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atherosclerosis Flashcards

1
Q

Atherosclerosis
-is characterized by lesions called _______ or ______

• they (Weaken or Strengthen?) the underlying ______

A

atheromas or atheromatous/fibrofatty plaques

Weaken; media

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2
Q

In Atherosclerosis, the atheromas do not protrude into and obstruct vascular lumen

T/F

A

F

They do

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3
Q

Atherosclerosis

• It is one of the 3 morphologic patterns of ___________.

• Others are
___________
__________

A

arteriosclerosis

Monckeberg Medial Calcific Sclerosis - Arteriolosclerosis

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4
Q

the cause of atheroma is ( simple or complex?) and __________.

A

Complex

multifactorial

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5
Q

Atherosclerosis

There are many risk factors. The various risk factors are considered in three main groups by some authors.

________
_________
_________

A

ENDOGENOUS FACTORS

ENVIRONMENTAL FACTORS

DISEASES

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6
Q

Aetiology of atherosclerosis
ENDOGENOUS FACTORS
•_____
•_____
•______ factors
•______ differences

A

Age

Sex

Genetic

Racial

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7
Q

ENDOGENOUS FACTORS
• Age
• atherosclerosis is a slow complex disease that typically starts in ______ and often progresses when people grow older.

A

childhood

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8
Q

In some people atherosclerosis progresses rapidly in the third decades

T/F

A

T

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9
Q

ENDOGENOUS FACTORS
• Sex
• in men risk increases after the age of _____ and in woman risk increases after the age ——-.

A

45

55

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10
Q

IHD- ____________

A

Ischemic heart disease

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11
Q

The lower incidence of IHD in women, especially in premenopausal age, is probably due to high levels of _________, both of which have anti- atherogenic influence.

A

oestrogen and high- density lipoproteins

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12
Q

ENDOGENOUSFACTORS

Genetic factors

• A well-established _____ predisposition to atherosclerosis and ischaemic heart disease is most likely _______.

• Genetic defects in _____ metabolism causing ______ are associated with accelerated atherosclerosis,

A

familial; polygenic

lipoprotein; hyperlipoproteinemia

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13
Q

____zygous familial hypercholesterolemia which often results in myocardial infarction before age ____ years

A

homo

20

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14
Q

Monozygotic twin of an affected individual of atherosclerosis has ____-fold increase compared to the general population.

A

eight

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15
Q

ENDOGENOUS FACTORS

• Racial differences

• (higher or lower ?) fasting blood glucose and (lesser or greater?) prevalence of diabetes in blacks and (lower or greater?) high-density lipoprotein values than in white men.

A

Higher
Greater
Lower

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16
Q

there is a striking difference in obesity between white and black women

T/F

A

T

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17
Q

ENVIRONMENTALFACTORS

• Higher incidence of atherosclerosis in (developed or underdeveloped ?) countries and low prevalence in (developed or underdeveloped?) countries, suggests the role of environmental influences.

A

Developed

Underdeveloped

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18
Q

Indeed, of all the known risk factor, _________ seems to be the most important determinant of the geographic differences in the incidence of atherosclerotic coronary artery disease.

A

serum cholesterol

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19
Q

ENVIRONMENTAL FACTORS

Cigarette smoking
• There is substantial (lesser or greater?) mortality from cigarette smoking.

The death rate depends on ____________

A

Greater; number of cigarettes smoked.

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20
Q

Cigarette smoking alter lipid profile

T/F

A

T

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21
Q

Cigarette smoking alter lipid profile.

(Low or High?) levels of HDL and (lower or higher?( values of LDL and triglycerides have been documented in heavy smokers.

Endothelial injury consequent to ______ exposure and chronic _____ that results in rapid ————— in smokers seems to be some of the mechanisms involved.

A

Low

Higher

carbon monoxide; hypoxia; aggregation of platelets

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22
Q

ENVIRONMENTAL FACTORS
• Cigarette smoking

It is a major risk factor for developing coronary artery disease, producing a marked decline in _____ dependent vasomotor response. It causes endothelial _______, possibly through increased _______, and this is also true for __________ or _________.

Significant increases in _______ and _____ are demonstrable in smokers and ___________ metabolites are reduced significantly.

A

endothelium; dysfunction

oxidative stress; passive smoking or environmental tobacco smoke

sICAM-1 and sVCAM-1

nitric oxide

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23
Q

ENVIRONMENTALFACTORS
• Hyperlipoproteinemia and diet

Meat, egg, and milk contain mostly (saturated or unsaturated?) fats and considerable quantities of ______, which leads to the concentration of ____LP in the plasma tend to be high.

