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Atherosclerosis Flashcards

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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
Who are AAA seen in?
Elderly
26
What size of aneurysms in diameter are at high risk of rupture?
>5cm
27
Contents of atheromatous plaque
Thin fibrous cap Large lipid core Prominent inflammation
28
Preventative measures of atheroma
``` Stop smoking Control BP Weight loss Regular exercise Dietary modifications ```
29
Secondary prevention of atheroma
Cholesterol lowering drugs | Aspirin
30
What does aspirin do?
Inhibits platelet aggregation to decrease risk of thrombosis on established atheromatous plaques
31
Most important risk factor for atheroma
Hypercholesterolaemia
32
Why is hypercholesterolaemia the most important risk factor for atheroma?
Causes plaque formation and growth in the absence of other risk factors
33
Risk factors for atheroma
``` Hypercholesterolaemia Smoking HTN DM Male Elderly Obesity Sedentary lifestyle Low socio economic status Low birthweight ```
34
Signs of major hyperlipidaemia
Biochemical - LDL, HDL, total cholesterol, triglycerides Corneal arcus Tendon xanthomata Xanthelasmata
35
What is corneal arcus?
White rim formed around the iris
36
What is xanthelasmata?
Yellowish deposit of fat under the skin, usually on or around the eyelids
37
Where do you see tendon xanthomata?
Knuckles | Achilles
38
What is normal blood flow?
Laminar
39
Two types of abnormal blood flow
Stasis | Turbulence
40
What is stasis?
Stagnation of blood flow
41
What is turbulence?
Forceful, unpredicted flow
42
Examples of defects in blood flow
``` Thromboembolism Atheroma Hyperviscosity Spasm External compression Vasculitis Vascular steel syndrome ```
43
Definition of vasculitis
Inflammation of blood vessel wall
44
Definition of vascular steel syndrome
Vascular network within a network steals blood from another vascular network in the same organ
45
Pathogenesis of thrombosis - virchows triad
1. Endothelial injury 2. Stasis or turbulent blood flow (i.e. abnormal blood flow) 3. Hypercoagulability of the blood
46
Possible outcomes of thrombus
Resolution Organisaion / recanalization Death Propagation (leading to embolism)
47
What do the factors of virchows triad cause?
Thrombus
48
Examples of changes in blood constitutents in virchows triad
Hyperviscosity | Post traumatic / post surgical hypercoagulablity
49
Examples of changes in blood flow in virchows triad
Post op stasis | Atheromatous plaque or aneurysm causing turbulent flow
50
Relationship between atheroma and thrombosis
Arterial thrombosis is most commonly superimposed on atheroma
51
Thrombus vs clot
Thrombus - solidifies within vascular system | Clot - solidifies outside vascular system
52
What is a post morteom clot?
Solidifying of blood after death
53
Definition of embolism
The movement of abnormal material in the bloodstream and its impaction in a vessel, blocking its lumen
54
Types of embolus
``` Systemic / arterial thromboembolus Venous thromboembolous Fat Gas Tumour Trophoblast Septic material Amniotic fluid Bone marrow Foreign bodies ```
55
Sources of arterial thromboembolus
Mural thrombosis Aortic aneurysms Atheromatous plaques Valvular vegetations
56
Where do venous thromboembolus originate and where do they go?
Originate from deep venous thrombosis (lower limbs) Travel to pulmonary arterial circulation (may occlude main pulmonary artery, bifurcation (saddle embolus) or smaller arteries
57
What is the most common form of thromboembolic disease?
Venous thromboembolus
58
What do multiple pulmonary emboli result in?
Pulmonary HTN | Right ventricular failure
59
When would you get a fat embolus?
After major fractures
60
Syndrome of fat embolism
Brain Kidneys Skin
61
When would you get a gas embolus?
Decompression sickness (e.g. a diver) Head and neck wounds Surgery CV lines
62
Risk factors for DVT and pulmonary thromboembolism
``` 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
Prophylaxis for surgical patients at risk
TEDs | s/c heparin
64
What risk stratification score is used to calculate a persons 10 year CVS risk score?
QRISK2
65
What statin is used for primary prevention?
Atorvastatin 20mg
66
What statin is used for secondary prevention?
Atorvastatin 80mg
67
Diagnostic criteria for orthostatic hypotension
Drop in SBP of at least 20mmHg and/or drop in DBP of at least 10mmHg after 3 mins of standing
68
When should statins be stopped?
Pregnancy | When an oral macrolide antibiotic is started

CVS Pathology (19 decks)

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