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Path Pro 2023 > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

What is arteriosclerosis?

A
  • Thickening and hardening of walls of arteries and arterioles
  • Usually as a result of hypertension or diabetes mellitus
  • often associated with loss of elasticity

(umbrella term)

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2
Q

What can arteriosclerosis result in? (3)

A
  • Poor tissue perfusion
  • Inelastic/weak vessels (leading to aneurysm)
  • Increased risk of thrombus formation
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3
Q

What is atherosclerosis?

A

Accumulation of intracellular and extracellular lipid in the intima and media of the large and medium sized arteries

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4
Q

What is an atheroma?

A

Necrotic core of the atherosclerotic plaque. The thickening and hardening of arterial wall as a consequence of atherosclerosis.

Atherosclerosis - disease process

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5
Q

What are 3 macroscopic features of atherosclerosis?

A

Fatty streak
Simple plaque
Complicated plaque

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6
Q

What are the macroscopic features of fatty streak? (3)

A
  • Lipid deposits in intima
  • Yellow
  • Slightly Raised
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7
Q

What are the macroscopic features of a simple plaque?”

A
  • Yellow/white
  • Raised (even more raised than fatty streak)
  • Irregular outline
  • Widely distributed
  • Enlarge and coalesce/become more prominent
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8
Q

What are the macroscopic features of a complicated plaque?

A

Thrombosis
Haemorrhage into plaque
Calcification
Aneurysm formation

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9
Q

Common sites for atherosclerosis

A 
Aorta (ABDOMINAL)
Coronary arteries
Carotid arteries
Cerebral arteries
Leg arteries
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10
Q

Normal arterial structure

A 
Intima 
Internal elastic lamina
Media (muscular)
External elastic lamina
Adventitia
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11
Q

What happens early on in atherosclerosis?

A

Proliferation of smooth muscle cells and foam cells

Extracellular lipid

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12
Q

Later changes in atherosclerosis

A

Fibrosis
necrosis
cholesterol clefts (holes)
+- inflammatory cells

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13
Q

Later vessel changes atherosclerosis

A

Internal elastic lamina disrupted
damage to media
ingrowth of BV
Plaque fissuring

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14
Q

Clinical effects of atherosclerosis

A 
Ischaemic heart disease
Cerebral Ischaemia 
Mesenteric ischaemia
Peripheral vascular disease
Aortic aneurysm
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15
Q

Ischaemic heart disease can lead to…

A

MI, death, angina pectoris, arrythmias, cardiac failure

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16
Q

Cerebral ischaemia can lead to

A

Transient ischaemic attack (mini stroke)
Cerebral infarct (stroke)
Multi infarct dementia

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17
Q

Mesenteric ischaemia can lead to…

A

Ischaemic colitis
Malabsorption
Intestinal infarction

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18
Q

Peripheral vascular disease can lead to…

A

Intermittent claudication (calf pain on exercise)
Leriche syndrome
Ischaemic rest pain
gangrene

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19
Q

What is leriche syndrome?

A

Pain in buttocks
Impotence
(from ischaemia of iliac arteries)

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20
Q

Risk factors atherosclerosis

A 
Age
Gender
Hyperlipidaemia (LDL high)
Smoking
Hypertension
Diabetes mellitus
Alcohol
Infection 
Oral contraceptive
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21
Q

Gender for atherosclerosis

A

Men affected more than women until menopause

Oestrogen is protective

22
Q

Apo E and atheroscelrosis

A

Genetic variations in Apo E = changes in LDL levels

caused by polymorphisms of genes (can be used as risk markers)

23
Q

Physical signs of familial hyperlipidaemia

A

Corneal arcus
Tendon Xanthoma (nodules)
Xanthalasma (yellow fatty eye deposits)

24
Q

Problems with smoking

A

Risk factor for ischaemic heart disease
activates coagulation
reduced prostaglandins
increased aggregation of platelets

25
Q

Why is hypertension a risk for IHD?

