Atherosclerosis

Question 1

Role of endothelial cells in heart

Answer 1

Maintenance of normal vessel homeostasis
Nonthrombogenic blood tissue interface
Modulate vascular resistance
Metabolize hormones

Question 2

Tight endothelial junctions

Answer 2

Can loosen when affected by hemodynamics factors (hypertension) and vasoactive agents (histamine)

Question 3

Role of vascular smooth muscle

Answer 3

Normal vascular repair
Migration and proliferation
Synthesis of collagen, elastin, proteoglycans

Question 4

Neointimal SMCs

Answer 4

Express a proliferation rather than contractile phenotype

Question 5

Arteriolosclerosis

Answer 5

Associated with htn, DM

Hyaline- mild chronic htn
Hyperplastic- malignant or accelerated htn; onionskin thickening

Question 6

Monckeberg Arteriosclerosis

Answer 6

Ring-like calcifications in the media of muscular arteries ( ulnar and radial)

Patients over 50

Palpable, seen on x ray

DOES NOT ALTER LUMEN SIZE or obstruct arterial flow

Question 7

Atherosclerosis

Answer 7

Most important and clinically significant

I final lesions called atherosclerotic plaques

Question 8

Lowers LDL

Answer 8

Omega-3 fatty acids and statins

Question 9

HDL Job

Answer 9

Mobilizes cholesterol from tissue, transports it to liver for excretion in bile

Question 10

Increase HDL

Answer 10

Exercise, EtOH

SOMETIMES LOWERED BY STATINS

Question 11

Hypercholesterolemia is induced by

Answer 11

Diabetes mellitus

Question 12

Inflammation marker

Answer 12

C reactive protein is a marker of inflammation and predicts risk of MI, stroke, peripheral artery disease

Question 13

Hyperhomocystinemia

Answer 13

Related to coronary artery disease, peripheral vascular disease, stroke

Question 14

Pathogenesis of atherosclerosis

Answer 14

1. Endothelial injury
2. Lipoproteins move into vessel wall
3. monocytes stick to injured endothelium and migrate into subendothelium where they turn into macrophages and foam cells
4. Platelets stick to injured endothelium
5. Factors are released by platelets, macrophages, and vascular wall cells (induce smooth muscle recruitment
6. SMCs proliferate and produce ECM
7. Lipid accumulates extracellularly and in cells

Question 15

Fatty streak

Answer 15

Collection of foamy macrophages in the intima

Question 16

Morphology of atherosclerotic plaques

Answer 16

Intimal thickening
Lipid accumulation
Covered by a fibrous cap
Patchy lesions
Inflammation

Question 17

Where is atherosclerosis more commonly found

Answer 17

Abdominal aorta > thoracic aorta

Question 18

Components of atherosclerotic plaques

Answer 18

SMCs, macrophages, T cells

Question 19

Critical stenosis

Answer 19

Chronic occlusion that significantly limits flow

Demand for oxygen exceeds supply

Anyone if > 70% occlusion

Question 20

Vulnerable Plaques

Answer 20

Fibrous cap in thinner
Lipid core is larger
Often does not cause clinically significant stenosis
Increased inflammation