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Cardiology > Fundamentals of atherogenesis > Flashcards

Fundamentals of atherogenesis Flashcards

1
Q

what are the risk factors for atherosclerosis?

A 
Age
Tobacco Smoking
High Serum Cholesterol
Obesity
Diabetes
Hypertension
Family History
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2
Q

Why does smoking cause atherosclerosis?

A

results in damage to the endothelium

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3
Q

how does obesity cause atherosclerosis?

A

fat contains growth factors and is pro-inflammatory

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4
Q

What is the distribution of atherosclerotic plaques along the length of an artery?

A

focal distribution

in areas where there may be turbulent flow eg at bifurcations

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5
Q

what is the structure of a plaque?

A

Lipid
Necrotic core
Connective tissue
Fibrous “cap”

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6
Q

What is the key initiating factor in atherosclerosis?

A

endothelial injury leading to endothelial dysfunction

circulating leukocytes then migrate into the vessel wall

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7
Q

When is inflammation goog?

A

pathogens
parasites
tumours
wound healing

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8
Q

Give examples of where inflammation is bad

A 
myocardial reperfusion injury 
atherosclerosis 
IHD
RA 
asthma
IBD
shock
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9
Q

How does LDL cause endothelial damage?

A

LDL passes in and out of the arterial wall and when in XS, it accumulates in the arterial wall and undergoes oxidation and glycation

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10
Q

How is adhesion of inflammatory cells brought about?

A

chemoattractants are released from the injured endothelium and send signals to leukocytes

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11
Q

Names some inflammatory cytokines found in plaques

A 
IL-1
IL-6
IL-8
IFN-g
TGF-b
MCP-1 (Monocyte chemoattractant protein)
C reactive protein
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12
Q

Which cytokine induces the production of the other cytokines?

A

IL-1

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13
Q

Which adhesion molecule facilitates capture and rolling of leukocytes?

A

selectins

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14
Q

Which adhesion molecule facilitates firm adhesion of leukocytes?

A

integrins

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15
Q

What is the name given to the earliest lesion of atherosclerosis?

A

fatty streaks

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16
Q

what do fatty streaks consist of?

A

lipid laden macrophages
T cells
within the intima

17
Q

What is the next stage of plaque formation after fatty streaks?

A

intermediate lesions

18
Q

What do intermediate lesions consist of?

A 
lipid laden macrophages - foam cells 
vascular smooth muscle cells 
T cells 
platelets 
extracellular lipid
19
Q

What is the next stage of plaque formation after intermediate lesions?

A

fibrous plaques / advanced lesions

20
Q

What is the definitive feature of fibrous plauqes?

A

covered by a fibrous cap

21
Q

What is a fibrous cap made of and how is it made?

A

collagen
elastin
made by SMCs that overly the lipid core and necrotic debris

22
Q

What is a fibrous cap made of and how is it made?

A

collagen
elastin
may be calcified
made by SMCs that overly the lipid core and necrotic debris

23
Q

What is a fibrous plaque made of?

A

fibrous cap
smooth muscle cells
foam cells
T cells

24
Q

What is the difference between the fibrous cap of stable angina and unstable angina?

A

the fibrous cap of stable angina plaque is much weaker

25
Q

What is the pathogenesis behind plaque rupture?

A

the plaque is constantly growing and receding and the fibrous cap has to be resorbed and redeposited to be maintained
if the balance is shifted in favour of increased enzyme activity (matrix metalloproteases), the cap becomes weak and ruptures

26
Q

What causes thrombus formation when a plaque ruptures?

A

exposure of BM, collagen and necrotic tissue

haemorrhage of blood vessels in the plaque

27
Q

Name two commonly used drugs in drug eluting stents

A

Sirolimus = rapamycin - immunosuppresant and anti-proliferative
Taxol - inhibits cell growth of neointima

28
Q

What are the four major cell types involved in atherogenesis?

A 
endothelium 
macrophages 
smooth muscle
cells 
platelets

Cardiology (7 decks)

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