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90 Cards in this Set
- Front
- Back
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risk factors of HTN
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Smoking
HTN nIDDM (type 2 diabetes) Family Hx Trigylcerides and Fat Male Age Inactivity Diet/drink act in a multiplicative fashion |
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HDL effect
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inverse correlation as clinicla predictor of HTN devo
-removes cholesterol from tissues and from atherosclerotic plaques |
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origin of cholesteral
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endogenous (biosynthetic)
exogenous (dietary) associates with apolipoprotein molecules and circulates as lipoproteins |
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fatty streak seen in atherosclerosis
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lipid deposition in INTIMA (foam cells)
seen as early as 1st year of life and is present in aorta of older children |
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atheromatous plaque seen in atherosclerosis
components |
-within INTIMA of arteries
-fibrous surface cap (made out of fibrous tissue, smooth m cells, inflamm cells, foam cells, collagen, elastin, GAGS, proteoglycans) covering deep lipid material -necrotic core of dead cells, lipid, cholesterol and cholesterol esters, foam cells, plasma proteins, Ca+ |
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what vessles do you see the plaque in
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-proximal portions of coronary aa.
-larger branches of carotid -circle of willis -large vessel of lower extremities -renal and mesenteric aa. |
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complicated lesions of atherosclerosis
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calcification
erosion thrombosis plaque hemorrhage |
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clinical presentation of atherosclerosis
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infarction
(IHD devo) aneurysm stroke ischemic bowel dz peripheral vascular occlusive dz renal arterial ischemia |
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monckebergs medial calcific stenosis
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Media
Medium sized Muscular -ring like calcification in media -radial, ulnar ->50 yo -unrelated to atherosclerosis -no intima involvement therefore no obstruction |
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what is arteriosclerosis
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hyaline thickening or proliferative changes in arterioles and small artieries
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2 types of arteriosclerosis
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1) hyaline
2) hyperplastic |
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hyaline arteriosclerosis
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-elderly
-assoc with HTN and diabetes -hyaline thickening -benign nephrosclerosis |
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hyperplastic arteriosclerosis
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-malignant HTN
-onionskin -concentric laminated thickening -necrotizing arteriolitis (fibrinoid necrosis) -intramural deposition of fibrinoid material in arterioles with vascular necrosis and inflammation |
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what is an anuerysm
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localized, abnormal dilatation of vessel where the wall is weak
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berry anuerysm
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small, sacular
-unrelated to atherosclerosis -not present at birth but devo at sights of congenital medial weakness at bifurcations of cerebral aa -most freq cause of subarachnoid hemorrhage |
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clinical significance of aneurysms
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rupture
impine on adjacent structures occlusion embolization |
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3 appearances of aneurysms
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saccular (portion of wall circumfernece)
fusiform (entire circumference) dissecting (blood enters wall and dissects through) |
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true aneursym
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-all vessel layers initially present
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false aneurysm
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pulsating
-extravascular hematoma that communicates with intravascaulr space -not all the layers |
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location of most atherosclerotic aneurysms
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descending aorts (esp ab)
-renal and iliac arteries |
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site of rupture of atherosclerosis aneurysm
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retroperitoneal (most commone)
intraperitoneal GI tract (3rd part of duodenum) |
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thoracic aneurysms etiology
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most atherosclerotic
-most related to cystic medial change traumatic syphilitic |
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syphilitic thoracic aneursyms
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-tree bark appearance
-ascending aorta and arch -tertiary stage obliterative endarteritis of vaso vasorum causes medial ischemia leading to medal scarring -dilation leads to aortic valve insufficiency and eventual HF |
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clinical presentation of thoracic aneurysms
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-encroach and compress
-erode bone -aortic valve ring dilatation CHF -ostial stenosis IHD |
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most common aortic catastrophe
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dissecting aorta
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risk factors for dissecting aorta
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HTN
male pregnancy marfans family hx |
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pathophys of dissecting aorta
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-blood dissects along laminar planes of media to form blood channel in wall
-cystic medial change usu in ascending aorta |
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cystic medial change
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-accumulation of myxoid material in media
-elastic fragmentation -medial fibrosis |
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clincial presentation of dissecting aorta
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severe, tearing chest pain often radiating through to back
-widening of aortic shadow -NL levels of troponin I, myocardial enzymes, and EKG |
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mycotic aneuryms pathogenesis
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septic emboli (IE)
direct extension infection by circulating organisms |
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etiologies of CA aneurysm
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IE
non-infective vasculitis (kawasaki, PAN) atherosclerosis |
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what is vasculitis
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inflammatory and often necrotizing vascular lesion in any organ due to immune mechanisms and Ags
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what is PAN
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focal, segmental, necrotizing panarteritis of medium-small muscular arteries due to immune complex deposition
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PAN is assoc with what?
