Atheroma Flashcards
Define atheroma
A build up of fatty material on the inside of the wall of an artery
Define atherosclerosis
the progressive narrowing and hardening within an artery potentially resulting in a complete blockage
Where can atheromas occur?
Lower abdominal aorta Coronary arteries Popliteal arteries Internal carotid arteries Vessels of circle of willis
How may atheromas be initiated?
By chronic injury to endothelium resulting in chronic inflam
What may cause injury to endothelium?
Smoking
HTN
Disturbed flow
Hyperlipidaemia
How do atheromas progress?
As white cells, constituents of blood and fat
How are plaques formed?
A: Platelets activated
B: Platelets deposit chemokines on endothelial cells that compromise surface of arterial wall
C: Adhesion of monocytes to vessel wall
D: Monocytes then migrate into wall and turn into macrophages
E: LDL circulate and macrophages ingest them causing lipid rich foam cells
F: Foam cells mature into atherosclerotic plaques
What is a type 1 lesion?
Initial lesion
What is a type 2 lesion?
Fatty streak lesion
What is a type 3 lesion?
Intermediate lesion
What is a type 4 lesion?
Atheroma lesion
What is a type 5 lesion?
Fibroatheroma lesion
What is a type 6 lesion?
Complicated lesion
Clinical manifestation of an artery can cause…
Heart attacks
Angina
Ischaemic heart disease
Clinical manifestation of the aorta can cause…
Aneurysm
Clinical manifestation of the carotid artery can cause…
Strokes
Symptoms of peripheral vascular disease…
Pain in both legs when walking
Infected ulcers on legs and feet needing abx
Symptoms of stoke (cerebral infarction)…
Dysphasia
HTN with sudden onset
Left arm and leg weakness
What other presentations may signify atheroma?
Bowel ischaemia
Emboli
Renal artery stenosis
Treatment of atheromas?
Revascularisation (surgical)
Secondary prevention
IHD is not only low o2 but…
Low nutrients substrates and inadequate removal of metabolites
IHD means there is an imbalance between the…
Supply and demand of the heart for oxygenated blood
Causes of IHD…
Low/no flow of oxygenated blood (due to atheroma, embolism, spasm)
High demand for o2 (thyrotoxicosis/htn)
90% of IHD is caused by…
Coronary artery disease
Fixed risk factors of IHD…
Genetics
Age
Gender
+ Fam history
Potentially reversible risk factors with treatment…
Hyperlipidaemia Smoking HTN Diabetes Alcohol Lack of exercise Obesity
Signs and symptoms of IHD…
Chest pain (radiating to left and jaw) SOB Palps Syncope Nausea/sweating/pale *NOTE: diabetic/elderly may not get chest pain*
Clincal presentations of IHD…
STEMI
NSTEMI
Unstable/stable angina
Sudden death
How can stable angina be relieved?
Rest and GTN spray
Stable angina may be caused by…
Plaque disruption/spasm
Unstable angina may be caused by…
Partial thrombosis/possible emboli
STEMI/NSTEMI may be caused by…
Plaque rupture/occlusion with thrombus
Name the complications of MI…
Cardiac arrest
Arrythmia
Pericarditis
Vulvular defects
Common treatment to all ACS and angina…
O2
Pain relief
Aspirin
Treatment for angina is…
Nitrates
B Blockers
Lifestyle changes
ACS treatment…
Thrombolytic therapy
PTCA (procedure to open arteries)
CABG (bypass, improves blood flow to heart)
Drugs
What does ACS include?
Unstable angina / MI
Major risk factors for developing atherosclerosis…
HTN Diabetes Hyperlipidaemia Family history Smoking Low level of HDL
Other risk factors for developing atherosclerosis…
Obesity Stress Age Sex Physical inactivity Homocystinuria
