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Phase 1 - S2 Pathology > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

what is an atheroma

A

accumulation of intracellular and extracellular lipids in the intima and media of large and medium sized arteries

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2
Q

what are the 3 possible macroscopic features of atheromas

A
  • fatty streak
  • simple plaque
  • complicated plaque
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3
Q

what are fatty streaks

A

lipid depositions in the intima giving a yellow and slightly raised appearance

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4
Q

what are simple plaques

A

depositions of lipids giving raised white/yellow areas which are irregularly shaped and widely distributed
they can merge together to form large areas

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5
Q

what are complicated plaques

A

simple plaques which have had something happen to them e.g. a haemorrhage of the plaque, a thrombosis, calcification or aneurysm formation

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6
Q

where are the most common sites for atherosclerosis

A
  • aorta
  • coronary arteries
  • leg arteries
  • cerebral arteries
  • carotid arteries
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7
Q

what are the layers of normal arteries

A
  • endothelium
  • sub endothelium CT
  • internal elastic lamina
  • muscular media
  • external elastic lamina
  • adventita
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8
Q

what are the microscopic features of atheromas

A
  • proliferation of smooth muscle cells
  • accumulation of foam cells
  • extracellular lipid
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9
Q

what are some of the later microscopic changes seen in atheromas

A

fibrosis, necrosis, cholesterol clefts, inflammatory cells, disruption of internal elastic lamina and so damage extends to media and plaque fissuring

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10
Q

what is fissuring

A

a split of the plaque, which exposures the vessel wall so leads to a thrombosis

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11
Q

what are the clinical affects of atherosclerosis

A

ischaemic heart disease giving:

  • death
  • MI
  • angina
  • cardiac failure

Cerebral ischaemia giving:

  • cerebral infarction
  • dementia

Mesenteric Ischaemia giving:

  • malabsorption
  • intestinal infarction

Peripheral Ischaemia giving:
- gangrene
-intermittent claudication
Leriche syndrome

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12
Q

what is intermittent claudication

A

there is pain in the calf muscles when walking which reduces with rest

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13
Q

what increases the chance of atherosclerosis

A
  • age
  • gender
  • smoking
  • hyperlipidaemia
  • diabetes
  • alcohol
  • infection
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14
Q

which gender are better protected from atherosclerosis

A

women

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15
Q

why does hyperlipidaemia cause atherosclerosis

A

there is a high plasma cholesterol and so particularly more LDLs are deposited and HDLs are protective

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16
Q

what are the physical signs of hyperlipidaemia

A
  • arcus
  • tendon xanthomas
  • xanthelasma
17
Q

how does hypertension cause atherosclerosis

A

high pressure causes endothelial damage

18
Q

what factors cause hereditary predisposition of atherosclerosis

A
  • variations in apoprotein metabolism and receptors
19
Q

what is atherosclerosis

A

the thickening and hardening of the arterial walls as a result of atheromas

20
Q

what are the 4 theories of the pathogenesis of atherosclerosis

A
  • thrombogenic theory
  • insudation theory
  • monoclonal hypothesis
  • reaction to cell injury
21
Q

what is the thrombogenic theory

A

that plaques formed due to repeated lipid derived thrombi with an overlying fibrous cap

22
Q

what is the insudation theory

A

where endothelial injury causes inflammation and increases the permeability of lipid from plasma

23
Q

what is the reaction to cell injury hypothesis

A

where plaques form in response to endothelial injury which increases permeability and allows platelet adhesion. monocytes can enter endothelium and smooth muscle cells proliferate and migrate

24
Q

what is the monoclonal hypothesis

A

where each plaque is monoclonal representing abnormal growth control

25
Q

what are the cells involved in atherosclerosis

A
  • endothelial cells
  • platelets
  • smooth muscle cells
  • macrophages
  • lymphocytes
  • neutrophils
26
Q

what do the endothelial cells do in atherosclerosis

A

cause an altered permeability to lipoproteins, cause the production of collagen and stimulate proliferation and migration of smooth muscle cells

27
Q

what do the platelets do in atherosclerosis

A

involved in homoeostasis, stimulation proliferation and migration of smooth muscle cells

28
Q

what do the smooth muscle cells do in atherosclerosis

A

take up LDLs and other lipids to become foam cells

synthesise collagen and proteoglycans

29
Q

what do the macrophages do in atherosclerosis

A

oxidise LDLs
take up lipids to become foam cells
secrete proteases which modify the matrix
stimulate proliferation and migration of smooth muscle cells

30
Q

what do the lymphocytes do in atherosclerosis

A

they secrete TNF which affects lipoprotein metabolism

stimulate proliferation and migration of smooth muscle cells

31
Q

what do the neutrophils do in atherosclerosis

A

secrete proteases leading to continued local damage and inflammation

32
Q

what causes endothelial damage

A

raised LDL
toxins
hypertension
stress

33
Q

what does endothelial damage cause

A 
platelet adhesion
growth factor release
smooth muscle proliferation and migration
LDL oxidation
lipid uptake by SMC and macrophages 
monocyte migration to intima
34
Q

what do foam cells do

A

further stimulate SMCs and recruit other inflammatory cells

35
Q

what can prevent atherosclerosis

A

no smoking, reduced fat intake, treat hypertension, limit alcohol, exercise

Phase 1 - S2 Pathology (13 decks)

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