6. Atherosclerosis Flashcards
Transient ischaemic attack
transient episode of neurologic dysfunction caused by ischemia (loss of blood flow) – either focal brain, spinal cord, or retinal – without acute infarction (tissue death).
TIAs have the same underlying cause as strokes: a disruption of cerebral blood flow (CBF)
cause the same symptoms associated with stroke, such as contralateral paralysis (opposite side of body from affected brain hemisphere) or sudden weakness or numbness.
A TIA may cause sudden dimming or loss of vision (amaurosis fugax), aphasia, slurred speech (dysarthria) and mental confusion. But unlike a stroke, the symptoms of a TIA can resolve within a few minutes or 24 hours. Brain injury may still occur in a TIA lasting only a few minutes.
Having a TIA is a risk factor for eventually having a stroke or a silent stroke.
Peripheral vascular disease
Peripheral artery disease (PAD), peripheral artery occlusive disease, and peripheral obliterative arteriopathy
a narrowing of the arteries other than those that supply the heart or the brain.
Most commonly the legs are affected.
The classic symptom is leg pain when walking which resolves with rest.
Other symptoms including skin ulcers, bluish skin, cold skin, or poor nail and hair growth may occur in the affected leg.
Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke. In up to half of people there are no symptoms.
The main risk factor is cigarette smoking. Other risk factors include diabetes, high blood pressure, and high blood cholesterol.
The underlying mechanism is usually atherosclerosis. Other causes include artery spasm.
Abdominal aortic aneurysm
triple-a
localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal.
They usually cause no symptoms except when ruptured.
Occasionally there may be abdominal, back or leg pain.
Large aneurysms can sometimes be felt by pushing on the abdomen.
Rupture may result in pain in the abdomen or back, low blood pressure or a brief loss of consciousness.
most commonly in those over 50 years old, in men, and among those with a family history.
Additional risk factors include smoking, high blood pressure, and other heart or blood vessel diseases.
Genetic conditions with an increased risk include Marfan syndrome and Ehlers-Danlos syndrome.
the most common form of aortic aneurysm.
In the United Kingdom screening all men over 65 is recommended.
Familial hypercholesterolemia
genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL, “bad cholesterol”), in the blood and early cardiovascular disease.
Many people have mutations in the LDLR gene that encodes the LDL receptor protein, which normally removes LDL from the circulation, or apolipoprotein B (ApoB), which is the part of LDL that binds with the receptor; mutations in other genes are rare.
People who have one abnormal copy (are heterozygous) of the LDLR gene may have premature cardiovascular disease at the age of 30 to 40. Having two abnormal copies (being homozygous) may cause severe cardiovascular disease in childhood.
Heterozygous FH is normally treated with statins, bile acid sequestrants, or other lipid lowering agents that lower cholesterol levels.
Homozygous FH often does not respond to medical therapy and may require other treatments, including LDL apheresis (removal of LDL in a method similar to dialysis) and occasionally liver transplantation.
Angina pectoris
sensation of chest pain, pressure, or squeezing, often due to ischemia of the heart muscle from obstruction or spasm of the coronary arteries.
While angina pectoris can derive from anemia, cardiac arrhythmias and heart failure, its main cause is coronary artery disease, an atherosclerotic process affecting the arteries feeding the heart.
There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a myocardial infarction (heart attack) and a heart attack can occur without pain).
Worsening (“crescendo”) angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may precede a heart attack, they require urgent medical attention and are, in general, treated in similar fashion to myocardial infarction.
Cardiac failure
congestive heart failure (CHF) or congestive cardiac failure (CCF)
occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs.
Signs and symptoms commonly include shortness of breath, excessive tiredness, and leg swelling. The shortness of breath is usually worse with exercise, when lying down, and at night while sleeping. There is often a limitation on the amount of exercise people can perform, even when well treated.
Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, and cardiomyopathy.
These cause heart failure by changing either the structure or the functioning of the heart.
Stroke
when poor blood flow to the brain results in cell death.
There are two main types of stroke: ischemic due to lack of blood flow and hemorrhagic due to bleeding. They result in part of the brain not functioning properly.
Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of one vision to one side among others. Signs and symptoms often appear soon after the stroke has occurred.
Long term complications may include pneumonia or loss of bladder control.
The main risk factor for stroke is high blood pressure. Other risk factors include tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, and atrial fibrillation among others.
An ischemic stroke is typically caused by blockage of a blood vessel.
A hemorrhagic stroke is caused by bleeding either directly into the brain or into the space surrounding the brain.
Bleeding may occur due to a brain aneurysm.
Multi infarct dementia
Vascular dementia, vascular cognitive impairment (VCI)
dementia caused by problems in the supply of blood to the brain, typically by a series of minor strokes.
Vascular dementia is the second most common form of dementia after Alzheimer’s disease (AD) in older adults.
Vascular dementia is thought to be irreversible and it is caused by a number of small strokes or sometimes a large stroke preceded or followed by other smaller strokes.
The term refers to a group of syndromes caused by different mechanisms all resulting in vascular lesions in the brain.
Some main presenting signs of this disease are: a single strategic infarct (affecting the thalamus, the anterior cerebral artery, the parietal lobes or the cingulate gyrus), multiple brain infarcts, haemorrhagic lesions.
Vascular lesions can be the result of diffuse cerebrovascular disease, such as small vessel disease or focal lesions, but usually both. Mixed dementia is diagnosed when patients have evidence of Alzheimer’s Dementia and cerebrovascular disease, either clinically or based on neuro-imaging evidence of ischaemic lesions. In practice, vascular dementia and Alzheimer’s disease often coexist, especially in older patients.
Vascular dementia is sometimes triggered by cerebral amyloid angiopathy, which involves accumulation of beta amyloid plaques in the walls of the cerebral arteries, leading to breakdown and rupture of the vessels. Since amyloid plaques are a characteristic feature of Alzheimer’s Disease, vascular dementia may occur as a consequence. However, cerebral amyloid angiopathy can also appear in people with no prior dementia condition and some beta amyloid plaques are often present in cognitively normal elderly persons.
Ischaemic colitis
inflammation and injury of the large intestine result from inadequate blood supply.
occurs with greater frequency in the elderly, and is the most common form of bowel ischemia.
Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.
Leriche syndrome
aortoiliac occlusive disease
a form of peripheral artery disease involving the bifurcation of the abdominal aorta as it transitions into the common iliac arteries.
Myocardial infarction
occurs when blood flow stops to part of the heart causing damage to the heart muscle.
The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired.
Most MIs occur due to coronary artery disease. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol, among others.
The mechanism of an MI often involves the rupture of an atherosclerotic plaque leading to complete blockage of a coronary artery.
Commonly used blood tests include troponin (most specific) and less often creatine kinase MB
