CVS

Question 1

What is atherosclerosis?

Answer 1

A chronic inflammatory disease influenced by many factors involving a vast array of inflammatory cells and cytokines. Disease of the intima

Question 2

List 5 risk factors of atherosclerosis

Answer 2

Age
Tobacco Smoking
High Serum Cholesterol
Obesity
Diabetes
Hypertension
Family History

Question 3

What is an atherosclerotic plaque

Answer 3

A plaque is a complex lesion of lipid, necrotic core, connective tissue, fibrous cap found focally distributed along the length of an artery

Question 4

Where are atherosclerotic plaques found

Answer 4

In peripheral and coronary arteries

Question 5

key cells involved in atherosclerotic plaque

Answer 5

endothelial cells, smooth muscle cells, macrophages, fibroblasts

Question 6

two main outcomes of plaque?

Answer 6

Vessel occlusion

Rupture and embolism

Question 7

What id the response to injury hypothesis?

Answer 7

Atherosclerosis is Initiated by an injury to the endothelial cells which leads to endothelial dysfunction.
Signals sent to circulating leukocytes which then accumulate and migrate into the vessel wall.
Inflammation ensues

Question 8

Whi is LDL important in atherosclerosi

Answer 8

It can pass in and out the arterial wal and can undergo oxidation and glycation. This damages the intima

Question 9

5 stages of atherosclerosis progression

Answer 9

1. Fatty streaks
2. Intermediate lesions
3. Fibrous plaques or advanced lesion
4. Plaque rupture
5. Plaque erosion

Question 10

What is characteristic of fatty streaks

Answer 10

Consist of aggregations of lipid–laden macrophages and T lymphocytes within the intimal layer of the vessel wall

Question 11

What is characteristic of intermediate lesions

Answer 11

Composed of layers of :
	Lipid laden macrophages (foam cells) 
	Vascular smooth muscle cells 
  	T lymphocytes
	Adhesion and aggregation of platelets to 	vessel wall
	Isolated pools of extracellular lipid

Question 12

What is characteristic of an intermeduate lesion

Answer 12

Impedes blood flow
Prone to rupture
Covered by dense fibrous cap made of ECM proteins including collagen (strength) and elastin (flexibility) laid down by SMC that overlies lipid core and necrotic debris
May be calcified
Contains: smooth muscle cells, macrophages and foam cells and T lymphocytes

Question 13

What is plaque rupture

Answer 13

Plaques constantly growing and receding.
Fibrous cap has to be resorbed and redeposited in order to be maintained.
If balance shifted eg in favour of inflammatory conditions (increased enzyme activity), the cap becomes weak and the plaque ruptures.
Basement membrane, collagen, and necrotic tissue exposure as well as haemorrhage of vessels within the plaque
Thrombus (clot) formation and vessel occlusion

Question 14

What is plaque erosion?

Answer 14

Second most prevalent cause of coronary thrombosis
Lesions tend to be small ‘early lesions’
Fibrous cap does not disrupt
Luminal surface underneath the clot may not have endothelium present but is smooth muscle cell rich.
There may be a prominent lipid core

Question 15

How can coronary artery disease be treated?

Answer 15

PCI - ppercutaneous coronary intervention (sent)

Question 16

Pharmacological interventions imp in CAD. Why?

Answer 16

1. aspirin, inhibits COX therefore prevens platelet aggregation
2. Clopidogrel/Ticagrelor – inhibitors of the P2Y12 ADP receptor on platelets
3. Statins – inhibit HMG CoA reductase, reducing cholesterol synthesis