Atheroma

Question 1

aetiology

Answer 1

smoking, hypertension, hyperlipidaemia, diabetes, age, sex, genetics

Question 2

pathogenesis

Answer 2

primary endothelial injury (smoking, hypertension, immune factors)
accumulation of lipids and macrophages (increased LDL, decreased HDL, V-CAM, IL-1 and TNF)
migration of smooth muscle cells
increase in size

Question 3

atheromatous narrowing of an artery is likely to produce critical disease if:

Answer 3

it is the only artery supplying the organ or tissue
the artery diameter is small
overall blood flow is reduced

Question 4

complications of atheroma

Answer 4

stenosis 
thrombosis
aneurysm 
dissection 
embolism

Question 5

arterial stenosis

Answer 5

narrowing of arterial lumen
reduced elasticity
reduced flow in systole
tissue ischaemia 
may effect any artery

Question 6

superadded throbosis

Answer 6

when plaques rupture thrombus forms over the top and can completely block the arterial lumen
coronary artery thrombosis: the lumen is filled with red-brown thrombus

Question 7

clinical effects of thrombosis

Answer 7

blocking artery will induce end organ ischaemic necrosis

• MI
• cerebral, renal and instestinal infarction

Question 8

aneurysm formation

Answer 8

definition: abnormal and persistent dilatation of an artery due to weakness in its wall
commonest site: abdominal aorta

Question 9

arterial dissection

Answer 9

splitting within the media by flowing blood
false lumen filled with blood within the media
sudden collapse and high mortality
arterial wall splits longitudinally

Question 10

embolism

Answer 10

superadded thrombus and plaque material may break off and embolise
usual targets: cerebral infarct, renal infarct, lower limb infarct