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Cardiovascular System > Atheroma > Flashcards

Atheroma Flashcards

1
Q

What are Atheroma/Atherosclerosis

A

Formation of focal elevated lesions (plaques) in intima of large and medium sized arteries

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2
Q

Complications of Atheroma

A
  • In coronary arteries the atheromatous plaques narrow the lumen and cause ischaemia
  • Angina due to myocardial ischaemia
  • Complicated by thromboembolism
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3
Q

Ateriosclerosis

A

Age related change in muscular arteries

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4
Q

What causes decrease in vessel diameter in Ateriosclerosis (3)

A

• Smooth muscle hypertrophy, apparent reduplication of internal elastic laminae, intimal fibrosis

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5
Q

Stages of Atheroma (3)

A

Fatty Streak
Early Atheromatous Plaque
Fully developed atheromatous plaque

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6
Q

Features of fatty streak (4)

A

Seen in young children
No clinical significance
May disappear
Masses of lipid-laden macrophages

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7
Q

Features of early atheromatous plaque (3)

A

Seen in young adults onwards
Smooth yellow patches on instima
Lipid-laden macrophages

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8
Q

Features of fully developed atheromatous plaque

A

Central lipid core with fibrous tissue cap
Covered by arterial endothelium
Contains inflammatory cells (macrophages T-cells mast cells)

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9
Q

What cells produce collagen in fibrous cap

A

Smooth muscle cells

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10
Q

Where are the inflammatory cells recruited from

A

Arterial endothelium

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11
Q

What causes the macrophages to be foamy

A

Uptake of oxidised lipoproteins via specialised membrane bound scavenger receptor

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12
Q

What is Dystrophic calcification

A

calcification occurring in degenerated or necrotic tissue). Is extensive and occurs late in plaque development

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13
Q

Complications of Atheroma (3)

A

Haemorrhage into plaque
Plaque rapture/fissuring
Thrombosis

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14
Q

Aetiology of Atheroma (3)

A

Hypercholesterolaemia
Elevated levels of LDL (bad cholesterol)
Mutation in cell membrane receptors for LDL

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15
Q

Signs of major hyperlipidaemia (7)

A 
Primary- familial
Secondary- idiopathic
Corneal arcus
Tendon xanthomata
Xanthelasmata
Family history
Biochemical
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16
Q

Risk Factors (5)

A 
Smoking
Hypertension
Diabetes mellitus
Male
Elderly
17
Q

Less Strong Risk Factors (5)

A 
Obesity
Lifestyle
Socioeconomic status
Low birthweight
Micro-organism
18
Q

2 Steps involved in the development of atheromatous plaque

A
  1. Injury to endothelial lining of artery

2. Chronic inflammatory healing and response of vascular wall to agent causing injury

19
Q

Development of Atheromatous Plaque (7)

A
  1. Endothelial injury and dysfunction
  2. Accumulation of LDL in vessel wall
  3. Monocyte adhesion to endothelium –> migration into intima and transformation to foamy macrophages
  4. Platelet adhesion
  5. Factor release from activates platelets, macrophages leads to smooth muscle recruitment
  6. Smooth muscle cell proliferation, extracellular matrix production and T cell recruitment
  7. Lipid accumulation
20
Q

Causes of endothelial injury

A 
Haemodynamic disturbances (turbulent flow)
Hypercholesterolaemia
Endothelial cells release growth factors and cytokines
21
Q

LDL accumulate and are modified by what

A

Free radicals produced by inflammatory cells

22
Q

injured endothelial cells lead to (3)

A
  • Enhances expression of cell adhesion molecules (ICAM-1, E-selectin)
  • High permeability for LDL
  • Increased thrombogenicity
23
Q

Where do microthrombi form

A

Denuded areas

24
Q

Consequences of Atheroma

A
  1. Progressive lumen narrowing due to high grade plaque stenosis
  2. Acute atherothrombotic occlusion
  3. Embolism of the distal arterial bed
  4. Ruptured atheromatous abdominal aortic aneurysm
25
Q

Stenosed atheromatous artery

A

Stable angina

26
Q

Very severe stenosis

A

Ischaemic pain at rest (unstable angina)

27
Q

Ileal, femoral, popliteal artery stenosis

A

Intermittent claudication (peripheral arterial disease)

28
Q

Longstanding tissue ischaemia

A

Atrophy of affected organ

29
Q

What is an aneurysm

A

Weakened spot of blood vessel

30
Q

Vulnerable Atheromatous plaque (3)

A

Thin fibrous cap
Large lipid core
Prominent inflammation
Secretion of proteolytic enzymes, cytokines and reactive oxygen species

31
Q

Preventative approaches (5)

A
  • Stop smoking
  • Control blood pressure
  • Weight loss
  • Regular exercise
  • Dietary modifications
32
Q

Secondary prevention (2)

A

Cholesterol lowering drugs such as statins

Aspirin- inhibits platelet aggregation and decreases risk of thrombosis

Cardiovascular System (42 decks)

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