A

Endothelilal damage from raised pressure?

26
Q

Diabetes mellitus risks

A

Increase risk of IHD
Cerebrovascular and peripheral vascular disease

(no protective effect for premenopausal women if have diabetes)

27
Q

Alcohol risk of IHD

A

Greater than 5 units per day = increased risk

Smaller amounts protective

28
Q

Infections causing atherosclerosis

A

Chlamydia pneumoniae
Helicobacter pylori
Cytomegalovirus

29
Q

Broad risk factors Atherosclerosis

A

Lack of exercise
Obesity
Stress/personality
Genetic predisposition

30
Q

What can cause genetic predisposition for atherosclerosis?

A

Variations in apolipoprotein metabolism

Variation in apolipoprotein receptors

31
Q

Theories of atherosclerosis

A

Thrombogenic
Insudation
Monoclonal
Reaction to injury

32
Q

Thrombogenic theory (1852 Rokitansky)

A

plaques are formed by repeated thrombi
Lipid derived from thrombi
Overlying fibrous cap

33
Q

Insudation theory (1856 Virchow)

A

Endothelial injury
inflammation
increased permeability to lipid from plasma

34
Q

Reaction to injury hypothesis (1972 Ross and Glomset)

A

Endothelial injury
hypercholesterolaemia = endothelial damage
injury increases permeability allows platelet adhesion

monocytes penetrate
smooth muscle cells proliferate

35
Q

Reaction to injury (1986 Ross)

A

Endothelial injury is subtle (undetectable visibly)

Oxidised LDL may cause damage to endothelium

36
Q

Monoclonal hypothesis (Benditt and Benditt)

A

Smooth muscle cell proliferation = crucial
monoclonal plaques - benign tumours?
viral causes

37
Q

Process of atherosclerosis

A

Thrombosis
Lipid accumulation
Production of intercellular matrix
Interactions between cell types

38
Q

Cells involved in atherosclerosis

A 
Endothelial cells
Platelets
Smooth muscle cells
Macrophages
Lymphocytes & Neutrophils
39
Q

Endothelial cells roll in atehrosclerosis

A

Haemostasis
Altered permeability to lipoproteins
Produce collagen
Stimulate proliferation and migration of SMC (EGF)

40
Q

Platelet role in atherosclerosis

A

Haemostasis

Stimulate proliferation and migration of SMC (PDGF)

41
Q

Smooth muscle cells role in atherosclerosis

A

Take up LDL and lipid
Become foam cells
Synthesise collagen and proteoglycans

42
Q

Macrophages role in atherosclerosis

A

Oxidise LDL
Become foam cells (engulf lipid)
Secrete proteases = modify matrix
Stimulate proliferation and migration of SMC

43
Q

Lymphocytes role in atherosclerosis

A

Produce TNF
Affect lipoprotein metabolism
Stimulate proliferation and migration of SMC

44
Q

Neutrophils role in atherosclerosis

A

Secrete proteases = local damage and inflammation

45
Q

Unified hypothesis

A

Endothelial damage
Effects of injury
SMC stimulated and produce matrix

46
Q

Why does endothetlial damage occur?

A

Raised LDL
Toxins (smoking)
Hypertension
haemodynamic stress

47
Q

What does endothelial injury cause?

A

Platelet adhesion

PDGF release = SMC proliferation and migration
Accumulation of lipid
LDL oxidation (lipid uptake by macrophages and SMC)

Migration of monocytes to intima

48
Q

What do foam cells do?

A

Secrete cytokines =
further SMC stimulation
recruitment of other inflammatory cells

49
Q

Prevention of atherosclerosis

A 
No smoking
Treat hypertension/diabetes mellitus 
Not too much alcohol
Regular exercise/weight control 
Lipid lowering drugs
50
Q

What can arteriosclerosis result in?

A
  • Poor perfusion
  • Inelastic/weak vessels (leading to aneurysm)
  • Increased risk of thrombus formation

Path Pro 2023 (21 decks)

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