Atheroma

Question 1

What is an atheroma?

Answer 1

Formation of a focal elevated lesion in the tunica intima of medium/large arteries.

Question 2

How do atheromas form?

What are the steps?

Answer 2

1. Injury to the endothelial lining (due to turbulence for example)
2. Chronic inflammatory and healing response.

Steps:

1. Fatty streak formation: injury causes inflammation, macrophages come down and form foam cells
2. Fibrolipid placque: lipid on intimal layer stimulates fibrocollagenous tissue - thins the media
3. Complicated

Question 3

What can atheroma formation lead to?

Answer 3

Atheroscleoris

Smooth muscle hypertrophy and intimal fibrosis

= resulting in decreased vessel diameter.

Question 4

What are the features of a fully developed placque?

Answer 4

• Central lipid core
• Collagenous cap
• Inflammatory cell aggregation
• Soft and highly thrombogenic
• May contain calcified areas

Question 5

Where do atheromas form?

Answer 5

In highly turbulent areas, such as bifurcations.

Question 6

What is complicated atherosclerosis?

Answer 6

The normal features + risk of haemorrage into arterial wall and/or rupture.

Question 7

What is the main aetiology for atherosclerosis?

Answer 7

Hypercholesterolaemia

Question 8

What are the big RF for atherosclerosis?

Answer 8

SMOKING

DM

HTN

male

eldery

obesity

Question 9

What is the big risk with atherosclerosis?

Answer 9

OCCLUSION

Placque ruptures = exposure to blood stream, activation of the coagulation cascase and thrombotic occlusion in a very short time.