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hep B and PANCA
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stages of PAN
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present concurrently
-acute: fibrinoid necrosis, acute inflamm, thrombosis causes infarction, hemorrhage, aneurysm formation -healing: acute and chronic inflammation, fibrosis, ischemia -healed: fibrosis and ischemia |
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symptoms of PAN
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fever, weight loss, malaise, ab pain, headache, myalgia, HTN
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PAN in kidneys
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in arterioles and glomeruli
cuase most deaths in PAN |
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PAN in coronary aa.
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IHD
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PAN in musculoskeletal
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myalgia, arthragia, arthritis
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PAN in GI tract
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nausea
vomitting ab pain |
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churg-strauss syndrome
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-variant of PAN
-allergic granulomatosis and angiitis -pulmonary and splenic involvment -eosinophilia and bronchial asthma -small vessels assoc with granulomas and eosinophils |
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kawasakis dz
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-infants and children
fever, lymphadenopathy, rash, oral/conjunctival erythema -necrotizing PAN: large, med, and small arteries, aneurysm formation |
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hypersensitivity angiitis
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acute vasculitis of arterioles, capillaries, and venules
-palpable purpura -lesions appear synchronous |
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etiology of hypersenstitivity angiitis
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7-10 days after exposure
-exogenous: drugs, food, infectious organisms -complication of systemic ilness (CT disorders or malignancies) |
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wegener's granulomatosis features
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necrotizing granulomas of upper nad lower respiratory tract and kidney
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symptoms of wegener's granulomatosis
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pneumonitis
chronic sinusitis nasopharyngeal mucosal ulcers |
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manifestations of wegener's granulomatosis
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-fibrinoid necrosis of small aa and vv
-early infiltration by neutros -mononuclear cell infiltration -fibrosis -granuloma formation with giant cells C-ANCA in 93% |
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giant cell arteritis types
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temporal arteritis
takayasu's arteritis |
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temporal arteritis
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-focal granulomatous inflammation of medium and small muscular arteries
-systemic vasculitis -see giant cels, monos, neutros, eosinos |
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temporal arteritis etiology
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reaction against vessel wall component (elastin) T cell mediated
usually elderly 50% - polymyalgia rheumatica responds to steroids |
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temporal arteritis symptoms
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malaise, fatigure
headache, claudication of jaw tenderness, absent pulse, palpable nodules along course of involved artery, visual impairment |
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takayasu's arteritis
aka |
aortic branch/arch dz
pulseless dz |
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what is takayasu's arteritis
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granulomatous aortoarteritis with patchy destruction of media
chronic inflammation of vaso vasorum and media leads to irregular thickening of wall and wrinkled intimal surface and luminal narrowing "tree barking" |
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symptoms of takayasu's arteritis
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absent pulse in carotid, radial, ulnar
fever, night sweats, malaise, myalgia, arthritis, arthralgia eye problems painful skin nodules |
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buerger's dz
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acute and chronic inflammatory thrombo-occlusive dz of small and medium size arteries and veins of extremities
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thrombosis in buerger's dz
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microabscesses with peripheral granulomatous inflammation in thrombi
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buerger's dz clinical presentation
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involve adjacent nerves
lower extremities (tibial) 25-50 yo male at onset smoking!!! excruciating pain, ischemia leading to gangrene and digital necrosis |
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raynaud's dz
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episodic functional vasospasm of small arteries and arterioles of extremities
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clinicla presentation of raynaud's dz
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-young, healthy females
-digits exhibit pallor, cyanosis, redness -provoked by cold (emotional stimuli, trauma, hormones, drugs) |
