 65 yo woman w/ right lower extremity pain (fell downstairs)  No history of smoking, HT, booze, weight loss, fractures, fever, (thin body woman, low bmi)  All renal, cardiac, liver, bone scree, thyroid, FBC, ESR and syphilis -  ALL NORMAL  Key findings:  “RAIL TRACKING” femoral artery calcification (Monckeberg classic appearance)  Temporal artery biopsy shows intense medial calcifications  Doppler US reveals “Patency of all lower extremity vessels

Final diagnosis: Monckeberg medial calcific stenosis. *Monkeys Love Calcium* (theres like 6mg in 1 banana, I checked* ^_^

 Def: generic, inclusive term that describes thickening/hardening of arterial wall.  Hardering is bc of replacement of normal tissue w/ scar tissue (collagen fibers)

 Changes in struc/func of arterial vasculature.  Morphology:  Thicker walls bc of medial/intimal thickening  Attributed to migrating SM cells of medial layer, changes in ECM, elastic replaced w/ collagen  Age related ArSC  increase in lumen size

 The elastic arteries dilate with age. These changes are most marked in the aorta, and its major proximal branches are less marked in the peripheral muscular arteries.  This must be taken into account when mass screening for abdominal aortic aneurysms is undertaken.

 Arteries become stiffer w/ age  Elastin is degraded while collagen is deposited  ^^happens due incr expression of Matrix- metalloproteinases (MMPs) 2 and 9.  Both 2/9 are prods of SM and have specificity for elastin.

 In young individuals (≤ 50 years) with distensible arteries and low pulse wave velocity, the reflected waves affect the central arteries during diastole, after left ventricular ejection has ceased.  The desired timing is disrupted in elderly individuals (> 50 years) by an increase in pulse wave velocity as a result of arterial stiffening.

 Mixed hypertension represents the classic hypertension and is found essentially in young and middle aged adults. This type is characterized by little increase of pulse pressure.

 characterized by an increase systolic blood pressure without increase of the diastolic blood pressure and is due to the age-related increase in stiffness of elastic arteries, i.e. arteriosclerosis of ageing.

 Increased P leads to incr Left Ventricle load  Left vent Hypertrophy  higher Oxy demand  left heart failure  Since we know most blood flow in Coronary As. during Diastole, a decreased diastolic pressure reduces blood flow (oxygen)  All of this can cause decr in perfusion P and lead to ischemia

 Two types: Chronic (benign) and Accelerated (malignant) . In patients with benign hypertension the major change is hyaline arteriolosclerosis. In malignant hypertension the major change is hyperplastic arteriolosclerosis.

 subendothelial deposition of a homogeneous, glassy pink material in H&E-stained sections that begins as a focal, segmental process that spreads to involve the entire circumference of the vessel.  hyaline arteriolosclerosis is accelerated in benign hypertension and diabetes mellitus, and diseases also associated with accelerated atherosclerosis.

 leakage of plasma components across vascular endothelium and excessive extracellular matrix production by smooth muscle  reduplication and thickening of the endothelial basement membranes are usually present.

 intimal thickening with consequent luminal reduction  consists of concentric, pale onionskin thickening of the intimal layer with loosely disposed layers of modified smooth muscle cells, thickened and duplicated basement membrane, and delicate layers collagen fibrils

 changes in arteries and arterioles are accompanied by fibrinoid necrosis of the arterioles.  Fibrin: material identified  Within the media, smooth muscle cells cannot be identified and cell nuclei are lost or fragmented

 age-related degenerative process in which the media of large and medium-sized muscular arteries calcify, and it is a fundamentally different process from occlusive atherosclerosis.  does not involve primarily the intimal layer of the artery, the lumen is kept open by the rigid media and, therefore, luminal narrowing is not a direct consequence

 A rare cause, occurs in healthy ppl independently of atherosclerosis  More frequent in people >50 and Diabetics.  After 35 yrs of disease, 95% of diabetic pts present arterial calcification  More prevalent in males

 typically affects arteries that are less prone to develop atherosclerosis. The vessels most commonly affected are the arteries supplying the extremities such as the femoral, tibial, radial, and ulnar arteries, and occasionally those of the viscera  medial calcification has NOT been reported to occur in the coronary arteries

 Sometimes exhibits Osseous Metaplasia containing marrow elements , this condition is characterized by calcification of both the tunica media and the internal elastic lamina

 Not known, but assoc w/ type 2 Diabetes and osteoporosis  is also observed with particularly high frequency and severity in disorders characterized by generalized metabolic, electrolyte, or pH derangements, such as hypervitaminosis D and end-stage renal disease.