Atheromatous Vascular Disease

Question 1

Define arteriosclerosis, atheroma and atherosclerosis?

Answer 1

Arteriosclerosis is the thickening and hardening of blood vessels. Causes a reduction in lumen size and a loss of elasticity. In small vessels hypertension is the most common cause.

Atheroma: is the accumulation of intracellular nad extracellular lipid in the tunica initima of medium and large aa. Also effects the tunica media.

Atherosclerosis: is the thickening and hardening of aa due to the formation of an atheroma.

Question 2

Describe the pathology of atherosclerosis?

Answer 2

1. Lipids enter intima through endothelial damage.
2. Lipids are phagocytosis by macrophages in the intima to make raised ‘fatty streaks’.
3. Some lipids are released by the macrophages forming a ‘lipid plaque’.
   Macrophages secrete cytokines which stimulate myofibroblasts to secrete collagen. Damage to the elastic lamina and media occur.
4. Collagen covers the plaque surface forming a ‘fibrolipid plaque’
   Media wall thins with muscle being replaced by collagen,
5. Lipid in the intima becomes calcified. Surface of plaque ulcerates. Thinning of the media leads to vessel weakness and inelasticity.

Question 3

What are complications of atheromatous disease?

Answer 3

CVD: MI, Stroke, Peripheral Arterial Disease, Carotid aa stenosis, Renal Stenosis, Aortic Stenosis, Aneurysm.

Question 4

What are the common sites of atheroma and what are the consequences?

Answer 4

Abdominal Aorta: Development of aneurysm.
Carotid aa: Embolic Stroke
Coronary aa: Angina, ACS
Cerebral aa: Stroke
Leg aa: PAD
Common iliac 
>Internal iliac (gluteal region)
>External iliac > femoral aa > popliteal aa
Popliteal > ant/post tibial aa

Question 5

Discuss the risk factors for atherosclerosis and methods to modify the risk.

Answer 5

Lifestyle:
Smoking cessation
Obesity (eat a healthy balanced diet and reduce fat intake)
Regular exercise
Avoid excessive alcohol intake

Treat contributing conditions:
Hypertension: ACE inhibitor +/- Ca channel blocker +/- diuretic
Hyperlipidaemia: Statin
Previous cardiac event: Anti platelet drugs e.g clopidogrel or asprin
Diabetes: Good control

Question 6

What is the difference between primary and secondary hyperlipidaemia?

Answer 6

1y = Genetic predisposition e.g. familial hypercholestrolaemia
2y = systemic metabolic disturbance e.g obesity, DM, alcohol