener (antineutrophil cyto ab)
3. Kawasaki (antiendothelial cell ab)
4. Giant cell (Temporal) arteritis
Takayasu arteritis
Polyarteritis nodosa

Front 39

list features of Giant cell (Temporal) arteritis

Back 39

- Most Common vasculitis!!!!!
- seen in pts >50
- chronic granulomatous inflamm
- major target is small arteries, like temporal artery in head
- aorta---NOT common site

Front 40

sx of Giant cell (temporal) arteritis?

Back 40

- fever, fatigue, weight loss
- HA w/ facial pain
- abrupt optical sx

Front 41

pathology of Giant cell (temporal) arteritis?

Back 41

- nodular intimal thickenings-->lumen stenosis & thrombosis
- granulomatous inflamm of inner media
- lymphos and multinucleated giant cells
- very edmatous intima
- fragmentation of internal elastic lamina

Front 42

Takayasu Arteritis info

Back 42

- aka "pulseless dx" due to weak pulse in upper extremeties
- can also lead to blindeness
- granulomatous
- med-large arteries
- young females

Front 43

Takayasu Arteritis pathology

Back 43

- aortic arch w/ narrowing of assoc great arteries
- patchy medial necrosis
- adventitial inflamm
- collagenous scarring of arterial wall

Front 44

Polyarteritis nodosa info

Back 44

- med vessels
- spares very small vessels (venules, arterioles, capillaries)
- EPISODIC
- HEPATITIS B ang present (30%)

Front 45

sx of Polyarteritis nodosa

Back 45

- malaise, fever, weight loss
- abdominal pain
- melena (blood in stool)

Front 46

pathology of Polyarteritis nodosa

Back 46

- acute or chronic
- many inflamm cells
- FIBRINOID NECROSIS
-Lung & Glomeruli sparred

Front 47

sx of Kawasaki dx?
(aka Mucocutaneous Lymph Node Syn)

Back 47

- Calor
- Cerival lymphadenopathy
- Conjuctiva erosion
- Coronary Artery aneurysm
- Convalescent desquamation
- strawberry tongue

Front 48

Kawasaki dx info

Back 48

- 80% in pts <4
- fibrinoid less than PAN

Front 49

what causes Hypersensitivity Leukocytoclastic Vasculitis?

Back 49

- immunologic rxn to antigen
- antigens often (aspirin, penicillin, thiazide diuretics, strep, staph, hepatitis, TB)

Front 50

what type of vessels are affected in Hypersensitivity Leukocytoclastic Vasculitis?

Back 50

- arterioles, capillaries, venules (small vessels only)

Front 51

what would you see histologically for Hypersensitivity Leukocytoclastic Vasculitis?

Back 51

- LEUKOCYTOCLASTIC (fragmented WBCs)
- nuclear debris from neutros
- fibrinoid necrosis

Front 52

what are the sx of Hypersensitivity Leukocytoclastic Vasculitis?

Back 52

- cutaneous vasculitis
- PALPABLE PURPURA in lower extremities
- common in LUNG (hemoptysis) & GLOMERULI (hematuria)

Front 53

which dx is common in lung and glomeruli?
which dx spares these 2 sites?

Back 53

- Hypersensitivity Leukocytoclastic Vasculitis
- Polyarteritis nodosa

Front 54

what is Churg-Strauss syndrome and where does it occur?

Back 54

- systemic vasculits
- basically everywhere except kidney

Front 55

what does Churg-Strauss syndrome look like histologically?

Back 55

- granulomatous inflamm w/ intense eosinophilia proliferation
- fibrinoid necrosis narrowing vessel lumen

Front 56

lab result for Churg-Strauss syndrome?

Back 56

- eosinophilia
- pANCA present 67%

Front 57

what is the major target for Wegener Granulomatosis?

Back 57

- LUNG

Front 58

what is the triad assoc w/ Wegener Granulomatosis?

Back 58

1. acute necrotizing granulomas of U/L resp tract
2. necrotizing or granulomatous vasculitis
3. focal necrotizing glomerulonephritis

Front 59

who gets Wegener Granulomatosis?

Back 59

- usually 40-50 yo males

Front 60

what is the gross representation of Wegener Granulomatosis?

Back 60

- persistent pnuemonitis w/ bilateral inflitrates w/ cavitation (like TB)

Front 61

labs for Wegener Granulomatosis?

