Pathophysiology of atheroma (part 1) Flashcards

1
Q

What is the other term for atheroma?

A

atherosclerosis

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2
Q

What is atherosclerosis?

A

formation of focal elevated lesion (plaques) in intima of large and medium sized arteries

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3
Q

What is the effect of atheromatous plaques forming in coronary arteries?

A

ischemia

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4
Q

What can angina cause?

A

myocardial ischemia

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5
Q

Is arteriosclerosis atheromatous?

A

it is not!

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6
Q

What is arteriosclerosis?

A

age-related change in muscular arteries

smooth muscle hypertrophy, apparent reduplication f internal elastic laminae, intimal fibrosis –> decrease vessel diameter

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7
Q

What duplicates in arteriosclerosis?

A

internal elastic laminae

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8
Q

What does arteriosclerosis cause in the elderly population?

A

contributes to high frequency of cardiac cerebral, colonic and renal ischemia in elderly

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9
Q

What is the earliest significant lesion of an atheroma called?

A

fatty streak

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10
Q

How does the fatty streak appear as?

A

yellow linear elevation of intimal lining

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11
Q

What comprises the fatty streak?

A

masses of lipid-laden macrophages

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12
Q

What will a fatty streak go on to develop?

A

atheromatous plaque

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13
Q

Who has a fatty streak?

A

young children

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14
Q

Can a fatty streak disappear?

A

yes

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15
Q

After the fatty streak what is next to form?

A

early atheromatous plaque

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16
Q

What is the structure of a fully developed atheromatous plaque?

A

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

17
Q

What provides the structural strength in the fully developed atheromatous plaque?

18
Q

What immune cells are recruited from the arterial endothelium? (reside in the fibrous cap)

A

inflammatory cell (macrophages, T-lymphocytes, mast cells)

19
Q

What is the central lipid core rich in?

A

cellular lipids/debris derived from macrophages (died in plaque)

20
Q

Why are the macrophages in the lipid core called foamy?

A

due to uptake of oxidised lipoproteins via specialised membrane bound scavenger receptor

21
Q

What usually occurs late in plaque development?

A

dystrophic calcification

22
Q

Where do atheromatous plaques form ?

A

at arterial branching points/bifurcations (turbulent flow)

23
Q

What additional elements does a complicated atheroma have?

A

features of established atheromatous plaque (lipid-rich core, fibrous cap) plus…

haemorrhage into plaque (calcification)

plaque rupture/fissuring

thrombosis

24
Q

What does complicated atheroma lead to?

A

it has clinical consequences

25
What is the most important risk factor for atheroma?
hypercholesterolaemia
26
What type of cholesterol is atheroma risk?
LDL Lack of membrane receptors for LDL elevated LDL levels
27
What are signs of major hyperlipidaemia?
primary or acquired need biochemical evidence: LDL, HDL, total cholesterol, triglycerides corneal arcus (premature) tendon xanthomata (knuckles, Achilles) xanthelasmata
28
What are risk factors for major hyperlipidaemia?
premature, family history MI/atheroma smoking hypertension diabetes mellitus male elderly acceleration of plaque formation driven by lipids