Atherosclerosis

Question 1

What is the definition of atherosclerosis

Answer 1

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

As a consequence , the arterial walls thicken and harden

Question 2

What is arteriosclerosis

Answer 2

The thickening of the walls of arteries and arterioles due to accumulation of lipids.

Question 3

What are macroscopic features of atherosclerosis?

Answer 3

Fatty streak ( an early stage warning) - yellow & slightly raised. This is lipid deposits in the intima.

The simple plaque - raised yellow and white. And widely distributed.

The complicated plaque - this is where something else has happened for example thrombosis , calcification , aneurysms formation , haemorrhage in the plaque.

Question 4

What are common sites of atherosclerosis?

Answer 4

Aorta - especially abdominal

Coronary arteries
Carotid arteries

Cerebral arteries
Leg arteries

Question 5

What are microscopic features of atherosclerosis?

Answer 5

1. Early stages : foam cells accumulation, extracellular lipid , proliferation of smooth muscle.
2. Later changes : fibrosis , necrosis , cholesterol clefts because the cholesterol crystallises , a decrease or increase in inflammatory cells

More later changes : disruption of the internal elastic lamina , damage extends into the media , in growth of blood vessels , plaque rupturing / fissuring.

Question 6

What are clinical effects of atherosclerosis?

Answer 6

Ischaemic heart disease 
Sudden death 
MI
angina pectoris 
Arrythmia 
Cardiac failure 

CEREBRAL ISHCAEMIA

• cerebral infaraction ( stroke)
• multi infaract dementia

INTESTINAL INFARCTION

Peripheral vascular disease

• leriche syndrome ( pain in the buttocks during exercise )
• ischaemic rest pain ( get pain in their legs even when they are at rest)
• worst case : gangrene

Question 7

What factors increase the risk of atherosclerosis?

Answer 7

1. Males are more at risk than females presumed hormonal basis
2. Age - slowly progressive through adult life
3. Cigarette smoking is a MAJOR risk factor
4. Excess alcohol
5. Diabetes mellitus
6. Infection which can contribute to this
7. Hyperlipidaemia : high plasma LDL contributes. High HDL levels is protective
8. Oral contraceptives ( but not so much now due to les soestrogen )
9. Those who. Are extremely stressed / personality type
10. STRONG genetic predisposition

Question 8

Why is atherosclerosis unpredictable sometimes ?

Answer 8

Because there could be genetic variations is Apo E which are associated with changes in LDL levels.

Thus , you can do everything you can to prevent development of atherosclerosis but still get it due to genetic predisposition

Question 9

Symptoms with hyperlipidaemia

Answer 9

Xanthelasma - yellow deposits of cholesterol deposits usually found on the eyelids of the skin.

Corneal Arcus ( fat deposits in the outer part of the cornea )

Tendon xanthoma ( nodules found and palpules found one the tendons of the hands )

Question 10

How to prevent developing atherosclerosis?

Answer 10

Don’t smoke

Reduce fat intake

Treat hypertension

Don’t drink too much alcohol

Regular exercise / weight control

Question 11

How to intervene with atherosclerosis?

Answer 11

• tell patients to stop smoking
• tell patients to modify diet
• treat patients hypertension
• treat diabetes
• lipid lowering drugs

Question 12

What are the cells involved in atherosclerosis?

Answer 12

1. Endothelial cells: key role in haemostasis , altered permeability to lipoproteins , stimulation and proliferation of smooth muscle cells.
2. Platlets : key role In haemostaiss , stimulates proliferation and migration of smooth muscle cells.
3. Smooth muscle cells : take up LDL and other lipid to become foam cells .
4. Macrophages : oxidise LDL to become foam cells.
5. Lymphocytes :
6. Neutrophils : secrete proteasses leading to continued local damage and inflammation