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Sem2: MDSA30160: Cardiorespiratory Disease > L4 Atheroma and Aneurysms > Flashcards

L4 Atheroma and Aneurysms Flashcards

1
Q

_______________: hardening of the arteries’

  • Arterial wall thickening and __________
  • Ageing phenomenon
  • Mainly ____________
A

Arteriosclerosis: hardening of the arteries’

  • Arterial wall thickening and loss of elasticity
  • Ageing phenomenon
  • Mainly small arteries/arterioles
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2
Q

_______________: ‘Degenerative disease of large and medium-sized arteries’

  • Arteries only (>2mm diameter)
  • Characterized by ____________ that protrude into vascular lumina leading to________ → ___________→_____________?
  • Incidence increases w/ age
A

Atherosclerosis (ATHEROMA):‘Degenerative disease of large and medium-sized arteries’

  • Arteries only (>2mm diameter)
  • Characterized by intimal lesions (atheroma) that protrude into vascular lumina =>Lipid accumulation => fibrosis of vessel wall => fibrous cap formation
  • Incidence increases w/ age
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3
Q

What is responsible for more morbidly and mortality in the western world than any other disease?

A

Atherosclerosis

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4
Q

What is a marker of reverse cholesterol transport and representative of reduced risk of atherosclerosis

A

HDL

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5
Q

What equation is used to calculate risk of Atherosclerosis?

A

Framingham Equations

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6
Q

Modifiable risk factors for Atheroma?

A

Modifiable

DYSLIPIDAEMIA

HIGH BLOOD PRESSURE

DYSGLYCAEMIA

CIGARETTE SMOKING

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7
Q

NON- Modifiable risk factors for Atheroma?

A

Non-Modifiable:

AGE

GENDER (Male, Post-Menopausal Female)

GENETICS

Familial Hypercholesteeremia

Lipoprotein Abnormalities

(Cascade Screening: one person positive test siblinds and children)

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8
Q

Distribution of Atheroma

A
  1. Abdominal Aorta
  2. Coronary Arteries
  3. Ilio-Fem-Popelitial
  4. Carotids
  5. Circle of Willis
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9
Q

Response to Injury Hypothesis?

A

Response to Injury Hypothesis:Chronic inflammatory healing response of arterial wall to endothelial injury

Spatial Heterogeneity (focal)- Occurs in specific spots along artery

Systemic - simultaneous involvement of multiple arteries

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10
Q

What is the earliest sign of Endothelial Damage possibly leading to Atheroma

A

REDUCED NITRIC OXIDE (NO) IS THE EARLIEST SIGN OF ENDOTHELIAL DAMAGE

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11
Q

What role do statins play for Atheromas?

A

STATINS INCREASE FIBROUS CAP TO STABILIZE ATHEROMA

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12
Q

Steps of Atheroma Formation (5)

A
  1. ENDOTHELIAL INJURY/LOSS
  2. Endothelial Dysfunction
  3. Macrophage Activation/Smooth Muscle Recruitment
  4. Macrophages/SMCs engulf Lipid
  5. Smooth muscle proliferation, Collagen Deposition, Extracellular lipid debris accumulate
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13
Q

Effects of Endothelial Injury ON the Vessel wall?

A
  1. ADHESION & MIGRATION

Enhanced expression of cellular adhesion molecules on endothelium- monocytes in blood adhere and enter wall

  1. Increased thrombogenicity w/platelet adhesion
  2. Increased LDL permeability – LDLs enter
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14
Q

Effects of Endothelial injury IN the Vessel wall?

A
  1. Growth factors (PDGF) secreted by platelets, endothelium, macrophages, smooth muscle cells.
  2. Myo-intimal cells proliferate
  3. Macrophages** (from blood) and **Smooth muscle cells (from media) migrate into the intima
  4. Smooth muscle cells in intima synthesize extracellular matrix including collagen
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15
Q

After Endothelial damage Macrophages engulf lipids => ____________

Extracellular lipid accumulates

_________accumulate => cause further damage

A

Macrophages engulf lipid => form foam cells

Extracellular lipid accumulates

Oxidized lipids accumulate => cause further damage

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16
Q

Activated MACROPHAGES:

  1. ________________
  2. Produce
    a) ____________________
    b) _____________________
    c) _____________________
A

Activated MACROPHAGES:

  1. Recruit more macrophages
  2. Produce

a) Oxygen-Free Radicals => aggravate lipid oxidation

b) Growth factors

c) Factors which induce death of Vascular Smooth Muscle Cells

17
Q

_____________ (neovascularisation) facilitates:

________________

________________

________________

A

ANGIOGENESIS (neovascularisation) facilitates:

  1. Lesion expansion
  2. Monocyte trafficking
  3. Hemorrhage into plaque
18
Q

VASCULAR SMOOTH MUSCLE CELLS:

  1. Synthesize ______________
  2. Secrete ________________
A

VASCULAR SMOOTH MUSCLE CELLS

  1. Synthesize collagen => fibrous cap is formed
  2. Secrete Bone Morphometric Protein => CALCIUM deposition
19
Q

The core of atheromas is composed of ______, _______, _________

A

The core of atheromas is composed of CHOLESTEROL, NECROTIC DEBRIS, FOAM CELLS ( oxidised LDL from macrophages)

20
Q

Consequences of Atheroma? (5)

A

Atherosclerotic stenosis (narrowing)

Critical stenosis in coronaries: >70 % occlusion (angina or chronic IHD)

Mesenteric: ischemic bowel

Ischemic encephalopathy (Circle of Willis: Supplies blood to brain)

Intermittent claudication (Pain w/ walking)

Acute Plaque Change

Plaque rupture => thrombosis => infarction

Hemorrhage into the plaque (sudden expansion)

Thrombosis

– Occlusion

– Growth of the plaque

– Embolus from the thrombus

Vasoconstriction

– Many local factors

Vascular Ectasia (dilation)

– due to structural weaknesses

– aneurysms

21
Q

Main Diseases associated with Atheroma?

A

Main Diseases associated with Atheroma

  • ISCHAEMIC HEART DISEASE – coronary occlusion
  • STROKES - cerebral / Circle of Willis occlusion
  • PERIPHERAL VASCULAR DISEASE - ilio/femoro/popliteal occlusion
  • ABDOMINAL AORTIC ANEURYSM – aorta -dilatation
22
Q

___________: LOCALISED PERMANENT ABNORMAL DILATATION OF A BLOOD VESSEL (or HEART)

CAUSED BY WEAKNESS OF _________

A

Aneurysms: LOCALISED PERMANENT ABNORMAL DILATATION OF A BLOOD VESSEL (or HEART)

CAUSED BY WEAKNESS OF THE MEDIA

23
Q

False vs. True Aneurysm vs. Dissection?

A

True Aneurysm – bounded by all arterial wall components (or wall of the heart) (ie intact but attenuated wall)

False Aneurysm (pseudoaneurysm) – breach in the vascular wall → extravascular hematoma that freely communicates with the intravascular space

Diseection -Tear in Inima, no Hematoma

24
Q

Shapes of Aneurysm?

A
25
Q

Berry Aneurysms are _________

A

Berry Aneurysms are Saccular

26
Q

Consequences of Aneurysm?

A

Consequences of Aneurism:

  • None
  • Pressure on adjacent structures
  • Occlusion by thrombus
  • Rupture with hemorrhage into tissue / space

Sem2: MDSA30160: Cardiorespiratory Disease (24 decks)

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