A

Saturated; cholesterol

low density

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24
Q

Diet rich in (saturated or unstaturated?) fats and cholesterol is androgenic.

A

saturated

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25
Q

Unsaturated fat is androgenic.

T/F

A

F

not

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26
Q

Excessive refined carbohydrates _______, ____eases blood lipid cholesterol lipoprotein

A

sucrose

incr

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27
Q

ENVIRONMENTAL FACTORS
• Lack of exercise

It has been shown that people with sedentary life style generally suffer (more or less?) from coronary artery disease than those with strenuous jobs.

A

More

28
Q

physical activity may reduce the incidence of complicated atheroma

T/F

A

T

29
Q

Individual with coronary prone behaviours such as ______,________,____,_______ (Type ___ personality) have a _______-fold increase risk of coronary artery disease compared with type ___ behaviour of _______ and ______ type.

A

time urgency, aggressiveness, ambition, competitiveness

A

two- to three

B; relaxed and happy- go-lucky

30
Q

Atherosclerosis is (more or less?) common in low socioeconomic person.

A

More

31
Q

ENVIRONMENTAL FACTORS
• Alcohol

A moderate intake of alcohol (_______ a day) appears to offer some protection from coronary disease

T/F

A

2 to 4 units

T

32
Q

heavy drinking is associated with hypertension and excess cardiac events.

T/F

A

T

33
Q

ENVIRONMENTAL FACTORS
• Other dietary factors

Diet deficient in _____,_______, and __________ fatty acids are associated with increased risk of vascular disease.

Low level of Vitamin ____, and other anti-oxidants may enhance the production of oxidized LDL.

A

fresh fruits, vegetables and polyunsaturated

E

34
Q

Major risk factors of atherosclerosis

• High ____ and ____ levels
• Hypertension
• Cigarette smoking
• Type ___ diabetes
• Physical ______
• High ______ fat
• Obesity

A

Cholesterol and Triglyceride

2

inactivity

Saturated

35
Q

lesser/uncertain potentially controllable risk factors of atherosclerosis

•_____
•_____ level
• hardened _____ fat intake
•_______ pneumoniae

A

alcohol

Lipoprotein

(trans)unsaturated

Chlamydia

36
Q

INSUDATION HYPOTHESIS/VIRCHOW’S IMBIBITION THEORY

• Virchow holds that atheromatous deposits are lined by __________
• Hence B Lp from plasma is imbibed through _____ (by _____) where it splits into ______ and ____
• These are retained and deposited while _____ are removed in the circulation.
• There is ________ connective tissue proliferation by _____ reaction towards cholesterol

A

vascular endothelium

endothelium; stress

cholesterol and its esters

PLs(phospholipids)

sub-intimal ; fibroblastic

37
Q

ENCRUSTATION THEORY
• First suggested in the 19th century by _______
• He asserted that materials from blood is deposited on the ____ surface of arteries and leads to _____ of the ____ lining
• A mordern version of this theory holds that _____ represents the initial event in atherosclerosis. Organization of these, leads to the formation of _____ & expansion of these lesions reflects repeated episodes of ______ and ____

A

Rokitansky

inner; thickening; inner

thrombi; plaques

thrombosis & organization

38
Q

THROMBOGENIC HYPOTHESIS

• This proposes that thrombus is _____________
• Lipid is derived from _______ and cells stimulated to proliferation by _____

A

incorporated into the intima of blood vessels

cell membrane

PDGFs

39
Q

Arteriosclerosis

Literally, “ ________________ ;” due to ______ of the blood vessel wall

A

hard arteries

thickening

40
Q

Three pathologic patterns of Arteriosclerosis

_______,_________, and __________

A

atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis

41
Q

__________ is the most common type of arteriosclerosis

A

Atherosclerosis

42
Q

Atherosclerosis

Affects ____ arteries and _________ sized muscular arteries

A

elastic

large/medium-

43
Q

Characteristics OF ATHEROSCLEROSIS

______ on the endothelium leads to Endothelial ______, which leads to
Invasion of ______ cells (mainly _____ and ______) through the disrupted endothelial barrier

A

Chronic stress; dysfunction; inflammatory; monocytes and lymphocytes

44
Q

Characteristics OF ATHEROSCLEROSIS

Adhesion of platelets to the damaged vessel wall → platelets release inflammatory mediators (e.g., cytokines) and _________ which stimulates ______ and _____ of _______ cells (___) in the tunica ______ and mediates differentiation of ________ into _____

A

platelet-derived growth factor (PDGF)

migration and proliferation ; smooth muscle ; SMC

intima; fibroblasts into myofibroblasts

45
Q

Characteristics OF ATHEROSCLEROSIS

•Inflammation of the vessel wall

•Macrophages and SMCs ingest _____ from ______ and transform into _____ that accumulate to form _______

