Atheroma/ Atherosclerosis Flashcards
what is Arteriosclerosis
Thickening and hardening of the walls of arteries and arterioles from any cause
what is Atheroma
Accumulation of intracellular and extracellular lipids in intima and media of large and medium sized arteries
In a stroke thromboembolism travels to what vessels
Cerebral arteries
The foam cells seen in the development of atherosclerosis are derived from macrophages and what cells???
smooth muscles
What 2 cells engulf oxidised lipids to form foam cells
Macrophages and smooth muscle
What are cholesterol clefts
small open space filled with a type of fat called cholesterol
What are some early microscopic changes seen in atherosclerosis
Accumulation of foam cells
proliferation of smooth muscle cells
extracellular lipid deposition
What are some examples of medium sized arteries affected in atherosclerosis
Coronary
renal
cerebral
mesenteric
What are some later changes that occur with atherosclerosis
fibrosis
necrosis
calcification
cholesterol clefts
ingrowth of blood vessels
What are some other risk factors for atherosclerosis
Lack of exercise
obesity
soft water
oral contraceptive pill
What are some prevention and interventions for atherosclerosis
No smoking
decrease fat intake
treat hypertension
aspirin
manage alcohol intake
Good glycemic control
What are the 3 chronological stages for plaque formation in atherosclerosis
Fatty streak
simple plaque
complicated plaque
What are the 3 types of cerebral ischaemia
Transient ischaemic attack
Cerebral infarction
multi-infarct dementia
What are the cellular events leading to formation of atherosclerosis
Chronic endothelial injury
Endothelial dysfunction
Smooth muscle emerge from media to intima
macrophage and smooth muscle cells engulf accumulated lipids and form foam cells
smooth muscle proliferate due to cytokines and growth factors
Collagen and matrix is deposited
What are the common sites for atherosclerosis
aorta
coronary arteries
carotid arteries
cerebral arteries
arteries of legs
What are the consequences of ischaemic heart disease
Myocardial infarction
angina pectoris
chronic congestive cardiac failure
sudden death from arrhythmia
What are the effects of erosion of luminal surface of plaque in atherosclerosis
thrombus formation occurs
can discharge debris leading to micro-emboli
What are the effects of mesenteric ischaemia
Ischaemic colitis
malabsorption
intestinal infarction
What are the features of abdominal aortic aneurysm
10-15cm in diameter
lined with thrombus
may rupture and produce emboli
What are the key cells involved in atherogenesis
Endothelial cells
platelets
smooth muscle cells
macrophages
What are the risk factors for atherosclerosis(9)
Age (non-modifiable)
Gender (non-modifiable)
Hyperlipidaemia
Smoking
Hypertension
Impaired glucose tolerance and diabetes mellitus
Alcohol
Geography
CIVILISATION & DIET
What can cause chronic endothelial injury in atherosclerosis
Raised LDL
Toxins
hypertension
What condition can result from atherosclerosis of aorta
aneurysm rupture
What condition can result from atherosclerosis of cerebral arteries
stroke
What condition can result from atherosclerosis of cerebral arteries
ischaemic damage
What condition can result from atherosclerosis of peripheral arteries
Distal gangrene
What conditions are associated with peripheral vascular disease
Intermittent claudication
ischaemic rest pain
gangrene
leriche syndrome
What does AAA or triple A stand for
Abdominal aortic aneurysm
What do platelets release in atherosclerosis
platelet derived growth factors
What is a fatty streak
first grossly visible lesion that forms in development of atherosclerosis
What is an aneurysm
Location dilatation of artery due to weakening of wall
What is prostacyclin
platelet activation inhibitor
What is the appearance of a fatty streak
Yellow
slightly raised
What is the appearance of a simple plaque
Raised yellow/white
1cm in diameter
irregular outline
What is the effect of complicated plaque formation in aorta
weakening of wall
aneurysm formation
What is the function of elastic lamina
tissue that separates tunica intima and tunica media
What is the fundamental lesion seen in atherosclerosis
plaque
What is the mechanism of acute myocardial infarction in relation to ischaemic heart disease
acute severe coronary obstruction
What is the mechanism of angina pectoris in relation to ischaemic heart disease
excess demand on heart
chronic obstruction
what is the mechanism of chronic heart failure in relation to ischaemic heart disease
multiple small infarcts accumulate leading to chronic obstruction
What is the mechanism of sudden cardiac death in relation to ischaemic heart disease
An old infarct triggers acute LV arrhythmia
What is the most common location for atherosclerosis?
Abdominal aorta > coronary artery > popliteal artery > carotid artery
A CoP Car
What is the role of endothelial cells in atherogenesis
Alter permeability to lipoproteins
secrete collagen
stimulate the proliferation and migration of smooth muscle cells
What is the role of macrophages in atherogenesis
Become foam cells
secrete proteases which modify matrix
stimulate the proliferation and
maturation of smooth muscle cells
What is the role of platelets in atherogenesis
Stimulate proliferation and migration of smooth muscle cells
What is the role of smooth muscle cells in atherogenesis
Take up LDL and become foam cells
synthesise collagen and proteoglycans
what is the triad for Leriche syndrome
Claudication of buttocks and thighs
absent of decreased femoral pulses
erectile dysfunction
What makes up the crystals commonly seen in Atherosclerotic plaque?
cholesterol
What molecule does smoking reduce in relation to atherosclerosis
prostacyclin
What occurs in complicated atheromatous plaque
Erosion of luminal surface of plaque
haemorrhage into plaque
plaque rupture
thrombus superimposed
What occurs in endothelial dysfunction of atherosclerosis
Platelet adhesion occurs and Platelet derived growth factor released
monocytes accumulate within intima and release growth factors and cytokines
T lymphocytes attracted to area
What occurs to the luminal surface of plaque in complicated atheromatous plaque
Rupture and ulceration of the luminal surface of the plaque
What processes occur in the formation of a complicated plaque
Calcification
thrombosis
haemorrhage into plaque
What undergoes atherosclerosis in a stroke
Carotid arteries
What vessels does atherosclerosis affect
large and medium arteries
What vessels does atherosclerosis not affect
veins
When is flow in artery affected due to obstruction
When lumen is reduced by 70-80%
<1mm diameter
Where do lipids deposit in fatty stream formation
intima
Where do monocytes accumulate in atherosclerosis
intima
Where do simple plaques usually occur
near ostia - opening of vessel
Where do smooth muscles emigrate to in atherosclerosis
Media to intima
Which receptor does oxidised LDL bind to when it is taken up into Macrophages in the pathogenesis of atherosclerosis?
SR-A ; Scavenger Receptor A
“blank” occurs over ruptured “blank” resulting in “blank”
Coronary thrombosis…..occur over ruptured ……atheromatous plaques……..resulting in……myocardial infarction…..
“blanks” are a form of Macrophage commonly seen in atherosclerosis that have taken up and accumulated LDL molecules.
Foam Cells………are a form of Macrophage commonly seen in atherosclerosis that have taken up and accumulated LDL molecules.
“blanks” and “blank” are 2 growth factors involved with the smooth muscle cell migration that occurs in the pathogenesis of atherosclerosis.
PDGF….and……FGF……are 2 growth factors involved with the smooth muscle cell migration that occurs in the pathogenesis of atherosclerosis.
