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PP A > Session 6 > Flashcards

Session 6 Flashcards

1
Q

Define atherosclerosis

A

Accumulation of the intracellular and extracellular lipid in the intima and media of large and medium sized arteries.

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2
Q

What is an alternative definition of atherosclerosis?

A

The thickening and hardening of arterial wall as a consequence of atheroma.

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3
Q

Define arteriosclerosis

A

The thickening of the walls of arteries and arterioles usually as a result of hypertension or diabetes mellitus.

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4
Q

What is the main different between arteriosclerosis and atherosclerosis?

A

Arteriosclerosis is due to something else, NOT atheroma

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5
Q

What are the macroscopic features of atherosclerosis?

A

Fatty streak, simple plaque and complicated plaque

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6
Q

What are fatty streaks?

A

Lipids deposited in the intima. Yellow and slightly raised.

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7
Q

What is simple plaque?

A

Raised yellow/white. Irregular outline. Widely distributed. Gradually enlarge and coalesce.

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8
Q

What is complicated plaque?

A

This is where something has happened to the atherosclerosis.

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9
Q

What causes complicated plaque?

A

thrombosis, haemorrhage into plaque, calcification or aneurysm formation

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10
Q

Why can you get haemorrhage into plaque?

A

When small new blood vessel forming in the plaque rupture and bleed.

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11
Q

What are the common sites of atherosclerosis?

A

Aorta, coronary arteries, coracoid arteries, cerebral arteries and leg arteries.

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12
Q

What is the normal arterial structure?

A

Endothelium, subendothelial CT, internal elastic lamina, muscular media, external elastic lamina and adventita CT.

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13
Q

What is the media in the arteries made up of?

A

Mainly muscle by there is some elastic tissue as well.

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14
Q

What are the early microscopic features of atherosclerosis?

A

Proliferation of smooth muscle cells, accumulation of foam cells and extracellular lipid.

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15
Q

What are the later microscopic features of atherosclerosis?

A

Fibrosis, necrosis, cholesterol clefts and +/- inflammatory cells. Disruption of internal elastic lamina, media. Ingrowth of blood vessels and plaque fissuring.

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16
Q

What are the clinical effects of atherosclerosis?

A

MI, angina, arrhythmias, cardiac failure

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17
Q

What affects can cerebral ischaemia have?

A

Transient ischaemic attack (mini-stroke), cerebral infarction (stroke) or multi-infarct dementia

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18
Q

What effects can mesenteric ischaemia have?

A

Ischaemic colitis, malabsorption or intestinal infarction

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19
Q

What causes peripheral vascular disease?

A

Atherosclerosis affecting the blood supply of the legs

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20
Q

What effects does peripheral vascular disease have?

A

Intermittent claudication, leriche syndrome (pain in buttocks), ischaemic rest pain and gangrene

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21
Q

What are some risk factors of atherosclerosis?

A

Age, gender, hyperlipidaemia, smoking, hypertension, diabetes, alcohol and infection.

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22
Q

How does age affect risk of getting atherosclerosis?

A

Risk increases with age

23
Q

How does gender affect risk of getting atherosclerosis?

A

Women relatively protected before menopause due to hormones.

24
Q

How does hyperlipidaemia affect risk of getting atherosclerosis?

A

High plasma cholesterol associated with atherosclerosis. LDL more significant and HDL is protective.

25
Q

What are chylomicrons?

A

Transport lipid from intestine to liver

26
Q

What is VLDL?

A

Carry cholesterol and TG from liver. TG removed leaving LDL.

27
Q

What is LDL?

A

Rich in cholesterol. Carry cholesterol to non-liver cells.

28
Q

What is HDL?

A

Carry cholesterol from periphery back to the liver

29
Q

What is apolipoprotein?

A

Found in the chylomicron. Transport lipid in the blood.

30
Q

What are genetic variations in Apo E associated with?

A

Changed in LDL levels

31
Q

What is familial hyperlipidaemia?

A

Genetically determined abnormality of lipoprotein. Leads to early development of atherosclerosis.

32
Q

What are the physical signs of familial hyperlipidaemia?

A
  • Corneal arcus - fat around cornea
  • Tendon xanthomas - accumulations of macrophages filled with fat
  • Xanthelasma - fat deposits around eyelids
33
Q

How does cigarette smoking affect risk of getting atherosclerosis?

A
  • Affects the coagulation system
  • Reduced PGI2 (prostaglandins)
  • increased platelet aggregation
34
Q

How does hypertension affect risk of getting atherosclerosis?

A

Causes endothelial damage because of raised pressure.

35
Q

How does diabetes mellitus affect risk of getting atherosclerosis?

A

Related to hyperlipidaemia and hypertension

36
Q

How does alcohol consumption affect risk of getting atherosclerosis?

A

Often associated with other risk factors such as smoking and high BP but still an independent risk factor.

37
Q

Give examples of infections that may increase risk of atherosclerosis?

A

Chlamydia pneumoniae, helicobacter pylori and cytomegalovirus.

38
Q

What was the first theory of atherosclerosis formation?

A

Thrombogenic theory - plaques formed by repeated thrombi and lipid derived from thrombi

39
Q

What was the second theory of atherosclerosis?

A

Insulation theory - endothelial injury and inc permeability to lipid from plasma

40
Q

What was the third theory of atherosclerosis?

A

Reaction to injury - plaque form in response to endothelial injury

41
Q

What was the fourth theory of atherosclerosis?

A

Monoclonal hypothesis - each plaque is benign tumor because they are due to smooth muscle cells multiplying

42
Q

What does the atherosclerosis process involve?

A

Thrombosis, lipid accumulation, production of intracellular matrix and interactions between cell types.

43
Q

What cell are involved in atherosclerosis?

A

Endothelial cells, platelets, smooth muscle cells, macrophages, lymphocytes and neutrophils.

44
Q

What role do endothelial cell splay in atherosclerosis?

A

Increase permeability to lipoproteins and stimulate proliferation and migration of smooth muscle cells.

45
Q

What role do platelets play in atherosclerosis?

A

Stimulate proliferation and migration of smooth muscle cells

46
Q

What role do smooth muscle cells play in atherosclerosis?

A

Take up lDL and other lipid to become foam cells. Also synthesis collagen and proteoglycans.

47
Q

What role do macrophages play in atherosclerosis?

A

Oxides LDL. Take up lipids to become foam cells. Secrete proteases which modify matrix and stimulate the proliferation and migration of smooth muscle cells.

48
Q

What role do lymphocytes play in atherosclerosis?

A

TNF and other cytokines may affect lipoprotein metabolism. Stimulate proliferation and migration of smooth muscle cells.

49
Q

What affect do neutrophils have on atherosclerosis?

A

Secrete proteases leading to continued local damage and inflammation

50
Q

What is endothelial injury due to?

A

Raised LDL, ‘toxins’ (smoking), hypertension and haemodynamic stress.

51
Q

What does endothelial injury cause?

A

Platelet adhesion, PDGF release, SMC proliferation adn migration. Insudation of lipid, LDL oxidation, uptake of lipid SMC and macrophages. Migration of monocytes into intima.

52
Q

How do you prevent atherosclerosis?

A

No smoking, reduce fat intake, treat hypertension, not too much alcohol, regular exercise.

53
Q

If someone has atherosclerosis, what can you do to help?

A

Stop smoking, modify diet, treat hypertension, treat diabetes and lipid lowering drugs.

PP A (13 decks)

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