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CVS Pathology > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

What does atheroma / atherosclerosis involve?

A

The formation of focal elevated lesions (plaques) in intima of large and medium sized arteries

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2
Q

What is atheroma?

A

Atheromatous plaques narrow the lumen causing ischaemia

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3
Q

What is atherosclerosis?

A

Age related change in muscular arteries

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4
Q

What happens in atherosclerosis?

A

Smooth muscle hypertrophy
Reduplication of internal elastic laminae
Intimal fibrosis
Decrease in vessel diameter

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5
Q

Pathology of atheroma

A

Fatty streak
Yellow linear elevation of intimal lining
Comprises masses of lipid laden macrophages

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6
Q

Two step process in the development of atheromatous plaques

A
  1. Injury to the endothelial lining of the artery

2. Chronic inflammatory and healing response of the vascular wall to agent causing injury

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7
Q

Pathogenesis of atherosclerosis

A
  1. Endothelial injury and dysfunction of endothelial cells
  2. Accumulation of LDL (lipoproteins) in vessel wall
  3. Monocyte adhesion to endothelium - migration into the intima and transformation to foamy macrophages
  4. Platelet adhesion
  5. Factor release from activated platelets and macrophages results in smooth muscle recruitment
  6. Smooth muscle cell proliferation, extracellular matrix and T cell recruitment
  7. Lipid accumulation (extracellular and in foamy macrophages)
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8
Q

Causes of endothelial injury

A 
Haemodynamic disturbances (turbulent flow)
Hypercholesteraemia
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9
Q

What happens in injured endothelial cells are functionally altered?

A

Enhanced expression of cell adhesion molecules
High permeability for LDL
Increased thrombogenicity

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10
Q

A fully developed atheromatous plaque consists of…..

A

Central lipid core with fibrous tissue cap, covered by arterial endothelium, rich in cellular lipids/debris derived from macrophages (died in plaque)
Collagens
Inflammatory cells

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11
Q

Pathology of complicated atheroma

A

Established atheromatous plaque
Haemorrhage into plaque which if heals leads to calcification
Plaque rupturing/fissuring
Thrombosis

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12
Q

What % of stenosis of a vessel lumen can result in a critical reduction of blood flow in a distal arterial bed resulting in reversible tissue ischaemia?

A

> 50 - 75%

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13
Q

What would a stenosed atheromatous coronary artery result in?

A

Stable angina

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14
Q

What would very severe stenosis of a coronary artery result in?

A

Ischaemic pain at rest - i.e. unstable angina

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15
Q

What would ileal, femoral or popliteal artery stenosis result in?

A

Intermittent claudication (peripheral artery disease)

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16
Q

What does long standing tissue ischaemia result in?

A

Atrophy of affected organ

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17
Q

Major complication of acute atherothrombotic occlusion

A

Rupture of the plaque

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18
Q

What does rupture of a atherothrombotic plaque result in?

A

Exposes highly thrombogenic plaque contents (collagen, lipid, debris) to blood stream - activation of coagulation cascade and thrombotic occlusion in very short time

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19
Q

What does total occlusion of an artery result in?

A

Irreversible ischaemia - necrosis

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20
Q

What would total occlusion of a coronary artery result in?

A

MI

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21
Q

What would total occlusion of a carotid or a cerebral artery result in?

A

Stroke

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22
Q

What would the total occlusion of e.g. ileal, femoral or popliteal artery result in?

A

Lower limb gangrene

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23
Q

What does embolic occlusion of small vessels lead to?

A

Small infarcts in organs

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24
Q

Pathology of ruptured AAA

A

Media beneath atheromatous plaques gradually weakned (lipid related inflammatory activity in plaque)
Leads to dilatation of great vessel
Slow but progressive
Sudden rupture leads to massive retroperitoneal haemorrhage

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25
Q

Who are AAA seen in?

A

Elderly

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26
Q

What size of aneurysms in diameter are at high risk of rupture?

A

> 5cm

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27
Q

Contents of atheromatous plaque

A

Thin fibrous cap
Large lipid core
Prominent inflammation

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28
Q

Preventative measures of atheroma

A 
Stop smoking
Control BP
Weight loss
Regular exercise 
Dietary modifications
29
Q

Secondary prevention of atheroma

A

Cholesterol lowering drugs

Aspirin

30
Q

What does aspirin do?

A

Inhibits platelet aggregation to decrease risk of thrombosis on established atheromatous plaques

31
Q

Most important risk factor for atheroma

A

Hypercholesterolaemia

32
Q

Why is hypercholesterolaemia the most important risk factor for atheroma?

