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Cardiovascular System > Pathophysiology of Atheroma > Flashcards

Pathophysiology of Atheroma Flashcards

1
Q

What is atheroma/atherosclerosis?

A

The formation of plaque in the intima of large and medium sized arteries

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2
Q

What is ischaemia?

A

A restriction of blood supply to tissues

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3
Q

Give a serious consequence of atheromatous plaques in the coronary arteries?

A

Angina due to myocardial ischaemia

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4
Q

Give an event which would complicate ischamia

A

Thromboembolism

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5
Q

Give a condition which causes a decrease in vessel diameter but which may be age-related rather than atheromatous

A

Arteriosclerosis

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6
Q

Give 4 arteries in which arteriosclerosis contributes to ischaemia in the elderly

A
  • cardiac
  • cerebral
  • colonic
  • renal
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7
Q

Give an event which would cause the clinical effects of arteriosclerosis to become more apparent

A
  • haemorrhage
  • major surgery
  • infection
  • shock
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8
Q

What is the earliest significant lesion present in patients at risk of developing atheroma?

A

Fatty streaks

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9
Q

In patients at risk, what might be formed from fatty streaks?

A

Atheromatous plaques

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10
Q

Give a brief description of the appearance of fatty streaks

A

Yellow linear elevations of intimal lining

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11
Q

From what stage in life would early atheromatous plaques develop?

A

Young adult onwards

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12
Q

What cells cause early atheromatous plaques?

A

Lipid-laden macrophages

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13
Q

Give a brief description of the composition of fully developed atheromatous plaques

A

Central lipid core rich in cellular lipids and macrophage debris, fibrous tissue cap, covered by arterial endothelium

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14
Q

What protein - produced by smooth muscle cells in the fibrous tissue cap - provides structural strength in the atheromatous plaque?

A

Collagen

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15
Q

What kind of cells reside in the fibrous tissue cap?

A

Inflammatory cells

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16
Q

Why are the macrophages in atheromatous plaques “foamy”?

A

Due to uptake of oxidised lipoproteins

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17
Q

What even occurs late in atheromatous plaque development?

A

Dystrophic calcification

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18
Q

Give an event that might occur in complicated atheroma

A
  • haemorrhage into plaque
  • plaque rupture/fissuring
  • thrombosis
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19
Q

What is the most important risk factor in the development of atheroma and what does it cause?

A

Hypercholesterolaemia

Causes plaque formation and growth in absence of other known risk factors

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20
Q

What results in biochemical evidence i.e. LDL, HDL, total cholesterol and lipid test results, would be indicative of hyperlipidaemia?

A

Results higher than the normal threshold

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21
Q

Give 3 signs/symptoms of major hyperlipidaemia

A
  • corneal arcus
  • tendon xanthomata
  • xanthelasmata
22
Q

Give 3 risk factors for developing atheroma other than hypercholesterolaemia and hyperlipidaemia

A
  • smoking
  • hypertension
  • diabetes mellitus
  • male
  • elderly

(obesity/sedentary lifestyle/low socio-economic status/low birthweight are less strong risk factors)

23
Q

How many steps are involved in the development of atheromatous plaques?

A

Two

24
Q

What are the steps involved in the development of atheromatous plaques?

A
  1. Injury to endothelial lining of artery

2. Chronic inflammatory and healing response of vascular wall to injury-causing agent

25
Q

What kind of exposure of the arterial wall would need to occur in order for atheromatous plaques to form?

A

Chronic/episodic exposure

26
Q

What are the first 3 steps in the development of atheromatous plaques?

A
  • endothelial injury and dysfunction
  • accumulation of lipoproteins in vessel wall
  • monocyte adhesion to endothelium
27
Q

What occurs in the development of atheromatous plaques after monocytes adhere to the endothelium?

A

They migrate into the intimal and transform into foamy macrophages

28
Q

What are the most important causes of endothelial injury?

A
  • haemodynamic disturbances i.e. turbulent flow

- hypercholesterolaemia

29
Q

How can chronic hypercholesterolaemia directly impart endothelial cell function?

A

By increasing local production of reactive oxygen species

30
Q

What molecules aggregate in the intimal and are modified by the free radicals produced by inflammatory cells?

A

Lipoproteins

31
Q

Give 3 functional alterations that occur in injured endothelial cells

A
  • enhanced expression of cell adhesion molecules
  • high permeability for LDL
  • increased thrombogenicity
32
Q

What is induced by the response to endothelial injury?

A
  • chronic inflammatory process

- process of tissue repair

33
Q

What is secreted by platelets, injured endothelium, macrophages and smooth muscle cells in atheromatous plaque development?

A

Growth factors

34
Q

In established plaques, further plaque growth is also initiated by small areas of

A

endothelial loss

35
Q

What is formed at denuded areas of plaque surface?

A

Microthrombi

36
Q

Critical reduction of blood flow in distal arterial beds will occur with stenosis of what percentage of the vessel lumen?

A

> 50-75%

37
Q

What would the clinical manifestation of a stenosed atheromatous coronary artery be?

A

Stable angina, ischaemic pain when exercising

38
Q

What would be the main clinical sign of very severe stenosis?

A

Ischaemic pain at rest

39
Q

What may be induced by ileal, femoral or popliteal artery stenosis?

A

Intermittent claudication

40
Q

What would occur in an organ affected by longstanding tissue ischaemia?

A

Atrophy of the affected organ

41
Q

What is caused by the total occlusion of an artery?

A
  • irreversible ischaemia

- necrosis of tissues

42
Q

Give 3 consequences of acute atherothrombotic occlusion

A
  • myocardial infarct
  • stroke
  • lower limb gangrene
43
Q

What event might follow the detachment of small thrombus fragments from thrombosed atheromatous arteries in a ruptured plaque?

A

Embolism distal to ruptured plaque

44
Q

Give 3 complications following embolisation of the distal arterial bed in atheroma

A
  • arrhythmias
  • cholesterol emboli
  • stroke
45
Q

What slow, progressive and often asymptomatic event occurs as a consequence of atheroma?

A

Abdominal aortic aneurysm

46
Q

What high-mortality event occurs in the sudden rupture of an abdominal aortic aneurysm?

A

Retroperitoneal haemorrhage

47
Q

Give 3 distinct morphological features of atheromatous plaques that rupture with subsequent thrombosis

A
  • thin fibrous cap
  • large lipid core
  • prominent inflammation
48
Q

Give a feature of highly stenotic plaques

A
  • large fibrocalcific component

- little inflammation

49
Q

Give 3 methods of prevention of atheroma

A
  • smoking cessation
  • control blood pressure
  • weight loss
  • regular exercise
  • dietary modifications
50
Q

What drugs might be used in the secondary prevention of atheroma?

A
  • cholesterol lowering drugs

- aspirin

Cardiovascular System (14 decks)

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