Pathophysiology of Atheroma

Question 1

Atheroma/atherosclerosis

Answer 1

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

Question 2

Serious consequence of atheroma

Answer 2

Atheroma can result in myocardial ischaemia which can lead to angina

Question 3

Angina

Answer 3

Chest pain due to restricted blood supply to the heart

Question 4

Atheroma can be complicated by

Answer 4

Thromboembolism

Question 5

Arteriosclerosis

Answer 5

Age-related

Smooth muscle hypertrophy, apparent reduplicate of internal laminae and intimal fibrosis

Question 6

Arteriosclerosis results in

Answer 6

Decrease in vessel diameter

Question 7

Arteriosclerosis can cause

Answer 7

Cardiac, cerebral, colonic and renal ischaemia

Question 8

Earliest significant lesion of atheroma

Answer 8

Fatty streak

Question 9

Fatty streak

Answer 9

Yellow linear elevation of intimal lining

Question 10

Fatty streak comprises

Answer 10

Masses of lipid-laden macrophages

Question 11

Early atheromatous plaque

Answer 11

Smooth yellow patches in intima

Question 12

Fully developed atheromatous plaque

Answer 12

Central lipid core with fibrous tissue cap, covered by arterial endothelium

Question 13

What provides fibrous tissue cap of plaque with structural strength

Answer 13

Collagens

Question 14

What resides in fibrous cap of plaque

Answer 14

Inflammatory cells (recruited from arterial endothelium)

Question 15

Central lipid core of plaque contains

Answer 15

Cellular lipids and debris from macrophages

Question 16

What occurs late in plaque development

Answer 16

Extensive dystrophic calcification

Question 17

Atheroma tend to form in areas of

Answer 17

Turbulent flow

Question 18

Areas of turbulent flow

Answer 18

Arterial branching points/bifurcations

Question 19

Late stage plaques

Answer 19

Confluent and cover large areas

Question 20

Complicated atheroma

Answer 20

Established atheromatous plaque plus haemorrhage into plaque (calcification), plaque rupture/fissuring and thrombosis

Question 21

Most important risk factor of atheroma

Answer 21

Hypercholesterolaemia

Question 22

Hypercholesterolaemia

Answer 22

High cholesterol in blood

Question 23

Hypercholesterolaemia can be a result of

Answer 23

Lack of LDL cell membrane receptors

Question 24

Signs of major hyperlipidaemia/hypercholesterolaemia

Answer 24

Familial vs acquired
Biochemical evidence
Corneal arcus
Tendon xanthomata
Xanthelasmata
Risk/premature/family history MI/atheroma

Question 25

Risk factors for atheroma

Answer 25

``` Hyperlipidaemia/hypercholesterolaemia Smoking Hypertension Diabetes mellitus Male Elderly ```

Question 26

Two-step process of formation of atheromatous plaque

Answer 26

1. Injury to endothelial lining of artery | 2. Chronic inflammatory and healing response of vascular wall to agent causing injury

Question 27

Chronic inflammation results in

Answer 27

Accumulation of lipids and inflammatory cells in the intimal layer which results in plaque formation

Question 28

Causes of endothelial injury

Answer 28

``` Heamodynamic disturbances (turbulent flow) Hypercholesterolaemia ```

Question 29

Altered function of injured endothelial cells

Answer 29

Enhanced expressed of cell adhesion molecules High permeability for LDL Increased thrombogenicity

Question 30

Clinical manifestation of consequences of atheroma

Answer 30

Lumen stenosis Acute atherothrombotic occlusion Embolisation of distal arterial bed Aortic aneurysm and rupture

Question 31

Vulnerable atheromatous plaque

Answer 31

Thin fibrous cap with large lipid core and prominent inflammation

Question 32

Result of pronounced inflammatory activity on plaque

Answer 32

Degradation and weakening of plaque, increasing the risk of plaque rupture

Question 33

Preventative and therapeutic approaches to atheroma

Answer 33

``` Stop smoking Control blood pressure Weight loss Regular exercise Dietary modifications ```

Question 34

Secondary prevention of atheroma

Answer 34

Cholesterol lowering drugs Aspirin - decrease risk of thrombosis Surgical options