atheroma

Question 1

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

Answer 1

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

Question 2

how can atheroma effect the coronary arteries

Answer 2

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

Question 3

what is arteriosclerosis

Answer 3

not atheromatous

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

Question 4

what is the clinical significance of arteriosclerosis

Answer 4

higher frequency of cardiac, cerebral ischaemia

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

Question 5

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

Answer 5

fatty streak

early atheromatous plaque

fully developed atheromatous plaque

Question 6

what are early atheromatous plaque and where does it occur

Answer 6

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

found in young adults onwards

Question 7

what do early atheromatous plaques develop into

Answer 7

fully developed atheromatous plaque

Question 8

what is a fatty streak in relation to atheroma development

Answer 8

earliest significant lesion, may disappear, in young children

may disappear, if not, may

Question 9

what are fully developed atheromatous plaque

Answer 9

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

Question 10

what role does collage play in atheroma development

Answer 10

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

Question 11

what inflammatory cells are in the cap - why

Answer 11

macrophages, t-lymphocytes, mast cells

recruited from arterial endothelium

Question 12

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

Answer 12

its rich in cellular lipids

and debris from dead macrophages from the plaque

Question 13

where do atheroma’s form

Answer 13

at arterial branching points/bifurcations

where there is TURBULENT FLOW

Question 14

what occurs in late stage plaque development - clinical significance

Answer 14

extensive calcification of the atheroma

can be seen on CT scans

Question 15

what is a complicated atheroma

Answer 15

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

there plaque ruptures and there is the formation of a thrombosis

Question 16

what is the most important risk factors for the atherosclerosis

Answer 16

hypercholesterolaemia

hyperlipidaemia

Question 17

what is hypercholesterolaemia

Answer 17

the presence of abnormal amount of cholesterol in the blood

Question 18

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

Answer 18

smoking
hypertension 
diabetes mellitus 
male 
elderly

Question 19

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

Answer 19

injury to endothelial lining of artery

chronic inflammation and healing response - chronic leads to plaques forming

Question 20

what are vulnerable atheromatous plaques

Answer 20

plaques that rupture with subsequent thrombosis

Question 21

what are the distinct features of vulnerable atheromatous plaques

Answer 21

typically thin fibrous cap, large lipid core, prominent inflammation

Question 22

what are the lifestyle changes that are preventative/therapeutic measure

Answer 22

smoking cessation 
BP control
weight loss
regular exercise
dietary modifications

Question 23

what is the most common drugs used in prevention - why

Answer 23

cholesterol lowering drugs

aspirin - inhibits platelet aggregation

Question 24

what is the final treatment option

Answer 24

surgery

Question 25

what happens after an injury to the epithelium

Answer 25

accumulation of lipoproteins | (LDL) in vessel wall

Question 26

what happens after LDL accumulation

Answer 26

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

Question 27

what happens after monocyte adhesion

Answer 27

platelet adhesion - which then release factors that recruit smooth muscle

Question 28

what happens after smooth muscle recruitment

Answer 28

smooth muscle proliferates

Question 29

what are the two factors that effect endothelial damage

Answer 29

haemodynamic disturbances (turbulent flow) hypercholesterolaemia ( reduce endothelial cell function)

Question 30

what happens after smooth muscle proliferation

Answer 30

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

Question 31

what is Progressive lumen narrowing due to high grade plaque stenosis

Answer 31

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

Question 32

what is stable angina an example of

Answer 32

stenosed atheromatous coronary artery

Question 33

what is unstable angina an example of

Answer 33

very sever stenosis - ischemia - pain at rest

Question 34

what causes intermittent claudication (pain in legs)

Answer 34

peripheral artery disease due to stenosis of ilea, femoral, popliteal arteries

Question 35

what happens when there is acute atherothrombotic occlusion

Answer 35

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

Question 36

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

Answer 36

Total occlusion → irreversible ischaemia → necrosis (infarction) of tissues MI - coronary arteries stroke - carotid, coronary arteries

Question 37

what is the difference between atherosclerosis vs thrombosis

Answer 37

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

Question 38

what is a atheromatous abdominal aortic aneurysm

Answer 38

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

Question 39

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

Answer 39

Sudden rupture → massive haemorrhage (high mortality) Aneurysms bigger than 5cm - at high risk of rupture

Question 40

what is an aneurysm

Answer 40

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