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23 Cards in this Set
- Front
- Back
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Location of vascular injury and vascular/clinical response
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Injury to the endothelium→ thrombi, thickening, & spasm → pain of ischemia & loss of function of organ
Injury to the media → aneurysm; rupture→ pulsatile mass, hypotension & pain Injury to the adventitia → weakening, false aneurysm with resulting lump (hematoma), pain Large vessels are sites for aneurysm and rupture Medium sized arteries thicken and narrow (stenosis) or thrombose → ischemia Small arteries & arterioles: arteriolar narrowing can cause hypertension Capillaries: petechial hemorrhage, microthrombi (DIC), narrowing in diabetes |
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Atheroma sites and three major elements
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Intimal, may involve media
Arteries: Aorta and its major branches (coronaries, cerebrals, peripheral, etc.) Branch sites - endothelial cushions Three Major Elements -Necrotic center of extracellular lipid -Fibrous cap -Proliferating cells (myofibroblasts) |
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Atheroma complications of the plaque
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Ulceration, fissuring (the cracked plaque)
Thrombosis (often caused by ulceration) Medial damage, causing aneurysms Hemorrhage into plaque Calcification |
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Atheroma clinical symptoms
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INSIDIOUS: Usually asymptomatic until 75% stenosis
Effects of the atheroma at various sites: -Aortic and branches: aneurysm, mural thrombus, rupture -Cardiac: infarct, ischemia, dysrhythmia, sudden death -GI: ischemia, infarction -Brain: infarction (stroke or CVA), ischemia -Peripheral Vascular Disease: ischemic atrophy, claudication & gangrene |
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Clinical complications of atherosclerosis
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Carotids and vertebral arteries (Cerebrovascular Disease): narrow, ulcerate, embolize, cause ischemia, or infarct
Coronary arteries (Ischemic Heart Disease): narrow, ulcerate or thrombose, causing ischemia, infarct, arrhythmia, heart failure Peripheral arteries (Peripheral Vascular Disease): same mechanisms cause ischemia, gangrene, usually of lower limbs, but also of intestinal vasculature Aorta: aneurysm, rupture, atheroembolism; mural thrombus with thromboembolism; also, stenosis of branches (renals, mesenterics, etc.), causing ischemia |
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Arteritis overview
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May present with involvement of any organ system
Commonly involves multiple organs Due to infection (bacterial, fungal, other) or immune |
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Inflammation of arterial vessel complications
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Weaken vessel walls causing aneurysm or rupture
Narrow the lumen causing ischemia Damage the endothelium, resulting in thrombosis Become complicated by arteriosclerosis (e.g., syphilitic aortitis with secondary atherosclerosis) |
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Kawasaki disease
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Idiopathic necrotizing arteritis
Kawasaki disease (muco-cutaneous lymph node syndrome): -arteritis in children (< 4 years old) -Fever & rash -Conjunctival or oral erythema/erosion -Erythema of palms/soles -Enlarged cervical lymph nodes -involvement of coronary arteries (manifests ~ a decade later) --Ectasia, aneurysm, AMI, SUD |
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Takayasu arteritis
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Idiopathic necrotizing arteritis
Thickening of aortic arch -↓pulses in upper extremities, ‘pulseless disease’ -coldness/numbness of fingers -ocular disturbances (visual defects, RHs, blindness) -HTN -neurological defects Microscopic = giant cell arteritis Women, < 40 years old most commonly affected |
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Thromboangiitis obliterans (Buerger disease)
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Idiopathic necrotizing arteritis
Pain and ischemia, legs and arms Relatively young men (< 35) Leads to gangrene of extremities Genetic predisposition possible Almost exclusively in smokers May improve with smoking cessation Small & medium sized arteries Lesion: -Cellular thrombosis with inflammation -Involves arteries and veins -Fibrosis around nerves and lymphatics |
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Phlebitis
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Acute inflammation of veins, usually with thrombosis
Caused by bacterial, parasitic, physical, chemical, allergic injury Examples: -Pylephlebitis (portal vein) from abdominal infection (e.g., appendicitis) -Dural sinuses in infections of ear and face -Pulmonary veins in pneumonia -Iliofemoral veins in puerperal sepsis -Hepato-veno-occlusive disease from chemotherapy -Migratory thrombophlebitis (Trousseau syndrome) --Transient attacks, variable sites --With internal cancers (e.g., pancreatic CA) -Idiopathic Thrombophlebitis (phlebothrombosis) |
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Phlebothrombosis
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Venous thrombosis without inflammation