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raynaud's phenomenon
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secondary to underlying disorder
-assoc with organic lesion -SLE or progressive systemic sclerosis |
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varicose veins
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dilated and tortuous due to increased luminal pressure and to decreased support
chronic compensatory medical hypertrophy and sclerosis; frequent thrombosis |
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predisposing factors to varicose veins
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-inc venous pressure
-pregnancy, obesity, thrombophlebitis, prolonged standing |
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most common sights for varicose veins
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superficial leg veins
-esophagus, anorectal, spermatic cord |
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clincial presentation of varicose veins
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symptoms related to chronic edema
-may be painful -stasis dermatitis and ulceration |
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thrombosis:
associated with |
neoplasm
pregnancy postop bed rest immobilization CHF |
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thrombosis:
symptoms |
often minimal
-pulmonary embolism (pulmonary infarcts are characteristically hemorrhagic, subplueral, and wedge-shaped) |
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superficial thrombophlebitis
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generally painful
pulmonary arterial embolism rare |
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obstruction syndromes:
SVC associated with? |
bronchogenic CA
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obstruction syndromes:
IVC associated with? |
renal cell carcinoma
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obstruction syndromes:
hepatic vein thrombosis associated with? |
hepatic tumors
OCPs |
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atriovenous fistula
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communication between an artery and vein
-secondary to trauma or other processes that mechanically penetrate the walls of both vessels |
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resulting changes in atriovenous fistula
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-ischemic changes from diversion of blood
-ballooning and aneurysm formation from inc venous pressure -high-output cardiac failure from hypervolemia |
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vascular ectasias aka
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telangiectasias
-aggregation of abnormally prominent vessels |
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telangiectasias examples
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-nevus flammeus
-port wine stain -spider telangiectasias -hereditary hemorrhagic (osler-weber-rendu) (AD) |
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sturge-Weber
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1. seizures
2. port wine stain |
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hemangioma
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larger vessel composed of masses of channels filled with blood
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hemangioma types
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capillary (tangle of closely packed capillary like channels; skin, subQ, liver, spleen, kidneys)
cavernous( large, cavernous channels, mucosal surfaces, liver, pancreas, spleen, brain) |
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von hippel lindae dz
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AD
hemangioblastoma of cerbellum, BS, retina -adenomas and cysts of liver, kidneys, pancreas) -inc incidence of RCCA |
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glomus tumor
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-subungual
-small, purplish, painful |
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most malignant of vascular tumoes
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angiosarcome
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angiosarcoma
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skin
soft tissue breast liver spleen arsenic, thorium, vinylchloride |
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hemangiopericytoma
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pericytes
varies from b9 to malignant 50% mets |
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kaposi's sarcoma types
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classic
african (endemic) transplant associated AIDS (epidemic) |
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classic KS
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-elderly east euro, mediterranean
-lower extremities |
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african KS
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younger men
equatorial africa |
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transplant associated KS
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-jewish or medit
-immunocompetence |
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AIDS KS
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-HHV8/KSHV
-immunosuppression |
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tumors of large veins
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leiomyosarcomas
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tumors of aorta, large arteries, pulmonary aa.
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sarcomas
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b9 tumors of lymphatics
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lymphangiomas
cavernous (cystic hygroma in neck or axilla) |
