Cardiopathology Flashcards
Arteriosclerosis
• Arteriolosclerosis
• Mönckebergmedial
calcific sclerosis
• Atherosclerosis,Arterial atherosclerosis
• Atherosclerosis
– ____ inflammatory disease of the arteries
• Progressive destruction and replacement of normal vessel structure
• Weaker and less ____ vessels
• Become permanently ____
• Atherosclerosis is one type of arteriosclerosis; there are three types: ○ Monckeberg medial calcific sclerosis ○ Atherosclerosis, arterial atherosclerosis - only occurs in the \_\_\_\_ (doesn't occur in capillaries or veins [unless you put the veins in the \_\_\_\_ for failing arteries])
multifactorial elastic dilated arteries arterial system
Atherosclerosis
• Uniquely human disease
• > ____of all deaths in the Western world
• Death due to atherosclerotic complications have decreased
– Change in ____ habits
– Improved treatment of ____ – ____ of recurrence
* Dogs don't get this disease unless on the same \_\_\_\_that people eat; not to the same extent as humans though * Treat MI to some extent; no \_\_\_\_ as to when it occurs * Rigorous medication and lifestyle changes that decrease risk of recurrence * Incoming: how to predict who's at risk?
half living MI prevention diet warning signs
Atherosclerosis
• Is the most ____ cause of arterial thrombosis
– Loss of endothelial ____
– Abnormal ____
• Occurs in medium sized arteries
– ____
• ____ Arteries
• RareinVeinsand Capillaries
* Arterial thrombosis > most common cause of MI * Endothelium is major player in coagulation cascade > lose integrity > high risk of AS * Hemodynamic stress > increase risk of endothelial injury * If occurs in capillary, immediately would be occlusive > but not enough \_\_\_\_ for it form there; why doesn't happen in veins > the \_\_\_\_ isn't that stressful
common integrity vascular flow coronary, renal, cerebral large stuff blood flow
Normal vasculature: intima
* Endothelial cells line lumen > some ECM with an internal elastic lamina; IEL has \_\_\_\_ that allows oxygenation of tunica media > made up of \_\_\_\_ cells (allows contractile ability; allows movement of blood) * The bottom half of media gets supplied by \_\_\_\_ (vessels) > brings oxygen in; adventitia has a lot of ECM and fibroblasts
fenestrations
SM
vaso vasorum
Atherosclerotic Lesions
• Begin in ____
• Progress to ____
• Occur in areas of hemodynamic stress
– ____, ostia, curves
• Changes in order of development – \_\_\_\_ – Fibrous (fibrofatty) plaque, Atheroma – Complicated plaque
• AS starts in intima and movement into media > formation of a true AS lesion; if only in intima it's of less concern, but once into media > affects \_\_\_\_ of vessel wall, integrity and elasticity of vessel wall • Most common site > hemodynamic stress > branching of vessels, at \_\_\_\_ (minor vessels branch off of bigger vessels), or \_\_\_\_ (structure of body) ○ Infants 3-7 > have prelesions; as long as teens following US diet you have some lesions; if they get bigger by time of adulthood they can cause problems ○ They begin at these sites, but they move away as they grow • Fatty streak > "\_\_\_\_" > protective response because you need to thicken things up to cushion blood to go down vessel at curves, etc; but also a \_\_\_\_
intima
media
bifurcations
fatty streak
oxygenation ostio curves prelesion nitus
Fatty streaks
- Linear, flat, yellow-white elevations on intimal surface that do not compromise ____
- Begin in early ____
- Precursors of ____ plaques (?)
• Contain – \_\_\_\_ – Extracellular fat and cholesterol – \_\_\_\_ • Also occur in areas not prone to atherosclerosis
• Can clinically observe them • Some areas of vasculature are resistant to forming \_\_\_\_ • Foam cells come from macrophages (trying to digest lipid) or SM cells ○ Filled with lipid and a tiny nucleus • Lymphocytes - both v • Do not change flow of blood, do not \_\_\_\_ vessel, they're present just under the endothelial cells
blood flow
childhood
fibrous
foam cells lymphocytes atheromas macrophages and T cells distend
Intercostal Artery, Fatty Streak
• Artery sliced longitudinally
• The little circles are ____ (tiny vessels coming off of major vessel)
• Little yellow lines connecting ostia, as blood is flowing there is turbulence right before ostia as it diverts into screen and some turb afterwards as well
○ The area above and below is largely ____ (paler area)
Renal Artery, Fatty Streak
• Presence of ostia and the yellow streaks before and after; ____ areas unaffected
• Can use lipophilic stain > \_\_\_\_ > areas right off ostia that pick up stain > primitive fatty streaks • Fatty streak ○ Endothelial cells on top; a tiny layer of EC lipid and foam cells (nuclei pushed to side and filled with lipid); some lymphocytes ○ Muscle middle layer unaffected
ostia
unaffected
paler
congo red
From Fatty Streak to Fibrous Plaque
• Risk site for atheroma > over time you have lipid > high \_\_\_\_ levels, or low levels of \_\_\_\_ > chol accumulate/LDL accum in fatty streaks > LDL are \_\_\_\_ > recruit macrophages and lymphocytes to site > produce mediators to recruit and other inflam molecules > accumulation of lipid > macro's from BS but all SM from the \_\_\_\_ > the SM cells divide > smooth muscle forming above the IEL, and elaborate the ECM (collagen deposition, etc.), become phagocytic and take in the lipid but they cannot metabolize lipid (LDL) > thickening of the \_\_\_\_ > protrude into BS > disrupt blood flow, mediators coming in disrupt endothelium and damage > \_\_\_\_ progression
chol chol scavengers media intima cyclic
Atheromatous, Fibrous, Lipid, or Fibrofatty Plaques, or Atheromas
- Grey-white, localized, firm protrusions
- Impede blood flow in ____ vessels
- Begins in intima but progresses to media
Consist of – \_\_\_\_ – Foam cells, necrotic debris – \_\_\_\_ derived collagen, elastin, proteoglycans • \_\_\_\_?
