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Mechanisms Of Disease > Atheroma > Flashcards

Atheroma Flashcards

0
Q

What is atherosclerosis?

A

The thickening and hardening of arterial walls as a consequence of atheroma

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1
Q

What is atheroma?

A

The 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

The thickening of the walls of arteries and arterioles as a result of hypertension or diabetes mellitus

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3
Q

List some macroscopic features of atheroma

A

Fatty streak
Simple plaque
Complicated plaque

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4
Q

What is a fatty streak?

A

A raised, yellow structure where lipid has deposited in the intima. Thought to be a precursor to atheroma

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5
Q

What is a simple plaque?

A

A raised, slightly yellow plaque. Can enlarge and coalesce

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6
Q

What is complicated plaque?

A

When pressure of the blood in the artery causes haemorrhage into the plaque. Leads to thrombosis, calcification and then aneurysm.

Have a rich lipid core and thin fibrous cap

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7
Q

List some common sites for atheroma

A

Aorta
Coronary arteries
Carotid artery
Leg arteries

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8
Q

What is contained within the intima, media and adventitia of arteries?

A

Intima - endothelium and sub endothelial connective tissue
Media - smooth muscle and elastic tissue
Tunica adventitia - external elastic lamina and adventitia

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9
Q

Pathology of atheroma?

A

Endothelial injury
Platelet adhesion and PDGF released - affects SMCs
Macrophages, lymphocytes, smooth muscle cells and LDLs accumulate
Macrophages phagocytose LDLs and become foam cells
Foam cells can die and release their contents, producing a lipid core
Macrophages release cytokines and growth factors, leading to proliferation of the smooth muscle layer towards the lipid core and into the media through the elastic lamina
Inflammatory response - collagen and other matrix proteins are laid down - fibrosis
Small blood vessels grow into the plaque

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10
Q

List some clinical effects of atheroma

A

Ischaemic heart disease
Cerebral ischaemia
Mesentric ischaemia
Peripheral vascular disease

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11
Q

Symptoms of ischaemic heart disease?

A

Myocardial infarction due to thrombus on a coronary artery
Angina
Cardiac arrhythmia
Cardiac failure

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12
Q

Symptoms of cerebral ischaemia

A

Transient ischaemic attack
Cerebral infarction (stroke)
Multi-infarct dementia

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13
Q

What do patients present with in mesentric ischaemia?

A

Ischaemic colitis - abdominal pain and bleeding
Malabsorption
Intestinal infarction - acute

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14
Q

What do pateints present with in peripheral vascular disease?

A

Intermittent claudication - calf pain on exercise

Gangrene

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15
Q

List the modifiable risk factors for atherosclerosis

A 
Diabetes
Hyperlipidaemia
Hypertension
Cigarette smoking
Exercise
16
Q

List the non-modifiable risk factors

A

Age and gender

17
Q

What is lipid in the blood carried by?

A

Lipoproteins

18
Q

Where and what do chylomicrons transport?

A

Triglycerides

Intestine to tissues

19
Q

What and to where do VLDLs transport lipids?

A

Cholesterol and triglycerides

From the intestine to the liver

20
Q

What and where do LDLs transport?

A

Cholesterol to non liver cells

21
Q

Where and what do HDLs transport?

A

Cholesterol

From peripheries back to liver

22
Q

Physical signs of familial hyperlipidaemia?

A

Corneal arcus
Tendon xanthomas
Xanthalasma

23
Q

How does smoking increase risk of atheroma?

A

Affects coagulation system
Increases platelet stickiness
Decreases prostaglandins
Increases fibrinogen levels

24
Q

How many units a day increase risk of IHD?

A

More than 5

25
Q

What role do endothelial cells have in atheroma?

A

Pro and anti-coagulant effects
Altered permeability to allow lipoproteins in
Secrete collage
Stimulate proliferation and migration of smooth muscle cells

26
Q

Role of platelets in atheroma?

A

Haemostasis

Stimulate proliferation and migration of smooth muscle cells by platelet derived growth factor

27
Q

Role of smooth muscle cells?

A

Respond to stimuli and migrate.
Take up LDL and become foam cells
Produce collagen and proteoglycans

28
Q

Role of macrophages?

A

Oxidise LDL
Take up lipids to become foam cells
Secrete proteases which modify the matrix and affects plaque stability
Proliferation and migration of SMCs

29
Q

Role of lymphocytes?

A

Produce tumour necrosis factor which may affect lipoprotein metabolism
Proliferation/migration of smooth muscle cells

30
Q

Role of neutrophils?

A

Secrete proteases leading to local damage and inflammation

Produce cytokines which modify extracellular matrix, affecting at ikith of the plaque

31
Q

What can endothelial injury be caused by?

A

Raised LDL
Hypertension
Haemodynamic stress

Mechanisms Of Disease (11 decks)

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