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Cardio > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

Atherosclerosis risk factors

A

Smoking
HTN
diabetes
Hyperlipidaemia

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2
Q

Where does atherosclerosis occur more frequently?

A

Birfucation/bends in blood vessels
Turbulent flow -> damage

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3
Q

What mechanism underpins atherosclerosis

A

Inflammation of macrophages
(can be due to lipid accumulation)

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4
Q

What is oxidised LDL?

A

Physically modified LDL which are highly inflammatory

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5
Q

What does oxidised LDL bind to

A

Scavenger receptors on macrophages
Allow removal of cholesterol by HDL

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6
Q

What is secreted by overactive macrophages (due to lipid accumulation)

A

ROS- O2 free radicals
Cytokines
Chemokines
MMP - enzymes that breakdown tissue
Apoptotic factors - kill host cells (can form an abscess)
Growth factors - trigger formation of scar tissue

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7
Q

What are the two inflammatory factors that macrophages release, and what do they do?

A

Cytokines (promotes endothelial adhesion of inflammatory cells)
Chemokines (attract monocytes)

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8
Q

What is the purpose of growth factors release?

A

Wound healing

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9
Q

What are the functions of metalloproteinases?

A

Breakdown collagen and fibrous gap by activating proteolysis, can lead to plaque rupture

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10
Q

What is released upon the death of overactive macrophages

A

Tissue factor (clotting factor)
OxyLipids - toxic and can trigger clotting in bloodstream

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11
Q

What is the fatberg model of atherosclerosis

A

Fat buildup in the artery walls -> atherosclerosis

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12
Q

What is the inflammatory model of atherosclerosis
(Virchow’s)

A

Chronic inflammation due increase in blood lipids -> atherosclerosis

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13
Q

What are the oxidative enzymes that macrophage release?

A

NADPH Oxidase - forms superoxide O2-, also H2O2 which kills off melanocytes
Inducible nitric oxide synthase (iNOS) - prod ^ conc of NO which can bind and destroy proteins
Myeloperoxidase - forms HOCl (beach), HONOO (Peroxynitrite which releases NO)

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14
Q

How do transcription factors affect contribute to atherosclerosis

A

Turned on by LDL/OxLDL -> macrophage activation

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15
Q

What is an endothelial erosion lesion

A

Selective death of endothelial cells -> Thrombosis (typically non-occlusive)
Related to diabetes as opposed to lipids
Can cause N-STEMI

Lower raters of hyperlipidaemia/hypertension
Greater rates of obesity w

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16
Q

What is the main transcription factor that regulates inflammation?

A

Nuclear Factor Kappa B (all receptors report here, which in turns activates upregulation of MMPs/IL-1 etc.)

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17
Q

What are modifiable risk factors for coronary heart disease?

A

Smoking, Lipids, Blood Pressure, Diabetes, Obesity, Sedentary Lifestyle

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18
Q

What are non-modifiable risk factors for coronary heart disease?

A

Age, Sex, Genetic Predisposition

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19
Q

What are the two types of macrophages?

A

Inflammatory and Non-inflammatory

20
Q

Macrophage functions?

A

Inflammatory - kill microorganisms
Non-Inflammatory - homeostasis like alveolar surfactant

21
Q

What is LDL and what does it do?

A

Low Density Lipoprotein - carries cholesterol from liver to rest of the body

21
Q

Explain the J curve

A

LDL cholesterol isn’t inherently bad, a small amount is necessary for normal function

High cholesterol levels = highest risk of CVD
Very low cholesterol levels > risk than moderate levels

22
Q

What is HDL and what does it do?

A

High Density Lipoprotein - carries cholesterol from peripheral tissues back to liver
Reverse cholesterol transport

23
Q

What are the functions of apoproteins?

A

Proteins on surface of LDL - dock molecule to the sites of delivery

bind lipids

24
Q

How can subendothelial LDL lead to inflammation?

A

LDLs leak through endothelial barrier
Become oxidised
Phagocytosed by macrophages -> foam cells (fatty macrophage)
Chronic inflamm

25
Q

What is a genetic disease that causes high cholesterol?

A

Familial Hyperlipidaemia - failure to clear LDL from blood

26
Q

What are the signs of familial hyperlipidaemia?

A

Xanthomas (fat bumps in skin), Early Atherosclerosis

27
Q

What is an enzyme involved in cholesterol production?

A

HMG-CoA-Reductase (targeted by statins)

28
Q

Mechanism of Cholesterol export pumps

A

ABCA1, ABCG1
Identify apolipoprotein A on HDL
Export cholesterol to ApoAHDL for removal from tissues

29
Q

What are the two macrophage scavenger receptors?

A

MSR A (CD204) // MCR B (CD36)

30
Q

What does MSR A bind to?

A

gram positive bacteria,
oxidised LDL,
dead cells

31
Q

What does MSR B bind to?

A

malaria parasites,
oxidised LDL,
dead cells

32
Q

What are the homeostatic roles of macrophage scavenger receptors

A

Safe clearance of OxLDL
Reverse cholesterol transport

33
Q

What is the main cytokine underpinning atherosclerosis

A

IL-1
triggers NFKb, cell death, prolif

34
Q

What is the main chemokine underpinning atherosclerosis

A

Monocyte chemotactic protein-1 (MCP-1) which binds CCR2

35
Q

What growth factors do macrophages release?

A

Platelet Derived Growth Factors
Transforming Growth Factor Beta

36
Q

Role of Platelet Derived Growth Factors
PDGF

A

vascular smooth muscle cell chemotaxis/survival/mitosis

37
Q

Role of Transforming Growth Factor Beta
TGFb

A

^ collagen synthesis
matrix deposition

38
Q

Components of Virchow’s triad

A

Underpins thrombosis
1. Abnormal blood flow - stenosis
2. Abnormal blood - ^clotting factor
3. Abnormal vessel wall - exposed collagen due to plaque, and damage

39
Q

Aspirin mechanism of action
- antiplatelet

A

Irreversibly blocks COX
.: platelets cannot make thromboxane A2 and aggregation is inhibited

40
Q

Clopidogrel mechanism of action

A

Irreversibly blocks ADP receptor on platelets

41
Q

Endothelial cells use of COX

A

Can make the prostacyclin PG12 which inhibits platelet aggregation

42
Q

How do thrombolytic agents work

A

E.g. Tissue Plasminogen activator/Strepokinase
Breakdown of plasminogen -> plasmin
activated plasmin can breakdown fibrin mesh

43
Q

Thrombosis signs and symptoms

A

Tissue necrosis
LOF on one side (Maj. ischaemic stroke)
Heart attack - severe chest pain w/ nausea

44
Q

What is contained within ruptured plaques

A

lots of activated macrophages with xs lipid

Cardio (10 decks)

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