atherosclerosis Flashcards
Atherosclerosis
-is characterized by lesions called _______ or ______
• they (Weaken or Strengthen?) the underlying ______
atheromas or atheromatous/fibrofatty plaques
Weaken; media
In Atherosclerosis, the atheromas do not protrude into and obstruct vascular lumen
T/F
F
They do
Atherosclerosis
• It is one of the 3 morphologic patterns of ___________.
• Others are
___________
__________
arteriosclerosis
Monckeberg Medial Calcific Sclerosis - Arteriolosclerosis
the cause of atheroma is ( simple or complex?) and __________.
Complex
multifactorial
Atherosclerosis
There are many risk factors. The various risk factors are considered in three main groups by some authors.
________
_________
_________
ENDOGENOUS FACTORS
ENVIRONMENTAL FACTORS
DISEASES
Aetiology of atherosclerosis
ENDOGENOUS FACTORS
•_____
•_____
•______ factors
•______ differences
Age
Sex
Genetic
Racial
ENDOGENOUS FACTORS
• Age
• atherosclerosis is a slow complex disease that typically starts in ______ and often progresses when people grow older.
childhood
In some people atherosclerosis progresses rapidly in the third decades
T/F
T
ENDOGENOUS FACTORS
• Sex
• in men risk increases after the age of _____ and in woman risk increases after the age ——-.
45
55
IHD- ____________
Ischemic heart disease
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.
oestrogen and high- density lipoproteins
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,
familial; polygenic
lipoprotein; hyperlipoproteinemia
____zygous familial hypercholesterolemia which often results in myocardial infarction before age ____ years
homo
20
Monozygotic twin of an affected individual of atherosclerosis has ____-fold increase compared to the general population.
eight
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.
Higher
Greater
Lower
there is a striking difference in obesity between white and black women
T/F
T
ENVIRONMENTALFACTORS
• Higher incidence of atherosclerosis in (developed or underdeveloped ?) countries and low prevalence in (developed or underdeveloped?) countries, suggests the role of environmental influences.
Developed
Underdeveloped
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.
serum cholesterol
ENVIRONMENTAL FACTORS
Cigarette smoking
• There is substantial (lesser or greater?) mortality from cigarette smoking.
The death rate depends on ____________
Greater; number of cigarettes smoked.
Cigarette smoking alter lipid profile
T/F
T
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.
Low
Higher
carbon monoxide; hypoxia; aggregation of platelets
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.
endothelium; dysfunction
oxidative stress; passive smoking or environmental tobacco smoke
sICAM-1 and sVCAM-1
nitric oxide
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.
Saturated; cholesterol
low density
Diet rich in (saturated or unstaturated?) fats and cholesterol is androgenic.
saturated
Unsaturated fat is androgenic.
T/F
F
not
Excessive refined carbohydrates _______, ____eases blood lipid cholesterol lipoprotein
sucrose
incr
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.
More
physical activity may reduce the incidence of complicated atheroma
T/F
T
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.
time urgency, aggressiveness, ambition, competitiveness
A
two- to three
B; relaxed and happy- go-lucky
Atherosclerosis is (more or less?) common in low socioeconomic person.
More
ENVIRONMENTAL FACTORS
• Alcohol
A moderate intake of alcohol (_______ a day) appears to offer some protection from coronary disease
T/F
2 to 4 units
T
heavy drinking is associated with hypertension and excess cardiac events.
T/F
T
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.
fresh fruits, vegetables and polyunsaturated
E
Major risk factors of atherosclerosis
• High ____ and ____ levels
• Hypertension
• Cigarette smoking
• Type ___ diabetes
• Physical ______
• High ______ fat
• Obesity
Cholesterol and Triglyceride
2
inactivity
Saturated
lesser/uncertain potentially controllable risk factors of atherosclerosis
•_____
•_____ level
• hardened _____ fat intake
•_______ pneumoniae
alcohol
Lipoprotein
(trans)unsaturated
Chlamydia
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
vascular endothelium
endothelium; stress
cholesterol and its esters
PLs(phospholipids)
sub-intimal ; fibroblastic
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 ____
Rokitansky
inner; thickening; inner
thrombi; plaques
thrombosis & organization
THROMBOGENIC HYPOTHESIS
• This proposes that thrombus is _____________
• Lipid is derived from _______ and cells stimulated to proliferation by _____
incorporated into the intima of blood vessels
cell membrane
PDGFs
Arteriosclerosis
Literally, “ ________________ ;” due to ______ of the blood vessel wall
hard arteries
thickening
Three pathologic patterns of Arteriosclerosis
_______,_________, and __________
atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis
__________ is the most common type of arteriosclerosis
Atherosclerosis
Atherosclerosis
Affects ____ arteries and _________ sized muscular arteries
elastic
large/medium-
Characteristics OF ATHEROSCLEROSIS
______ on the endothelium leads to Endothelial ______, which leads to
Invasion of ______ cells (mainly _____ and ______) through the disrupted endothelial barrier
Chronic stress; dysfunction; inflammatory; monocytes and lymphocytes
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 _____
platelet-derived growth factor (PDGF)
migration and proliferation ; smooth muscle ; SMC
intima; fibroblasts into myofibroblasts
Characteristics OF ATHEROSCLEROSIS
•Inflammation of the vessel wall
•Macrophages and SMCs ingest _____ from ______ and transform into _____ that accumulate to form _______
cholesterol; oxidized LDL; foam cells.
