Atherosclerosis Flashcards
define atherosclerosis
Atherosclerosis is the accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries
Common sites
- Aorta- especially abdominal (AAA- Abdominal aortic aneursym)
- Coronary arteries
- Carotid arteries
- Cerebral arteries
- Leg arteries
normal arterial structure
- Endothelium
- Subendothelial connective tissue
- Internal elastic lamina
- Muscular media
- External elastic lamina
- Adventitia
macroscopic features of atherosclerosis
- Fatty streak
- Simple plaque
- Complicated plaque
fatty streak
early age of atheroma
- Lipid deposits in intima
- Yellow
- Relationship to atherosclerosis somewhat debatable
Simple plaque
- Raised yellow/white
- Irregular outline
- Widely distributed
Complicated plaque
- Thrombosis
- Haemorrhage into plaque
- Calcification- degenerate lipid material
- Aneurysm formation
microscopic features: early changes
1) Proliferation of smooth muscle cells
2) Accumulation of foam cells
3) Extracellular lipid
microscopic features: later changes
4) Fibrosis
5) Necrosis
6) Cholesterol cleft- where cholesterol used to be
7) +/- inflammatory cells
8) Disruption of internal elastic lamina
9) Damage extends into media
10) Ingrowth of blood vessels
11) Plaque fissuring
clinical effects of atherosclerosis
ischaemic heart disease
cerebral ischameia
mesenteric ischaemia
abdominal aortic aneurysm (AAA)
peripheral vascular disease
ischaemic heart disease
- Sudden death
- MI
- Angina pectoris
- Arrhythmias- irregular heart beats
- Tachycardia
- Bradycardia
- Atrial fibrillation
- Ventricular fibrillation
- Cardiac failures
Cerebral ischaemia
- Transient ischaemic attack
- Cerebral infarction (stroke)
- Multi-infarct dementia
Mesenteric ischaemia
in which injury to the small intestine occurs due to not enough blood supply
- Ischaemic colitis
- Malabsorption
- Intestinal infarction
Abdominal aortic aneurysm (AAA)
is a localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal. They usually cause no symptoms, except during rupture.
peripheral vascular disease
- Intermittent claudication
- Leriche syndrome
- Ischaemic rest pain
- Gangrene
intermittent claudication
painful to walk
- pain onset for a given distance gets shorter overtime
Leriche syndrome
- pain the buttock on exercise (erectile dysfunction)
Ischaemic rest pain
risk factors of atherosclerosis pathogenesis
age
gender
hyperlipidaemia
cigarette smoking
hypertension
DM
alcohol consumption
infection
Age
- Slowly progressive throughout adult life
- Risk factors operate over years