deck_629882 Flashcards by Sare Bear

Define atheroma

The accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries

How well did you know this?

Not at all

Perfectly

Define atherosclerosis

The thickening and hardening of arterial walls as a consequence of atheroma

How well did you know this?

Not at all

Perfectly

Define arteriosclerosis

The thickening of the walls of arteries and arterioles usually as a result of hypertesnion or diabetes mellitus

How well did you know this?

Not at all

Perfectly

What are the three types of atheroma?

Fatty streakSimple plaqueComplicated plaque

How well did you know this?

Not at all

Perfectly

What is a fatty streak atheroma?What does it look like?

Lipid deposits in intimaYellow, slightly raised

How well did you know this?

Not at all

Perfectly

What does a simple plaque atheroma look like?

Raised yellow/whiteIrregular outlineWidely distributedEnlarge and coalesce

How well did you know this?

Not at all

Perfectly

What is another name for a complicated plaque?

Thrombosis

How well did you know this?

Not at all

Perfectly

How is complicated plaque caused?

Haemorrhage into plaque with subsequent calcification

How well did you know this?

Not at all

Perfectly

What can a complicated plaque cause?

Aneurysm formation

How well did you know this?

Not at all

Perfectly

Name five common sites of atheroma formation

AortaCoronary arteriesCarotid arteriesCerebral arteriesLeg arteries

How well did you know this?

Not at all

Perfectly

What is this image?

**** Fatty streak atheroma

How well did you know this?

Not at all

Perfectly

What is this an image of?

****Simple plaque

How well did you know this?

Not at all

Perfectly

What is this an image of?

**** Complicated plaque

How well did you know this?

Not at all

Perfectly

Give structure of normal artery

Endothelium Sub endothelial ctInternal elastic laminaMuscular mediaExternal elastic laminaAdventitiaESIMEAEven sexy idiots make ellen angry

How well did you know this?

Not at all

Perfectly

What are the early microscopic changes in atheroma?

Proliferation of smooth muscle cellsAccumulation of foam cellsExtracellular lipid

How well did you know this?

Not at all

Perfectly

What are later micrscopic changes involved in atheroma?

FibrosisNecrosisCholesterol cleftsChange in number of inflammatory cells

How well did you know this?

Not at all

Perfectly

What are the clinical effects of atheroma formation?

Ischaemic heart diseaseCerebral ischaemiaMesenteric ischaemiaPeripheral vascular disease

How well did you know this?

Not at all

Perfectly

What five conditions are associated with ischaemic heart disease?

Sudden deathMIAngina pectorisArrhythmiasCardiac failure

How well did you know this?

Not at all

Perfectly

What are three effects of cerebral ischaemia?

Transient ischaemic attackCerebral infarction ( stroke)Multi-infarct dementia

How well did you know this?

Not at all

Perfectly

What are three effects of mesenteric ischaemia?

Ischaemic colitisMalabsorptionIntestinal infarction

How well did you know this?

Not at all

Perfectly

What are the four effects of peripheral vascular disease?

Intermittent claudicationLeriche syndromeIscaemic rest painGangrene

How well did you know this?

Not at all

Perfectly

Give eight risk factors for atheroma formation

AgeGenderHyperlipidaemiaCigarette smokingHypertensionDiabetes mellitusAlcohol Infection

How well did you know this?

Not at all

Perfectly

How does age affect the risk of having an atheroma form?

Slow increase in risk as you ageRisks factors accumulate over the course of your life

How well did you know this?

Not at all

Perfectly

How does gender effect your risk of atheroma formation?

Women protected before menopause due to hormones

How well did you know this?

Not at all

Perfectly

How does hyperlipidaemia cause atheroma?

High plasma cholesterol associated with atheroma

What are the most significant factors in hyperlipidaemia?

LDL levels are dangerousHigh HDL are protective

How are lipids carried in the blood?

Lipoproteins

What do lipoproteins carry (be specific)

Cholesterol, triglycerides, phospholipids and apolipoprotein, to be precise

What is the structure of a lipoprotein

Hydrophobic lipid core, hydrophillic outer layer of phospholipid and apolipoprotein

Name four different types of lipid

ChylomicronsLDL VLDLHDL

What is the role of chylomicrons?

Transport lipid from intestine to liver

What is the role of LDL's?

Carry cholesterol to non-liver cells

What is the role of VLDL's?

Carry cholesterol and TG from liverr

What is the role of HDL?

Carry cholesterol from adipose tissue to the liver

What apolipoprotein are atheromas linked to?

