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Pathological Processes > PP 6 Atherosclerosis > Flashcards

PP 6 Atherosclerosis Flashcards

1
Q

What blood test is used to aid diagnosis of myocardial infarction?

A

Troponin I + T
4 hours after MI

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2
Q

When should the troponin test be taken after MI?

A

4 hours after

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3
Q

Atheroma meaning

A

Necrotic core of atherosclerotic plaque

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4
Q

Arteriosclerosis meaning

A

Thickening of walls of arteries or arterioles

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5
Q

What is arteriosclerosis usually due to?

A

Hypertension
Diabetes mellitus - smooth muscle hypertrophy

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6
Q

What can arteriosclerosis lead to?

A

Poor tissue perfusion
Inelastic/weak vessels > aneurysm
Increased risk of thrombosis

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7
Q

Atherosclerosis meaning

A

Accumulation of intracellular and extracellular lipids in intima + media of large + medium sized arteries

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8
Q

What can cause chronic endothelial damage?

A

Hyperlipidaemia
Hypertension
Smoking - toxins
Haemodynamic stressors

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9
Q

What does endothelial dysfunction lead to?

A

Platelet adhesion
Smooth muscle cell proliferation and migration
Lipids cross into intima
Monocytes > macrophages

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10
Q

What do foam cells secrete?
What does this cause?

A

Cytokines
- Further smooth muscle cell stimulation
- Recruitment of other inflammatory cells

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11
Q

What do smooth muscle cells produce?

A

Matrix material - collagen + elastin

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12
Q

What are the components of an atherosclerotic plaque?

A

Cells
Lipids
Extracellular matrix

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13
Q

What are the cells in an atherosclerotic plaque?

A

Endothelial cells
Platelets
Neutrophils
Macrophages
WBCs
SMC

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14
Q

What lipids make up atherosclerotic plaques?

A

Intracellular - foam cells
Extracellular - pools

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15
Q

What makes up the extracellular matrix in atherosclerotic plaque?

A

Collagen
Elastin
Proteoglycans

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16
Q

Function of endothelial cells

A
  • Role in haemostasis
  • Altered permeability to lipoproteins
  • Production of collagen
  • Stimulation of proliferation + migration of SMCs
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17
Q

What is the microscopic appearance of a stable/simple atherosclerotic plaque?

A

Fibrosis
Necrosis
Cholesterol clefts
+/- inflammatory cells

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18
Q

What is the microscopic appearance of an unstable/complicated atherosclerotic plaque?

A

Disruption of the internal elastic lamina
Damage extends into media
New vessels grow into plaque
Plaque breaks/erodes/ulcers

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19
Q

What is the microscopic appearance of a fatty streak?

A

Accumulation of foam cells
Extracellular lipid
Proliferation of smooth muscle cells

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20
Q

What is the macroscopic appearance of a stable/simple atherosclerotic plaque?

A

Raised white/yellow
Irregular outline
Enlarged - widely distributed

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21
Q

What is the macroscopic appearance of an unstable/complicated atherosclerotic plaque?

A

Yellow + red (haem + thrombosis)
Irregular
Rough + hard - calcified

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22
Q

What is the macroscopic appearance of a fatty streak?

A

Slightly raised yellow area in intima

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23
Q

Complications of atherosclerosis

A

Ulceration
Thrombosis
Vasospasm
Embolisation - from thrombus or plaque
Calcification
Haemorrhage
Aneurysm
Rupture of atherosclerotic artery

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24
Q

Vasospasm meaning

A

Sudden constriction of blood vessel

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25
Q

Effect of calcification on vessels

A

Stiffens vessel
Reduced elasticity

26
Q

Effects of arterial narrowing + occlusion

A

Ischaemia
Infarction
Specific effects dependent on site

27
Q

What does cerebral ischaemia cause?

A

Transient ischaemic attack
Stroke - cerebral infarction
Vascular dementia

28
Q

What differentiates a TIA from a stroke?

A

TIA - symptoms of stroke <24 hours

29
Q

What is a TIA?

A

Transient ischaemic attack

30
Q

What can an atherosclerotic plaque in carotid arteries cause?

A

Plaque can embolism > cerebral circulation
Causes TIA or stroke

31
Q

What does myocardial ischaemia cause?

A

Sudden death
Myocardial infarction
Angina pectoris
Arrhythmias
Cardia failur

32
Q

What does acute mesenteric ischameia cause?

