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The Heart > Atherosclerosis > Flashcards

Atherosclerosis Flashcards

1
Q

Atherosclerosis

A

Fibro-inflammatory lipid plaque affecting elastic and muscular arteries
Develops over decades
Affects M 40-60 and post menopausal women

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2
Q

Arteriosclerosis

A

Caused by Ath/degenerative changes

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3
Q

Arteriolosclerosis

A

Thickening of arteriolar walls

Hyalinisation and hyperplasia

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4
Q

Stages of atherosclerosis and distribution

A

Initiation and formation/adaptation/clinical stages
Ath affects Abdominal aorta/coronary/popliteal/internal carotid/descending thoracic aorta/circle of Willis arteries
UL/renal/mesenteric arteries are spared

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5
Q

Macroscopic changes in atherosclerosis

A

White fibrous cap/Yellow grumous core
3-15mm diameter
Single or multiple and raised

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6
Q

Microscopic changes in atherosclerosis

A

Fibrous cap- SM/CT/proteoglycans/collagen/elastin
Core- lipid debris/plasma proteins/TL/fibrin/chol and chol esters/PC/SM/foamy Mac
Peripheral neovascularisation and CI

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7
Q

Effects of ath plaque

A

Asymptomatic
Calcification
Fissure/ulceration/embolisation/thrombosis/Hm leading to stenosis/infarct/atrophy/ischemia/aneurysm (may rupture due to high P)

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8
Q

Ath evolution

A

Foamy cells (IL-1/6/8 TNF MCP-1)
Fatty streak
Intimal lesions (ICAM/VCAM/selectins)
Fibrous lesions (MMP/PDGF/MPO/oxLDL/IL-18)
Complicated lesions and rupture (CD40-L and PAPP-A)
Ass. Acute phase reactants- Crp/SAA/WBC/PLA-2/fibrinogen

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9
Q

Ath risk factors

A

HTN >160/110 mm/hg
Smoking/stress/low PA/family history/coloured people
high fat diet/increased age/M>F/homocysteinemia/dyslipidemia
alterations in chol metabolism

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10
Q

Theories of ath

A

Lipid theory
Thrombotic theory
Monoclonal growth of SM cells

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11
Q

Fatty plaque

A

Precursor of atheroma and Ass. To high fat diet
Fatty spot 1mm to 10mm streak
Progression- recede/persist/conversion to fibrous plaque
Composition- fat laden mac and SM/fat droplets/TL/proteoglycans/collagen and elastin

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12
Q

Intimal cushion

A 
Ass. To ath changes (gelatinous lesion) 
White areas of intimal thickening (intimal SM and matrix)
Little collagen and lipids 
Occurs at Ostia (openings at BV exits) 
Affect BP over time
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13
Q

Intimal lesion

A

Ass. To HTN/smoking/stress
Caused by mechanical changes/hemodynamic stress/immune complex deposition/chemotherapy
Leads to increased intimal permeability/SM and Mac adhesion and proliferation/atheroma formation

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14
Q

Macrophages in atheroma

A

Monocytes/MGC/epithelioid mac/granulocytes/histiocytes
Monocyte (in blood)–> Mac (in tissues)
Adhesion/migration/phagocytosis
Mac produce IL-1/TNF (increase adhesion) and ROS/PDGF/TGF (SM chemotaxis)
Mac have scavenger R (modified VLDL-R) thus lipids are internalised/hydrolysed/esterified

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15
Q

SM cells

A

SM derived from (myo)intima
Stimulation of prol by PDGF/FbGF/EGF/TGF alpha
Inhibition of prol by heparin and TGF beta
SM cells proliferate/become fat laden/increased ECM production> atheroma

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16
Q

Complicated ath plaques

A

Erosion/ulceration/fissure/Hm/mural thrombi/rupture/aneurysm/calcification

17
Q

Ischemic HD

A

Highly ass. To cardiac mortality

Tx- beta blockers/angioplasty/thrombolysis

18
Q

Peripheral vascular disease

A

Pain while walking
Ischemia and gangrene
Increased in DM and RF for ath

19
Q

Mesenteric ischemia

A

Celiac and mesenteric arteries affected
Various symptoms none> intestinal angina/ischemia
Pain post meal/bloody diarrhoea
Infarct/obstruction/gangrene

20
Q

Cerebrovascular disease

A

Primary causes- thrombosis/Hm/embolism
Sites of occlusion-carotid bifurcation/middle cerebral/basilar Aa
Results in TIA/stroke

21
Q

Manckeberg calcific medial stenosis

A

Calcification of small and medium arteries
Femoral/radial/ulnar/genital
Affects >50yrs M=F
Primary causes- vasotonic/nicotine/adrenaline

22
Q

Arteriosclerosis/arteriolosclerosis

A

Hyaline changes in BVW due to plasma leakage and increased SM ECM
Ass. To HTN/DM/smoking
Affects- kidney/gallbladder/intestine/adrenal gland/pancreas
Leads to narrowing of BV lumen at small muscular Aa/arterioles

23
Q

Malignant HTN

A

> 160/110 Mm/hg
Progressive vascular compromise
Affect heart/brain/kidney/retina (arteriolar constriction and dilation> Hm/edema/necrosis)
Small muscular arteries undergo fibrinoid necrosis
SM prol in concentric pattern onion skin

The Heart (12 decks)

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