Atherosclerosis

Question 1

What is arteriosclerosis? What is it usually as a result of?

Answer 1

The thickening of the walls of the arteries and arterioles usually as a result of hypertension or diabetes mellitus, often associated with loss of elasticity.

Question 2

What is atherosclerosis?

Answer 2

Accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries.

Question 3

What is atheroma?

Answer 3

Necrotic core of the atherosclerotic plaque. The thickening and hardening of arterial walls as a consequence of atherosclerosis.

Question 4

What are the different theories of atherosclerosis?

Answer 4

Thrombogenic theory, insudation theory, monoclonal hypothesis, reaction to injury hypothesis.

Question 5

Describe thrombogenic theory.

Answer 5

Plaques formed by repeated thrombi, lipid derived from thrombi, overlying fibrous cap, inflammation secondary effect.

Question 6

Describe insudation theory.

Answer 6

Endothelial injury, inflammation, increased permeability to lipid from plasma.

Question 7

What happens in the reaction to injury hypothesis?

Answer 7

Smooth muscle cells proliferate and migrate.

Question 8

Describe monoclonal hypothesis.

Answer 8

Each plaque is monoclonal, is each plaque a benign tumour? Could atherosclerosis have viral aetiology?

Question 9

What are the components of atherosclerotic plaque?

Answer 9

Cells: endothelial, platelets, neutrophils, macrophages, leucocytes, smooth muscle cells. Lipid: intracellular (foam cells) and extracellular (pools). Extracellular matrix: collagen, elastin and proteoglycans.

Question 10

Describe microscopic appearances in atherosclerosis.

Answer 10

Fatty streak: proliferation of smooth muscle cells, accumulation of foam cells, extracellular lipid. Simple plaque: fibrosis, necrosis, cholesterol cells. Complicated plaque: disruption of the internal elastic lamina, new vessel formation -> haemorrhage.

Question 11

Describe macroscopic appearance of fatty streak.

Answer 11

Lipid deposition, slightly raised yellow in the intima.

Question 12

Describe macroscopic appearance of simple plaque.

Answer 12

Raised yellow/white, irregular outline, widely distributed, enlarge and coalesce.

Question 13

Describe macroscopic appearance of complicated plaque.

Answer 13

Yellow and red (haem and thrombosis), irregular, rough, hard and calcified.

Question 14

What are some complications of atherosclerosis?

Answer 14

Ulceration, thrombosis, vasospasm, embolisation, calcification, haemorrhage, aneurysm formation, rupture of atherosclerotic artery.

Question 15

Effects of arterial narrowing and occlusion.

Answer 15

Ischaemia, infarction. Depends on the site.

Question 16

Describe atherosclerosis and carotid arteries.

Answer 16

Assessed TIA and strokes, atheromatous deposits can embolise to the cerebral circulation.

Question 17

Describe atherosclerosis and the brain.

Answer 17

Cerebral ischaemia: transient ischaemic attack, cerebral infarction, vascular dementia.

Question 18

Describe atherosclerosis and the heart.

Answer 18

Myocardial ischaemia: sudden death, MI, angina pectoris, arrhythmias, cardiac failure.

Question 19

Describe atherosclerosis and the GI tract.

Answer 19

Mesentric ischaemia: acute- intestinal infarction, chronic- ischaemic colitis malabsorption.

Question 20

Describe atherosclerosis and the peripheral arteries.

Answer 20

Peripheral vascular disease: acute limb ischaemia, intermittent claudication, ischaemic rest pain, gangrene.

Question 21

Describe atherosclerosis and the abdominal aorta.

Answer 21

Aneurysmal formation, rupture of AAA, thrombosis and emboli.

Question 22

What are risk factors?

Answer 22

Age, gender, hyperlipidaemia, smoking, hypertension, diabetes, alcohol, infection.

Question 23

How to reduce atherosclerotic burden.

Answer 23

Statins, anti-hypertensives, exercise, non smoker, CANTOS, manage diabetes, weight management.