A

Causes plaque formation and growth in the absence of other risk factors

33
Q

Risk factors for atheroma

A 
Hypercholesterolaemia
Smoking
HTN
DM
Male
Elderly 
Obesity 
Sedentary lifestyle
Low socio economic status
Low birthweight
34
Q

Signs of major hyperlipidaemia

A

Biochemical - LDL, HDL, total cholesterol, triglycerides
Corneal arcus
Tendon xanthomata
Xanthelasmata

35
Q

What is corneal arcus?

A

White rim formed around the iris

36
Q

What is xanthelasmata?

A

Yellowish deposit of fat under the skin, usually on or around the eyelids

37
Q

Where do you see tendon xanthomata?

A

Knuckles

Achilles

38
Q

What is normal blood flow?

A

Laminar

39
Q

Two types of abnormal blood flow

A

Stasis

Turbulence

40
Q

What is stasis?

A

Stagnation of blood flow

41
Q

What is turbulence?

A

Forceful, unpredicted flow

42
Q

Examples of defects in blood flow

A 
Thromboembolism 
Atheroma
Hyperviscosity
Spasm 
External compression 
Vasculitis 
Vascular steel syndrome
43
Q

Definition of vasculitis

A

Inflammation of blood vessel wall

44
Q

Definition of vascular steel syndrome

A

Vascular network within a network steals blood from another vascular network in the same organ

45
Q

Pathogenesis of thrombosis - virchows triad

A
  1. Endothelial injury
  2. Stasis or turbulent blood flow (i.e. abnormal blood flow)
  3. Hypercoagulability of the blood
46
Q

Possible outcomes of thrombus

A

Resolution
Organisaion / recanalization
Death
Propagation (leading to embolism)

47
Q

What do the factors of virchows triad cause?

A

Thrombus

48
Q

Examples of changes in blood constitutents in virchows triad

A

Hyperviscosity

Post traumatic / post surgical hypercoagulablity

49
Q

Examples of changes in blood flow in virchows triad

A

Post op stasis

Atheromatous plaque or aneurysm causing turbulent flow

50
Q

Relationship between atheroma and thrombosis

A

Arterial thrombosis is most commonly superimposed on atheroma

51
Q

Thrombus vs clot

A

Thrombus - solidifies within vascular system

Clot - solidifies outside vascular system

52
Q

What is a post morteom clot?

A

Solidifying of blood after death

53
Q

Definition of embolism

A

The movement of abnormal material in the bloodstream and its impaction in a vessel, blocking its lumen

54
Q

Types of embolus

A 
Systemic / arterial thromboembolus 
Venous thromboembolous 
Fat
Gas
Tumour
Trophoblast 
Septic material 
Amniotic fluid 
Bone marrow 
Foreign bodies
55
Q

Sources of arterial thromboembolus

A

Mural thrombosis
Aortic aneurysms
Atheromatous plaques
Valvular vegetations

56
Q

Where do venous thromboembolus originate and where do they go?

A

Originate from deep venous thrombosis (lower limbs)
Travel to pulmonary arterial circulation (may occlude main pulmonary artery, bifurcation (saddle embolus) or smaller arteries

57
Q

What is the most common form of thromboembolic disease?

A

Venous thromboembolus

58
Q

What do multiple pulmonary emboli result in?

A

Pulmonary HTN

Right ventricular failure

59
Q

When would you get a fat embolus?

A

After major fractures

60
Q

Syndrome of fat embolism

A

Brain
Kidneys
Skin

61
Q

When would you get a gas embolus?

A

Decompression sickness (e.g. a diver)
Head and neck wounds
Surgery
CV lines

62
Q

Risk factors for DVT and pulmonary thromboembolism

A 
Cardiac failure
Severe trauma / burns 
Post op / post partum 
Nephrotic syndrome
Disseminated malignancy 
Oral contraceptive
Increased age 
Bed rest / immobilisation 
Obesity 
PMH of DVT
63
Q

Prophylaxis for surgical patients at risk

A

TEDs

s/c heparin

64
Q

What risk stratification score is used to calculate a persons 10 year CVS risk score?

A

QRISK2

65
Q

What statin is used for primary prevention?

A

Atorvastatin 20mg

66
Q

What statin is used for secondary prevention?

A

Atorvastatin 80mg

67
Q

Diagnostic criteria for orthostatic hypotension

A

Drop in SBP of at least 20mmHg and/or drop in DBP of at least 10mmHg after 3 mins of standing

68
Q

When should statins be stopped?

A

Pregnancy

When an oral macrolide antibiotic is started

CVS Pathology (19 decks)

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