vascular disorders 2

atherosclerosis

chronic inflammatory response to a triggering injury to endothelium; LDL accumulates in intima and becomes oxidized

critical stenosis

clinical consequence of atherosclerosis; starts with progressive plaque growth → gradual occlusion → ischemia of tissues

occlusion by thrombus

clinical consequence of atherosclerosis; starts with plaque rupture → thrombosis causing rapid occlusion → ischemia of the tissues; thrombus may be incorporated into plaque ot may embolize

aneurysm and rupture

clinical consequence of atherosclerosis; ECM is degraded within tunica media → vessel wall vulnerable to widening → also inc risk for vessel rupture

atherosclerosis diagnosis

diagnosed with imaging (CT, doppler ultrasound), measuring BP with ankle-brachial index (ABI), and exercise or stress testing

ankle-brachial index (ABI)

measures systolic pressure at the ankle at ratio of systolic pressure at the arm; normally 1.0-1.4; low may indicate atherosclerotic plaque blocking blood flow to lower extremeties; high may indicate reduced blood flow to upper extremeties or increased blood flow to lower

atherosclerosis prevention and treatment

prevented by controlling modifiable risk ractors; treatment includes medications that dec LDL levels, dec BP and dec platelets or surgery such as vascular bypass surgery, angioplasty and stenting, and endarterectomy

vascular bypass surgery

surgical treatment that involves grafting another blood vessel around the site of blockage

angioplasty and stenting

surgical treatment that involves insertion of a mesh stent into blood vessel to push plaque to the side and keep the vessel open

endarterectomy

surgical process that involves sutting open the blood vessel and removing the plaque

peripheral artery disease (PAD)

the narrowing of the arteries other than in the heart or brain most commonly caused by atherosclerosis; presented by intermittent claudication, cyanosis, cold skin, nonhealing skin ulcers, abnormal hair growth on affected limb

intermittent claudication

when legs do not receive proper blood flow due to blockage, resulting in pain due to tissue becoming hypoxic, especially when increased demand on leg; pain subsides when person rests

aneurysm

abnormal localized dilation of the arterial wall due to weakness in the tunica media; commonly found in intracranial (berry), thoracic aorta (above diaphragm) and abdominal aorta (below diaphragm)

true aneurysm

when all layers of the vessel wall are intact but dilated; includes saccular and fusiform aneurysms

saccular aneurysm

type of true aneurysm; only one part/side of the blood vessel balloons up

fusiform aneurysm

type of true aneurysm; whole vessel wall is affected (all around)

false aneurysm

intima or media layer disrupted causing blood to collect between the adventitia and inner layers; causes vessel to bulge outwards

aortic dissection

tear in intima layer allows blood to accumulate within vessel walls → separates vessel layers; blood continues to pool and seep into pocket, splitting layers of vessel wal further apart

aortic dissection pathogenesis

tear in aortic intima → hemorrhage into the media under systemic pressure → separation of vessel wall layers; dissection propagates → impaired flow to tissues and compression of adjacent structures; external wall can rupture, causeing massive internal hemorrhage

aneurysm pathogenesis

occurs where structure or function of CT in the vessel wall is compromised; risk factors include atherosclerosis and hypertension; may also be caused by genetic disorders that affect CT, inflammation, or trauma

aortic dissection symptoms

may be presented by sudden rippling pain in anterior chest or in the back, cardiac damage (MI, aortic valve regurgitation), hypotension, syncope, ischemia in extremities

aortic dissection management

forcus on pain control; antihypertensives to control BP; surgery to exercise tear and replace segment of aorta with synthetic vascular graft

abdominal aortic aneurysm (AAA)

90% of aortic aneurysms; smoking is a risk factor; most are fusiform and lined with calcified atherosclerotic plaques containing thrombi; usually asymptomatic, but may cause pain in abdomen or lower back or form pulsatile abdominal mass

thoracic aortic aneurysm (TAA)

less than 10% of aortic aneurysms; hypertension is a major risk factor; usually asymptomatic but may cause dyspnea or persistent cough, difficulty swallowing, hoarseness, pain due to bone erosion, or cardiac disease

aneurysm complications

may rupture and cause hemorrhage, causing rapid bleeding and shock, also causing abrupt pain in chest, neck, back, or abdomen; thrombi may also form, forming emboli and organ ischemia

aneurysm diagnosis and management

most are asymptomatic and diagnosed incidentally by imaging, or AAAs may be detected by abdominal palpation; management by serial imaging to monitor growth, reducing risk factors, and surgical treatment

raynaud phenomenon

episodes of excessive vasoconstriciton in the extremeties to cold temperature or emotional stress; affects the hands, sudden onset of cold fingers with skin changing color, pain and numbness, or acute or chronic ischemia

primary raynaud phenomenon

idiopathic with no know specific cause; due to hyperreactivity of sympathetic NS, causing more vasoconstriction than normal

secondary raynaud phenomenon

occurs as a result of another condition that causes vascular insufficiency of the extremities; ex. autoimmune diseases, vascular disease, environmental causes, drugs, etc.

vasculitis

general term referring to inflammation of blood vessels due to inappropriate immune attack on blood vessels; may be infectious or non infectious; shown by systemic signs of inflammation, palpable purpura, BP or pulse alterations; treated with immunosuppressants

varicose veins (varicosities)

abnormally dilated superficial veins caused by chronically increased intraluminal pressure and weakened vessel walls; caused by elevated venous BHP → valve incompetence → vein dilation

varicose veins symptoms and treatment

chronic venous insufficiency in deep veins, congestion, edema, pain, skin pigmentation, inc risk of thrombosis, ischemia; treatment includes leg elevation, compression therapy, weight loss exercise, sclerotherapy, and endoveous laser treatment

thrombophlebitis

thrombus in a vein accompanied by inflammation in the vessel wall; most commonly presented as DVT; may be asymptomatic but may also cause inflammation; treatments include anticoagulants and thrombectomy