Difference between revisions of "Vascular disease"

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==Atherosclerosis==
==Atherosclerosis==
===General===
===General===
*Cardiac atherosclerosis -> myocardial infarction, coronary thrombosis.
*[[Coronary artery atherosclerosis]] -> myocardial infarction, coronary thrombosis.
*Peripheral atherosclerosis -> peripheral vascular disease -> amputations.
*Peripheral artery atherosclerosis -> peripheral vascular disease -> amputations.
*Carotid atherosclerosis -> thrombotic stroke.
*Carotid artery atherosclerosis -> thrombotic stroke.


Clinical risk factors:
Clinical risk factors:
Line 22: Line 22:
*Intimal hyperplasia.
*Intimal hyperplasia.
*Lipid deposition.
*Lipid deposition.
*Foam macrophages within intima & media.
*Foamy macrophages within intima & media.
*Cholesterol clefts
*Cholesterol clefts
*Luminal narrowing.
*Luminal narrowing.


Image: [http://commons.wikimedia.org/wiki/File:RCA_atherosclerosis.jpg RCA with atherosclerosis (WC)].
Image:  
*[http://commons.wikimedia.org/wiki/File:RCA_atherosclerosis.jpg RCA with atherosclerosis (WC)].


Notes:
Notes:

Revision as of 15:30, 8 January 2011

The article covers vascular disease. Vasculitides are covered in a separate article called vasculitides.

Great vessels

When things go wrong here, you see a cardiac surgeon.

Atherosclerosis

General

  • Coronary artery atherosclerosis -> myocardial infarction, coronary thrombosis.
  • Peripheral artery atherosclerosis -> peripheral vascular disease -> amputations.
  • Carotid artery atherosclerosis -> thrombotic stroke.

Clinical risk factors:

  • Age.
  • Blood pressure - modifiable (antihypertensives).
  • Cholesterol - modifiable (statins, diet).
  • Diabetes mellitus - modifiable (hypoglycemic medications, diet, lifestyle).
  • Smoking - modifiable (cessation).
  • Family history.

Microscopic

Features:

  • Intimal hyperplasia.
  • Lipid deposition.
  • Foamy macrophages within intima & media.
  • Cholesterol clefts
  • Luminal narrowing.

Image:

Notes:

  • Considered "complex" if any of the following are present:[1]
    • Calcifications.
    • Thrombosis.
    • Haemorrhage.

Aortic dissection

Associations

Heritable:[2]

Others:

Cystic medial degeneration

General

  • AKA cystic medial necrosis.[4]
    • Often not cystic and not necrotic.

Microscopic

Features:[5][6]

  • Basophilic ground substance in the media (seen on Movat's stain).
  • Disruption of the elastic lamina (seen on elastic trichrome stain).
  • +/-Focal necrosis.

Images: Marfan's syndrome (radiographics.rsna.org).

Medial calcific sclerosis

  • AKA Moenckeberg medial calcific sclerosis, calcific medial sclerosis of Monckeberg, and Monckeberg's arteriosclerosis.

General

  • Usually of no clinical consequence.

Microscopic

Features:[7]

  • Medial calcification (purple irregular stuff -- calcium phosphate).

Note:

  • Lumen unaffected.

Images:

Hyperplastic arteriolosclerosis

General

  • Hyperplasia = proliferation of cells.
  • Associated with malignant hypertension.

Microscopic

Features:[7]

  • Onion-skin appearance of intima & media due to:
    • Intimal hyperplasia.
    • Smooth muscle hyperplasia.

Image: Hyperplastic arteriolosclerosis (utah.edu).

See also

References

  1. Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 4. ISBN 978-1416002741.
  2. Gleason TG (2005). "Heritable disorders predisposing to aortic dissection". Semin. Thorac. Cardiovasc. Surg. 17 (3): 274-81. doi:10.1053/j.semtcvs.2005.06.001. PMID 16253833.
  3. Loeys BL, Schwarze U, Holm T, et al (August 2006). "Aneurysm syndromes caused by mutations in the TGF-beta receptor". N. Engl. J. Med. 355 (8): 788-98. doi:10.1056/NEJMoa055695. PMID 16928994. http://content.nejm.org/cgi/content/full/355/8/788.
  4. URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
  5. URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
  6. Ha HI, Seo JB, Lee SH, et al. (2007). "Imaging of Marfan syndrome: multisystemic manifestations". Radiographics 27 (4): 989–1004. doi:10.1148/rg.274065171. PMID 17620463. http://radiographics.rsna.org/content/27/4/989.full.
  7. 7.0 7.1 Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 7. ISBN 978-1416002741.