Atheroma Flashcards
How can you prevent coronary artery disease?
Lifestyle interventions
Reduce BP
Reduce cholesterol- statins
What is atheroma?
The build up of fatty material on the inside wall of the artery.
What is atherosclerosis?
Progressive narrowing and hardening within the artery potentially resulting in complete blockage.
What is the pathogenesis of an atheroma?
Chronic injury of endothelium causes chronic inflammation.
Causes of flow include hyperlipidaemia, disturbed flow, smoking and hypertension.
Progress as white cells, fat and blood constituents infiltrate.
What are the different stages of atheroma?
Type 1- Initial lesion- isolated macrophage. First decade, clinically silent.
Type 2- Fatty streak lesion. First decade, clinically silent.
Type 3- Intermediate lesion- Type 2 changes with small extracellular lipid pools. Third decade, clinically silent.
Type 4- Atheroma lession. Third decade, clinically silent or overt.
Type 5- Fibroadenoma lession. From fourth decade, clinically silent or overt.
Type 6- Complicated lesion- surface defect, haematoma, thrombus.
Where can atheroma form?
In any artery
Coronary artery- heat attack/ angina (ischematic heart disease)
Aorta- aneurysm due to weakening of the wall.
Carotid- causing strokes.
Peripheral vascular disease.
What causes atherosclerotic plaques.
Aneuysms and rupture Thrombosis Haematoma formation Embolisation Critical stenosis.
What are the side effects of athersosclerosis
Chest pain or angina Pain in leg or arm Shortness of breath Fatigue Confusion Muscle weakness.
A 65 year old man with a history of hypertension presents with a sudden onset dysphasia, left arm and leg weakness. He had a similar episode 2 weeks ago but only lasted 1 mintue. What has happened to him?
Cerebral infarction- stroke
A 70 year old man who has smoked all of his life has had severe pain in both his legs when walking for more than 10m and has had a number of infected ulcers in his feet and lower legs requiring antibiotics What has he got?
Peripheral vascular disease
What are some other presentations of plaque build up?
Bowel ischaemia, renal artery stenosis, emboil
What is ischaemic heart disease?
Imbalance between supply and demand for oxygenated blood.
Causes a decrease in oxygen and decrease in nutrient substrates causing inadequate removal of metabolites.
What causes ischaemic heart disease.
Decreased flow/no flow of oxygenated blood due to atheroma, embolism and spasm.
Increase demand for oxygen due to thyrotoxicosis and myocardial hypertrophy (hypertension).
What are the risk factors for ischaemic heart disease?
Fixed factors- family history, male, age, ACE gene detection.
Reversible factors- Hyperlipidaemia, smoking, hypertension, diabetes, obesity.
What are the signs and symptoms of ischemic heart disease?
Chest pain, central radiating to left arm or jaw. Elderly people or diabetes may not get chest pain. Shortness of breath Palpitations Syncope Nauseous, pale sweating.
