Atheroscleroma / Atheroma

Question 1

what is atheroma?

Answer 1

inflammatory process characterised by the accumulation of lips, macrophages and smooth muscle cells in internal plaques of large and medium sized epicardial coronary arteries.

Question 2

what are the stages of atheroma?

Answer 2

non atheromatous
fatty streak
early atheromatous plaque
fully developed atheromatous plaque
complicated atheroma

Question 3

what is the aetiology of atheroma?

Answer 3

most important cause is hypercholestrolaemia
other causes include: smoking, diabetes, hypertension, age, sex (males).
less common causes include: obesity, sedentary life style, poor socioeconomic background, low birth weight

Question 4

what signs can you test for in hypercholesterolaemia?

Answer 4

whether it is familial or acquired
biochemistry evidence - LDL, HDL, total cholesterol, triglycerides
physical signs - corneal arcus, Xanthelasma, tendon xanthomata
family history of MI/ atheroma

Question 5

what is the 2 step process which leads to plaque formation?

Answer 5

1- endothelial lining destruction with increases permeability to and accumulation of LDL.
2- chronic inflammatory and healing response of vascular wall to agent causing injury

Question 6

what is the main cause to injury of endothelial wall?

Answer 6

turbulence of blood flow, usually at bifurcations

Question 7

in atheromatous plaques, what forms the fibrous cap?

Answer 7

smooth muscle + collagen

Question 8

macrophages take up lipoproteins at focal sites within endothelium which creates ……..
what does result in?

Answer 8

creates lipid laden foamy cells

this results in fatty streaks

Question 9

what does the release of cytokines such as PDGF do?

Answer 9

promotes further accumulation of macrophages + smooth muscle cell migration and proliferation

Question 10

what is it called when the fibrolipid plaque may become unstable and undergo thrombosis?

Answer 10

complicated plaque

Question 11

non atheromatous atheroma is mostly…… related.

Answer 11

age

Question 12

what does non atheromatous atheroma contribute to in the elderly?

Answer 12

cardiac, cerebral, renal, colonic ischaemia

Question 13

what are the clinical effects of non atheromatous atheroma?

Answer 13

most apparent when CVS is under stress by:

haemorrhage, stroke, surgery, infection, shock

Question 14

fatty streak may occur in …….

Answer 14

children

it may disappear

Question 15

what type of cells does the fibrous cap contain in fully developed atheromatous plaques?

Answer 15

macrophages, T-lymphocytes, mast cells

Question 16

what is a complicated atheromatous plaque?

Answer 16

a fully developed atheromatous plague + either haemorrhage (calcification), plaque rupture, or thrombosis

Question 17

what are the 3 stages of the clinical manifestations of atheroma?

Answer 17

stable angina (stenosed atheromatous coronary artery)
unstable angina (ileal, femoral, popliteal stenosis, intermittent claudication = peripheral arterial disease)
acute atherothrombic occlusion (rupture of plague) or total occlusion (MI, stroke, lower limb gangrene)

Question 18

what occurs with long standing ischaemia?

Answer 18

atrophy of affected organ

i.e. atherosclerotic renal artery stenosis = renal atrophy

Question 19

what are the features of vulnerable atheromatous plaques?

Answer 19

thin fibrous layer
large lipid core
prominent inflammation (weakens plaque therefore increased risk of rupture)

Question 20

what are the non pharmacological therapies for treating atheroma?

Answer 20

weight loss
dietary improvements
daily exercise
smoking cessation
control bp

Question 21

what are the pharmacological therapies for treating atheroma?

Answer 21

cholesterol lowering drugs i.e. statins
aspirin (inhibits platelet aggregation)
surgery

Question 22

What attracts smooth cells to the endothelial wall to form the fibrous cap with collagen?

Answer 22

foamy cells (macrophages + LDL/lipids) secrete growth factors which activate smooth muscle migration and proliferation