Atheroma and it's complications

Question 1

What are the 4 stages of the pathogenesis of atheroma (AKA atherosclerosis)

Answer 1

1 Primary endothelial injury
2 accumalation lipids and macrophages
3 migration of smooth muscle cells
4 increase in size

Question 2

How do atheromatous plaques progress over time? how does this affect the lumen of the artery an the arterial wall?

Answer 2

Fatty streak
Fibrofatty plaque
Complicated plaque ( with overlying thrombus)

Progression is associated with further loss of luminal patency and arterial wall weakness

Question 3

How does a:
-stable plaque
-acute occlusion
-chronic closure
lead to a cardiac arrest?

Answer 3

Stable plaque can lead to an unstable plaque which can = transient ischaemia = cardiac arrest

acute occlusion leads to an acute MI and cardiac arrest

Chronic closure can lead to scar formation/cardiac fibrosis which in itself can = cardiac arrest or can go onto cause remodelling a scar anatomy = ischaemic cardiomyopathy = cardiac arrest

Question 4

In which 3 scenarios is atheromatous narrowing of an artery likely to produce critical disease?

Answer 4

if:
It is the only artery supplying an organ or tissue (i.e. There is no collateral circulation)

The artery diameter is small (e.g coronary artery versus common iliac artery)

Overall blood flow is reduced (i.e. cardiac failure)

Question 5

What are the 5 complications of atheroma?

Answer 5

STENOSIS

THROMBOSIS

ANEURYSM

DISSECTION

EMBOLISM

Question 6

What is arterial stenosis? what does this lead to?

Answer 6

NARROWING OF THE ARTERIAL LUMEN and REDUCED ELASTICITY

=REDUCED FLOW IN SYSTOLE
=TISSUE ISCHAEMIA

Question 7

What happens to the myocardium in cardiac fibrosis?

Answer 7

LOSS OF CARDIAC MYOCYTES

REPLACEMENT BY FIBROUS TISSUE

LOSS OF CONTRACTILITY

REDUCED ELASTICITY & FILLING

Question 8

what are the 5 complications of aneurysm?

Answer 8

RUPTURE (6cm)

THROMBOSIS

EMBOLISM

PRESSURE EROSION OF ADJACENT STRUCTURES

INFECTION

Question 9

In arterial dissection:

• what is the pathogenesis?
• who does it affect?
• what can it cause?

Answer 9

• splitting within the media by flowing blood resulting in a false lumen filled with blood within media
• middle age +/- atheroma
• sudden collapse and high mortality

Question 10

Other than atheroma what other 5 pathologies are assoc. with atheroma?

Answer 10

HYPERTENSION
TRAUMA
COARCTATION
MARFAN’S
PREGNANCY

Question 11

which four main organs does atheroma commonly affect?

Answer 11

HEART
BRAIN
KIDNEYS
LIMBS