A

cholesterol; oxidized LDL; foam cells.

fatty streaks

46
Q

Fatty streak

Aka

____________ lesions

A

early atherosclerotic lesions

47
Q

Characteristics OF ATHEROSCLEROSIS

•Lipid-laden macrophages and SMCs produce ______ (e.g.,_____) → development of a ___________(____)

A

extracellular matrix

collagen; fibrous plaque (atheroma)

48
Q

fibrous plaque in atherosclerosis

Aka

_________

A

atheroma

49
Q

Characteristics OF ATHEROSCLEROSIS

•________ cells in the atheroma (e.g., macrophages) secrete matrix _________ that lead to _______ of the fibrous cap of the plaque due to the __________

By this time, a minor stress is enough to rupture the fibrous cap

Leading to ________ of the intima

A

Inflammatory; metalloproteinases

weakening; breakdown of extracellular matrix

Calcification

50
Q

the ______ and _____ of calcification of the intima affect the risk of complication

A

amount and pattern

51
Q

Characteristics OF ATHEROSCLEROSIS

Basically,

Plaque rupture → exposure of _________ (e.g., collagen) → _______ formation with vascular occlusion or ________

A

thrombogenic material

thrombus

spreading of thrombogenic material

52
Q

Foam cells are typical and specific for atherosclerotic changes.

T/F

A

F

Not specific for it

53
Q

COMPLICATIONS of atherosclerosis

  1. Stenosis of _____-sized vessels results in impaired blood flow and ischemia leading to
    i.__________ (lower extremity arteries, e.g., popliteal)
    ii.______ (coronary arteries)
    iii. ________ disease (mesenteric arteries)
  2. Plaque rupture with thrombosis results in _______ (coronary arteries) and ____ (e.g., middle cerebral artery).
  3. Plaque rupture with embolization results in ___________, characterized by _________ within the embolus
  4. Weakening of vessel wall results in ________ (e.g., abdominal aorta)
A

medium

Peripheral vascular disease ; Angina; Ischemic bowel

myocardial infarction ; stroke

atherosclerotic emboli; cholesterol crystals

aneurysm

54
Q

DOWNSTREAM CELLULAR Injury/DEATH
In atherosclerosis

Coronary arteries = _________ and __________

Internal carotid and & middle cerebral >- ________ and _______

Superior mesenteric > __________

popliteal artery >-______ ISCHEMIA
( ______ + _______ )

A

ANGINA +MYOCARDAIL INFARCTION

STROKE +CEREBRAL ATROPHY

SMALL INTESTINE

PERIPHERAL

gangrene +claudication

55
Q

claudication is ????

A

Leg cramping

56
Q

Arteriolosclerosis: _______ of the _____ arteries and _______

Two main types are
______ and ________

A

hardening; small; arterioles

Hyaline arteriolosclerosis
Hyperplastic arteriolosclerosis

57
Q

Hyaline arteriolosclerosis

Deposition of ______ (above or below?) the endothelium due to _____

H&E:__________ deposits (____) within the arteriolar walls

A

proteins

Below; leakage

pink amorphous; hyaline

58
Q

Causes of hyaline arteriolosclerosis:

__________ hypertension, chronic ______ , and _________

A

chronic essential

diabetes

normal aging

59
Q

Hyperplastic arteriolosclerosis

Proliferation of ___________ cells in response to __________

H&E: “_______ “ appearance of the arteriole

A

subendothelial smooth muscle

very high blood pressure

onion-skin

60
Q

Cause of hyperplastic arteriolosclerosis

_________ hypertension

A

malignant

61
Q

Mönckeberg arteriosclerosis (less common)

______ calcification of the _____ and internal elastic lamina causes stiffening of the arteries
Mainly affects ______-sized arteries

X-ray:______ appearance

A

Dystrophic; media

medium

pipestem

62
Q

intima is involved in Mönckeberg arteriosclerosis

T/F

A

F
intima is not involved)

63
Q

in Mönckeberg arteriosclerosis

There is blood flow obstruction.

T/F

A

F

There is no blood flow obstruction.

64
Q

Treatment of atherosclerosis

______ changes

Surgery like _______,______,_____ etc

And medications

A

Lifestyle

Angioplasty +stent, bypass surgery, endarterectomy

65
Q

Medications of atherosclerosis include

______ medication eg_____

______ medication eg_____

______ medication eg___,__,___

A

Cholesterol; statins

Anti-platelets; aspirin

Blood pressure; beta blockers, ACE inhibitors, diuretics

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