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Cardiovascular Module > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

Atherosclerosis

A

Degenerative disease of medium and large arteries
Lipid deposition in arterial wall
Fibrosis and chronic inflammation
Formation of asymmetric obstructive fibre-fatty plaques

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2
Q

Atheroma/atheromatous/ fibrofatty plaque

A

Elevated lesion made of
lipid core
Fibrous cap
Forms into intimal layer of artery

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3
Q

Is the progression of atherosclerosis slow or fast

A

Slow

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4
Q

Etiology of Atherosclerosis

A

Ischemic heart disease is an indicator of the incidence of atherosclerosis

Factors increasing IHD and therefore AS:

Increasing Age because of increasing to causative factors

Male gender

Genetic factors ( familial predisposition)

Hyperlipidemia, hypertension, diabetes, Cigarettes ==> most important causes

fatty diet
low birth weight
sedentary lifestyle

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5
Q

Hyperlipidaemia

A

Higher level of blood LDL cholesterol predisposes to atherosclerosis

High levels of HDL cholesterol associated with lower risk of atherosclerosis

LDL/HDL ratio very important

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6
Q

Hypertension in atherosclerosis

A

The higher the blood pressure the greater the risk of atherosclerosis

Synergistic with other factors

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7
Q

At what age is hypertension a stronger risk factor to develop a atherosclerosis then hyper cholesterolemia

A

Above 45

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8
Q

Can antihypertensive reduce his incidence of atherosclerosis related diseases

A

Yes

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9
Q

Diabetes mellitus in atherosclerosis

A

Gives 2 fold increase in risk of ischemic heart disease

A lot of them have hypercholesteroleamia
A lot of them are hypertensive , low HDL
Increased platelet adhesiveness
Increased response to aggregating agents

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10
Q

Level of HDL in type two diabetes patients

A

Reduced HDL level

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11
Q

Metabolic syndrome / syndrome X

A

Cluster of conditions that increase risk of heart disease
Associated with diabetes and hypertension

Major risk factor for coronary heart disease

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12
Q

Component of insulin resistance

A

Hyperinsulinemia

Glucose intolerance

Reduced HDL

Hypertriglyceridemia

Central obesity

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13
Q

Factor with the Strongest epidemiological association with high incidence of atherosclerosis

A

Smoking

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14
Q

How is smoking related to the incidence of atherosclerosis

A

Directly correlated with the number of cigarettes smoke per day

Decreased smoking also decrease his risk of complication in atherosclerosis

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15
Q

Possible mechanism of effect of smoking on developing atherosclerosis

A

Decreased endothelial PGI2 synthesis

Increased platelet aggregation

Increased fibrinogen

Decreased HDL level

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16
Q

Smocking one or more packs of cigarette a day increases risk of death from IHD by …

A

200%

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17
Q

How does diet impact risk of AS

A

High diet in saturated fatty acid and cholesterol—> high plasma level of cholesterol, LDL, VLDL

When low fat diets and cholesterol , low plasma cholesterol too

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18
Q

Is alcohol a dependent or an independent risk factor in a AS

A

Independent

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19
Q

Is obesity a dependent or independent risk factor in

atherosclerosis

A

Independent

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20
Q

HDL level in obesity

A

Low

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21
Q

How can oral contraceptive lead to AS

A

Impact BP, plasma lipids, and coagulation

Decreases HDL

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22
Q

Impact of regular physical exercise in atherosclerosis

A

Decrease risk of IHD

23
Q

Impact of stress and behavior on AS

A

Increase risk

24
Q

Based on behavior and stress , what patient are most at risk of AS

A

Ambitious, aggressive, impatient, short tempered individual

25
Q

Homocystinuria in As

A

Patient with high homocystine in blood and urine have premature vascular disease

26
Q

Coagulation factors that can help predict risk of AS

A

High serum fibrinogen ( high risk of IHD)

High Factor VII

high plasminogen activitor inhibitor 1

27
Q

If you have 2 major risk factors how much does your risk of AS increases

A

4 folds

28
Q

If you have 3 major risk factors how much does your risk of AS increases

A

7

29
Q

Can atherosclerosis develop in the absence of any apparent risk factors

A

Yes

30
Q

AS pathogenesis : thrombogenic/ encrustations theory of rokitansky

A

Atheroma formed from repeated mural thrombi
Mural thrombi gets replaced by fibrous tissue and covered by endothelium

Plaque formed in intima

31
Q

AS pathogenesis : theory of virchow

A 
Atheroma formed by : 
Injury to intima 
Insudation of plasma into injured area
Fibrosis 
Fatty degeneration
32
Q

