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- What is the function of endothelial cells?
- 1. synthetic and metabolic (endothelin, NO, thrombogenic factors etc.)
2. transfer of molecules
3. non-thrombogenic blood-tissue interface
- What is the function of smooth muscle?
- 1. controlvasoconstriction and dilatation
2. produce growth factors and cytokines
3. response to vascular injury
- Arteriosclerosis
- hardening of the arteries
- What are the three forms of arteriosclerosis?
- 1. atherosclerosis (most common/important)
2. arteriolosclerosis (HTN)
3. Monckeberg medial sclerosis
- What arteries are affected by atherosclerosis?
- 1. aorta
2. carotid
3. iliac
4. coronary
5. popliteal
- Atherosclerosis
- -contributes to half of deaths in Western society
-MI - 20-25% of deaths
-considered to by a response to injury of endothelium
- What are the risk factors for atherosclerosis? (7)
- 1. age
2. sex M
3. genetics
4. hyperlipidemia
5. HTN
6. cigarette smoking
7. diabetes
- Hypertension
- -140/90
-cornary heart disease and CVA
-95% idiopathic
-renal disease and adrenal disease
- Malignant Hypertension
- rapidly rising with diastolic over 120mmHg
- Aneurysm
- localized dilatation of the BV or heart wall
- What are the major causes of aortic aneurysms?
- -atherosclerosis - AAA
-cystic medial degeneration
-trauma, congenital defects, infections
- Abdominal Aortic Aneurysms
- caused from atherosclerosis with risk of rupture being related to size and a 50% mortality rate from rupture
- What are the clinical consequences of and AAA?
- -rupture
-obstruction
-embolism
-compression of the adjacent structures
- Aortic Dissection
- -dissection of blood into arterial media
-HTN risk factor
-due to medial damage
-may rupture
-sudden onset of sharp pain
- What is the treatment for aortic dissection?
- antiHTN, surgery, save 65-75% of patients
- Vasculitis
- -inflammation of the vessel walls
-classified by location and antineutrophil cytoplasmic autoantibody (ANCA) production
- How do patients present with vasculitis?
- fever, myalgia, arthralgia, malaise
- ANCA production
- classifies vasculitis (c-ANCA, p-ANCA)
- Giant Cell Arteritis
- *most common vasculitis
-granulomatous inflammation involving arteries of head (temp.)
- What are symptoms of giant cell arteritis and diagnosis and treatment?
- -older patient, may cause blindness, pain/headache, biopsy required for diagnosis
-treated with anti-inflamm. agents/steroids
- Takayasu Arteritis
- fibrous thickening or aortic arch and branches with ocular disturbances and weakened pulses (>females)
- What are the side effects of Takayasu Arteritis?
- -lower blood pressure and pulse in upper extremity than lower extremity
-renal artery narrowing by 50%- HTN
- Wegener's Granulomatosis
- -necrotizing vasculitis causing acute necrotizing granulomas of upper respiratory tract or lung and necrotizing granulomatous vasculitis of small to medium sized vessels with renal disease, glomerulonephritis
*95% = c-ANCA positive
- What age and sex is Wegener's granulomatosis?
- 40 yo
males
- What is the clinical presentation of Wegener's Granulomatosis?
- -persistent pneumonitis
-chronic sinusitis
-muscosal ulceration
-renal disease
- Varicose Veins
- -dilated superficial veins of upper and lower legs
-secondary to inc. venouspressure: standing, preg., familial tendency
-complications: rare, ulcer
-esophageal arices
-hemorrhoids
- Thrombophlebitis
Phelebothrombosis
- -thromobosed vein with inflamm. 90% in deep leg
- What are risk factors for thrombophlebitis?
- 1. postop state
2. preg.
3. neoplasia
4. cardiac failure
5. prolonged bed rest
- Deep Vein Thrombosis clinical presentation
- -edema, heat, tenderness, pain with pressure or dorsiflexion of the foot (Homan sign)
-may lead to pulm. embolism
- What is Homan sign?
- pain with pressure or dorsiflexion of the foot with deep vein thrombosis
- Sup. and Inf. Vena Cava Syndromes
- -caused by compression of the vena cava with obstruction
-cyanosis and venous delatation
- Lymphangitis
- -group A Beta-hemolytic strep
-subcuaneous red streaks and lymph node enlargement
-may lead to septicemia
- Hemangioma
- -vascular neoplasm, benign, tongue, conj. etc.
-inc. in vessels filled with blood
- Kaposi's Sarcoma
- -vascular neoplasm in Jewish pop. classic or european that is endemci and trasplant and AIDS assoc.
-25% of AIDS patients with HHV* infection
- Angiosarcoma
- -vascular neoplasm that is malignant soft and red, often found in heart
- Angiosarcoma
- -vascular neoplasm that is malignant soft and red, often found in heart
