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Path Pro 2023 > Atherosclerosis COPY > Flashcards

Atherosclerosis COPY Flashcards

1
Q

What is an atheroma?

A

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

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2
Q

What is atherosclerosis?

A

Thickening and hardening of arterial walls due to an atheroma

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3
Q

What is arteriosclerosis?

A

Thickening and hardening of walls of arteries and arterioles as a result of hypertension/diabetes mellitus

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4
Q

3 stages of atherosclerosis

A

Fatty streak
Simple plaque
Complicated plaque

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5
Q

Fatty streak

A

Lipid deposits in intima
Yellow
Raised

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6
Q

The simple plaque

A 
Yellow/white 
Raised
Irregular outline
Widely distributed 
Enlarge and coalesce
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7
Q

Complicated plaque

A

Thrombosis
Haemorrhage into plaque
Calcification
Aneurysm formation

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8
Q

Common sites for atherosclerosis

A 
Aorta (ABDOMINAL)
Coronary arteries
Carotid arteries
Cerebral arteries
Leg arteries
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9
Q

Normal arterial structure

A 
Intima 
Internal elastic lamina
Media (muscular)
External elastic lamina
Adventitia
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10
Q

What happens early on in atherosclerosis?

A

Proliferation of smooth muscle cells and foam cells

Extracellular lipid

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11
Q

Later changes in atherosclerosis

A

Fibrosis
necrosis
cholesterol clefts (holes)
+- inflammatory cells

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12
Q

Later vessel changes atherosclerosis

A

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

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13
Q

Clinical effects of atherosclerosis

A 
Ischaemic heart disease
Cerebral Ischaemia 
Mesenteric ischaemia
Peripheral vascular disease
Aortic aneurysm
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14
Q

Ischaemic heart disease can lead to…

A

MI, death, angina pectoris, arrythmias, cardiac failure

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15
Q

Cerebral ischaemia can lead to

A

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

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16
Q

Mesenteric ischaemia can lead to…

A

Ischaemic colitis
Malabsorption
Intestinal infarction

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17
Q

Peripheral vascular disease can lead to…

A

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

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18
Q

What is leriche syndrome?

A

Pain in buttocks
Impotence
(from ischaemia of iliac arteries)

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19
Q

Risk factors atherosclerosis

A 
Age
Gender
Hyperlipidaemia (LDL high)
Smoking
Hypertension
Diabetes mellitus
Alcohol
Infection 
Oral contraceptive
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20
Q

Gender for atherosclerosis

A

Men affected more than women until menopause

Oestrogen is protective

21
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)

22
Q

Physical signs of familial hyperlipidaemia

A

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

23
Q

Problems with smoking

A

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

24
Q

Why is hypertension a risk for IHD?

A

Endothelilal damage from raised pressure?

25
Q

Diabetes mellitus risks

A

Increase risk of IHD
Cerebrovascular and peripheral vascular disease

(no protective effect for premenopausal women if have diabetes)

26
Q

Alcohol risk of IHD

A

Greater than 5 units per day = increased risk

Smaller amounts protective

27
Q

Infections causing atherosclerosis

A

Chlamydia pneumoniae
Helicobacter pylori
Cytomegalovirus

28
Q

Broad risk factors Atherosclerosis

A

Lack of exercise
Obesity
Stress/personality
Genetic predisposition

29
Q

What can cause genetic predisposition for atherosclerosis?

A

Variations in apolipoprotein metabolism

Variation in apolipoprotein receptors

30
Q

Theories of atherosclerosis

A

Thrombogenic
Insudation
Monoclonal
Reaction to injury

31
Q

Thrombogenic theory (1852 Rokitansky)

A

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

32
Q

Insudation theory (1856 Virchow)

A

Endothelial injury
inflammation
increased permeability to lipid from plasma

33
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

34
Q

Reaction to injury (1986 Ross)

A

Endothelial injury is subtle (undetectable visibly)

Oxidised LDL may cause damage to endothelium

35
Q

Monoclonal hypothesis (Benditt and Benditt)

A

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

36
Q

Process of atherosclerosis

A

Thrombosis
Lipid accumulation
Production of intercellular matrix
Interactions between cell types

37
Q

Cells involved in atherosclerosis

A 
Endothelial cells
Platelets
Smooth muscle cells
Macrophages
Lymphocytes & Neutrophils
38
Q

Endothelial cells roll in atehrosclerosis

A

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

39
Q

Platelet role in atherosclerosis

A

Haemostasis

Stimulate proliferation and migration of SMC (PDGF)

40
Q

Smooth muscle cells role in atherosclerosis

A

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

41
Q

Macrophages role in atherosclerosis

A

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

42
Q

Lymphocytes role in atherosclerosis

A

Produce TNF
Affect lipoprotein metabolism
Stimulate proliferation and migration of SMC

43
Q

Neutrophils role in atherosclerosis

A

Secrete proteases = local damage and inflammation

44
Q

Unified hypothesis

A

Endothelial damage
Effects of injury
SMC stimulated and produce matrix

45
Q

Why does endothetlial damage occur?

A

Raised LDL
Toxins (smoking)
Hypertension
haemodynamic stress

46
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

47
Q

What do foam cells do?

A

Secrete cytokines =
further SMC stimulation
recruitment of other inflammatory cells

48
Q

Prevention of atherosclerosis

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

Path Pro 2023 (21 decks)

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