Wake Cv Diseases Of Blood Vessels

Front 1

What is the response to injury of the endothelium?

Back 1

Injury to the endothelium
→ thrombi, thickening, & spasm
→ pain of ischemia & loss of function of organ

Front 2

What is the response to injury of the media?

Back 2

Injury to the media
→ aneurysm;
rupture
→ pulsatile mass, hypotension & pain

Front 3

What is the response to injury of the adventitia?

Back 3

Injury to the adventitia
→ weakening, false aneurysm with resulting lump (hematoma), pain

Front 4

What is the response to injury in large vessels?

Back 4

Large vessels are sites for aneurysm and rupture

Front 5

What is the response to injury in medium sized arteries?

Back 5

Medium sized arteries thicken and narrow (stenosis) or thrombose → ischemia

Front 6

What is the response to injury in small arteries and arterioles?

Back 6

arteriolar narrowing can cause hypertension

Front 7

What is the response to injury in capillaries?

Back 7

- petechial hemorrhage
-microthrombi (DIC)
- narrowing in diabetes

Front 8

What are the 3 types of lesions in atherosclerosis?

Back 8

1. Fatty streak (small, intracellular fat , innocuous)
2. Atheroma (raised, lipid center, dangerous)
3. Fibrous plaque (intimal scar, innocuous)

Front 9

Is atherosclerosis seen in all arteries?

Back 9

NO. It is gerenally seen in systemic arteries but not in pulmonary arteries.

Front 10

What are the sites of atheroma?

Back 10

- Intimal, may involve media

- Arteries: Aorta and its major branches (coronaries, cerebrals, peripheral, etc.)

- Branch sites - endothelial cushions

Front 11

What are the three major elements of atheroma?

Back 11

- Necrotic center of extracellular lipid

- Fibrous cap

- Proliferating cells (myofibroblasts)

Front 12

Atheroma
What are the complications of the plaque?

Back 12

- ULCERATION, fissuring (the cracked plaque)
- THROMBOSIS (often caused by ulceration)
- Medial damage, causing ANEURYSMS
- Hemorrhage into plaque
- CALCIFICATION

Front 13

When are atheroma symptomatic?

Back 13

when >75% stenosis
... up until this point the atheroma is insidious

Front 14

CLINICAL COMPLICATIONS OF ATHEROSCLEROSIS
in
Carotids and vertebral arteries

Back 14

(Cerebrovascular Disease):
narrow,
ulcerate,
embolize,
cause ischemia, or infarct

Front 15

CLINICAL COMPLICATIONS OF ATHEROSCLEROSIS
in
Coronary arteries

Back 15

(Ischemic Heart Disease):
narrow,
ulcerate or thrombose,
causing ischemia, infarct, arrhythmia, heart failure

Front 16

CLINICAL COMPLICATIONS OF ATHEROSCLEROSIS
in
Peripheral Arteries

Back 16

(Peripheral Vascular Disease):
narrow,
ulcerate or thrombose,
cause ischemia, gangrene, usually of lower limbs, but also of intestinal vasculature

Front 17

CLINICAL COMPLICATIONS OF ATHEROSCLEROSIS
in
Aorta

Back 17

aneurysm, rupture, atheroembolism;
mural thrombus with thromboembolism;
also, stenosis of branches (renals, mesenterics, etc.), causing ischemia

Front 18

Arteritis

Back 18

- May present with involvement of any organ system
- Commonly involves multiple organs
- Due to infection (bacterial, fungal, other) or immune

Front 19

Inflammation of an arterial vessel may:

Back 19

- 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)

Front 20

Idiopathic Necrotizing Arteritis:

Back 20

- Kawasaki disease (muco-cutaneous lymph node syndrome)
- Takayasu arteritis
- Thromboangiitis obliterans (Buerger disease)

Front 21

Kawasaki disease (muco-cutaneous lymph node syndrome)

Back 21

- arteritis in children (most often <5 y/o) with skin and lymph node involvement
- sometimes (leads to aneurysm or dilation) coronary arteries

SXS: Fever x 10d, rash (hands/mouth), no acture complications, but body attacks coronary arteries

Front 22

Takayasu arteritis

Back 22

- Thickening of aortic arch:
- Blindness/CNS deficits
- ↓pulses in upper extremities, ‘pulseless disease’
- Microscopic = giant cell arteritis
- Women, 15- 45 years most commonly affected

Front 23

Thromboangiitis obliterans (Buerger disease)

(General and Lesion)

Back 23

- Pain and ischemia, legs and arms
- Relatively young men
- Leads to gangrene of extremities
- Genetic predisposition possible
- Almost exclusively in smokers
- May improve with smoking cessation

Lesion:
- Cellular thrombosis with inflammation
- Involves arteries and veins
- Fibrosis around nerves and lymphatics

(No agent has been identified)

Front 24

Phlebitis

Back 24

- Acute inflammation of veins, usually with thrombosis
- Caused by bacterial, parasitic, physical, chemical, allergic injury

Front 25

Examples of Phlebitis

Back 25

- 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 "bush-teas", chemotherapy
- Migratory thrombophlebitis (Trousseau syndrome)
- Idiopathic Thrombophlebitis (phlebothrombosis)

Front 26

Migratory thrombophlebitis (Trousseau syndrome)

Back 26

- Transient attacks, variable sites
- With internal cancers (e.g., pancreatic CA)

Front 27

Phlebothrombosis

Back 27

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

Front 28

What are the complications of Phlebothrombosis?