fatty streaks
Fatty streak
Aka
____________ lesions
early atherosclerotic lesions
Characteristics OF ATHEROSCLEROSIS
•Lipid-laden macrophages and SMCs produce ______ (e.g.,_____) → development of a ___________(____)
extracellular matrix
collagen; fibrous plaque (atheroma)
fibrous plaque in atherosclerosis
Aka
_________
atheroma
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
Inflammatory; metalloproteinases
weakening; breakdown of extracellular matrix
Calcification
the ______ and _____ of calcification of the intima affect the risk of complication
amount and pattern
Characteristics OF ATHEROSCLEROSIS
Basically,
Plaque rupture → exposure of _________ (e.g., collagen) → _______ formation with vascular occlusion or ________
thrombogenic material
thrombus
spreading of thrombogenic material
Foam cells are typical and specific for atherosclerotic changes.
T/F
F
Not specific for it
COMPLICATIONS of atherosclerosis
- 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) - Plaque rupture with thrombosis results in _______ (coronary arteries) and ____ (e.g., middle cerebral artery).
- Plaque rupture with embolization results in ___________, characterized by _________ within the embolus
- Weakening of vessel wall results in ________ (e.g., abdominal aorta)
medium
Peripheral vascular disease ; Angina; Ischemic bowel
myocardial infarction ; stroke
atherosclerotic emboli; cholesterol crystals
aneurysm
DOWNSTREAM CELLULAR Injury/DEATH
In atherosclerosis
Coronary arteries = _________ and __________
Internal carotid and & middle cerebral >- ________ and _______
Superior mesenteric > __________
popliteal artery >-______ ISCHEMIA
( ______ + _______ )
ANGINA +MYOCARDAIL INFARCTION
STROKE +CEREBRAL ATROPHY
SMALL INTESTINE
PERIPHERAL
gangrene +claudication
claudication is ????
Leg cramping
Arteriolosclerosis: _______ of the _____ arteries and _______
Two main types are
______ and ________
hardening; small; arterioles
Hyaline arteriolosclerosis
Hyperplastic arteriolosclerosis
Hyaline arteriolosclerosis
Deposition of ______ (above or below?) the endothelium due to _____
H&E:__________ deposits (____) within the arteriolar walls
proteins
Below; leakage
pink amorphous; hyaline
Causes of hyaline arteriolosclerosis:
__________ hypertension, chronic ______ , and _________
chronic essential
diabetes
normal aging
Hyperplastic arteriolosclerosis
Proliferation of ___________ cells in response to __________
H&E: “_______ “ appearance of the arteriole
subendothelial smooth muscle
very high blood pressure
onion-skin
Cause of hyperplastic arteriolosclerosis
_________ hypertension
malignant
Mönckeberg arteriosclerosis (less common)
______ calcification of the _____ and internal elastic lamina causes stiffening of the arteries
Mainly affects ______-sized arteries
X-ray:______ appearance
Dystrophic; media
medium
pipestem
intima is involved in Mönckeberg arteriosclerosis
T/F
F
intima is not involved)
in Mönckeberg arteriosclerosis
There is blood flow obstruction.
T/F
F
There is no blood flow obstruction.
Treatment of atherosclerosis
______ changes
Surgery like _______,______,_____ etc
And medications
Lifestyle
Angioplasty +stent, bypass surgery, endarterectomy
Medications of atherosclerosis include
______ medication eg_____
______ medication eg_____
______ medication eg___,__,___
Cholesterol; statins
Anti-platelets; aspirin
Blood pressure; beta blockers, ACE inhibitors, diuretics