Usually in deep veins of legs (DVT) or pelvic veins Exact incidence uncertain, but high (autopsy patients, as high as 60%) Pain, tenderness, swelling, or may be asymptomatic Complication: pulmonary embolus -up to 50% of patients -source usually deep veins in thigh for fatal emboli Clots usually form in relation to valve cusps (sites of maximum stasis), propagate upward |
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Varicose veins
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Abnormally dilated, tortuous veins
Produced by prolonged increase in intraluminal pressure Often in relation to injury or defect of the vein proximally Legs (estimated 20% of population) -Clustering in families suggests a structural abnormality, such as defective valves -Complications: Inflammation, thrombosis, stasis dermatitis, ulceration of the skin -Not pulmonary embolism |
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Varicose veins names at different sites
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Perianal (hemorrhoids)
Testis (varicocele, dilatation of pampiniform plexus) Esophageal varices (hepatic cirrhosis): varices in distal esophagus, cardia of stomach, & perianal region -occur in hepatic cirrhosis -portal hypertension → porto-systemic anastomoses -Complication: hemorrhage when varices torn or eroded |
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Atherosclerotic aneurysms: epidemiology, location, mechanism
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Age: >50, males 5:1, relatively common
Location: abdominal aorta (97%) usually below renals, may involve iliacs, but may occur in thoracic aorta; Mechanism: atheromas --> medial destruction, ulcerated plaques |
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Atherosclerotic aneurysms: presentation, complications
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Presentation: pulsatile abdominal mass or pain; or rupture causes abdominal pain, swelling and shock; or incidentally on x-ray (calcified wall)
Complications: -rupture (retroperitoneal hemorrhage), -stenosis of ureter by pressure or fibrosis, -occlusion of aortic branch (renal, mesenteric), -embolism (thrombo- or atheromatous) |
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Atherosclerotic aneurysms: rupture, diagnosis, therapy
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Rupture related to size: greater than 7cm. -- 80% rupture and die; less than 5 cm. -- rarely ruptures
Diagnosis: Ultrasound - clinical cut-off is 6cm. Therapy is surgery: open damaged aorta, insert prosthetic graft (usually just below renals, into both iliacs); alternative: stent |
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Syphilitic aneurysms: location, mechanisms, presentation
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Location: Ascending thoracic aorta & arch
-aortic intimal tree-barking Mechanism: Tertiary syphilis involves vasa vasorum causes vasculitis, and medial damage Presentation (varies): -dyspnea, stridor, dysphagia, cough, pain -congestive heart failure due to aortic insufficiency (AI) -aneurysm can compress esophagus or recurrent laryngeal nerve -symptoms depend on structures involved |
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Syphilitic aneurysms: causes of death, therapy
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Causes of death:
-heart failure due to AI -hemorrhage due to rupture Therapy: surgery - aortic and/or valve replacement |
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Mycotic aneurysm: definition, mechanism, complication, cause
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Causes of death:
heart failure due to AI hemorrhage due to rupture Therapy: surgery - aortic and/or valve replacement |
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Dissecting hematoma of aorta (pseudoaneurysm): age, location
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Age: 40-60, males 6:1
Location: 95% have intimal tear in ascending aorta -5% have no intimal tear (probably just small) -if hemorrhage extends to aortic branches, can cause differences in pressure and pulse in arms or legs |
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Dissecting hematoma of aorta: types, mechanisms
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Type A: Most common - involves ascending aorta & may extend distally
Type B: Begins distal to subclavian artery, extends distally (3x better prognosis than Type A, because does not involve vessels to head) Mechanisms: -hypertension -trauma (deceleration injuries in motor vehicle accidents); -others associated with aortic medial degeneration (e.g. Marfan syndrome) -not ordinarily caused by atherosclerosis; -hemorrhage dissects into outer layers of media -can rupture outward to pleural, pericardial cavities, or into retroperitoneum or re-enter lumen -Creates false lumen (e.g., double-barrelled aorta), visible on x-ray |
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DIssecting hematoma of aorta: presentation, therapy
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Presentation:
-85% pain in chest, or radiating to back; -usually normal or elevated blood pressure -if coronary artery involved, may have MI and drop in BP; -sensory or motor changes if compromise spinal cord vasculature -histology: mucinous lakes, elastic fiber fragmentation, cystic medial degeneration Therapy: anti-hypertensives, surgery (usually a prosthetic graft) |
