Atheroma Final

Question 1

What is the definition of atheroma?

Answer 1

• build-up of fatty material on the inside wall of an artery

Question 2

What is the definition of atherosclerosis?

Answer 2

• the progressive narrowing and hardening within an artery potentially resulting in a complete blockage

Question 3

Which vessels does atheromas affect?

Answer 3

affects arteries - slowly progressive

Question 4

What are the causes of injury in an atheroma?

Answer 4

• hyperlipidaemia
• disturbed flow
• smoking
• hypertension
• progresses as white cells, fat and blood constituents infiltrate injury

Question 5

What are the stages of artheroma ?

Answer 5

• INITIAL LESION - isolated macrophages
• FATTY STREAK LESION - mainly intracellular accumulation
• INTERMEDIATE LESION - type 2 changes and core of EC lipid
• FIBROARTHEROMA LESION- lipid core and fibrotic layers.
• COMPLICATED LESIONS -surface defect, hematoma-hemorrage, thrombus

Question 6

How do artheromas clinical manifest?

Answer 6

• coronary artery - heart attacks/angina (ischaemic heart disease
• aorta - aneurysm due to weakening of the wall
• carotid - narrowing causing stroke
• peripheral vascular disease

Question 7

Atherosclerotic plaques develop slowly over decades but may acutely cause symptoms due to..

Answer 7

• aneurysm and rupture
• thrombosis
• haematoma formation
• embolization
• development of critical stenosis (blocking or narrowing)

Question 8

A 65 year old gentleman with a history of hypertension presents with sudden onset dysphasia (language problems), left arm and leg weakness.
He had a similar episode 2 weeks ago, but it only lasted 1 minute.

Answer 8

• cerebral infarction (stroke)

Question 9

A 70 year old gentleman who has smoked for most of his life has attended clinic.

Over the last year he has had severe pain in both his legs when walking for more than 10m, and has had a number of infected ulcers in his feet and lower legs requiring antibiotics.

Answer 9

• peripheral vascular disease

Question 10

50 year old gentleman with type 2 diabetes presents with 30 minute history of ‘central, crushing chest pain’.
The ECG showed marked ST elevation affecting V1 to V4.
The gentleman was taken to the cath lab for a revascularisation procedure (primary percutaneous coronary intervention(PCI)).

Answer 10

myocardial infarction

Question 11

What is the treatment for atheromas?

Answer 11

• revascularization

- secondary prevention

Question 12

What is the cause of ischaemic heart disease?

Answer 12

• imbalance between supply (perfusion) and demand of the heart for oxygenated blood
• decrease in oxygen and nutrients
• inadequate removal of metabolites

Question 13

What are the causes of ischaemic heart disease?

Answer 13

• DECREASE FLOW OF OXYGENATED BLOOD (atheroma, embolism, spasm)
• INCREASED DEMAND FOR OXYGEN (thyrotoxicosis, myocardial hypertrophy eg. hypertension)

Question 14

What are the risk factors for ischaemic heart disease which are fixed and you cant change?

Answer 14

• positive family history
• male sex
• age
• genetic factors (eg. ACE gene deletion)

Question 15

What are the risk factors for ischaemic heart disease which are potentially reversible with treatment?

Answer 15

• hyperlipidemia
• smoking
• hypertension
• diabetes
• lack of exercise
• obesity
• heavy alcohol consumption

Question 16

What are the signs and symptoms of ischaemic heart disease?

Answer 16

• chest pain, often central, crushing, radiating to left arm or into jaw (may not get chest pain in elderly or diabetes)
• shortness of breath
• palpitations
• syncope (temporary loss of consciousness caused by fall in BP)
• nausea, sweating, pale

Question 17

What are the clinical presentations of ischaemic heart disease?

Answer 17

• stable angina
• unstable angina
• NSTEMI (non - ST-segment elevation myocardial infarction)
• STEMI
• sudden death

Question 18

What is the difference between stable and un-stable angina?

Answer 18

Stable angina
- lasts up to 20 min
-induced by effort 
-resolved by rest or GTN 
Unstable angina 
-lasts longer 
- occurs at rest
- often early symptom to MI

Question 19

What happens with the plaque stages in stable angina, unstable angina, NSTEMI, STEMI?

Answer 19

stable angina - plaque disruption and spasm

unstable angina - partial thrombosis, possible emboli

NSTEMI + STEMI -plaque rupture, occlusion with thrombus

Question 20

What investigations can be done to recognise angina’s?

Answer 20

• obs (BP, pulse, oxygen saturations, respiratory rate)
• bloods (including cardiac enzymes)
  ECG (exercise tolerance test)

Question 21

What are complications of myocardial infarctions?

Answer 21

• cardiac arrest
• arrhythmias
• pericarditis (inflammation of the pericardium)
• valvular defects
• ventricular wall rupture
• deep vein thrombosis
• pulmonary embolus

Question 22

What are the treatments for anginas and acute coronary syndrome?

Answer 22

immediate treatments 
- oxygen
- pain relief 
- aspirin 
Angina
 - lifestyle 
- nitrates (dilates vasculature)
- B-blockers
acute coronary syndrome 
- Thrombolytic therapy
- PTCA (Percutaneous coronary intervention)
- CABG (coronary artery bypass graft)

Question 23

What are the major risk factors for atherosclerosis?

Answer 23

• hypertension
• diabetes mellitus
• hyperlipidemia
• smoking
• family history
• low levels of HDL

Question 24

What are the other risk factors for atherosclerosis?

Answer 24

• obesity
• advanced age
• male sex
• physical inactivity
• homocystinuria (disorder of methionine metabolism)
• emotional stress

Question 25

Which lipid id bad cholesterol ?

Answer 25

LDL

HDL = good cholesterol

Question 26

how can hyperlipidaemia be treated?

Answer 26

• reduce cholesterol and saturated fats in diet

- role of statins

Question 27

How can you prevent atheroma?

Answer 27

• stop smoking
• control hypertension
• weight reduction
• increase exercise
• moderation of alcohol
• increase HDLs and reduce LDLs