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Medicine Year 1 - Semester 2 - Part 1 > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

What is atherosclerosis ?

A

Gruel; hardness to elastic and medium-large arteries

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2
Q

What is an atheroma ?

A

Intimal fibrous cap
Central core rich in lipids

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3
Q

Clinical Significance of Atherosclerosis

A

IN 2016 - atherosclerosis was related to the top 2 causes of death

Although death rates from heart and circulatory diseases have fallen and plateoud from 1969 to 2017.

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4
Q

Describe features of symptomatic atherosclerosis

A

Contributes to 1/2 of all deaths (western world)

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5
Q

State some clinical conditions linked to atherosclerosis

A

MI
Stroke
Aneurysm
Peripheral Vascular Disease

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6
Q

How has the peak of deaths from atherosclerosis reduced from 1963 to the 2000’s ?

A

Improved methods of treatment
Prevention of recurrences
Prevention of atherosclerosis

50% decreased death rate heart attack
70% decreased death rate stroke

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7
Q

Risk Factors for atherosclerosis

A

Age
Sex
Genetics
Hyperlipidaemia
Hypertension
Smoking
Diabetes Mellitus

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8
Q

Hyperlipidaemia

A

Elevated concentrations of lipids/fats in the blood. (LDL)

One of the most prevalent risk factors contributing to the evolution of atherosclerosis.

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9
Q

What does hyperlipidaemia cause ?

A

Impairs endothelial function
Accumulates within intima
Causes oxidative modification of LDL

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10
Q

Describe oxidative modification of LDL

A

Inhibits the motility of macrophages

Stimulates the release of cytokines

Cytotoxic to endothelial and smooth muscle cells

Chemotactic centre for monocytes

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11
Q

State the stages of atherosclerosis

A

Initiation/ Formation Stage (subclinical)
Adaptation stage (subclinical)
Clinical Stage

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12
Q

How is atherosclerosis developed ?

A

Chronic endothelial injury/ dysfunction
Role of Lipids -
Role of macrophages
Smooth muscle proliferation
Formation of a fibro-lipid plaque
Injury to the plaque - thrombus formation

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13
Q

Describe chronic endothelial injury / dysfunction risk factors

A

Haemodynamic disturbances
Hypercholesterolemia
Hypertension
Smoking
Toxins
Viruses
Immune Reactions

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14
Q

What happens when endothelial cells are injured ?

A

This creates gaps in between endothelial cells
IN these gaps you get monocytes
Monocytes adhere to the endothelium

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15
Q

State the steps leading to atherosclerosis

A

Chronic Endothelial injury

Endothelial dysfunction (monocyte adhesion and immigration)

Smooth muscle emigration from media to intima
(macrophage activation)

Macrophages and smooth muscle cells engulf lipid

Smooth muscle proliferation, collagen and other ECM deposition, extracellular lipid

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16
Q

What does endothelial dysfunction lead to ?

A

Increased endothelial permeability

Increased leukocyte adhesion

Increased monocyte adhesion and migration

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17
Q

Yellow dots

A

Low density cholesterol

18
Q

Monocytes

A

Monocytes pass through the endothelium and change themselves into macrophages, eating away oxidised LDL.

19
Q

Function of macrophages

A

Macrophages eat away, phagocyte oxidised LDL

20
Q

Role of macrophages

What do they secrete ?

A

Engulf oxidised LDL = foam cells

Secrete :

  • IL1 (interleukin 1)
  • TNF (tumor necrosis factor)
  • MCP1
  • Growth factors
  • INterferon
21
Q

Fatty streak

A

Accumulation of LDL
Raised streak of yellow

22
Q

Foam cells

A

Macrophages that phagocytes oxidised LDL

23
Q

Role of smooth muscles proliferation

A

Collagen and ECM deposition

Fatty streak —> Mature fibro-fatty atheroma

24
Q

What happens once macrophages / foam cells die ?

A

The LDL cholesterol in the cytoplasm will form crystals.

All cholesterol forms a lipid debris centre.

25
Q

Summary of atheroma formation

A

Monocytes adhere and emigrate into the tunica intima.

Monocytes change into macrophages

In addition to monocytes, LDL also goes into the tunica intima and becomes oxidised .

Macrophages phagocytose, oxidise LDL

This forms foam cells and these cells produce granules which further attracts more monocytes.

Foam cells and granules cause migration of smooth muscle cells from the tunica media to the intima.

These muscle cells produce collagen, forming the fibrous caps.

Eventually the foam cells die and form cholesterol crystals in the centre

26
Q

Describe the morphology of atheromatous plaque

A

Patchy and raised white to yellow
0.3-1.5 cm

Core of lipid
Fibrous cap

26
Q

Where are atheroma commonly found ?

A

Abdominal aorta
Coronary Arteries
Popliteal arteries - back of leg
Descending thoracic aorta
Internal carotid arteries
Vessels of the circle of Willis

27
Q

Most common site of atheroma ?

A

Abdominal aorta

28
Q

Atheroma in coronary artery

A

Contributes to heart attacks

29
Q

Vessels of the Circle of Willis

A

Circuit of the blood vessels in the brain
Patient could have a stroke due to blockage

30
Q

How do complicated lesions look like ?

A

Calcification
Rupture or ulceration
Haemorrhage
Thrombosis
Aneurysmal dilation

31
Q

What are fatty streaks precursors to ?

A

Plaques

32
Q

Fatty streaks morphology

A

Foam cells and T lymphocytes
Elongated streaks 1cm or longer

Fatty dots <1mm

33
Q

Where are fatty dots found ?

A

IN the aorta, present before the age of 1 in everyone
In coronary artery from adolescence

34
Q

If there are complications, what can atherosclerosis lead to ?

A

Thrombosis
Calcification
Aneurysmal dilation
Ischaemic Events

35
Q

Describe what happens in the preclinical phase

A

Normal artery

Fatty streak

Fibrofatty plaque

Advanced/ vulnerable plaque

36
Q

Describe what happens in the clinical phase

A

Aneurysm and Rupture

Occlusion by thrombosis

Critical stenosis (progressive plaque growth)

37
Q

Primary prevention of atherosclerosis

A

Stop smoking
Control hypertension
Weight reduction
Lowering total LDL
Reduce calories intake

38
Q

Secondary prevention of atherosclerosis

A

Prevent complication

Antiplatelet drugs in thrombosis

Lower blood lipid levels

39
Q

What do smooth muscle cells produce ?

A

Collagen

40
Q

What is the white parts found in the left ventricle ?

A

Fibrous scar tissue - could be due to myocardial infarction.

41
Q

Why may the thyroid appear white ?

A

Auto-immune thyroiditis

Medicine Year 1 - Semester 2 - Part 1 (51 decks)

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