Flashcards in Atheroma Final Deck (27)
What is the definition of atheroma?
- build-up of fatty material on the inside wall of an artery
What is the definition of atherosclerosis?
- the progressive narrowing and hardening within an artery potentially resulting in a complete blockage
Which vessels does atheromas affect?
affects arteries - slowly progressive
What are the causes of injury in an atheroma?
- disturbed flow
- progresses as white cells, fat and blood constituents infiltrate injury
What are the stages of artheroma ?
- 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
How do artheromas clinical manifest?
- coronary artery - heart attacks/angina (ischaemic heart disease
- aorta - aneurysm due to weakening of the wall
- carotid - narrowing causing stroke
- peripheral vascular disease
Atherosclerotic plaques develop slowly over decades but may acutely cause symptoms due to..
- aneurysm and rupture
- haematoma formation
- development of critical stenosis (blocking or narrowing)
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.
- cerebral infarction (stroke)
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.
- peripheral vascular disease
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)).
What is the treatment for atheromas?
- secondary prevention
What is the cause of ischaemic heart disease?
- imbalance between supply (perfusion) and demand of the heart for oxygenated blood
- decrease in oxygen and nutrients
- inadequate removal of metabolites
What are the causes of ischaemic heart disease?
- DECREASE FLOW OF OXYGENATED BLOOD (atheroma, embolism, spasm)
- INCREASED DEMAND FOR OXYGEN (thyrotoxicosis, myocardial hypertrophy eg. hypertension)
What are the risk factors for ischaemic heart disease which are fixed and you cant change?
- positive family history
- male sex
- genetic factors (eg. ACE gene deletion)
What are the risk factors for ischaemic heart disease which are potentially reversible with treatment?
- lack of exercise
- heavy alcohol consumption
What are the signs and symptoms of ischaemic heart disease?
- chest pain, often central, crushing, radiating to left arm or into jaw (may not get chest pain in elderly or diabetes)
- shortness of breath
-syncope (temporary loss of consciousness caused by fall in BP)
- nausea, sweating, pale
What are the clinical presentations of ischaemic heart disease?
- unstable angina
-NSTEMI (non - ST-segment elevation myocardial infarction)
- sudden death
What is the difference between stable and un-stable angina?
- lasts up to 20 min
-induced by effort
-resolved by rest or GTN
- occurs at rest
- often early symptom to MI
What happens with the plaque stages in stable angina, unstable angina, NSTEMI, STEMI?
stable angina - plaque disruption and spasm
unstable angina - partial thrombosis, possible emboli
NSTEMI + STEMI -plaque rupture, occlusion with thrombus
What investigations can be done to recognise angina's?
- obs (BP, pulse, oxygen saturations, respiratory rate)
- bloods (including cardiac enzymes)
ECG (exercise tolerance test)
What are complications of myocardial infarctions?
- cardiac arrest
- pericarditis (inflammation of the pericardium)
- valvular defects
- ventricular wall rupture
- deep vein thrombosis
- pulmonary embolus
What are the treatments for anginas and acute coronary syndrome?
- pain relief
- nitrates (dilates vasculature)
acute coronary syndrome
- Thrombolytic therapy
- PTCA (Percutaneous coronary intervention)
- CABG (coronary artery bypass graft)
What are the major risk factors for atherosclerosis?
- diabetes mellitus
- family history
- low levels of HDL
What are the other risk factors for atherosclerosis?
- advanced age
- male sex
- physical inactivity
- homocystinuria (disorder of methionine metabolism)
- emotional stress
Which lipid id bad cholesterol ?
HDL = good cholesterol
how can hyperlipidaemia be treated?
- reduce cholesterol and saturated fats in diet
- role of statins