Atheroma and its Complications

Question 1

Most common complication of atheroma?

Answer 1

MI (most commonly due to occlusion of LAD)

Atheromas tend to be worse at bifurcations of arteries, as there is more turbulent flow

Question 2

Complications of atheroma?

Answer 2

Stenosis
Thrombosis 
Aneurysm
Dissection
Embolism
Ischaemia

Question 3

What is arterial stenosis?

Answer 3

Narrowing of the arterial lumen
Results in:
Reduced elasticity
Reduced flow in systole
Tissue ischaemia, e.g with increased cardiac demand

Question 4

Consequences of cardiac ischaemia?

Answer 4

Reduced exercise tolerance
Angina - can be unstable (onset is unrelated to exercise)
Infarct
Can cause atrophy of cardiac myocytes

Cardiac failure

Question 5

Describe cardiac fibrosis

Answer 5

Loss of cardiac myocytes Replaced by fibrous tissue resulting in:
Loss of contractility
Reduced elasticity and diastolic filling is impaired

Question 6

What does arterial stenosis in different arteries cause?

Answer 6

Coronary arteries - angina and MI

Carotid arteries - TIA (symptoms persist for

Question 7

Consequence of atheromatous plaque rupture?

Answer 7

Sometimes, cholesterol crystals create more turbulent flow so increased risk of plaque rupture

Often triggers thrombosis

Question 8

Consequences of arterial thrombosis?

Answer 8

MI
Cerebral infarction
Renal infarction
Bowel infarction

Question 9

Aneurysm formation?

Answer 9

Abnormal dilatation of artery; can be congenital, Berry aneurysm and subarachnoid haemorrhage)

Weakening of media by atherosclerosis
Elastic degeneration and fragmentation - loss of stretch/recoil

Question 10

Complications of aneurysm?

Answer 10

Rupture - surgery is risky so risk-benefit analysis must be done; but, over 6 cm makes the aneurysm too risky to leave

Thrombosis

Embolism

Question 11

What is arterial dissection?

Answer 11

Splitting within the media by flowing blood - tends to occur in middle age +/- an atheroma?
False lumen fills with blood within the media (partial tear allows blood to pour into wall, separating layers)
Leads to sudden collapse and has a high mortality

Question 12

Risk factors for aortic dissection?

Answer 12

Atheroma
Hypertension
Trauma, e.g: road-traffic accidents
Coarctation - congenital narrowing of the aorta
Marfan syndrome - genetic disorder of connective tissue
Pregnancy

Question 13

Potential consequences of athero-embolism?

Answer 13

Cerebral infarct
Renal infarct and renal failure
Lower limb infarction