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Cardiovascular > Atheroma > Flashcards

Atheroma Flashcards

1
Q

What is the process of atheroma?

A

Atherosclerosis

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2
Q

What is atheroma?

A

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

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3
Q

Give an example of somewhere that plaques may form that has clinical implications

A

Coronary arteries - atheromatous plaques narrow lumen - ischaemia of the myocardium (clinical manifestation is angina)

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4
Q

What is meant by a complicated plaque?

A

When the plaque ruptures (atheromatous plaque - lipid-rich core and fibrous cap)

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5
Q

What causes 90% of MI’s?

A

Rupture of a plaque in the coronary artery - thrombus/blood clot forms on top therefore occluding the lumen (blocking blood supply to the myocardium)

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6
Q

What effect does blocking the blood flow to the myocardium have?

A

Ischaemia -> infarction

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7
Q

What is stable angina?

A

Predictable chest pain that comes on in exertion

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8
Q

What causes the pain felt in stable angina?

A

Increased oxygen demand of the myocardium

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9
Q

What is unstable angina?

A

Unpredictable chest pain that comes on at rest

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10
Q

What causes the pain felt in unstable angina?

A

Decreased oxygen supply by the coronary arteries

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11
Q

What is a thromboembolism?

A

Obstruction of a blood vessel by a blood clot that has become dislodged from another site in the circulation

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12
Q

What colour is plaques in the intima?

A

Yellow

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13
Q

What is arteriosclerosis?

A

Not atheromatous plaques - age related changes in muscular arteries (thickening and hardening of the walls of the arteries), decreasing vessel diameter

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14
Q

What should the diameter of the intima be?

A

Thin

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15
Q

What is a fatty streak?

A

Earliest significant lesion in young children - yellow linear elevation of intimal lining due to masses of lipid-laden macrophages (no clinical significance and may disappear, however, patients at risk can go onto form atheromatous plaques)

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16
Q

What is the next stage?

A

Early atheromatous plaque - young adults onwards, smooth yellow patches in intima due to lipid laden macrophages (progress to established plaques)

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17
Q

What is a fully developed atheromatous plaque?

A

Central lipid core with fibrous cap, covered by arterial endothelium

18
Q

What holds the structure of the plaque?

A

Collagens (produced by smooth muscle cells - in tunica media) in cap provide structural strength

19
Q

What are foamy macrophages?

A

Macrophages that appear foamy due to their uptake of oxidised lipoproteins

20
Q

What is the lipid core made up of?

A

Rich in lipids and debris derided from macrophages

21
Q

What occurs late in plaque development and is often a marker on angiograms/CT?

A

Calcification

22
Q

What is the most important risk factor for atheroma?

A

Hypercholesterolaemia

23
Q

What is bad cholesterol?

A

LDL

24
Q

How many Caucasians are heterozygous for a mutation that causes a genetically determined lack of cell membrane receptors for LDL?

A

1/500

25
Q

How many patients in the UK are homozygous for this mutation?

A

1 in 1 million - usually die from coronary artery disease in teens - the defect makes the body unable to remove LDL (bad) cholesterol from the blood - this results in a high level of LDL in the blood

26
Q

What are some signs of major hyperlipidaemia?

A 
Familial
Biochemical evidence
Corneal arcus
Tendon xanthomata
Xanthelasmata
27
Q

What are the other risk factors for atheroma?

A 
Smoking (damages vessel walls)
Hypertension (damages vessel walls)
Diabetes (damages vessel walls)
Male
Elderly
28
Q

What are some less strong risk factors for atheroma?

A

Obesity
Sedentary lifestyle
Low socio-economic status
Low birthweight

29
Q

What is the two step process that causes the development of atheromatous plaques?

A

Injury to endothelial lining of artery

LDL passes through endothelium of blood vessel and lodges in the intima

30
Q

What are patients given who have high cholesterol?

A

Statins - lower LDL cholesterol and increase HDL cholesterol

31
Q

What is the difference in vessel lumen between stable angina and unstable angina?

A

Stable angina is stenosed coronary artery
Unstable angina is very stenosed coronary artery - they don’t need to exert themselves for the lack of oxygen and blood flow to be noticeable

32
Q

What is ischemic pain of myocardium called?

A

Angina

33
Q

What happens when an artery in the legs gets stenosed?

A

Intermittent clauducation - clinical manifestation of peripheral arterial disease (muscles in the legs don’t get enough blood and therefore oxygen when you exercise - pain stops when you stop walking)

34
Q

What does total occlusion of the coronary artery, carotid artery and the popliteal artery cause?

A

Myocardial infarct
Cerebral infarct
Lower limb gangrene (infarct)

35
Q

What can embolic occlusion of small vessels cause?

A

Small infarcts in organs

36
Q

What can happen with a thrombus in artery?

A

Small thrombus fragments can detach and embolise

37
Q

What can a plaque cause (not including if it ruptures)

A

Can cause the media below to become weak and therefore cause an aortic aneurysm (often asymptomatic and sudden rupture has a high mortality)

38
Q

What plaques have a high risk of rupture?

A

Typically thin fibrous cap, large lipid core and prominent inflammation

39
Q

What are ways to help prevent atheroma?

A 
Stop smoking
Control blood pressure
Weight loss
Regular exercise
Dietary modifications
Cholesterol lowering drugs

(aspirin - inhibits platelet aggregation to decrease the risk of thrombus forming on established plaques)

40
Q

What is vascular disease?

A

Atherosclerosis in all different places - can cause heart attacks, strokes and peripheral vascular disease

Cardiovascular (3 decks)

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