pathophysiology of atheroma

Question 1

What is an atheroma

Answer 1

Formation of focal elevated lesions (plaques) in the intima of large and medium sized arteries

Question 2

What is the earlies significant lesion of an atheroma

Answer 2

Fatty streak - yellow linear elevation of the intimal lining

Question 3

Describe a fully developed artheromatous plaque

Answer 3

Central lipid core with fibrous tissue cap, covered by arterial endothelium

Question 4

What is the main risk factor for atheroma

Answer 4

Hypercholesterolaemia

Question 5

What are the clinical signs of hyperlipidaemia

Answer 5

• Corneal arcus - pale ring around iris
• Tendon xanthomata - lumps on tendons
• Xanthelasmata - collection of foamy macrophages and lipids over the eyes underneath the skin

Question 6

Describe the development of an atheromatous plaque

Answer 6

1. • Injury to the endothelial lining of the artery
2. Accumulation of LDL in the vessel wall
3. Monocyte adhesion to the endothelium - migration into intima and transformation into foamy macrophages
4. platelet adhesion

Question 7

What is a consequence of atheroma

Answer 7

Progressive narrowing of the lumen due to high grade plaque stenosis

Question 8

What is embolisation

Answer 8

thrombus breaks off and travels to another artery where it causes ischaemia

Question 9

Describe the typical vulnerable arthermoatous plaque

Answer 9

Thin fibrous cap, large lipid core and prominent inflammation

Question 10

What is the management of atherosclerosis

Answer 10

1. • Preventative and lifestyle changes
2. Anti-platelets : aspirin then clopidogrel and then ticagrelor