CH7 - Arteriosclerosis

Question 1

What is arteriosclerosis?

Answer 1

Literally, hard arteries; due to thickening of the blood vessel wall

Question 2

What are the three pathologic patterns for arteriosclerosis ?

Answer 2

atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis

Question 3

What is atherosclerosis?

Answer 3

Intimal plaque that obstructs blood flow

Question 4

What does atherosclerosis consists of?

Answer 4

a necrotic lipid core (mostly cholesterol) with a fibromuscular cap, often undergoes dystrophic calcification

Question 5

What does atherosclerosis involve?

Answer 5

large- and medium-sized arteries; abdominal aorta, coronary artery, popliteal artery, and internal carotid artery are commonly affected.

Question 6

How are the risk factors for atherosclerosis divided?

Answer 6

into modifiable and nonmodiliable.

Question 7

What are modifiable risk factors for atherosclerosis?

Answer 7

it includes hypertension, hypercholesterolemia (LDL increases risk; HDL decreases risk), smoking, and diabetes.

Question 8

What are nonmodifiable risk factors for atherosclerosis?

Answer 8

Age, gender, genetics

Question 9

How does age affect atherosclerosis?

Answer 9

number and severity of lesions increase with age

Question 10

How does gender affect atherosclerosis?

Answer 10

increased risk in males and postmenopausal females; estrogen is protective

Question 11

How does genetics affect atherosclerosis?

Answer 11

multifactorial, but family history is highly predictive of risk

Question 12

What is the pathogenesis of atherosclerosis?

Answer 12

Damage to endothelium allows lipids to leak into the intima. 2. Lipids are oxidized and then consumed by macrophages via scavenger receptors, resulting in foam cells. Inflammation and healing leads to deposition of’extracellular matrix and proliferation o

Question 13

What are fatty streaks?

Answer 13

flat yellow lesions of the intima consisting of lipid-laden macrophages

Question 14

What are the morphologic stages in atherosclerosis?

Answer 14

1) Begins as fatty streaks; arise early in life (present in most teenagers) 2) Progresses to atherosclerotic plaque

Question 15

What are the complications of atherosclerosis?

Answer 15

1) Stenosis of medium sized vessels 2) plaque rupture 3) weakening of vessel wall

Question 16

What accounts for >50% of disease in Western countries?

Answer 16

complications of atherosclerosis

Question 17

What does stenosis of medium-sized vessels result in?

Answer 17

impaired blood flow and ischemia

Question 18

What does stenosis lead to? (what arteries are involved)

Answer 18

i. Peripheral vascular disease (lower extremity arteries, e.g., popliteal) ii. Angina (coronary arteries) iii. Ischemic bowel disease (mesenteric arteries)

Question 19

In atherosclerosis, what does plaque rupture with thrombosis results in?

Answer 19

myocardial infarction (coronary arteries) and stroke (e.g., middle cerebral artery)

Question 20

In atherosclerosis, what does plaque rupture with embolization result in?

Answer 20

atherosclerotic emboli, characterized by cholesterol crystals within the embolus

Question 21

In atherosclerosis, what does weakening of vessel wall result in?

Answer 21

aneurysm (e.g., abdominal aorta)

Question 22

What is arteriolosclerosis?

Answer 22

Narrowing of small arterioles

Question 23

What is arteriolosclerosis divided into?

Answer 23

hyaline and hyperplastic types

Question 24

What is hyaline arteriolosclerosis caused by?

Answer 24

proteins leaking into the vessel wall, producing vascular thickening;

Question 25

In hyaline arteriolosclerosis what is seen on microscopy?

Answer 25

proteins are seen as pink hyaline on microscopy

Question 26

Hyaline arteriolosclerosis is a consequence of what?

Answer 26

long-standing benign hypertension or diabetes

Question 27

What does hyaline arteriolosclerosis result in?

Answer 27

reduced vessel caliber with end-organ ischemia

Question 28

What does hyaline arteriolosclerosis classically produce?

Answer 28

glomerular scarring (arteriolonephrosclerosis) that slowly progresses to chronic renal failure

Question 29

What is hyperplastic arteriolosclerosis?

Answer 29

it involves thickening of vessel wall by hyperplasia of smooth muscle onion-skin appearance

Question 30

What is hyperplastic arteriolosclerosis a consequence of?

Answer 30

malignant hypertension

Question 31

What does hyperplastic arteriolosclerosis result in?

Answer 31

reduced vessel caliber with end-organ ischemia

Question 32

What may hyperplastic arteriolosclerosis lead to?

Answer 32

fibrinoid necrosis of the vessel wall with hemorrhage

Question 33

What does the fibrinoid necrosis in hyperplastic arteriolosclerosis classically cause and how does it appear?

Answer 33

acute renal failure with a characteristic flea-bitten appearance

Question 34

What is monckeberg medial calcific sclerosis?

Answer 34

calcification of the media of muscular (medium-sized) arteries; nonobstructive

Question 35

How does monckeberg medial calcific sclerosis present clinically?

Answer 35

Not clinically significant; seen as an incidental finding on x-ray or mammography