Cause of injury to endothelium leading to atherosclerosis

A

Hyperlipidemia

oxidized LDL produced by macrophage derived free radicals

hemodynamic factors which can determine the focal distribution of atheroma

Hemodynamics stress which can lead to severe atheroma

33
Q

How can response to endothelial injury leads to atherosclerosis

A

Injury —> increased permeability to plasma constituents (with lipids , LDL, cholesterol ). —> monocyte and platelet adherence enhanced

34
Q

Mediators of cell injury

A

Mechanical shear stress in HPT

BIOCHEMICAL abnormalities

Immunological factors

Inflammation

Genetic alteration

35
Q

LDL oxidation mechanism to be taken up by macrophages

A

Free radicals from inflammatory cells

Glycation in diabetes

36
Q

Impact of LDL oxidative

A

More readily ingested by macrophages through the scavenger receptors on macrophages ( form foamy macrophages)

37
Q

What happens at site of injury

A

There migrate there

Become macrophages and express gene for GF

GF Released and make smooth muscle cells migrate, accumulate and proliferate in intima

Prolifération of SM cells + synthesis of extra cellular matrix components —> accumulation of collagen, proteoglycans, uptake of lipids —> foam cells

38
Q

How do you see subsequent accumulation of foam cells microscopically

A

Fatty streaks

39
Q

Chronic injury impact

A

Lymphocyte and macrophage interaction stimulate Gf

macrophages and endothelium stimulate GF, smooth muscle

Loss of endothelial covering allowing platelet adherence

40
Q

Morphology of AS

A

Principal :
Fatty streak
Fibrofatty plaque
Complicated lesion

Major :
Fatty dots
Intermediate lesions
Fibroatheroma

41
Q

Fatty streak

A

Ubiquitous lesion found in arterial tree at all ages
When low does not cause anything

Tiny, multiple, yellow, flat spots and form linear elevations/ streaks

42
Q

Where are fatty streaks more obvious

A

Aorta

43
Q

Progression of fatty streak

A

Some can become fibrous plaque
Some can regress and disappear
Some stay same

44
Q

Fibrous plaque/ fibrolipid/ fibrofatty/ lipid plaque

A

White / whitish yellow
Elevated lesions
Variable sizes
Impinge lumen of artery

Fibrous cap (firm and white) on superficial part of luminal surface

Deep part is yellow to white and soft

Atheroma in middle of large plaque with yellow porridge like debris

45
Q

Histology of AS

A

Fibrous cap ( thick band of collagen rich connective tissue , numerous smooth muscles, macrophages endothelium in lumen side)

Under cap ( varying number of smooth muscles , macrophages, with deposit of lipids)

Beneath ( rich number of macrophages full of lipids (foam cells), t lymphocytes, necrosis ( mass of lipid material, cholesterol clefts, cellular debris. Lipid laden foam cells )

46
Q

Main arteries with plaques

A

Origin aorta ( mostly below origin of renal arteries)

Coronary arteries

Popliteal arteries

Descending thoracic artery

Internal carotid

Circle of Willis

47
Q

Vessels generally spared by As

A

Upper extremities vessels

Mesenteric artery

Renal arteries

48
Q

Complicated lesions components

A

Calcification - make arteries rigid and eggshell brittle

Plaque rupture , fissuring or ulceration - exposure of subendothelial collagen and thrombus formation —> rupture leads to discharge of content of plaque into blood causing cholesterol emboli —> intra plaque hemorrhage at vasa vasorum

49
Q

Superimposed thrombosis cause and consequence

A

Thrombosis and intraplaque hemorrhage accumulation

Can lead to occlusion of medium sized muscular arteries

50
Q

Clinical manifestations of AS - Slow, insidious narrowing of vascular lamina —> ischemia of tissues leads to

A

Angina , Chronic IHD with risk of cardiac failure

Peripheral vascular disease, dry gangrene , intermittent claudication

Atherosclerotic cerebral atrophy, dementia

Carotid atheroma with transient ischemic attacks

Renal artery stenosis with risk of secondary hypertension

Mesenteric artery occlusion with risk of ischaemic enteritis / colitis

51
Q

Clinical presentation of Sudden occlusion of lumen by superimposed thrombosis or intraplaque hemorrhage ( thrombosis )

A

Myocardial infarction

Peripheral gangrene

Infarctive stroke

Gangrenous bowel

52
Q

Clinical presentation of emboli

Due to superimpose md thrombi

A

Transient ischemic attack
Cerebral infarction
Renal infarct
Mesenteric artery occlusion + gangrenous bowel

53
Q

Clinical presentation of aneurysm

A 
Severe cases 
Ischaemic atrophy 
Loss of elastic tissue 
Weakness of vessel wall
Rupture 
Cause death

Cardiovascular Module (21 decks)

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