Back 61

- cANCA 95%

Front 62

does Wegener Granulomatosis have renal involvement? give 2 sx of Wegener Granulomatosis?

Back 62

- yes
- also chronic sinusitis and mucosal ulcers of pharynx

Front 63

what is Thromboangiitis Obliterans (Beurger dx)? where is it commonly located?

Back 63

- a segmental, thrombosing, acute & chronic vascular inflamm-->leading to vascular insufficiency
- primarily in extremities (tibial, radial arteries)

Front 64

sx of Thromboangiitis Obliterans (Beurger dx)?

Back 64

- cold sensitivity (reynauds)
- very severe ULCERS of fingers, toes, feet
- painful even at rest

Front 65

what is thought to cause Thromboangiitis Obliterans (Beurger dx)?

Back 65

smoking in young people, <35 yo

Front 66

Infectious vasculitis culprits?
1.bacterial-->
2.rickettsial-->
3.spirochetal-->
4. fungal-->
5. viral-->

Back 66

1. neisseria
2. RMSF
3. syphilis
4. aspergilosis, mucor (mold genus found in often in soil)
5. herpes zoster

Front 67

what cells are targeted by rickettsial related vasculitis?
what is a sign of rickettsial vasculitis?

Back 67

- endothelial cells (inflamm & hemorrhage)
- HEMORRHAGIC RASH

Front 68

where does aspergillosis attack?
what is result?

Back 68

- vessel walls
- often in lung tiss, causes arterial thrombosis & infarction

Front 69

Varicose veins are caused by?

Back 69

--->vein dilatation--->incompetent valves-->venous stasis and pedal edema--> prolonged intraluminal press

Front 70

what complications can you see w/ Varicose veins?

Back 70

- stasis dermatitis & ulceration of overlying skin

Front 71

T/F varicose veins are noncontributory to pulmonary thromboembuli?

Back 71

True

Front 72

where does thrombophlebitis occur?

Back 72

deep leg veins

Front 73

what is the clinical picture leading to a DVT?

Back 73

- cardiac failure
- prego
- obese
- pt on bed rest w/ prolonged immobilization

Front 74

what sign can help diagnose thrombophlebitis?

Back 74

- Homan sign (dorsiflexion of foot)
- get edema and pain over affected veins

Front 75

what is the most common vascular tumor? is it malignant?

Back 75

- Hemangioma (capillary type specifically)
- no its benign ALWAYS

Front 76

what is a hemangioma? where do they occur?

Back 76

- vascular tumor consisting of inc # of blood filled vessels
- can be localized or involve large segment of body
- they can be superficial (skin) or internal (liver)

Front 77

what are the 2 types of Hemangioma?

Back 77

1. Cavernous type
2. Capillary type

Front 78

Capillary Hemangioma

Back 78

- skin, lips, subcutaneous tiss
- NOT encapsulated but very well circumscribed
- LARGEST SINGLE TYPE OF VASCULAR TUMOR
- can appear in juveniles and newborns but they usually regress by age 7

Front 79

Cavernous Hemangioma

Back 79

- less dilated vessels
- less cricumscribed
- no inflamm cell invasion
- see blood filled thin walled vessels
- usually involve deep tiss
--->usually found accidentally on autopsy

Front 80

Glomus Tumor (Glomangioma) benign? where? what?

Back 80

- BENIGN but painful
- found on digit often under fingernail
- smooth muscle cells of glomus body see specialized arteriovenous anastomosis

Front 81

what is the gross representation of Kaposi sarcoma?

Back 81

- red to purple patches consisting of dilated blood vessels (often feet in non HIV assoc)
- may appear as raised plaques
(((think tom hanks in Philadelphia)))

Front 82

histology of Kaposis?

Back 82

- SPINDLE CELLS, slit spaces

Front 83

Kaposi's is most commonly assoc w/?

Back 83

HIV
---but it doesnt have to be

Front 84

what kind of tumor is an Angiosarcoma?

Back 84

-MALIGNANT
- involving endothelial cells

Front 85

How do you get hepatic angiosarcoma?

Back 85

carcinogenic exposure
--->thorotrast, arsenic, polyvinyl choride

Front 86

are cells in Angiosarcoma well differentiated or highly anaplastic?

Back 86

can be either