Atheroma Flashcards
what are the synonyms?
atherosclerosis
hardening of the arteries
coronary artery disease
ischaemic heart disease
what is the aetiology?
cigarette smoking hypertension hyperlipidaemia diabetes age (older) sex (males) genetics
how does artheroma happen?
primary endothelial injury
accumulation of lipids and macrophages
migration of smooth muscle cells
increase in size
what cause primary endothelial injury?
smoking hypertension hyperlipidemia immune factors toxins viruses
what are the lipids and macrophages that accumulate?
increased LDL
reduced HDL
V-CAM, IL-1 and TNF
what are the smooth muscle cells that migrate?
PDGF
FGF
TGFalpha
what happens during the progression of atheromatous plaques?
fatty streak
fibrofatty plaque
complicated plaque (with overlying thrombus)
what is associated with progression of atheromatous plaques?
further loss of luminal patency and arterial wall weakness
when is artheromatous narrowing of an artery likely to produce critical disease?
if it is the only artery supplying an organ or tissue
if the artery diamater is small
if overall blood flow is reduced
what are the complications of atheroma?
stenosis thrombosis aneurysm dissection embolism
what is arterial stenosis?
narrowing of the arterial lumen
reduced elasticity
reduced flow in systole
tissue ischaemia
what are the clinical effects of cardiac ischaemia?
reduced exercise tolerance angina unstable angina myocardial infarction cardiac failure
what is cardiac fibrosis?
loss of cardiac myocytes
replacement by fibrous tissue
loss of contractility
reduced elasticity and filling
what is the effect of arterial stenosis on carotid arteries?
TIA, stroke and vascular dementia
what is the effect of arterial stenosis on renal arteries?
hypertension and renal failure
what is the effect of arterial stenosis on peripheral arteries?
claudication and foot/leg ischaemia
what are the clinical effects of thrombosis?
MI
cerebral infarction
renal infarction
intestinal infarction
what is aneurysm formation?
abnormal and persistent dilation of an artery due to a weakness in its wall
what are the types of aneurysm formation?
mycotic atherosclerotic dissecting congenital arteriovenous traumatic syphillitic
what is the most common site of aneurysm formation?
abdominal aorta
what are the complications of aneurysms?
rupture thrombosis embolism pressure erosion of adjacent structures infection
what is arterial dissection?
splitting within the media by flowing blood
false lumen is filled with blood within the media
sudden collapse and high mortality
what is embolism?
both superadded thrombus and plaque material may break off and embolise
