Atheroma Flashcards
What is atherosclerosis?
Progressive narrowing and hardening of the artery - result of atheroma. Potentially resulting in a complete blockage.
What is the definition of atheroma?
Build up of fatty material on the inside wall of an artery
Which 5 parts of the body does atheroma affect the most?
Lower abdominal aorta, coronary arteries, internal carotid arteries, popliteal arteries and vessels of circle of Willis.
What initiates atheroma?
Chronic injury to the endothelium resulting in chronic inflammation.
Give 4 causes of endothelium injury
Hyperlipidaemia, disturbed flow, smoking, hypertension.
How many stages of atheroma are there?
6
What happens during type 1 atheroma
Initial legion - isolated macrophage foam cells (from first decade)
Describe type 2 atheroma
Fatty streak lesion - mainly intracellular accumulation.
Describe type 3 atheroma
Intermediate lesion - lipid pools (third decade)
Describe type 4 atheroma
Fatty changes and core of lipid pool
Describe type 5 atheroma
Fibrotic and calcific layers form ( fourth decade)
What is type 6 atheroma
Surfaced defect - haemorrhage or thrombus.
What could atherosclerosis in he coronary artery cause?
Heart attack, angina ischaemic heart disease.
What could atherosclerosis in the aorta cause?
Aneurysm
What could atherosclerosis in the carotid arteries cause?
Stroke
What could atherosclerosis in the popliteal’s cause?
Peripheral vascular disease
List 5 complications of atherosclerotic plaques
Aneurysm and rupture Thrombosis Haematoma formation Embolisation Development of critical narrowing of artery (stenosis)
What does chronic ischaemia result in?
Redness and loss of skin
List 3 other complications of atherosclerosis
Bowel ischaemia
Renal artery stenosis
Emboli
How would you treat atherosclerosis?
Revasculisation
Secondary prevention
How many deaths from ischemic heart disease are there a year?
60 deaths per 100 000
How much does one MI increase your risk of developing heart failure and stroke by?
3-6 fold
What happens during ischaemic heart disease?
In balance between supply (perfusion) and demand of the heart for oxygenated blood.
As well as a decrease in oxygen in heart failure there is also…
Decrease in nutrient substrates and inadequate removal of metabolites.
What might cause a decreased flow of oxygenated blood to the heart?
Atheroma
Embolism
Spasms
What can cause an increase in demand for oxygen?
Thyrotoxicosis
Myocardial hypertrophy eg hypertension
List four fixed risk factors for developing ischaemic heart disease
Age
Gender
Genetics
Positive family history
List 7 reversible (with treatment) risk factors of IHD.
Obesity High cholesterol Lack of exercise Smoking Hypertension Diabetes
Where is the common area for narrowing of the coronary arteries?
Left main coronary artery
Who might have a silent MI?
Elderly and diabetic
What are five signs and symptoms of an MI?
Chest pain - crushing radiating down left arm and jaw Shortness of breath Palpitations Syncope Nauseous, sweating, pale
What is stable angina?
Chest pain on exertion, relieved by GTN
What is unstable angina?
Chest pain at rest as well as exercise can lead to MI
Name the 2 different types of heart attacks
STEMI
NSTEMI
Which is more severe NSTEMI or STEMI?
STEMI
Stable angina is caused by?
Plaque disruption and spasm
Unstable angina is caused by
Plaque disruption and spasm and partial thrombosis, possible emboli
What investigations would you carry out on someone believed to have an MI?
Observations - pulse, BP, sats, resps
Bloods - trop
Chest x ray - fluid on lungs?
ECG
What would you perform to find the location of the clot?
An angiogram
List 7 complications of an MI
Cardiac arrest Arrhythmias Pericarditis Valvular defects Ventricular wall rupture DVT PE
What three treatments would you give to someone believed to be having an MI?
Oxygen
Pain relief
Aspirin
What would you use to treat angina?
Nitrates
Lifestyle
Beta blockers
What are 12 risk factors for developing atherosclerosis
Hypertension Obesity Diabetes mellitus Smoking Hyperlipidemia Family history Low HDLS age Male Physical inactivity Emotional stress Homocystinuria
What is LDL cholesterol?
Bad cholesterol delivered to peripheral tissue
What is HDL cholesterol?
Good cholesterol removes bad cholesterol from tissues and takes to liver where it is excreted as bile.
How can we prevent/modify atheroma?
Stop smoking Control hypertension Weight reduction Increase exercise Moderate alcohol Increase HDL and lower LDL.
