Vascular disorders
51
Al-Quds University School of Medicine Vascular disorders 1 st laboratory Prepared by : LAYTH HUSSEIN 3 rd year-spring semester
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Transcript of Vascular disorders
Al-Quds UniversitySchool of Medicine
Vascular disorders1st laboratory
Prepared by : LAYTH HUSSEIN
3rd year-spring semester
FIRST CASE
Ahmad is a 67-year-old heavy smoker male. Was rushed to the PMC , following a
sudden onset of an episode of crushing substernal chest pain. His course was
marked by severe myocardial infarction and he died 3 days later. At autopsy,
the attached photo-of his coronary artery- was taken. What would be the most
common cause of death?
This was his coronary under microscope
The diagnosis of this case is : atherosclerosis
Let’s refresh our minds :
What is atherosclerosis?It is a chronic inflammatory disorder of the intimal layer of large and middle arteries
characterized by atheroma formation.
How does patient feel?does not cause symptoms until blood flow to part of the body becomes slowed or blocked.
If the arteries to the heart become narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, and other symptoms.
Narrowed or blocked arteries may also cause problems and symptoms in intestines, kidneys, legs, and brain.
What about diagnosis?Doppler tests use ultrasound or sound waves. Magnetic resonance arteriography a special type of MRI scan. Special CT scans called CT angiography.
Treatment?STOP SMOKING & improve your lifestyle.
Atherosclerosis-coronary artery
Fatty streak
From top to bottom : severe, moderate, mild aortic atherosclerosis.
Atheroma
Cholesterol clefts
Diabetes & Atherosclerosis
!!!!!!!!!!!!!!
Second Case
A 65-year-old man has sudden onset of severe abdominal pain. Physical
examination reveals his temperature is 37 C, heart rate 110/minute,
respirations 25/minute, and blood pressure 145/100 mmHg. He has diminished
pulses in the lower extremities. There is a pulsatile abdominal mass. His
serum creatine kinase is not elevated. He has had fasting blood glucose
measurements in the range of 180 to 220 mg/dL for over 20 years. What is
your medical diagnosis?
HR: 60-80 bpm.RR:12-18 pbm.Glucose: 110-125 mg/dl
The diagnosis of the case is : Atherosclerotic AAA .
What is aneurysm ?a general term for any swelling (dilation) of the aorta to greater than 1.5 times normal. Usually representing an underlying weakness in the wall of the aorta at that location.
How does patient feel?Abdominal Aortic AneurysmsMost (AAAs) develop slowly over years. They often don't cause signs or symptoms unless they rupture. When symptoms are present, they can include:A throbbing feeling in the abdomen.Deep pain in the back or the side of the abdomen that lasts for hours or days.
Thoracic Aortic AneurysmsSymptoms may include:Pain in the jaw, neck, back, or chest .Coughing and/or hoarseness.Shortness of breath and/or trouble breathing or swallowing.
What about diagnosis?Ultrasound and Echocardiography ,CT ,MRI ,Angiography.
Treatment?Medicines
Medicines are used to lower blood pressure, relax blood vessels, and lower the risk that the aneurysm will rupture (burst). Beta blockers and calcium
channel blockers are the medicines most commonly used.Surgery
The two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.
Abdominal aneurysm-after operation
Cystic medial degeneration
Third Case
Yesterday, you attended a pathology class for dr.Marwan. The main topic was “vascular disorders”. He talked about many, but unfortunately, you didn’t understand the “Aortic dissection “condition. After class you asked your
colleagues and while googling, you found the following media.
Aortic dissection-grossly
Hypertension.
Marfan syndrome.
Trauma.
Pregnancy.
Anterograde or retrograde
80% and 50%
Surgery and medications.
This aorta has been opened longitudinally .The red-brown thrombus can be seen in on both sides of the section as it extends around the aorta. This creates a "double lumen" to the aorta. This aorta shows severe atherosclerosis which, along with cystic medial necrosis and hypertension, is a risk factor for dissection.
Fourth Case
A 39‐year‐old Jordanian man became unwell with a flu‐like illness
characterized by malaise, fevers and arthralgia affecting his wrists and knees.
These symptoms settled after a 3‐week period, but one evening he noted that
his left middle finger was painful and purple. There was no obvious precipitant
to this, no previous history of vascular spasm, no features of a generalized
connective tissue disease and no significant past medical, drug or family history. He had smoked 15–20 cigarettes a day from the age of 18 yr.
On admission to his local hospital, worsening ischemia of the right index and
left middle fingers was apparent. And doctors were forced to amputate them.
This condition shows …………… disease.
This condition shows BUERGER’S disease.
