Atherosclerosis Flashcards
Calcification of the walls of muscular arteries, typically involving the internal elastic membrane. Does not encroach of vessel lumen and not clinically significant.
Monckeberg medial sclerosis
Two most important causes of endothelial dysfunction
Hemodynamic disturbances
Hypercholesterolemia and dyslipoproteinemias
Foam cells and their effect
Modified LDL accumulated in macrophages in hyperlipidemia
Directly impair endothelial cell function
Produced by inflammasome activation from foam cells
IL1
Result of inflammation in hyperlipidemia
Smooth muscle cell proliferation and synthesis of ECM proteins
Infections that can cause endothelial injury in vessels
Herpesvirus
CMV
Chlamydophila pneumonia
Factors that drive intimal smooth muscle proliferation and matrix synthesis to stabilize atherosclerotic plaques
PDGF
Fibroblast growth factor
TGF-alpha
Frequency of vessel involvement in atherosclerosis
Lower abdominal aorta
Coronary arteries
Popliteal A
Internal carotid A
Vessels in circle of Willis
Composition of fatty streak in atherosclerosis
Lipid filled foamy macrophages that coalesce
Intimal thickening plus lipid accumulation that encroach on vessel lumen
Atherosclerotic plaque
Composition of superficial fibrous cap on atherosclerotic plaque
Smooth muscle cells and relatively dense collagen
Shoulder of atherosclerotic plaque
Beneath and to the side of the cap. More cellular area containing macrophages, T cells, and smooth muscle cells
Deep to fibrous cap of atherosclerotic plaque
Necrotic core
Composition of necrotic core of an atherosclerotic plaque
Lipids
Debris from dead cells
Foam cells
Fibrin
Thrombus
Other plasma proteins
Type of lipids primarily found in necrotic core of atherosclerotic plaque
Cholesterol and cholesteryl esters
Possible pathologic changes in an atheromatous plaque
Rupture, ulceration, or erosion of the plaque surface
Thrombosis
Hemorrhage into plaque
Atheroembolism
Aneurysm formation
Soft, velvety, yellow, flat papules or plaques on the eyelids
Xanthelasma
Subcutaneous nodules on the Achilles tendon, associated with atherosclerosis
Tendinous xanthomas
Possible physical exam findings in atherosclerosis
Xanthelasma
Tendinous xanthomas
Eruptive xanthoma
Arcus senilis
Lipid deposit in cornea, common in elderly or younger with hyperlipidemia
Arcus senilis
Complications of atherosclerosis in the coronary arteries
IHD
Exercise induce CP
MI
Complication of atherosclerosis in the mesenteric artery
Ischemic colitis
Complications of atherosclerosis in iliac A
Claudication pain
Limb gangrene
Impotence
Complications of atherosclerosis in femoral and/or popliteal A
Claudication pain
Limb gangrene
Complications of atherosclerosis in renal A
Elevated renin and aldosterone
Secondary HTN
Complication of atherosclerosis in the subclavian A
Subclavian steal syndrome
Indicator of significant atherosclerotic disease
Subclavian steal syndrome
Exercise leads to ischemia due to increased metabolic demand in affected arm. Affected arm is perfused through retrograde flow in the ipsilateral vertebral A, leading to diminished posterior cerebral circulation. Pt has vertigo and lightheadedness 2/2 vertebrobasilar insufficiency.
Subclavian steal syndrome
Early stage characteristics of atherosclerotic stenosis
Outward vessel remodeling
Preserved lumen patency
Cut-off point for critical stenosis
Occlusion of 70% of vessel lumen
Three general acute atherosclerotic plaque changes
Rupture/fissuring
Erosion/ulceration
Hemorrhage into the atheroma
Characteristics of vulnerable atherosclerotic plaques
Thin fibrous caps
Large lipid cores
Greater inflammation
Characteristics of stable atherosclerotic plaques
Thickening and densely collagenous fibrous caps
Minimal inflammation
Underlying atheromatous core