A

Intestinal infarction

33
Q

What does chronic mesenteric ischaemia cause?

A

Ischaemic colitis
Malabsorption

34
Q

What is ischaemic colitis?

A

Inflammation of colon

35
Q

What does peripheral vascular disease cause?

A

Acute limb ischaemia
Intermittent claudication
Ischaemic rest pain
Gangrene

36
Q

What are the symptoms of limb ischaemia?

A

6 Ps
Pallor
Pain
Paraesthesia
Perishingly cold
Paralysis
Pulselessness

37
Q

What is intermittent claudication?

A

Limping

38
Q

What can an atherosclerotic plaque in the abdominal aorta cause?

A

Rupture
Thrombosis + emboli > acute limb ischaemia
Aneurysmal formation

39
Q

How does gender have an effect on atherosclerosis?

A

Protective effect in premenopausal women

40
Q

What three areas can there be defects in lipid metabolism?

A

Enzyme defects
Receptor defect
Apolipoprotein defects

41
Q

Enzyme defects in lipid metabolism

A

Lipoprotein lipase

42
Q

Receptor defects in lipid metabolism
Example of conditions caused by this

A

LDL receptor mutations
e.g familial hypercholesteroaemia

43
Q

Apolipoprotein defects in lipid metabolism

A

ApoA1 deficiency
ApoA1 variants
ApoE variants

44
Q

Presentation of familial Hyperlipidaemia

A

Tendon xanthomas
Xanthlasma
Cornea arcus

45
Q

What is cornea arus?

A

White/blue circle around eye

46
Q

What is the clinical significance of cornea arcus?

A

Concern in young children
Normal in older people
Sign of high cholesterol

47
Q

What can familial Hyperlipidaemia lead to?

A

Early development of atheroscleosis

48
Q

Prevention + reduction of familial Hyperlipidaemia

A

Decrease cholesterol + LDLs in diet
Statins - lipid lowering drugs
Low fat + high fibre diet
Aspirin

49
Q

Effects of cigarette smoking on atherosclerosis

A
  • Risk factor for atherosclerosis and ischaemic heart disease
  • dose related
  • risk decreases after stopping
50
Q

Effects of hypertension on atherosclerosis

A

Link between high BP and IHD

51
Q

Effects of cigarette on atherosclerosis

A
  • Double IHD risk
  • Protective effect in premenopausal women lost
  • High risk of cerebrvasular + peripheral vascular disease
52
Q

Effects of alcohol consumption on atherosclerosis

A

> 5 units/day = increased risk of IHD
Small amounts can be productive

53
Q

How can you reduce the atherosclerotic burden?

A

Statins - decreases cholesterol
Anti-hypertensives - decreases BP
Exercise
Normal BMI
Non-smoker
Alcohol in moderation
Balance diet - decreased diabetes risk
Diabetes medication
CANTOS - targets inflammation

54
Q

What is an example of a diet which reduces the risk of diabetes?

A

Mediterranean

55
Q

Three macroscopic features of atherosclerosis

A

Fatty streak
Simple plaque
Complicated plaque v

56
Q

Identify four theories explaining the pathogenesis of atherosclerosis

A

Thrombogenic theory
Insulation theory
Monoclonal hypothesis
Reaction to injury hypothesis

57
Q

Modifiable risk factors of atherosclerosis

A
  • smoking
  • obesity
  • Hyperlipidaemia
  • hypertension
58
Q

Non modifiable risk factors of atherosclerosis

A
  • older age
  • male
  • post menopausal women
  • family history
59
Q

What is the most important risk factor of atherosclerosis

A

Hypercholesteroaemia

60
Q

Where does atherosclerosis commonly affect? (5)

A
  • abdominal aorta
  • coronary arteries
  • carotid arteries
  • cerebral arteries
  • arteries in leg
61
Q

Outline the formation of plaque + what occurs after

A
  • chronic endothelial damage
  • accumulation of LDL in tunica intima
  • oxidation of LDL
  • phagocytosis by macrophage > foam cells
  • migration of SMC into tunica media > fatty streak
  • plaque growth
  • SMC on surface form fibrous cap
  • endothelium stretches over plaque + platelets adhere to gaps
  • central plaque cells die > Atheroma
  • small blood vessels grow into plaque from tunica adventitia
62
Q

Why does physical activity reduce your risk of atherosclerosis?

A

Regular physical activity can lower BP + improve cholestrol levels

Pathological Processes (14 decks)

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