Cardiovascular Module - Robbins - Blood Vessels
Terms
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- What are the consequences of narrowing or obstructing blood vessels over time?
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Restricted blood flow can cause
(1) tissue atrophy
(2) infarction
depending on severity and rate of the narowing
(3) Weakens vessels walls --> leads to dilation, dissection, or rupture
(4) Thrombi develop --> can embolize and obstruct downstream vessels
OR
(5) Restriction of blood flow over time causes tissue atrophy - Name two congenital anomalies of the blood vessels
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(1) Berry aneurysms: vascular outpouchings resulting from areas of congenital wall weakness (d/t loss of elastic tissue, increased BP, inc. metalproteases)
--> may occur in cerebral vessels that may rupture catastrophically
(2) Arteriovenous fistulas - abnl communications b/w arteries and veins. May be congenictal or secondary to trauma, inflammation, or a healed ruptured aneurysm
Consequences: AV fistulas
(1)Left-to-Right shunts --> increasing venous return, predisposing to HIGH-OUTPUT HEART FAILURE - Arteriosclerosis denotes...
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(1) arterial wall thickening
(2) loss of elasticity - What are the three patterns of arteriosclerosis?
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(1) Atherosclerosis
(2) Arteriolosclerosis (primarily associated with hypertension)
(3) Monckeberg medial calcific sclerosis - Monckeberg Medial Calcific Sclerosis is characterized by...
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Medial calcific calcification in SMALL -to- MEDIUM-sized muscular arteries
(FEMORAL, TIBIAL, RADIAL, ULNER, GENITAL arteries) - Typical age to get Monckeberg Medial Calcific Sclerosis
- after age 50
- Pathogenesis of Monckeberg Medial Calcific Sclerosis
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unknown
NOT related to atherosclerosis - Clinical consequence of Monckeberg Medial Calcific Sclerosis
- Calcific deposits are NON-obstructive and NOT usually clinically significant
- Define Atherosclerosis
- a slowly progressive disease of LARGE -to- MEDIUM sized MUSCULAR and LARGE ELASTIC arteries
- What arteries are typically affected by atherosclerosis
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Abdominal Aorta
Coronary arteries
Popliteal arteries
Descending thoracis aorta
Internal carotid arteries
Circle of Willis - Atherosclerosis is characterized by...
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elevated intimal-based fibrofatty plaques composed of lipids, proliferating smooth muscle cells and increased ECM
Lesions are initially focal, with PATCHY vessels involvement both circumferentially and longitudinally -
Atherosclerosis - Morphology
Name and describe the characteristic atheromatous plaque. -
Atheroma or Fibrofatty plaque
A raised white-yellow intimal-based lesion, protruding into the vessel lumen. - Atheroma or Fibrofatty plaque - Histology
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Plaques are composed of:
Superficial fibrous caps! containing SMCs, lymphocytes, and dense ECM overlying necrotic cores...
Necrotic cores contain dead cells, lipid, cholesterol clefts, lipid-laden foam cells (macs and SMCs), and plasma proteins;
Small blood vessels proliferate at the intimal-meial interface - What are the two common variants of the atheroma or fibrofatty plaque?
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(1) Fatty Streak - early, uncomplicated leasion composed of intimal collections of lipid-laden macrophages and SMCs
Occur in pts as young as 1 y.o.
** A causal relationship b/w fatty streaks and atheromatous plaques is suspected but remains unproved
(2) Complicated plaques - calcified hemorrhagic fissured or ulcerated atheromas
**they predispose to local thromobosis, medial thinnning, cholesterol microemboli, and aneurysmal dilation -
Risk of developing atherosclerosis increases with...
List major and minor risk factors -
Nonmodifiable major risk factors for atherosclerosis:
Age, male, family history, genetic abnormalities