MOD Atheroma Flashcards
What does endothelial injury cause?
Thrombosis Platelet adhesion - platelet plug Migration of macrophages into intima PDGF release stimulating SMC proliferation and migration. Oxidation of LDL Insudation of lipid Foam cells through uptake Foam cells secrete cytokines for further SMC stimulation and recruitment of other inflammatory cells
How to prevent atherosclerosis
Stop smoking
Reduce alcohol intake (5 units a day is risk factor)
Regular exercise
Reduce LDL intake
Treat hypertension/DM
Lipid lowering drugs such as statins which reduce cholesterol synthesis
Fatty streak
Lipid deposit in intima
Raised yellow streak
Simple plaque
Raised white streak
Irregular outline
Widely distributed
Complicated plaque
Thrombosis
Haemorrhage into plaque
Calcification
Aneurysm (elastic fibres reduced)
Early microscopic changes
Extracellular lipid deposition
Proliferation of SMC
Foam cells
Later microscopic changes
Fibrosis Necrosis Extends into media Disruption of internal elastic lamina Ingrowth of vessels Plaque fissuring Cholesterol clefts
Common sites
Abdominal aorta Cerebral arteries Carotid artery Coronary artery Leg artery
Modifiable risk factors
Increasing age Male gender Family history Genetics Ethnicity
Modifiable
Hypertension dSmoking Hyperlipidaemia Exercise Obesity Stress
Leads to…
Coronary heart disease Cerebral ischaemia Mesenteric ischaemia Peripheral vascular disease Abdominal aortic aneurysm
Peripheral vascular disease symptoms
Intermittent claudication Leriche's syndrome - buttocks claudication - impotence Ischaemic rest pain Gangrene
Mesenteric ischaemia results in
Ischaemic colitis
Malabsorption
Intestinal infarction
Cerebral ischaemia leads to
TIA temporary disruption, no death
Stroke cerebral infarction
Multi infarct dementia
Cells involved
Endothelial Platelets SMC Macrophages Lymphocytes Neutrophils
