Vascular Diseases

Vascular Diseases

1. Overview

   • Anatomy
     • Arteries
       • Large (elastic)
       • Medium (muscular)
         • Coronary
         • Renal
       • Small
         • less than 2mm, arteriols are 20-100 micrometer
     • Veins
       • Collecting Venules
       • Large
     • Capilaries
       • Arterial part
       • Venal Part
         • Inflammation Response

2. Classification

   • Narrowing & Obstruction
     • Progressive (Atherosclerosis)
     • Acute (Thrombi & Emboli)
   • Weakening & Dilation

3. Essential Hypertension (unknown etiology)

   • Causes
     • Genetic
     • Environment
     • Endocrinal
       • Kidney Renin
       • Adrenal
         • Pheochromacytoma
           • Too much Epi
         • Cortex
           • Cushing sx
             • Too much steroids
           • Conn sx
             • Too much aldostrone
       • Thyroid Gland
         • Thyroxin increase BP and BMR
       • Pre-eclampsia in pregnant women (endothelial dysfunction cause vasoconstriction)

4. Arteriosclerosis

   • Types
     • Arteriolosclerosis
       • Small AA (especially in Renal)
     • Atherosclerosis
       • Large AA
       • Medium AA
     • Monckelberg Medial Sclerosis
       • Medium AA Calcific Media No laminal narrowing

5. Aneurysm

   • Syphilic
     • Obliterative endarteritis in Vaso Vasorum of Aorta
     • Brassy Dry Cough
   • Berry
     • Circle of willis
     • Congenital or Plaque induced
   • Atherosclerotic (most common)
     • Aortic then Abdominal (under renal above illiacs)
   • Ventricular
     • Cause: Large MI
     • LV Aneurysm which lead to rupture or emobli of mural thrombi
   • True vs False (rupture and hematomas communication)

6. Aortic Dissection

   • Due to hypertension or cystic medial degeneration, Marfan sx (elastin)
   • May or may not have aneruysm
   • Blood go thru intima causing chest pain to media (problem here) and if it reaches adventitia it will cause death

7. Vasculitis

   • Causes
     • Infections
       • Aspergillus
       • Mucor -(mycotic aneurysm)
       • Mechs
         • 1. drug induced immuno complex deposition
         • 2. Antineutrophil Cytoplasmic abs (ANCAs)
           • C-ANCA
             • Targets protinase-3
           • P-ANCA
             • Targets Myeloperoxidase
               • Directs injury to ECs and activates PMNs
         • 3. Antiendothelial Cells abs
       • Examples
         • Giant Cell Arteritis (Temporal Artertitis)
           • T cell mediated
           • Pts age above 50
           • Temporal, lingual, opthalamic aa
           • Can be palpated and responds to steroids
           • Sudden onset headach
           • Granuloma present
         • Polyarteritis Nodosa
           • Small, medium Arteries
           • 90% responds to steroids & Cyclophophamide
           • Young pts
           • No treatment = death renal f
           • Abdominal, Peripheral Pain, purpura legs
           • Histologically similar to GCA but no Granuloma
         • Kawasaki dx (Mucocutanous lymph node sx)
           • Usually self limited in children
           • Coronary arteries
           • Pgensis
             • T cell then B cells that make abs against EC & SMC
             • Genetic & Virus
           • Signs, symp
             • Desquamenting skin rash on palms & soles
             • Leading cause of death in aquired heart dx in infants
             • Fever & lymphadenopathy
             • Oral erythema and conjuctivitis
           • tx: IV immunogolbulin reduces heart risk
         • Buerger dx (thromboangitis Obliterans)
           • Segmental Vasculitis Affecting Radial, Tibia affecting toes, fingers with gangrenes & ulcers
           • Young smokers (HS due to smoking)
           • Raynaud Phenomenon (patriotic color change White, Red, Blue)
           • Instep Claudication w/ severe pain
         • Wegener granulomatosis
           • initially resp tract, might mouth, then Kidney(worst)
             • necrotic Palate (later) and strawberry gingivitis (early)
             • Kidney glomeruli (later)
           • 80% death without tx
           • Pgensis (cell mediated hs to inhaled/infectious antigen)
             • ANCA-C
               • Necrotizing granulomatoius vasculitis
                 • Like in GC
         • Raynaud Phenomenon
           • Vasoconstriction of arteries in toes, fingers due to cold or emotions
           • Proximal f: Red Middle f: White Distal f: Blue
           • 5% population, age: around 14
           • 10% Associated with SLE, Buerger dx, Scleroderma, Atherosclerosis
     • Non-infections (immune mediated)
       • 20 types

8. Veins & Lymphatics

   • Varicose in Veins
     • Varicose Veins
       • Dilated superficial veins
       • Increased hydrostatic in elderly and pregnant
       • Pain, Pedal edema,
       • no emboli
     • Hemorrhoids
       • Veins without valves
       • Become clincal worse due to high hydrostatic p (pregnant, elderly, cirrhosis, constipation)
     • Esophageal
       • Liver cirrhosis back up in portal vein until it reaches the esophageal veins where a rupture can happen and a very bad hemorrhages can happen
     • Lingual (under tongue)
   • Thrombophlebitis
     • 90% deep leg veins
     • Reasons:
       • Immobilization
       • CHF
       • Surgery in abdomin
       • Trauma
       • Pregnancy
       • Hypercoaguble (genetic & Neoplasia)
     • The real bad thing is emboli

9. Vascular Growth

   • Non-Neoplasm
     • Pyogenic Granuloma
       • Tumor-like fast growth but no neoplasm
       • Pregnancy tumor - soft red nodule often in skin, oral, & gingiva
       • Similar to granulation tissue
       • Surgical tx
       • Trauma, irritant, hormones
     • Ectasia: Dilated vessel
       • Nevus Flammeus
         • H&E birthmark mostly regress except (Port Wine Stain)
           • Port Wine Stain associated with Sturge-Weber sx
       • Spider Telangioectasia
         • Radiating red vessels
       • Hereditary Hemorrhagic Telangioectasia
         • Autosomal dominant - malformation of skin & mucosa vessels
         • AKA (Osler Weber Rendu Disorder)
     • Lymphangioma
       • Too much lymphatics
       • H & N (tongue) in birth
   • Tumors
     • Hemangioma
       • (Benign) Too much vessels that regress by age of 7, they start to increase in quanities after birth
     • Kaposi Sarcoma
     • Angiosarcoma
       • Lymphadema
       • Endothelial cells in skin, liver, breast due to liver carcinogens
       • Well to poorly defferantiated