• Change the diameter of the lumen > initial reaction the vessel maintains shape and accommodate same amount of blood > eventually will not be able to • \_\_\_\_ > as you thicken intima > you do not have great oxygenation > some cells/tissue die • Collagen/other ECM proteins deposited from the SM cells • Reversible? ○ Able to intervene/return things back to normal ○ Can take atheroma and take it backwards > how can do without weakening the vessel wall? § Modifying \_\_\_\_ and preventing formation > focused on \_\_\_\_ efforts
small and medium lipids and cholesterol SMC reversible necrotic debris diet prevention
Mild Atheroma
• In the brain; fresh
• Yellowish spots are affected areas > look a little firmer > there are ostia coming off around it
○ Roll back > half of the vessel wall is occluded by atheroma > reduction in blood flow > increased risk of formation of ____ on top
§ Can have consider vessel involvement and the tissue is relatively unaffected at this stage
Fibrofatty Plaques
• This tissue is fixed
• Arrows are pointing at small atheromas; ostia nearby with areas of ____ > unlikely to have occluded the vessel
thrombi
hemodynamic stress
The Anatomy of Atherosclerotic Plaque
* Within an atheroma > progression to the \_\_\_\_ > fibrous cap (laying down of collagen, can see with \_\_\_\_ stain); and a lipid core (\_\_\_\_, cholesterol, \_\_\_\_, necrotic debris) * Amount of media is not the \_\_\_\_ on either side > usually completely comproised by lipid core * Strong blue > fibrous cap * C > lipid core; has cholesterol clefts; \_\_\_\_ inflammatory response occurring * Majority of media on bottom is compromised (when compared to top/left)
media trichrome LDL foam cells same chronic
Foam Cells
• Foam cells in intima and medial layer > as progresses it forms a larger dense core ○ Presence in \_\_\_\_, and a major component of \_\_\_\_
fatty streak
atheroma
Cholesterol Clefts
* When process tissue, the \_\_\_\_ is washed away > forms streaks in tissue * Can see some cells * This is part of the \_\_\_\_ in the center
lipid
lipid core
Complicated Plaque
• Fibrous plaque with one of the following complications:
– ____ of intimal surface
– Thrombosis or Occlusion
– Extensive ____
– Dystrophic calcification – Intimal \_\_\_\_ – Vessel distension/weakening – \_\_\_\_ – Embolic showers from ruptured plaque
• As long as atheroma isn't diminishing blood flow too much > you're going to be okay (unless \_\_\_\_) • Any time you take away endothelial layer (ulceration) > \_\_\_\_ surface (VWF, bring in clotting factors) • If thrombus gets too larger > leads to occlusion [???] • Extensive necrosis > large necrotic core > not only larger atheroma, but also because it decreases \_\_\_\_ and is at risk for calcification/rupture • Deposition of \_\_\_\_ > makes it less elastic (dystrophic); or you can have emboli forming from the necrotic core when the thrombus surface bursts • Intimal hemorrhage ○ When tissue is hypoxic, and occlude blood vessels > angiognesis of \_\_\_\_ > hemorrhage and then it can blow up the atheroma to occlude vessel • Aneurysm ○ Vessel wall is weakened and becomes less elastic > SM is being replaced with \_\_\_\_ and collagen > the vessel wall will distend (bulging - \_\_\_\_; or can be even - \_\_\_\_; and a dissecting aneurysm)
ulceration necrosis hemorrhage aneurysm overexertion thrombogenic elasticity Ca++ vaso vasorum
fat
saccular
fusiform/cylindrical
Ulcerated and Fibrofatty Plaques
• ____ adhering to atheroma > red
• Take cross section (blue) > regular atheromas, and some that are compromised by ulceration
• Red is ____ atheroma
Large Necrotic Core
• Media has been replaced by ____ and necrotic debris
Thickened Intima - Necrotic Core
• Thickening of intima > necrosis of underlying tissue
• Large thrombus on top (cut off in section)
• ECM underneath; then larger area of lipid debris, foam cells, etc.
platelets
unaffected
lipid
Hemorrhagic Plaque
• BV try to grow in, but then a ____ into the plaque
• Up top > fibrous cap
• Underneath > large area of hemorrhage into site and a lot of ____
bleed
necrosis
Dystrophic Calcification
• Calcium deposits seen in tissue section > stain purple
• Up top is normal; below it is firbous cap, and under the cap there is the SMC dividing, foam cells, lipid, etc (conjuncture, cannot see at this magnification)
• Green necrotic core > purple stain surrounding > ____
• All dark purple > calcified > if squeezed vessel it would feel \_\_\_\_
dystrophic calcification
crunchy
Monckeberg medial calcific sclerosis
• MMCS >looks different than dystrophic calcification > accum of purple deposits in \_\_\_\_ > all the \_\_\_\_, less \_\_\_\_ and feels \_\_\_\_ ○ Different presentation than last slide!
media
way around
elastic
crunchy
Thrombosed atheroma
* Most \_\_\_\_ thing that happens * Not really a normal part of \_\_\_\_ * Large amount of clefts and necrotic debris > so little \_\_\_\_ left > completely occluded vessel to a thrombus forming on top of a atheroma > most common cause of \_\_\_\_ * Different stain * Thrombus inside the lumen; on right you see large amount of lipid and debris > atheroma, and thrombus formed on top
important
vessel
lumen
MI
