Atheroma and its complications

Question 1

What is the epidemiology of atheroma?

Answer 1

It is extremely common in the developed world and it most important in arterial disease
It is the principal cause of death and disability in western countries

Question 2

What is the aetiology of atheroma?

Answer 2

Cigarette smoking 
Hypertension 
Hyperlipidemia 
Diabetes 
Age (older)
Sex (males) 
Genetics

Question 3

What causes prpimary endothelial injury?

Answer 3

Smoking, hypertension, hyperlipidemia, immune factors, toxins and viruses

Question 4

What causes an accumulation of lipids and macrophages?

Answer 4

Increased LDL
Reduced HDL
V-CAM, IL-1 and TNF

Question 5

What causes the migration of smooth muscle cells?

Answer 5

PDGF, FGF, TGFalpha

This results in an increased wall of the blood vessel

Question 6

How does an atheromatous plaque become complicated?

Answer 6

First a fatty streak appears
Then a fibrofatty plaque
Then a complicated plaque with an overlying thrombus

Question 7

When will an atheromatous narrowing or an artery produce a critical disease?

Answer 7

If it is the only artery supplying an organ - there is no collateral circulation
The artery diameter is very small (e.g. coronary artery vs common iliac artery)
Overall blood flow is reduced (i.e. cardiac failure)

Question 8

What are possible complications of atheroma?

Answer 8

Stenosis
Thrombosis 
Aneurysm 
Dissection 
Embolism

Question 9

What is arterial stenosis?

Answer 9

Narrowing of the arterial lumen
Reduced elasticity
Reduced flow in systole
Tissue ischaemia

Question 10

What does coronary stenosis produce?

Answer 10

Cardiac ischaemia

Question 11

What are the clinical effects of cardiac ischaemia?

Answer 11

Reduced exercise tolerance 
Angina
Unstable angina
Myocardial infarction 
Cardiac failure

Question 12

What is cardiac fibrosis?

Answer 12

Loss of cardiac myocytes
Replacement by fibrous tissue
Loss of contractility
Reduced elasticity and filling

Question 13

What arteries can be affected by arterial stenosis?

Answer 13

Coronary arteries 
Carotid arteries (TIA, stroke, vascular dementia) 
Renal arteries (hypertension and renal failure) 
Peripheral arteries (claudication and foot/leg ischaemia)

Question 14

What are the clinical effects of thrombosis?

Answer 14

MI
Cerebral infarction
Renal infarction
Intestinal infarction

Question 15

How can aneurysms form?

Answer 15

Due to abnormal and persistent dilatation of an artery due to a weakness in its wall

Question 16

Where is the most common site for aneurysm formation?

Answer 16

Abdominal aorta

Question 17

What are the possible complications from an aneurysm?

Answer 17

Rupture (6cm) 
Thrombosis
Embolism 
Pressure erosion of adjacent structures
Infection

Question 18

What is an arterial dissection?

Answer 18

Splitting within the media by flowing blood

The false lumen fills with blood within the media

Question 19

When can an arterial dissection occur?

Answer 19

Middle age with or without atheroma

Question 20

What are the symptoms of an arterial dissection?

Answer 20

Sudden death

High mortality

Question 21

What are risk factors for developing an aortic dissection?

Answer 21

Atheroma
Hypertension
Trauma
Coarctation
Marfan's
Pregnancy

Question 22

What are the targets of an embolism?

Answer 22

Cerebral infarct
Renal infarct and renal failure
Lower limb infarction