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
How many units a day increase risk of IHD?
More than 5
25
What role do endothelial cells have in atheroma?
Pro and anti-coagulant effects Altered permeability to allow lipoproteins in Secrete collage Stimulate proliferation and migration of smooth muscle cells
26
Role of platelets in atheroma?
Haemostasis | Stimulate proliferation and migration of smooth muscle cells by platelet derived growth factor
27
Role of smooth muscle cells?
Respond to stimuli and migrate. Take up LDL and become foam cells Produce collagen and proteoglycans
28
Role of macrophages?
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
Role of lymphocytes?
Produce tumour necrosis factor which may affect lipoprotein metabolism Proliferation/migration of smooth muscle cells
30
Role of neutrophils?
Secrete proteases leading to local damage and inflammation | Produce cytokines which modify extracellular matrix, affecting at ikith of the plaque
31
What can endothelial injury be caused by?
Raised LDL Hypertension Haemodynamic stress