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cardiovascular > atheroma > Flashcards

atheroma Flashcards

1
Q

what is the definition of how a atheroma is formed (atherosclerosis)

A

Formation of focal elevated lesions (plaques) in intima of large and medium-sized arteries

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2
Q

how can atheroma effect the coronary arteries

A

the plaques narrow the lumen and lead to ischaemia - leads to angina due to MI

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3
Q

what is arteriosclerosis

A

not atheromatous

age related changes leading to vessel smooth muscle hypertrophy, duplication of internal elastic lamiae - decreased vessel diameter

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4
Q

what is the clinical significance of arteriosclerosis

A

higher frequency of cardiac, cerebral ischaemia

more apparent effect when CVS is stressed - haemorrhage, shock, infection

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5
Q

what are the 3 ‘‘steps’’ in the atheroma development

A

fatty streak

early atheromatous plaque

fully developed atheromatous plaque

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6
Q

what are early atheromatous plaque and where does it occur

A

smooth yellow patches in intima (innermost structure) laden with lipids

found in young adults onwards

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7
Q

what do early atheromatous plaques develop into

A

fully developed atheromatous plaque

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8
Q

what is a fatty streak in relation to atheroma development

A

earliest significant lesion, may disappear, in young children

may disappear, if not, may

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9
Q

what are fully developed atheromatous plaque

A

central lipid core with fibrous tissue cap - covered by arterial endothelium

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10
Q

what role does collage play in atheroma development

A

produced by smooth muscle cells in the cap - they provide structural strength

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11
Q

what inflammatory cells are in the cap - why

A

macrophages, t-lymphocytes, mast cells

recruited from arterial endothelium

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12
Q

what is in the central lipid core of a fully developed atheroma

A

its rich in cellular lipids

and debris from dead macrophages from the plaque

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13
Q

where do atheroma’s form

A

at arterial branching points/bifurcations

where there is TURBULENT FLOW

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14
Q

what occurs in late stage plaque development - clinical significance

A

extensive calcification of the atheroma

can be seen on CT scans

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15
Q

what is a complicated atheroma

A

features of a fully developed atheroma (lipid rich core, fibrous plaque)

there plaque ruptures and there is the formation of a thrombosis

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16
Q

what is the most important risk factors for the atherosclerosis

A

hypercholesterolaemia

hyperlipidaemia

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17
Q

what is hypercholesterolaemia

A

the presence of abnormal amount of cholesterol in the blood

18
Q

what factors other than the two major ones effect atherosclerosis (5) and almost all cardiovascular disease

A 
smoking
hypertension 
diabetes mellitus 
male 
elderly
19
Q

what is the two step process that causes the development of atheromatous plaques

A

injury to endothelial lining of artery

chronic inflammation and healing response - chronic leads to plaques forming

20
Q

what are vulnerable atheromatous plaques

A

plaques that rupture with subsequent thrombosis

21
Q

what are the distinct features of vulnerable atheromatous plaques

A

typically thin fibrous cap, large lipid core, prominent inflammation

22
Q

what are the lifestyle changes that are preventative/therapeutic measure

A 
smoking cessation 
BP control
weight loss
regular exercise
dietary modifications
23
Q

what is the most common drugs used in prevention - why

A

cholesterol lowering drugs

aspirin - inhibits platelet aggregation

24
Q

what is the final treatment option

A

surgery

25
Q

what happens after an injury to the epithelium

A

accumulation of lipoproteins

(LDL) in vessel wall

26
Q

what happens after LDL accumulation

A

monocytes (white blood cells) adherer to endothelium surface and make foamy macrophages

27
Q

what happens after monocyte adhesion

A

platelet adhesion - which then release factors that recruit smooth muscle

28
Q

what happens after smooth muscle recruitment

A

smooth muscle proliferates

29
Q

what are the two factors that effect endothelial damage

A

haemodynamic disturbances (turbulent flow)

hypercholesterolaemia ( reduce endothelial cell function)

30
Q

what happens after smooth muscle proliferation

A

growth factors lead to synthesis of collagen and elastin to crate the cap

31
Q

what is Progressive lumen narrowing due to high grade plaque stenosis

A

when there stenosis of over 50% of the vessels lumen - leading to critical reduction of blood flow in distal arterial bed

32
Q

what is stable angina an example of

A

stenosed atheromatous coronary artery

33
Q

what is unstable angina an example of

A

very sever stenosis - ischemia - pain at rest

34
Q

what causes intermittent claudication (pain in legs)

A

peripheral artery disease

due to stenosis of ilea, femoral, popliteal arteries

35
Q

what happens when there is acute atherothrombotic occlusion

A

Rupture exposes highly thrombogenic plaque contents (collagen, lipid, debris) to blood stream → activation of coagulation cascade and thrombotic occlusion in very short time - leading to a acute event

36
Q

what happens if there is complete occlusion In a acute atherothrombotic occlusion - examples

A

Total occlusion → irreversible ischaemia → necrosis (infarction) of tissues

MI - coronary arteries
stroke - carotid, coronary arteries

37
Q

what is the difference between atherosclerosis vs thrombosis

A

an atheroma is a deposit of fatty LDL tissue, where a thrombus is coagulation within the vessel

38
Q

what is a atheromatous abdominal aortic aneurysm

A

a aneurism in the abdomen usually above the bifurcation of the descending aorta into the iliac arteries

asymptomatic in elderly

39
Q

what happens if a atheromatous abdominal aortic aneurysm ruptures - when would this be

A

Sudden rupture → massive haemorrhage (high mortality)

Aneurysms bigger than 5cm - at high risk of rupture

40
Q

what is an aneurysm

A

ballooning of a vessel caused by a localized, abnormal, weak spot on a blood vessel wall.

cardiovascular (26 decks)

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