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Mechanisms of Disease > Lecture 6 - Atheroma > Flashcards

Lecture 6 - Atheroma Flashcards

1
Q

what is an atheroma?

A

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

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2
Q

what is atherosclerosis

A

thickening and hardening of arterial walls as a consequence of atheroma

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3
Q

what is arteriosclerosis?

A

thickening of walls of arteries and arterioles, usually as a result of hypertension or diabetes mellitus

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4
Q

what is the macroscopic appearance of a fatty streak?

A

lipid deposits in intima

yellow, slightly raised

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5
Q

what is the macroscopic appearance of a simple plaque?

A

raised yellow or white
irregular outline
widely distributed
enlarge and coalesce

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6
Q

what is the macroscopic appearance of a complicated plaque?

A

thrombosis
haemorrhage into plaque
calcification
aneurysm formation

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7
Q

what are the early microscopic changes in atheroma?

A

proliferation of smooth muscle cells
accumulation of foam cells
extracellular lipid

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8
Q

what are the later microscopic changes in atheroma?

A

fibrosis
necrosis
cholesterol clefts
change in number of inflammatory cells

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9
Q

what are the cellular events in atheroma?

A

endothelial damage –> platelets –> pdgf –> smooth muscle proliferation
proliferation and migration of smooth muscle takes lipid with it
macrophages arrive and phagocytose the fat, becoming foam cells

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10
Q

what are the effects of severe atherosclerosis in a coronary artery?

A 
ischaemic heart disease
sudden death
mi
angina pectoris
arrythmias
cardiac failure
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11
Q

what is the result of cerebral ischaemia?

A

transient ischaemic attack
cerebral infarction
multi infarct dementia

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12
Q

what is the result of mesenteric ischaemia?

A

ischaemic colitis
malabsorption
intestinal infarction
anuerysm due to high pressure, hardening and weakening

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13
Q

what is the result of peripheral vascular disease?

A

intermittent claudication
leriche syndrome
ischaemic rest pain
gangrene

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14
Q

what are the risk factors for atheroma?

A 
age
gender
hyperlipidaemia
cigarette smoking
hypertension
diabetes mellitus
alcohol
infection
lack of exercise
obesity
oral contraceptives
stress
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15
Q

why is age a risk factor for atheroma?

A

slowly progressive throughout adult years

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16
Q

why is gender a risk factor for atheroma?

A

women protected relatively before menopause

presumed hormonal basis

17
Q

why is hyperlipidaemia a risk factor for atheroma?

A

high plasma cholesterol associated with atheroma
ldl most significant
hdl protective

18
Q

why is cigarette smoking a risk factor for atheroma?

A

risk factor for ischaemic heart disease

19
Q

why is hypetension a risk factor for atheroma?

A

strong link between ischaemic heart disease and high bp

potential endothelial damage by high bp

20
Q

why is diabetes mellitus a risk factor for atheroma?

A

doubles ischaemic heart disease risk

associated with high risk of cerebrovascular and peripheral vascular disease

21
Q

what is the unifying hypothesis of atherogenesis?

A

endothelial injury due to raised ldl, toxins, hypertension and haemodynamic stress
endothlial injury causes platelet adhesion, pdgf release, smooth muscle cell proliferation and migration, insudation of lipid, ldl oxidation, uptake of lipid, migration of monocytes into intima
stimulated smc produce matrix material
foam cells secrete cytokines causing further smc stimulation and recruitment of other inflammatory cells

22
Q

how can atheroma be prevented?

A 
stop smoking
modify diet
treat hypertension
treat diabetes
lipid lowering drugs
23
Q

what increases susceptibility to coronary heart disease?

A

genetic disorders eg familial hypercholesterolaemia
geographical eg less common in mediterranean
ethnicity eg common in asians

24
Q

what are the risk factors for chd?

A 
smoking
gender - more common in men
hypertension - increased epithelial damage
diabetes - increased ihd risk
alcohol
infection

Mechanisms of Disease (11 decks)

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