Arteriosclerosis/Atherosclerosis Flashcards
What is Arteriosclerosis?
“Hardening of Arteries”
= Wall thickening and decreased elasticity
What is Arteriosclerosis?
“Hardening of Arteries”
= Wall thickening and decreased elasticity
What are the 3 types of Arteriosclerosis?
- Arteriolosclerosis
- Atherosclerosis
- Monckeberg Medial Sclerosis
Arteriolosclerosis usually occurs in what type of vessels and what is the end result?
- Small arteries and arterioles
= Downstream ischemic injury
Monckeberg Medial Sclerosis
Age related calcification of muscular arteries
Age related calcification of muscular arteries
Monckeberg Medial Sclerosis
What is the clinical manifestation of Monckeberg Medial Sclerosis?
NONE
- no narrowing, not clinically significant
What are the NON-modifiable risk factors for Atherosclerosis?
Genetics - multifactorial inheritance Increasing age (40-60) and MALE gender
What NON-modifiable factor is actually protective against Atherosclerosis development?
Premenopausal estrogenized women
What are the Modifiable risk factors for Atherosclerosis?
- Hypertension and Hyperlipidemia
- Metabolic syndrome, obesity, smoking, diabetes
- Lack of exercise, stress
What are the Modifiable risk factors for Atherosclerosis?
- Hypertension and Hyperlipidemia
- Metabolic syndrome, obesity, diabetes, smoking
- Lack of exercise and stress
What is the good cholesterol? What increases/decreases it?
HDL
- Increases: Exercise and moderate alcohol
- Decreases: Obesity and smoking
What is the bad cholesterol? What increases and decreases it?
LDL
- Increases: Fried foods and animal products
- Decreases: Fiber and statins
What things in the blood stream can be risk factors for Atherosclerosis?
Inflammation - C reactive protein
Homocysteine
LDL
Metabolic syndrome needs 3 of the 5 to diagnose. What are the 5?
- Insulin resistance
- Increased BP
- Decreased HDL
- Increased triglycerides
- Abdominal obesity
A majority of the pathogenesis of Atherosclerosis occurs in the ____ phase at a young age
Pre-clinical phase
The first step in developing Atherosclerosis is?
Endothelial injury/activation
What things can injure/activate the endothelium?
Turbulent blood flow
Hypertension
Cytokines, lipids, etc.
When the endothelium is injured/activated, what occurs to it?
INCREASED procoagulants, adhesion molecules and proinflammatory factors
After endothelial activation/injury, what occurs next in the pathogenesis of Atherosclerosis?
Increased permeability, leukocyte and monocytes
After increased permeability, what occurs next in the pathogenesis of Atherosclerosis?
Smooth muscle cell recruitment and macrophage activation
Smooth muscle cells are recruited from where to where?
From the media layer, across the internal elastic lamina to the intima layer where they proliferate
Macrophages are activated in the ____ layer
Intima
Once macrophages and smooth muscle cells are in the initima layer, what do they do?
Engulf lipids and proliferate
What is the final step of the pathogenesis of Atherosclerosis?
Smooth muscle cell proliferation and ECM (collagen) deposition
What 3 factors can activate ECM (collagen) deposition with Atherosclerosis development?
- PDGF
- Fibroblast growth factors
- TGF-alpha
What 3 factors can activate ECM (collagen) deposition in the development of Atherosclerosis?
- PDGF
- Fibroblast growth factors
- TGF-alpha
What is at the core of the plaque in Atherosclerosis?
Necrotic cell debris and lipids/cholesterol
What is overlying the core of the plaque in Atherosclerosis?
Fibrous cap - macrophages/smooth muscle/etc.
What will be seen on the luminal side of Atherosclerosis?
Fatty streak
Once Atherosclerosis reaches the Clinical phase, what 3 things can potentially occur?
Critical stenosis
Occlusion with thrombus
Aneurysm with rupture
Balloon Angioplasty
Compresses and can rupture the plaque
Thrombosis and spasm can cause abrupt reclosure of what Atherosclerosis intervention?
Balloon Angioplasty
Coronary Metallic Stents
Expandable metallic mesh
What can occur with Coronary Metallic Stents?
- Endothelial injury
- Thrombosis
- Antithrombotic drugs have to be given to try and prevent restenosis
What is the solution to restenosis after a coronary metallic stent was placed?
Drug - eliciting stents
What do Drug - eliciting stents release?
Anti-proliferative drugs to block smooth muscle activation
What do Drug - eliciting stents prevent?
Restenosis
Vascular grafts can replace vessels or bypass them. When are synthetic grafts used?
Large vessels only
Vascular grafts can replace or bypass vessels. What are the main autologous grafts used?
Internal mammary artery
Saphenous vein
