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ESA 2 Mech Of Disease > Atheroma > Flashcards

Atheroma Flashcards

0
Q

What is atherosclerosis?

A
  • Thickening and hardening of arterial walls as a consequence of atheroma
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1
Q

What is the definition of an atheroma?

A
  • Accumulation of Intracellular and extracellular lipid in the intima and media of large and medium sized arteries
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2
Q

What is arteriosclerosis?

A
  • Thickening of the walls of arteries and arterioles usually as a result of hypertension or diabetes
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3
Q

What is a fatty streak?

A
  • Lipid deposits in intima

- Yellow in colour and slightly raised

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4
Q

What causes acute inflammation in the blood vessels?

A
  • Endothelial damage possibly due to oxidised LDLs
  • Platelets build up, platelet activating factor to produce ADP which drugs attach to.
  • e.g drugs: TXA2 (turned off by aspirin)
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5
Q

What is produced due to acute inflammation?

A

Neutrophils which can phagocytose

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6
Q

What is then produced in chronic inflammation?

A
  • Macrophages which also phagocytose

- Lymphocytes

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7
Q

How do foam cells form?

A
  • Macrophages have receptors for LDLs as they mop up the LDLs they form foam cells
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8
Q

What type of growth factors are produced from platelets?

A
  • Platelet derived growth factor
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9
Q

What does PDGF lead to?

A
  • Proliferation and migration of smooth muscle cells into the position of the platelets
  • Causing atheroma plaque inducing fibrotic tissue
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10
Q

What is meant by simple plaque?

A
  • When a new epithelium forms over the proliferated smooth muscle cells
  • Has an irregular outline
  • Typically raised an yellow/white in colour.
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11
Q

What is the effect of the simple plaque forming?

A
  • Reduces luminal area (stenosis) and increased resistance as a result
  • This leads to more damage to epithelium so is a recurrent problem.
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12
Q

What is complicated plaque?

A
  • More unstable than simple plaque due to calcification
  • Rupture leads to thrombosis use to release of cells from atheroma
  • Haemorrhage into plaque
  • If occurs in a coronary artery -> MI
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13
Q

What are the possible results of complicated plaque?

A
  • Thrombosis
  • Dissection of blood vessels
  • Aneurysm
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14
Q

What causes an aneurysm and what is it?

A
  • Blood vessel wall has become weakened

- Ballooning of blood vessel wall which if ruptures can lead to extensive bleeding

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15
Q

What is a dissection of a blood vessel and what can it lead to?

A
  • When blood forces it’s way through blood vessel wall

- Blood in pericardium -> tampernarde -> acute failure

16
Q

What are the possible drugs used to help with IHD?

A
  • Beta blockers: anti-hypertensives
  • Statins: lower cholesterol levels
  • ACE inhibitors: allow for better remodelling of plaques
17
Q

Where are the common sites for atheroma?

A
  • Aorta (especially abdominal)
  • Coronary arteries
  • Carotid arteries
  • Cerebral arteries
  • Leg arteries
18
Q

What are the possible later changes to a blood vessel due to atheroma?

A
  • Fibrosis
  • Necrosis
  • Cholesterol changes
  • Disrupted internal elastic lamina
  • Plaque fissuring
19
Q

What can atheroma lead to in a clinical sense?

A
  • Ischaemic heart disease
  • Cerebral ischaemia
  • Mesenteric ischaemia
  • Peripheral vascular disease
20
Q

What can ischaemic heart disease lead to?

A
  • MI
  • Angina pectoris
  • Arrhythmias
  • Cardiac failure
21
Q

What can cerebral ischaemia lead to?

A
  • Transient ischaemic attack (mini stroke)
  • Cerebral infarction (stroke)
  • Multi-infarct dementia
22
Q

What can mesenteric ischaemia lead to?

A
  • Ischaemic colitis
  • Malabsorption
  • Intestinal infarction
23
Q

What can peripheral vascular disease lead to?

A
  • Intermittent claudication (calf pain on exercise)
  • Leriche syndrome (aortoilliac occlusion disease)
  • Ischaemic rest pain
  • Gangrene
24
Q

What is the pathogensis for atheroma?

A
  • Age: risk factors operate over years
    slowly progressive throughout adult life
  • Gender: women relatively protected premenopausal
    hormone basis
  • Hyperlipidaemia: high plasma cholesterol
    LDL most significant, HDL protective
25
Q

What is the role of apoprotein E in establishing whether someone’s at a higher risk of atheroma?

A
  • Genetic variations of Apo E are associated with changes in LDL levels
26
Q

What is familial hyperlipidaemia?

A
  • Genetically determined abnormalities of lipoproteins leads to early development of atheroma
27
Q

What are the signs of familial hyperlipidaemia?

A
  • Arcus
  • Tendon xanthomas
  • Xanthelasma
28
Q

What are the risk factors for atheroma?

A
  • Smoking
  • Hypertension
  • Diabetes
  • Alcohol
  • Infection
  • Lack of exercise
  • Obesity
  • Soft water
  • Oral contraceptives
  • Stress
  • Genetic predisposition
29
Q

How is smoking a risk factor?

A
  • Coagulation system affected
  • Reduces PG12
  • Increases platelet aggregation
30
Q

How is hypertension a risk factor?

A
  • Strong link to IHD

- Endothelial damage due to increased pressure

31
Q

How is diabetes a risk factor?

A
  • Doubles IHD risk

- Increases cerebrovascular and peripheral vascular disease

32
Q

What level of alcohol is considered a risk for IHD?

A
  • x>5 units per day
33
Q

What infections are particularly associated with IHD?

A
  • Chlamydia pneumoniae
  • Helicobacter pylori
  • Cytomegalovirus
34
Q

Why may there be endothelial injury?

A
  • Increased LDL
  • Toxins
  • Hypertension
  • Haemodynamic stress

ESA 2 Mech Of Disease (11 decks)

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