Atherosclerosis & Hypertension

Question 1

What is atherosclerosis?

Answer 1

Disease of large and medium-sized arteries

Artery wall thickens and hardens as a result of a build up of fatty materials forming plaques or atheromas

Question 2

What is atheroma texture like?

Answer 2

it is porridge like

Question 3

What is arteriosclerosis?

Answer 3

Hardening and thickening of the arteries for any reason

Question 4

What is atherosclerosis?

Answer 4

When an artery wall thickens as a result of a build up of fatty material. Blockage can be partial or complete and this predisposis to thrombus formation resulting in ischaemic damage to cells.

Question 5

What is arteriosclerosis?

Answer 5

When an artery wall thickens as a result of a build-up of fatty material

Question 6

What is atherogenesis?

Answer 6

The process of development of atheromatous plaques

Question 7

What is arteriolosclerosis?

Answer 7

Thickening and hardening of arterioles

Question 8

What is the leading cause of death in the developed world?

Answer 8

Atherosclerosis (mostly due to ischaemic heart disease and stroke)

Question 9

What are the non-

modifiable risk factors for atherosclerosis?

Answer 9

Increasing age

Male gender

Family history

Question 10

What are the modifiable risk factors for atherosclerosis?

Answer 10

Hyperlipidaemia (LDL vs HDL

Hypertension

Cigarette smoking

Diabetes

Question 11

What are some other risk factors that can cause atherosclerosis?

Answer 11

Inflammation

Hyperhomocystenaemia

Lipoprotein A

Haemostatic factors

Metabolic syndrome

Question 12

What percentage of CV events occur in absence of overt risk factors?

Answer 12

Up to 20%

Question 13

What kind of effect do risk factors have?

Answer 13

They have an additive effect

Question 14

What is the response to injury hypothesis?

Answer 14

A normal vessel wall with endothelium, thin intima, and more fibrous tissue on outside called intima.

Chronic endothelial injury causes endothelial dysfunction and increased permeability and so white blood cells adhere to endothelium migrating into intima as well as platelets.

Monocytes become macrophages and then lymphocytes come in.

Smooth muscle cells proliferate within plaque and a big plaque filled with inflammatory cells is formed and an indentation in lumen of vessel is created.

Question 15

Is atherosclerosis always visibly problematic?

Answer 15

No sometimes lesions can appear silent.

Question 16

What are fatty streaks?

Answer 16

Fat deposits under surface of cells.

Question 17

Do fatty streaks always become atheromas?

Answer 17

No they can develop during childhood and never cause problems

Question 18

What are fibrous plaques?

Answer 18

Rasied lesions with soft lipid core covered by a firm fibrous cap and only involve a partial circumference of the wall.

Question 19

Is atherosclerosis present in veins?

Answer 19

No because it is a disease of arteries under pressure. Pulmonary trunk and veins are not typically affected.

Question 20

Does the aorta typically have atherosclerosis?

Answer 20

Yes

Question 21

Do upper limbs typically get atheromas?

Answer 21

Very rarely, cerebral arteries, coronary arteries

Question 22

What is calcification useful for?

Answer 22

Can be seen clearly on CT scan.

Question 23

What are some complications that are associated with atherosclerosis?

Answer 23

Calcification (easy to see on CT scan)

Ulceration and formation of atheroemboli which can occlude a branch downstream

Rupture or erosion of the surface of the atheroma causing thrombosis leading to occlusion of artery at that point or the thrombus can embolise and occlude another artery downstream.

Haemorrhage is bleeding within the plaque

Aneurysmal dilatation of the weakened artery wall

Question 24

What are major consequences of atherosclerosis?

Answer 24

Angina pectoris when coronary arteries become slowly narrowed due to being occluded by a thrombus on a plaque after the plaque has ruptured or by haemorrhage into a plaque causing myocardial infarction and sudden death.

In the brain atherosclerotic plaques in the Circle of Willis or carotid arteries can cause transient ischaemic attacks which result in strokes

In the peripheral arteries can cause intermittent claudication, impotence, and non-healing leg ulcers.

Weakening of aortic wall can cause an abdominal aortic aneurysm. Atheroemboli or thromboemboli that block arteries downstream such as those in the legs or kidney: gangrene of toes and kidney infarction can result.

Question 25

What are the types of hypertension?

Answer 25

Primary HT is essential hypertension or idiopathic hypertension

Secondary hypertension is caused by other conditions or drugs

Question 26

What are some causes of secondary hypertension?

Answer 26

Drugs

Renal and vascular diseases

Endocrine causes

Neurogenic causes

Pregnancy related causes

Question 27

What kind of drugs can cause secondary hypertension?

Answer 27

Corticosteroids, amphetamines

Question 28

What kind of conditions can cause secondary HT?

Answer 28

Chronic renal disease, acute glomerulonephritis and renal artery obstruction

Coarctation of aorta

Psychogenic causes

Cushing’s syndrome, hyperthyroidism

Question 29

What is the result of malignant hypertension?

Answer 29

Severe rise in BP

Renal failure

Retinal haemorrhages/exudes

Encephalopathy

Question 30

What are the 2 types of vascular diseases associated with hypertension?

Answer 30

Hyaline arteriolosclerosis

Hyperplastic arteriolosclerosis

Question 31

What is the difference between hyaline and hyperplastic arteriolosclerosis?

Answer 31

Hyaline: Homogenous eosinophilic hyaline thickening of tunica media. Lumen is narrowed with ischaemia of tissue.

Hyperplastic: Occurs in severe HT. Results in concentric proliferation of smooth muscle cells in the vessel wall giving an onion skin appearance.

In Other Words: Hyaline = eosinphilic hyaline thickening of tunica media and Hyperplastic = concentric thickening of smooth muscles.

Question 32

What causes hyaline arteriolosclerosis?

Answer 32

This is caused by injury to endothelial layer by high pressure state, leakage of proteins into the arteriolar wall, stimulating smooth muscle hypertrophy and fibrosis.

Question 33

What structures are larger in hyaline arteriologsclerosis?

Answer 33

Smooth muscle in the media and intimal thickening

Narrowed lumen causing ischaemia

Hyalinisation is the accumulation of amorphic eosinophilic material.

Question 34

In which condition does hyperplastic arteriolosclerosis typically occur?

Answer 34

In severe malignant HT

Concentric proliferation of smooth muscle cells in vessel wall give an onion skin appearance.

Question 35

Which condition do we typically see fibrinoid necrosis in?

Answer 35

Hyperplastic arteriolosclerosis

Question 36

What happens to the heart during hypertensive vascular disease?

Answer 36

LV hypertrophy

LA enlargement

Arrhythmias

Heart failure

Accelerated coronary atherosclerosis leading to myocardial infarctions

Big heavy hearts are often a risk factor for sudden death

Question 37

What causes strokes?

Answer 37

Infarctions or ischaemia from plaques

Haemorrhagic strokes are caused by hyaline arteriosclerosis or Charcot-Bouchard microaneurysms (aneurysms in the brain that can rupture)

Question 38

What is a risk factor for Dementia and encephalopathy?

Answer 38

Malignant HyperTension

Question 39

How does the kidney change in response to hypertensive vascular disease?

Answer 39

Arterioles that supply the glomeruli are most often affected

Glomeruli become ischaemic and non-functioning

Tubular function becomes impaired and chronic renal failure can result

Question 40

What is the usual problem with aortic atherosclerosis?

Answer 40

It often forms emboli that occurs elsewhere. Aortas are very wide and hard to occlude