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Cardiology - Vasculitides (*Vasculitides inherited blood vessel…
Cardiology - Vasculitides
*Vasculitides
inherited blood vessel disorders
see other notes
*Medium Vessel Arteritis
Kawasaki disease = special case for young < 4
--> mostly asian kids < 4
mostly middle aged MALES
--> other 2 MEDIUM vessels divide into SMOKING males vs NON smoking
Polyarteritis Nodosa
*PAN = Poly Arteritis Nodosa
Mainly medium arteries involved
sporadic
PAN
acronym for Poly Arteritis Nodosa
PA = PAN ALL medium arteries of the body
--> renal artery most common
PA = PAlpable Purpura common
N = Nodosa NOT the LUNGS
--> no lung involvement
Palpable Purpura
non-blanching (pressing on it does not change the colour)
--> indicates it is a hemorrage
cause by mini hemorrages in the cutaneous capillaries
Children's *Kawasaki Arteritis
medium-small arteritis that effects kids < 5 years old
5 5 and 5 rules for Kawasaki Arteritis
--> age < 5
--> fever > 5 days
--> 5 things wrong with their extremities
A burn from a Kawasaki motorcycle gives you a rash...
put on some Warm CREAM
Warm = > 5 day fever (5 letters)
C =
cervical lymphadenopathy
(unilateral) and conjunctivitis (bilateral)
--> not wearing glasses and 1 bee to the eye
--> 1 bee goes down your throat and straight to the lymph node
R =
rash
over entire body
--> from the hot fuel tank
E =
erythema
on
palms
and
soles
--> from the handle bars and foot pegs
A =
ASA (spirin)
is the treatment
--> only indiction when you are allowed to give aspirin
--> otherwise can cause Reyes syndrome
M =
mucus
membranes
-->
dry, red strawberry tongue
--> 2nd bee gt you twice
*Buerger's Disease
Mainly medium arteries involved
men > 40 who are heavy smokers
*Large Vessel Arteritis
2 sets, both affect women
Polymyalgia / Giant Cell arteritis in older women
--> age > 50
Takayasu in young Asian women
--> age < 50
Takayasu Arteritis
young Asian women < 40
IYA ATTACKA ya AORTA!!
Notes
:
main difference between Takayasu arteritis and Giant Cell Arteritis /PMR = polymyalgia rheumatica
Takayasu is in younger Asian females
--> GCA is in older people, ALL over 50
Takayasu affects the aorta and its branches
--> GCA the temporal artery
IYA ATTACKA ya AORTA!!
Takayasu affects the aorta and its branches
*Giant Cell Arteritis = GCA
Notes
:
note that PMR and GCA are from CD4 lymphocytes and macrophages that can turn into giant cells
the main mediator for the inflammation is IL-6
ESR is elevated fro the disease, but IL 6 actually gives the best factor of how severe the disease is
Clinical Cases
Clinical Case
Clinical Case
Notes
:
note that
Giant Cell Arteritis F Factors
similar to GB stones
--> think GIANT = Fat and forty females of GB
--> GCA is Women in fifties
female
fifty
face pain = jaw claudication, vision loss
--> opthalamic artery occlusion
fifty ESR level
four = HLADR4
flu and fever from PMR
firm temporal artery
PMR = *Polymyalgia Rheumatica
*Small Vessel Arteritis
Wegeners syndrome = weCeners
--> all "C"s for WeCeners syndrome
--> 3 C areas of infection
--> 2 Cs for tx
--> 1C anca diagnosis
Osler-Weber- Rendu Syndrome
Osler-Weber-Rendu Syndrome
recurrent epistaxis = nosebleeds
telangiectasias = spider veins
*Wegeners syndrome = WeCeners
all "C"s for WeCeners syndrome
--> 3 C areas of infection
--> 2 Cs for tx
--> 1C anca diagnosis
*Good Pasture / Small vessel arteritis Differentials
Good Pasture and all SMALL vessel arteritis ALL have similar clinical presentations
--> kidney GN nephritic
--> lung involvement
difference clinically = sinus involvement
--> Good pastures does NOT have sinusitis
--> Good Pastures is also IF positive since underlying pathology is from CB3 and IgG deposition in GBM of lung alveoli and Glomerulus GBM
*Step 1 = clinical LUNG + KIDNEY
present with BOTH hematuria and hematemesis
Good Pasture and all SMALL vessel arteritis ALL have similar clinical presentations
--> kidney GN nephritic
--> lung involvement
Differentials at this point:
Good Pasture and all
SMALL vessel arteritis ALL have similar clinical presentations
--> WeCeners Wegeners syndrome
--> CHRUG strauss
--> microscopic polyangiitis
IF immunoflourenscence
check for antibodies at the GBM of Glomerulus
+ Positive IF
pos + for antibodies / cb3 compliment at the GBM of Glomerulus
Good Pastures Syndrome
+ Negative IF
neg - for antibodies / cb3 compliment at the GBM of Glomerulus
this means that the GN nephritic is NOT from antibodies but from small vessel arteritis
need to do a ANCA test to see if P or C ANCA
ANCA test to see if P or C ANCA for GN nephritis
ANCA = anti neutrophil cytoplasm antibody
P ANCA = PERI nuclear antibodies to
C ANCA = Cytoplasm nuclear antibodies to
