Atheromatous vascular disease Flashcards
Define atherosclerosis
- Non-specific thickening and hardening of the walls of arteries causing a loss of contractility and elasicity, and decreased blood flow
- Often due to prolonged hypertension in smaller arteries
What are the risk factors for atherosclerosis development?
- Age: older
- Male
- Family history
- Smoking
- Diet: high fat, low fruit and veg
- Obesity
- Hypertension
- Hyperlipidaemia - high serum cholesterol, low HDLs, high LDLs
- Diabetes
Distinguish between macro- and micro-vascular diseases
Macrovascular disease may result in MI, stroke, or peripheral vascular disease, and would present as such. Initially, ischaemia of the leg may provoke intermittent claudication.
Microvascular diseases are unique to diabetes and are nephropathy, neuropathy and retinopathy, presenting as decline in “organ” function.
List specific sites where atheroma may develop and describe the clinical consequences and complications
Common sites of atheroma:
- aortic bifurcation
- branch points
- around ostia (funnel-shaped openings, especially in abdominal aorta near kidneys)
- other sites of haemodynamic stress (where endothelial damage is most commonly present).
Clinical complications:
- stenosis
- resulting hypoperfusion of distal tissues
- thrombus on the plaque causing total occlusion
- bleeding into the plaque
- aneurysm formation
- cholesterol embolism to distal sites.
What can you do to modify the atherosclerotic process?
General lifestyle: (most important)
- Stop smoking
- Exercise more
- Eat a balanced diet
- Lose weight if obese
- (opposite to risk factors)
Hypertension, hyperlipidaemia and diabetes are risk factors for progression of the disease state, and their reduction (via lifestyle, diet and pharmacology) will decrease risk of complications.
Pro-thrombotic state is a risk factor for complications of atherosclerosis, so antiplatelet agents reduce risk of complications
