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Semester 2-PP > Session 6-Atherosclerosis > Flashcards

Session 6-Atherosclerosis Flashcards

1
Q

Define atherosclerosis

A

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

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2
Q

Define arteriosclerosis

A

Thickening of walls of arteries and arterioles usually as a result of hypertension or diabetes mellitus

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3
Q

What are the three macroscopic features of atherosclerosis?

A

1) fatty streak
2) simple plaque
3) complicated plaque

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4
Q

Describe the fatty streak macroscopic feature of atherosclerosis

A
  • Lipid deposits in intima

- Yellow, slightly raised

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5
Q

Describe the simple plaque macroscopic feature of atherosclerosis

A
  • Raised yellow/white
  • Irregular outline
  • Widely distributed
  • Enlarge and coalesce
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6
Q

What happens to the complicated plaque macroscopic feature of atherosclerosis?

A
  • thrombosis
  • haemorrhage into plaque
  • calcification
  • aneurysm formation
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7
Q

What are the common sites of atherosclerosis?

A
  • aorta
  • coronary arteries
  • carotid arteries
  • cerebral arteries
  • leg arteries
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8
Q

Which vessel has the most elastic tissue?

A

Aorta

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9
Q

What are the early microscopic changes in atherosclerosis?

A
  • proliferation of smooth muscle cells
  • accumulation of foam cells
  • extracellular lipid
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10
Q

What are the later microscopic changes in atherosclerosis?

A
  • fibrosis
  • necrosis
  • cholesterol clefts
  • inflammatory cells
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11
Q

What are the latest microscopic changes in atherosclerosis?

A
  • disruption of internal elastic lamina
  • damage extends into media
  • ingrowth of blood vessels
  • plaque fissuring
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12
Q

What is plaque fissuring?

A

Allows blood into plaque and exposes substances that will lead to thrombosis

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13
Q

What are the clinical effects of atherosclerosis?

A
  • ischaemic heart disease
  • cerebral ischaemia
  • mesenteric ischaemia
  • peripheral vascular disease
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14
Q

What can ischaemic heart disease lead to?

A
  • sudden death
  • myocardial infarction
  • angina pectoris
  • arrhythmias
  • cardiac failure
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15
Q

What can cerebral ischaemia lead to?

A
  • transient ischaemic attack
  • cerebral infarction (stroke)
  • multi-infarct dementia
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16
Q

What is transient ischaemic attack?

A

Mini stroke - resolved in 24 hours

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17
Q

What can mesenteric ischaemia lead to?

A
  • ischaemic colitis
  • malabsorption
  • intestinal infarction
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18
Q

What can peripheral vascular disease lead to?

A
  • intermittent claudication
  • leriche syndrome
  • ischaemic rest pain
  • gangrene
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19
Q

What is intermittent claudication?

A

Pain in calves on walking, resolves after rest

20
Q

What is Leriche syndrome?

A

Pain in bum

21
Q

What are the factors affecting the onset of atherosclerosis?

A
  • age
  • gender
  • hyperlipidaemia
  • cigarette smoking
  • hypertension
  • diabetes mellitus
  • alcohol
  • infection
22
Q

True or false: high plasma cholesterol is associated with atherosclerosis

A

TRUE

23
Q

What do lipoproteins carry?

A

Cholesterol and triglycerides

24
Q

What do chylomicrons transport?

A

Lipid from intestine to liver

25
Q

What do VLDLs transport?

A

Cholesterol and triglycerides from liver

26
Q

What do LDLs carry?

A

Cholesterol to non-liver cells

27
Q

What do HDLs carry?

A

Cholesterol from periphery back to liver

28
Q

What can be used as risk markers for atherosclerosis?

A

Polymorphisms of genes involved in genetic variations in ApoE

29
Q

What are the physical signs of familial hyperlipidaemia?

A

Arcus
Tendon xanthomas
Xanthelasma

30
Q

What are risk factors of atherosclerosis?

A
  • lack of exercise
  • obesity
  • soft water
  • oral contraceptives
  • stress
31
Q

What is the thrombogenic theory?

A
  • Plaques formed by repeated thrombi

- Lipid derived from thrombi with an overlying fibrous cap

32
Q

What is the insudation theory?

A
  • endothelial injury
  • inflammation
  • increased permeability to lipid from plasma
33
Q

What is the reaction to injury hypothesis?

A
  • plaques form in response to endothelial injury
  • hypercholesterolaemia leads to endothelial damage
  • injury increases permeability and allows platelet adhesion
  • monocytes penetrate endothelium
  • smooth muscle cells proliferate and migrate
34
Q

What is the monoclonal hypothesis?

A
  • smooth muscle proliferation
  • each plaque is monoclonal
  • abnormal growth control
35
Q

What is the role of endothelial cells in atherosclerosis?

A
  • haemostasis
  • altered permeability to lipoproteins
  • production of collagen
  • stimulation of proliferation and migration of smooth muscle cells
36
Q

What is the role of platelets in atherosclerosis?

A
  • haemostasis

- stimulate proliferation and migration of smooth muscle cells (PDGF=platelet derived growth factor)

37
Q

What is the role of smooth muscle cells in atherosclerosis?

A
  • take up LDL and other lipid to become foam cells

- synthesise collagen and proteoglycans

38
Q

What is the role of macrophages in atherosclerosis?

A
  • oxidise LDL
  • take up lipids to become foam cells
  • secrete proteases which modify matrix
  • stimulate proliferation and migration of smooth muscle cells
39
Q

What is the role of lymphocytes in atherosclerosis?

A
  • TNF may affect lipoprotein metabolism

- stimulate proliferation and migration of smooth muscle cells

40
Q

What is the role of neutrophils in atherosclerosis?

A

-secrete proteases leading to continued local damage and inflammation

41
Q

What can endothelial injury be due to?

A
  • raised LDL
  • toxins eg cigarette smoke
  • hypertension
  • haemodynamic stress
42
Q

What can endothelial injury cause?

A
  • platelet adhesion, PDGF release, smooth muscle cells proliferation and migration
  • insudation of lipid, LDL oxidation, uptake of lipid by smooth muscle cells and macrophages
  • migration of monocytes into intima
43
Q

How can atherosclerosis be prevented?

A
  • no smoking
  • reduce fat intake
  • treat hypertension
  • not too much alcohol
  • regular exercise/weight control
44
Q

What is the name of the uncommon disease where there is calcification of the media of large arteries?

A

Monkeberg’s disease

45
Q

Complete the sentences:

Atheroma is the _________ core of the atherosclerotic plaque. It consists of _______ cells, _______ and _______________ crystals.

A

Necrotic
Dead
Debris
Cholesterol

Semester 2-PP (13 decks)

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