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Flashcards in Atherosclerosis Deck (35)
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1

Define Atheroma

Accumulation of Intracellular and extracellular lipid in the intima and media of large/ medium sized arteries

2

Define Atherosclerosis

The thickening and hardening of arterial walls as a consequence of Atheroma

3

Define Arteriosclerosis

The thickening of the walls of arteries and arterioles, due to hypertension or Diabetus Mellitus

4

What 2 conditions are causes by Atherosclerosis, making it the biggest killer in the world?

MI
Stroke

5

Describe the 3 stages/ Macroscopic features of Atherosclerosis

1. Fatty streak (Early stages);
- Lipid deposit in intima
- Yellow, slightly raised

2. Simple plaque;
- Raised yellow/ white
- Irregular outline
- Widely distributed
- Enlarge and coalesce

3. Complicated plaque (Other things happen);
- Ulceration (Fibrous cap eroded from underneath)
- Thrombosis
- Haemorrhage into plaque
- Calcification
- Aneurysm formation

6

Name the 5 most common sites of Atherosclerosis

Aorta (Especially abdominal)
Coronary arteries
Carotid arteries
Cerebral arteries
Leg arteries

7

What are the 3 early changes in Microscopic features of Atherosclerosis

Proliferation of smooth muscle cells
Accumulation of foam cells
Extracellular lipid deposition

8

What are the 6 later changes in Microscopic features of Atherosclerosis

- Necrosis and fibrosis
- Cholesterol clefts
- Disruption of internal elastic lamina
- Damage extends into media
- Ingrowth of blood vessels from adventitia
- Plaque fissuring

9

What are cholesterol clefts?


What are the 3 basic components of a plaque?

Needle shaped clefts left in the plaque, after cholesterol crystals have been dissolved by solvents used in microscopy

- Cells (Macrophages, WBCs, smooth muscle cells)
- Intra and Extracellular lipid
- ECM (Collagen, Elastin, Proteoglycans)

10

What conditions are caused by Atherosclerosis at;

1. Heart
2. Brain
3. Kidneys
4. Legs
5. Bowel

1. Ischaemic heart disease
2. Cerebral ischaemia
3. kidneys- Abdominal Aortic Aneurysm
4. Legs- Peripheral vascular disease
5. Bowel- Mesenteric ischaemia

11

What are 5 outcomes of Ischaemic heart disease

Sudden death
MI
Angina
Arrhythmia
Cardiac failure

12

What are 3 outcomes of Cerebral Ischaemia

- Transient ischaemic attack (Mini stroke, resolves in <24h)
- Cerebral infarction (Stroke)
- Multi-Infarct dementia

13

What are 3 outcomes of Mesenteric Ischaemia

Ischaemic colitis
Malabsorption
Intestinal infarction

14

What are 2 outcomes of Peripheral Vascular Disease

Gangrene
Intermittent claudication

15

What are 2 outcomes of Abdominal Aortic Aneurysm in Kidneys

Hypertension
Renal failure

16

Identify 11 risk factors for Atherosclerosis

DISHH GAFAAG

Diabetes (-> Hypercholesterolaemia)
Infection
Smoking
Hyperlipidaemia (High LDL)
Hypertension

Gender
Age
Familial hyperlipidaemia
Alcohol consumption (Excess, small amounts protect)
Apolipoprotein E Genotype
Geography (Lower in Asia, South America, Africa)

17

How is gender a risk factor for atherosclerosis

What 3 organisms cause infection which may lead to atherosclerosis

Women are relatively protected before menopause
(Hormones?)

Chlamidyia pneumoniae
Helicobater pylori
Cytomegalovirus

18

Explain how genetics can make you more likely to get Atherosclerosis in 2 ways?

Variations in Apolipoprotein metabolism
Variations in Apolipoprotein receptors

19

What are the 3 theories of of how Atherosclerosis comes about?

- Thrombogenic Theory/ Encrustations Hypothesis
- Monoclonal Hypothesis
- Reaction to injury hypothesis/ Insudation Theory

20

Describe the Monoclonal Hypothesis

Each plaque is monoclonal, so plaques could be benign

Possibly Induced by virus/ cholesterol

21

Describe the Thrombogenic theory/ Encrustation hypothesis

Plaques are formed by repeated thrombi and lipid deposit is derived from the thrombi

22

Describe Reaction to injury hypothesis/ Insudation Theory

Atherosclerosis is chronic inflammation due to endothelial injury

Increased Permeability leads to;
- Monocytes penetrate endothelium
- Extracellular lipid deposition + Foam cells
- SMC proliferation

23

What 4 processes are involved in atherosclerosis

Thrombosis
Lipid accumulation
Production of intercellular matrix
Interactions between cell types

24

What 6 cells are involved in Atherosclerosis

Endothelial cells
Platelets
SMCs
Macrophages
Lymphocytes
Neutrophils

25

What are 2 roles of Endothelial cells in Atherosclerosis?

- Produce collagen
- Stimulate proliferation and migration of SMCs

26

What are 2 roles of Smooth Muscle Cells in Atherosclerosis?

- Take up lipid to become Foam Cells
- Make collagen + proteoglycans

27

What are 3 roles of Macophages in Atherosclerosis?

- Take up lipids and LDL to become foam cells
- Stimulate Proliferation and migration of SMCs
- Modify matrix by secreting proteases

28

What is the role of Platelets in Atherosclerosis?

- Stimulate Proliferation and migration of SMCs

29

What is the role of Neutrophils in Atherosclerosis?

- Secrete proteases leading to continued local damage and inflammation

30

What are 2 roles of Lymphocytes in Atherosclerosis?

- TNF affect lipoprotein metabolism
- Stimulate SMC proliferation and migration