Back 28

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

Front 29

Varicose Veins Sites

Back 29

- Perianal (hemorrhoids)
- Vulva (this & those above may be related to pregnancy)
- Testis (varicocele, dilatation of pampiniform plexus)
- Esophageal varices (hepatic cirrhosis): varices in distal esophagus, cardia of stomach, & perianal region

Front 30

Esophageal Varices pathology

Back 30

- occur in hepatic cirrhosis
- portal hypertension → porto-systemic anastomoses

Complication: hemorrhage when varices torn or eroded

Front 31

Varicose Veins

Back 31

(not primarily inflammatory)
- Abnormally dilated, tortuous veins
- Produced by prolonged increase in intraluminal pressure
- Often in relation to injury or defect of the vein proximally

Front 32

What is the usual site of varicos veins?

Back 32

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

DO NOT CAUSE pulmonary embolism b/c these are insuperficial vein

Front 33

Classifactions of Aneurysms and Dissections

Back 33

- By location

- By etiology (atherosclerotic, syphilitic (luetic), "dissecting" traumatic, mycotic, congenital

- By appearance

* he thinks that etiology is best way to classify

Front 34

Atherosclerotic
Aneurysms and Dissection
(Epidemiology)

Back 34

- 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

Front 35

Atherosclerotic
Aneurysms and Dissection
PRESENTATION

Back 35

pulsatile abdominal mass or pain;
or rupture causes abdominal pain, swelling and shock;
or incidentally on x-ray (calcified wall)

Front 36

Atherosclerotic
Aneurysms and Dissection
COMPLICATIONS

Back 36

- rupture (retroperitoneal hemorrhage),
- stenosis of ureter by pressure or fibrosis,
- occlusion of aortic branch (renal, mesenteric),
- embolism (thrombo- or atheromatous)

Front 37

How does rupture relate to size?

Back 37

- greater than 7cm. -- 80% rupture and die;

- less than 5 cm. -- rarely ruptures

Front 38

How do you treat an aneurysm?

Back 38

Therapy is surgery:

open damaged aorta, insert prosthetic graft (usually just below renals, into both iliacs);

alternative: stent

Front 39

Syphilitic Aneurysms
Location

Back 39

Ascending thoracic aorta & arch

Front 40

Syphilitic Aneurysms
Mechanism

Back 40

Tertiary syphilis involves vasa vasorum causes vasculitis, and medial damage

Front 41

Syphilitic Aneurysms
Presentation

Back 41

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

Front 42

If you have a thoracic aneurysm, what do you suspect the mechanism is?

Back 42

syphilitic

Front 43

Syphilitic Aneurysms
Causes of Death

Back 43

- heart failure due to AI
- hemorrhage due to rupture

Front 44

Syphilitic Aneurysms
Gross Appearance

Back 44

Tree Barking

Front 45

Syphilitic Aneurysms
Therapy

Back 45

surgery - aortic and/or valve replacement

Front 46

Mycotic Aneurysm
(Definition, Mechanism, Complication, Cause)

Back 46

Definition: "Mycotic" refers to any infection, not necessarily fungal

Mechanism: infection causes destruction of media

Complication: Infarcts distally, septic or bland

Cause: Sequela of infective endocarditis or endarteritis

Front 47

Mycotic Aneurysm
(Definition, Mechanism, Complication, Cause)

Back 47

Definition: "Mycotic" refers to any infection, not necessarily fungal

Mechanism: infection causes destruction of media

Complication: Infarcts distally, septic or bland

Cause: Sequela of infective endocarditis or endarteritis

Front 48

What is a pseudoaneurysm?

Back 48

Disection Hematoma of Aorta

Front 49

Disection Hematoma of Aorta
Epidemiology

Back 49

Age: 40-60, males 6:1

Front 50

Disection Hematoma of Aorta
Location

Back 50

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

Front 51

Disection Hematoma of Aorta
Types

Back 51

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)

Front 52

Disection Hematoma of Aorta
Mechanisms

Back 52

- trauma (deceleration injuries in motor vehicle accidents);
- others associated with aortic medial degeneration (e.g. Marfan syndrome) or hypertension
- 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

Front 53

What is the most common mechanism of Disection Hematoma of Aorta?

Back 53

HTN

Front 54

Disection Hematoma of Aorta
Presentation

Back 54

- 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

Front 55

Disection Hematoma of Aorta
Therapy

Back 55

anti-hypertensives

surgery (usually a prosthetic graft)

Front 56

ARTERIO-VENOUS FISTULA

Back 56

(arterio-venous aneurysm or arteriovenous malformation)
- Noncapillary connection between artery and vein
- May be numerous vessels or an aneurysm

- Causes: developmental, trauma, rupture, inflammation

- Significance: important cause of intracranial hemorrhage; some cause heart failure (due to A-V shunting)

Front 57

What are the effects of the atheroma at the various sites?

Back 57

- 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