PP 6 Atherosclerosis Flashcards by Emily Stephens

What blood test is used to aid diagnosis of myocardial infarction?

Troponin I + T
4 hours after MI

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When should the troponin test be taken after MI?

4 hours after

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Atheroma meaning

Necrotic core of atherosclerotic plaque

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Arteriosclerosis meaning

Thickening of walls of arteries or arterioles

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What is arteriosclerosis usually due to?

Hypertension
Diabetes mellitus - smooth muscle hypertrophy

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What can arteriosclerosis lead to?

Poor tissue perfusion
Inelastic/weak vessels > aneurysm
Increased risk of thrombosis

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Atherosclerosis meaning

Accumulation of intracellular and extracellular lipids in intima + media of large + medium sized arteries

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What can cause chronic endothelial damage?

Hyperlipidaemia
Hypertension
Smoking - toxins
Haemodynamic stressors

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What does endothelial dysfunction lead to?

Platelet adhesion
Smooth muscle cell proliferation and migration
Lipids cross into intima
Monocytes > macrophages

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What do foam cells secrete?
What does this cause?

Cytokines
- Further smooth muscle cell stimulation
- Recruitment of other inflammatory cells

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What do smooth muscle cells produce?

Matrix material - collagen + elastin

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What are the components of an atherosclerotic plaque?

Cells
Lipids
Extracellular matrix

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What are the cells in an atherosclerotic plaque?

Endothelial cells
Platelets
Neutrophils
Macrophages
WBCs
SMC

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What lipids make up atherosclerotic plaques?

Intracellular - foam cells
Extracellular - pools

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What makes up the extracellular matrix in atherosclerotic plaque?

Collagen
Elastin
Proteoglycans

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Function of endothelial cells

Role in haemostasis
Altered permeability to lipoproteins
Production of collagen
Stimulation of proliferation + migration of SMCs

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What is the microscopic appearance of a stable/simple atherosclerotic plaque?

Fibrosis
Necrosis
Cholesterol clefts
+/- inflammatory cells

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What is the microscopic appearance of an unstable/complicated atherosclerotic plaque?

Disruption of the internal elastic lamina
Damage extends into media
New vessels grow into plaque
Plaque breaks/erodes/ulcers

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What is the microscopic appearance of a fatty streak?

Accumulation of foam cells
Extracellular lipid
Proliferation of smooth muscle cells

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What is the macroscopic appearance of a stable/simple atherosclerotic plaque?

Raised white/yellow
Irregular outline
Enlarged - widely distributed

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What is the macroscopic appearance of an unstable/complicated atherosclerotic plaque?

Yellow + red (haem + thrombosis)
Irregular
Rough + hard - calcified

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What is the macroscopic appearance of a fatty streak?

Slightly raised yellow area in intima

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Complications of atherosclerosis

Ulceration
Thrombosis
Vasospasm
Embolisation - from thrombus or plaque
Calcification
Haemorrhage
Aneurysm
Rupture of atherosclerotic artery

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Vasospasm meaning

Sudden constriction of blood vessel

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Effect of calcification on vessels

Stiffens vessel Reduced elasticity

Effects of arterial narrowing + occlusion

Ischaemia Infarction Specific effects dependent on site

What does cerebral ischaemia cause?

Transient ischaemic attack Stroke - cerebral infarction Vascular dementia

What differentiates a TIA from a stroke?

TIA - symptoms of stroke <24 hours

What is a TIA?

Transient ischaemic attack

What can an atherosclerotic plaque in carotid arteries cause?

Plaque can embolism > cerebral circulation Causes TIA or stroke

What does myocardial ischaemia cause?

Sudden death Myocardial infarction Angina pectoris Arrhythmias Cardia failur

What does acute mesenteric ischameia cause?

Intestinal infarction

What does chronic mesenteric ischaemia cause?

Ischaemic colitis Malabsorption

What is ischaemic colitis?

Inflammation of colon

What does peripheral vascular disease cause?

Acute limb ischaemia Intermittent claudication Ischaemic rest pain Gangrene

What are the symptoms of limb ischaemia?

**6 Ps** Pallor Pain Paraesthesia Perishingly cold Paralysis Pulselessness

What can an atherosclerotic plaque in the abdominal aorta cause?

Rupture Thrombosis + emboli > acute limb ischaemia Aneurysmal formation

How does gender have an effect on atherosclerosis?

Protective effect in premenopausal women

What three areas can there be defects in lipid metabolism?

Enzyme defects Receptor defect Apolipoprotein defects

Enzyme defects in lipid metabolism

Lipoprotein lipase

Receptor defects in lipid metabolism Example of conditions caused by this

LDL receptor mutations *e.g familial hypercholesteroaemia*

Apolipoprotein defects in lipid metabolism

ApoA1 deficiency ApoA1 variants ApoE variants

Presentation of familial Hyperlipidaemia

Tendon xanthomas Xanthlasma Cornea arcus

What is cornea arus?

White/blue circle around eye

What is the clinical significance of cornea arcus?

Concern in young children Normal in older people Sign of high cholesterol

What can familial Hyperlipidaemia lead to?

Early development of atheroscleosis

Prevention + reduction of familial Hyperlipidaemia

Decrease cholesterol + LDLs in diet Statins - lipid lowering drugs Low fat + high fibre diet Aspirin

Effects of cigarette smoking on atherosclerosis

- Risk factor for atherosclerosis and ischaemic heart disease - dose related - risk decreases after stopping

Effects of hypertension on atherosclerosis

Link between high BP and IHD

Effects of cigarette on atherosclerosis

- Double IHD risk - Protective effect in premenopausal women lost - High risk of cerebrvasular + peripheral vascular disease

Effects of alcohol consumption on atherosclerosis

>5 units/day = increased risk of IHD Small amounts can be productive

How can you reduce the atherosclerotic burden?

Statins - decreases cholesterol Anti-hypertensives - decreases BP Exercise Normal BMI Non-smoker Alcohol in moderation Balance diet - decreased diabetes risk Diabetes medication CANTOS - targets inflammation

What is an example of a diet which reduces the risk of diabetes?

Mediterranean

Three macroscopic features of atherosclerosis

Fatty streak Simple plaque Complicated plaque v

Identify four theories explaining the pathogenesis of atherosclerosis

Thrombogenic theory Insulation theory Monoclonal hypothesis Reaction to injury hypothesis

Modifiable risk factors of atherosclerosis

- smoking - obesity - Hyperlipidaemia - hypertension

Non modifiable risk factors of atherosclerosis

- older age - male - post menopausal women - family history

What is the most important risk factor of atherosclerosis

Hypercholesteroaemia

Where does atherosclerosis commonly affect? (5)

- abdominal aorta - coronary arteries - carotid arteries - cerebral arteries - arteries in leg

Outline the formation of plaque + what occurs after

- chronic endothelial damage - accumulation of LDL in tunica intima - oxidation of LDL - phagocytosis by macrophage > foam cells - migration of SMC into tunica media > fatty streak - plaque growth - SMC on surface form fibrous cap - endothelium stretches over plaque + platelets adhere to gaps - central plaque cells die > Atheroma - small blood vessels grow into plaque from tunica adventitia

Why does physical activity reduce your risk of atherosclerosis?

Regular physical activity can lower BP + improve cholestrol levels

PP 6 Atherosclerosis Flashcards

(61 cards)