Atheroma, Thrombosis & Embolism Flashcards
what is the definition of atheroma?
Intimal lesion that protrudes into a vessel wall. It consists of a raised lesion with a soft core of of lipid (mainly cholesterol and cholesterol esters) and is covered by a fibrous cap.
what is the two features of an atheroma?
fibrous cap
necrotic centre
what are commonly affected vessels for atheroma?
bifurcations abdominal aorta coronary arteries popliteal arteries carotid vessels circle of willis
what are non-modifiable major risk factors for development of atherosclerosis?
increasing age
male gender
family history
genetic abnormalities
what are modifiable major risk factors for development of atherosclerosis?
hyperlipidemia Ldl:Hdl hypertension cigarette smoking diabetes c-reactive proteins
How does atherosclerosis develop?
it develops as chronic inflammatory response of the arterial wall to endothelial injury.
how does lesion progression occurs?
occurs through interactions of modified lipoproteins, monocyte-derived macrophages, T-lymphocytes and the normal cellular constituent of the arterial wall
what is the contemporary view of atherosclerosis?
the response-to-injury hypothesis
what is the fatty streak?
its the earliest lesion in atherosclerosis and is composed of lipid filled foamy macrophages
how does the fatty streak begin?
begins as multiple minute flat yellow spots that eventually coalesce into streaks
what does atherosclerotic plaque consist of?
consists of intimal thickening and lipid accumulation
what does atherosclerotic appear as?
appears white yellow and superimposed thrombus on the plaque appears red.
what is a thrombus?
a solid mass of blood constituents formed within the vascular system in vivo
where is arterial thrombosis most commonly superimposed on?
on a atheroma
what is venous thrombosis most commonly due to
stasis
what are three areas of virchows triad
endothelial injury
hyper coagulability
abnormal blood flow
what is the typical mechanism arterial thrombosis?
Typically from rupture of atheromatous plaque
what is the typical mechanism venous thrombosis?
Typically from combination of factors from Virchow triad
where is arterial thrombosis normally located
Left heart chambers, arteries
where is VTE normally located?
Venous sinusoids of muscle and valves of veins
what diseases associated with arterial thrombosis?
Acute coronary syndrome
Ischaemic stroke
claudication
what diseases associated with VTE?
Deep vein thrombosis (DVT)
Pulmonary embolism
what’s the composition of arterial thrombosis?
Mainly platelets
what’s the composition of VTE?
Mainly fibrin
how do you treat arterial thrombosis?
Anti-platelet agents (clopidogrel)
how do you treat VTE?
Anticoagulants (heparin, warfarin)
what are the causes of endothelial damage? 5
smoking hypertension surgery catheter PICC lines trauma
what’s the hereditary components of hypercoagulability? 3
Factor V leiden
Prothrombin G20210A
Protein C and S deficiency
what’s the acquired factors of hypercoagulability? 5
Cancer chemotherapy OCR/HRT Pregnancy Obesity HIT
what are the two causes of stasis?
immobility
polycythemia
what are the differences between clot vs thrombus?
platelets only involved in thrombus
clot can occur inside or outside clot whereas thrombus occurs only inside vessel
clot is gelatinous whereas thrombus is firm
thrombus attached to the vessel wall whereas clot isn’t attached
what leads to an embolisation?
occlusion of vessel dissolution incorporation into vessel wall recanalisation embolisation
what is an embolus?
A mass of material in the vascular system able to become lodged in the vessel and block its lumen
what is the most common embolism and where is it derived from?
Pulmonary embolus derived from deep vein thrombosis
what are the types of emboli? 7
thrombus derived atheromatous plaque material vegetation on heart valves fragments of tumour amniotic fluid gas fat
