Arteriosclerosis

Question 1

What are the three types of arteriosclerosis?

Answer 1

Atherosclerosis, Arteriolosclerosis and Monckeberg medial calcific sclerosis

Question 2

What are the risk factors for atherosclerosis?

Answer 2

1. Modifiable - HTN, hypercholesterolemia (LDL increases risk, HDL decreases risk), smoking, diabetes
2. Non modifiable - age, male gender and post menopausal women, genetics

Question 3

What is atherosclerosis? Which vessels does it involve? Which four specific ones?

Answer 3

Intimal plaque that obstructs blood flow. Consists of a necrotic lipid core (mostly cholesterol) with a fibromuscular cap. Often undergoes dystrophic calcification. Involves large and medium sized arteries. Abdominal aorta, coronary artery, popliteal artery, and internal carotid artery.

Question 4

What is the pathogenesis of arteriosclerosis?

Answer 4

Damage to endothelium allows lipid to leak into the intima. Lipids are oxidized and consumed bby macrophages via scavenger receptors resulting in foam cells. Inflammation and healing leads to deposition of extracellular matrix and proliferation of smooth muscle.

Question 5

When does atherosclerosis begin? What does it progress to?

Answer 5

Arises early in life (teen years). Begins as fatty streaks (flat yellow lesions of the intima consisting of lipid-laden macrophages. Progresses to atherosclerotic plaques.

Question 6

What are the four complications of atherosclerosis?

Answer 6

1. Stenosis of medium sized vessels
2. Plaque rupture with thrombosis
3. Plaque rupture with embolization
4. Weakening of vessel wall resulting in aneurysm

Question 7

What does Stenosis of medium sized vessels result in?

Answer 7

Impaired blood flow and ischemia leading to 1. Peripheral vascular disease (lower extremity arteries, popliteal), Angina due to coronary arteries, Ischemic bowel disease (mesenteric artery involvement)

Question 8

What does Plaque rupture with thrombosis result in?

Answer 8

MI (coronary arteries) and stroke (Middle cerebral artery)

Question 9

What does Plaque rupture with embolization result in?

Answer 9

Atherosclerotic emboli characterized by cholesterol crystals within the embolus.

Question 10

What is arteriolosclerosis and what are its two classifications?

Answer 10

Narrowing of small arterioles, divided into hyaline and hyperplastic types.

Question 11

What is arteriolosclerosis and what are its two classifications?

Answer 11

Narrowing of small arterioles, divided into hyaline and hyperplastic types.

Question 12

What causes hyaline arteriolosclerosis? What is it a consequence of? What does it result in?

Answer 12

Caused by proteins leaking into the vessel wall, producing vascular thickening. Proteins are seen as pink hyaline. Consequence of long standing benign hypertension or diabetes. Results in reduced vessel caliber with end-organ ischemia. Classically produces glomerular scarring that slowly progresses to chronic renal failure.

Question 13

What causes hyperplastic arteriolosclerosis? What is it a consequence of? What does it result in?

Answer 13

Thickening of the wall by hyperplasia of smooth muscle (onion skin appearance). Consequence of malignant hypertension. Results in reduced vessel caliber with end-organ ischemia. May lead to fibrinoid necrosis of the vessel wall with hemorrhage.

Question 14

Which type of arterioloscleoris produces glomerulal scarring that slowly progresses to chronic renal failure?

Answer 14

Hyaline Arteriolosclerosis

Question 15

Which type of arterioloscleoris produces a flea bitten appearance and causes acute renal failure?

Answer 15

Hyperplastic Arteriolosclerosis

Question 16

You are looking at an XRAY and you notice a calcification of an artery without obstruction of this medium sized vessel. What could be causing this? Is it clinically significant?

Answer 16

Monckeberg Medial Calcific Stenosis which is not a clinically significant presentation.