Lecture 17: Pathology of CAD Flashcards

1
Q

Top three regions for atherosclerosis

A
  1. Lower aorta; 2. Coronaries; 3. Femorals, popliteals
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2
Q

Describe what happens to the monocytes…What causes all this?

A

Capture, roll, arrest and diapedesis into subendothelial space; cytokine production from damaged endothelial cells

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3
Q

Once absorbed into endothelial space, a monocyte becomes a…how?

A

Macrophage foam cell; engulfing LDL particles

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4
Q

What is the earliest recognizable form of atherosclerosis?

A

Fatty streaks

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5
Q

What are the six (3 –> 3) key features of plaque progression?

A

Inflammation, neovascularization, intra-plaque hemorrhage –> lipid core expansion, oxidative stress, apoptosis

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6
Q

Describe plaque neovascularization and three types

A

Vasa vasorum proliferate as neovessels: 1. Vasa vasorum interna, 2. Vasa vasorum externa, 3. Venous vasa vasorum

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7
Q

What is the danger of plaque neovascularization (2)?

A

Neovessels are fragile –> intraplaque hemorrhage –> 1) larger plaque size and 2) free hemoglobin increases oxidative stress

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8
Q

Type 1 AHA Class

A

Eccentric intimal thickening (no lipid), some isolated foam cells

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9
Q

Type II AHA Class

A

Foam cells (intracellular lipids)

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10
Q

Type III AHA Class

A

Type II lesion + some extracellular lipid pools

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11
Q

Type IV AHA Class

A

Fibrous cap and lipid pool

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12
Q

Type VA AHA Class

A

Larger cap, larger lipid core (lipid rich)

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13
Q

Type VB AHA Class

A

Lipid core with dystrophic calcification (calcific)

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14
Q

Type VC AHA Class

A

Lipid is replaced by fibro-collagenous tissue (fibrotic)

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15
Q

Type VI AHA Class

A

Fibrous cap disrupted, thrombus associated, intra-plaque hemorrhage

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16
Q

Which types can produce symptoms?

A

Type IV - VII (early)

17
Q

Which decade are Types I and II?

18
Q

Which decade are Types III and IV?

19
Q

Which decade are Types V and VI?

20
Q

Positive plaque remodeling: definition and associated with…

A

Increase in plaque size and External Elastic Membrane (EEM) area; Unstable lipid rich plaque, allowing considerable plaque expansion despite normal luminal size

21
Q

Negative plaque remodeling : definition and associated with…

A

Decrease in plaque size and External Elastic Membrane (EEM) area; Diminished plaque size with reduction in lumen size

22
Q

Three complications of plaque morphology

A

Rupture-thrombosis, erosion-thrombosis, calcific nodule

23
Q

Define plaque thrombosis

A

Thrombogenic necrotic lipid core gets exposed to the flowing blood and results in thrombus formation

24
Q

Define plaque erosion

A

The luminal thrombus overlies area that lacks surface endothelium but does not communicate with the lipid core

25
Define calcific nodules
Plaques with calcified nodule protruding into the lumen through a disrupted thin fibrous cap (FC), with secondary thrombus formation
26
Three clinical phase possibilities of coronary atherosclerosis
1. Wall weakening/mural thrombosis --> aneurysm and rupture; 2. Plaque rupture/hemorrhage --> occlusion by thrombus; 3. Plaque growth --> critical stenosis
27
Stenting can lead to...
Restenosis via neoatherosclerosis due to deposition of ECM via myofibroblasts (from vessel wall injury)
28
In vein grafts, atherosclerotic lesions are...They lack?
Densely fibrotic; lipid core