Apo EPolymorphisms of genes involved lead to at least 6 Apo E phenotypes

What can polymorphisms of genes causing increased Apo E be used for?

Risk markers for atherome

What is familial hyperlipidaemia?

Genetically determined abnormalities of lipoproteins which leads to early development of atheroma

What are the associated physical signs of familial lipidaemia?

- Corneal arcus- Tendon xanthomas- Xanthelasma

What is cigarette smoking a powerful risk factor for, other than atheroma? (Vascular disease)

Ischaemic Heart Disease

Give three possible modes of action of cigarette smoking causing atheromas

Coagulation systemReduced prostacyclin (PGI2, eicosanoids)Increased platelet aggregation

What is hypertension linked to? How does it cause damage?

Strong link to IHD? Endothelial damage caused by raised blood pressure

What affect does DM have on IHD risk?

Doubles the chance

What effect does DM have on premenopausal women?

Lose their protected status

What three atheroma related diseases are associated with DM?

IHD, cebrovascular and peripheral vascular disease,.

What two other risk factors is DM related to?

Hyperlipidaemia and hypertension

How many units of alcohol per day must be consumed for their to be increased risk IHD

Why is alcohol so potent a risk factor?

Often associated with other lifestyle related risk factors

What is interesting about alcohol consumption?

Smaller amounts are protective of atheroma

Give five more risk factors of atheroma formation

Lack of exerciseObesitySoft waterOral contraceptiveStress and personality

What two variations in phenotype can account for increased genetic predisposition

Variations in apolipoprotein metabolismVariations in apolipoprotein receptors

What are the four theories concerning atheroma pathogenesis?

Thrombogenic theoryInsudation theoryMonoclonal hypothesisReaction to injury hypothesis

What is the insudation theory of atheroma formation?

Endothelial injuryInflammationIncreased permeability to lipid from plasma

What is the reaction to injury hypothesis?

Plaques form in response to endothelial injury as a result of hypercholesterolaemiaInjury increases permeability and allows platelet adhesion monocytes penetrate endotheliumSmooth muscle cells proliferate and migrate

How does hypercholesterolaemia damage endothelium?

Oxidised LDL can cause subtle and undetectable injury

What is the monoclonal hypothesis?

Belief that artheroma may have viral aeitology, stemming from the observation that each plaque is monoclonal, and may thus represent abnormal growth control .

What is given a crucial role in the monoclonal hypothesis?

Smooth muscle prolifeation

What are the four processes involved in atheroma formation?

ThrombosisLipid accumulationProduction of intercellular matrixInteractions between cell types

What are the six cells involved in atheroma?

Endothelial cellsPlateletsSmooth muscle cellsMacrophagesLymphocytesNeutrophils

What the four roles of endothelial cells in atheroma formation?

Key role in haemostasisAltered permeability to lipoproteinSecretion of collagenStimulation of proliferation and migration of smooth muscle cells

What are the two rolls of platelets in atheroma formation?

Key role in haemostasisStimulate proliferation and migration of smooth muscle cells (PDGF - platelet derived growth factor)

What are the two roles of smooth muscle cells

Take up LDL and other lipid to become foam cellsSynthesis collagen and proteoglycans

What are the four roles of atheroma formation of macrophages?

Oxidise LDL take up lipids to become foam cellsSecrete proteases which modify matrixStimulation proliferation and migration of smooth muscle cells

How are lymphocytes involved in atheroma formation?

Tumour necrosis factor (TNF) may affect lipoprotein metabolismStimulate proliferation and migration of smooth muscle cells

What is the role of neutrophils in atheroma formation?

Secrete proteases leading to continues local damage and inflammation

What are the two steps of the unifying hypothesis?

Endothelial injury Results of endothelial injury

What causes endothelial injury under the unifying hypothesis?

Raised LDLToxins HypertensionHaemodynamic stress

What does endothelial injury result in under the unifying hypothesis?

- Platelet adhesion, PDGF release, smooth muscle cells (SMC) proliferation and migration - Insudation of lipid, LDL oxidation, uptake of lipid by SMC and macrophages- Migration of monocytes into intima - Stimulated SMC produce matrix material- Foam cells secrete cytokines

What does the secretion of cytokines by foam cells cause in atheroma formation?

Further SMC stimulationRecruitment of other inflammatory cells

What are the five ways of reducing risk of atheroma formation?

No smokingReduce fat intakeTreat hypertensionNot too much alcoholRegular exercise/weight control

What are five interventions to halt atheroma formation?

Stop smokingModify dietTreat hypertensionTreat diabetesLipid lowering drugs