Buerger's disease (thromboangiitisobliterans): a reversible cause of upper limb digital infarcts.
Reversed by STOP smoking
A rare disease of the arteries and veins in the arms and legs.
blood vessels become inflamed, swell and can become blocked with blood clots (thrombi)
More common in the Middle East and Far East
Virtually everyone diagnosed with Buerger'sdisease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco.
Affects small and medium arteries and veins of the hands and feet. And may affect the nerves.
A possible role for Rickettsia in this disease has been proposed
mechanisms underlying Buerger's disease are still largely unknown
tobacco may trigger an immune response in susceptible persons.
Fifth case
While doing your elective stage in Hamburg university hospital, a 12-month-Japanese male, was admitted with a high fever greater than 38 °C which
lasted for 5 days. He didn’t not respond to normal doses of acetaminophen
(Tylenol) or ibuprofen. On physical examination you founded the following:
Extremely red eyes (without pus or drainage). Bright red, chapped, and cracked
lips. Red mucous membranes in the mouth. Strawberry tongue, with negative
culture. Red palms of the hands and the soles of the feet. Skin rashes on the
middle of the body, NOT blister-like. According to your pathology knowledge,
detect the proper diagnosis.
The diagnosis of the case is : Kawasaki disease /川崎病.
It is called also Mucocutaneous lymph node syndrome; Infantile polyarteritis.
Is a rare condition in children that involves inflammation of the blood vessels.
Kawasaki disease occurs most frequently in Japan, after congenital heart defects, Kawasaki disease is the leading cause of heart disease in children. Most of patients are younger than age 5. The disease occurs more often in boys than in girls.
Kawasaki disease is a poorly understood illness. The cause has not been determined. It may be an autoimmune disorder. S.aureus may also have a role.
The disorder affects the mucus membranes, lymph nodes, walls of the blood vessels, especially the coronary arteries. And the heart .No tests specifically diagnose Kawasaki disease. The diagnosis is usually made based on the patient having most of the classic symptoms.
Treatment
I.V gamma globulin is the standard treatment. It is given in high doses. The child's condition usually greatly improves within 24 hours of treatment with IV gamma globulin.And aspirin…..as soon as possible.
Dose: 2 gm/kg . within 10 days of onset of symptoms.
Coronary artery aneurysms, or ectasia, develop in 15%–25% of untreated children.
Sixth Case
Hassan is your 12th –year- favorite neighbor, complains from severe
pain in the tip of his fingers and toes especially when dealing with
cold materials. He stated that after playing in snow, the painful
episode attacked him and a discoloration of his fingers progressed
from white (pallor) to blue (cyanosis) then the normal red color was
restored. What is your medical diagnosis?
The diagnosis of the case is: Raynaud’s phenomenon.
Rf : is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas.
Stress and cold are classic triggers of the phenomenon.
It comprises both Raynaud's disease (also known as "Primary Raynaud's phenomenon") where the phenomenon is idiopathic. and Raynaud's syndrome (secondary Raynaud's), where it is caused by some instigating factors.
Vascular abnormalitiesEndothelial dysfunction :A deficiency of vasodilatory mediators, including nitric oxide.
Neural abnormalitiesit is presumed that patients with Raynaud's phenomenon repeatedly undergo cutaneous vasoconstriction to many stressful stimuli.
Intravascular abnormalitiesIn Raynaud and systemic sclerosis, increased platelet activation and aggregation has been demonstrated.An increased production of platelet thromboxane A2, a potent vasoconstrictor, has been found in patients with Raynaud phenomenon.
A T H E R O S C L E R O S I S
N K W E R T Y H U I O P K R J
E A E R T B U E R G E R Y A M
U W A S D F G H J K L I U Y N
R A A S D F V G J G R T Y N M
Y S A W D R G T A R E T Y U N
S A A X C F G H A E W R U D D
M K Q W E F G R Z W Q E Y S S
D I S S E C T I O N M Y E W W
M A S D F G H J K L B V C S S
TEST TIME
Atherosclerosis
What does the word” atherosclerosis” mean to you?
Aneurysm
a general term for any swelling (dilation) of the aorta to greater than……..times normal
Aortic dissection
1-What is DeBACKY type 2 ?2-What is preferred surgery or medications?
BUERGER DISEASE
IS IT REVERSIBLE? HOW ?
KAWASAKI DISEASE
RAYNAUD’S PHENOMENON
WHAT IS THE DIFFERENCE BETWEEN PRIMARY AND SECONARY TYPES OF RF?
Atherosclerosis
RAYNAUD’S PHENOMENON
KAWASAKI DISEASE
BUERGER DISEASE
Aortic dissection
Aneurysm
