Artherosclerosis Flashcards
Arteriosclerosis
Disease of small arteries and arterioles caused by HTN. Begins with endothelial injury
Monkeberg medial sclerosis
calcification of media in large arteries. seldom causes medical problems
atherosclerosis
fatty deposits in the arterial wall. caused by poor lifestyle choices. causes hardening
atheroma
basic lesion of atherosclerosis. fatty deposit in arterial wall. -obstruct blood flow and cause hypoxia (ischemia, infarct).
-weaken arteriole wall, causing dilation (aneurysm) > hemorrhage
atherosclerosis uncontrollable risk factors
age: dramatic rise 40-60, and increases thereafter
gender: men, post-menopausal women. in very elderly, more women than men
genetics: family hx
Vascular inflammation: in the absence of known inflammation, it’s assumed to be vascular inflammation
CRP
made by liver. most valuable marker of systemic inflammation. independent risk factor in atherosclerosis. ?related or just a marker? tbd
controllable risk factors for atherosclerosis
High LDL: promotes athero. increased in consumption of saturated fats & trans fats (plant like unsaturated fats become animal like saturated fats) and cholesterol-rich foods. Lowered by statins
high HDL: associated w less risk of athero. increased by exercise and moderate alcohol consumption. marker, not cause, of athero avoidance
HTN: incr risk by 50%
Smoking: 1ppd doubles risk of CAD. cessation cuts risk by 50% after 1 yr
metabolic syndrome: insulin-resistance
diabetic hyperglycemia: ie diabetes. good sugar control mitigates athero
other: lack of exercise, obesity, stress
Athero pathology
Damaged endothelium becomes leaky, fat/cholesterol passes into arterial wall.
Endothelial cells become sticky
Neutrophils, macrophages and platelets stick to them.
Macrophages phagocytize the lipid to become foam cells
Collagen + extracellular matrix join, and the atheroma grows.
Atheroma causes turbulent blood flow, leading to more endothelial damage
Advanced athero
mix of fat,fibrous tissue, macrophages, few lymphocytes.
Most common places for atherosclerosis
- lower abd aorta
- coronary arteries
- popliteal arteries
- decending thoracic aorta
- internal carotid arteries in neck
- circle of willis at base of brain
Most dangerous atheromas
The new ones! They are soft, semi-solid, prone to sudden thrombosis and occlusion leading to infarct
Consequences of atherosclerosis (in order)
- MI due to CAD
- cerebral infarction
- aortic aneurysm
- PVD
Stenosis
Result of slow atheroma growth
brain and leg and heart ischemia lead to…
TIA + dementia
intermittent claudication
HF
old atherosclerosis
STABLE. They have a sealed fibrous cap. impede blood flow gradually, producing progressive downstream ischemia. If rupture of fibrous cap happens then thrombosis.
