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
Unsaturated fat is androgenic. T/F
F not
26
Excessive refined carbohydrates _______, ____eases blood lipid cholesterol lipoprotein
sucrose incr
27
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
28
physical activity may reduce the incidence of complicated atheroma T/F
T
29
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
30
Atherosclerosis is (more or less?) common in low socioeconomic person.
More
31
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
32
heavy drinking is associated with hypertension and excess cardiac events. T/F
T
33
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
34
Major risk factors of atherosclerosis • High ____ and ____ levels • Hypertension • Cigarette smoking • Type ___ diabetes • Physical ______ • High ______ fat • Obesity
Cholesterol and Triglyceride 2 inactivity Saturated
35
lesser/uncertain potentially controllable risk factors of atherosclerosis •_____ •_____ level • hardened _____ fat intake •_______ pneumoniae
alcohol Lipoprotein (trans)unsaturated Chlamydia
36
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
37
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
38
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
39
Arteriosclerosis Literally, " ________________ ;" due to ______ of the blood vessel wall
hard arteries thickening
40
Three pathologic patterns of Arteriosclerosis _______,_________, and __________
atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis
41
__________ is the most common type of arteriosclerosis
Atherosclerosis
42
Atherosclerosis Affects ____ arteries and _________ sized muscular arteries
elastic large/medium-
43
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
44
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
45
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
46
Fatty streak Aka ____________ lesions
early atherosclerotic lesions
47
Characteristics OF ATHEROSCLEROSIS •Lipid-laden macrophages and SMCs produce ______ (e.g.,_____) → development of a ___________(____)
extracellular matrix collagen; fibrous plaque (atheroma)
48
fibrous plaque in atherosclerosis Aka _________
atheroma
49
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
50
the ______ and _____ of calcification of the intima affect the risk of complication
amount and pattern
51
Characteristics OF ATHEROSCLEROSIS Basically, Plaque rupture → exposure of _________ (e.g., collagen) → _______ formation with vascular occlusion or ________
thrombogenic material thrombus spreading of thrombogenic material
52
Foam cells are typical and specific for atherosclerotic changes. T/F
F Not specific for it
53
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)
medium Peripheral vascular disease ; Angina; Ischemic bowel myocardial infarction ; stroke atherosclerotic emboli; cholesterol crystals aneurysm
54
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
55
claudication is ????
Leg cramping
56
Arteriolosclerosis: _______ of the _____ arteries and _______ Two main types are ______ and ________
hardening; small; arterioles Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis
57
Hyaline arteriolosclerosis Deposition of ______ (above or below?) the endothelium due to _____ H&E:__________ deposits (____) within the arteriolar walls
proteins Below; leakage pink amorphous; hyaline
58
Causes of hyaline arteriolosclerosis: __________ hypertension, chronic ______ , and _________
chronic essential diabetes normal aging
59
Hyperplastic arteriolosclerosis Proliferation of ___________ cells in response to __________ H&E: "_______ " appearance of the arteriole
subendothelial smooth muscle very high blood pressure onion-skin
60
Cause of hyperplastic arteriolosclerosis _________ hypertension
malignant
61
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
62
intima is involved in Mönckeberg arteriosclerosis T/F
F intima is not involved)
63
in Mönckeberg arteriosclerosis There is blood flow obstruction. T/F
F There is no blood flow obstruction.
64
Treatment of atherosclerosis ______ changes Surgery like _______,______,_____ etc And medications
Lifestyle Angioplasty +stent, bypass surgery, endarterectomy
65
Medications of atherosclerosis include ______ medication eg_____ ______ medication eg_____ ______ medication eg___,__,___
Cholesterol; statins Anti-platelets; aspirin Blood pressure; beta blockers, ACE inhibitors, diuretics