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Cardiovascular Module - Robbins - Blood Vessels


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What are the consequences of narrowing or obstructing blood vessels over time?
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


(5) Restriction of blood flow over time causes tissue atrophy
Name two congenital anomalies of the blood vessels
(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...
(1) arterial wall thickening
(2) loss of elasticity
What are the three patterns of arteriosclerosis?
(1) Atherosclerosis

(2) Arteriolosclerosis (primarily associated with hypertension)

(3) Monckeberg medial calcific sclerosis
Monckeberg Medial Calcific Sclerosis is characterized by...
Medial calcific calcification in SMALL -to- MEDIUM-sized muscular arteries
Typical age to get Monckeberg Medial Calcific Sclerosis
after age 50
Pathogenesis of Monckeberg Medial Calcific Sclerosis

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
Abdominal Aorta
Coronary arteries
Popliteal arteries
Descending thoracis aorta
Internal carotid arteries
Circle of Willis
Atherosclerosis is characterized by...
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
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?
(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

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