Session 6 Flashcards by Aleem Hussain

What is atherosclerosis?

The accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries

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What is atheroma?

Thickening and hardening of arterial walls as a consequence of atherosclerosis

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What is arteriosclerosis?

Thickening of the walls of arteries and arterioles

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Arteriosclerosis is often as a result of… (2)

Hypertension

Diabetes mellitus

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What causes the fatty streak that can be seen in atherosclerosis?

Lipid deposits in tunica intima

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What appearance do fatty streaks take in atherosclerosis?

Yellow, slightly raised

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Describe the appearance of a simple plaque in atherosclerosis

Raised yellow/white
Irregular outline
Widely distributed

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What can be seen as a result of a ‘complicated plaque’ (4)

Calcification
Thrombosis
Haemorrhage into plaque
Aneurysm formation

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List some common sisters of atherosclerosis (5)

Aorta (particularly abdominal aorta)
Coronary arteries
Carotid arteries 
Cerebral arteries 
Leg arteries

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Name the different layers of an artery from inside to outside

Endothelium 
Sub-endothelial connective tissue (tunica intima)
Internal elastic lamina
Tunica media
External elastic lamina
Tunica adventitia

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What early microscopic features might your see in atherosclerosis? (3)

Proliferation of smooth muscle cells
Accumulation of foam cells
Extracellular lipid

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What later microscopic features might you see in atherosclerosis? (4)

Fibrosis
Necrosis
Cholesterol clefts
Inflammatory cells

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What further microscopic features (after early and later changes) might be seen in atherosclerosis? (4)

Disruption of internal elastic lamina
Damage extends into media
Ingrowth of blood vessels
Splitting/cracking of plaque

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Name 4 potential clinical effects of atherosclerosis

Ischaemic heart disease
Cerebral ischaemia
Mesenteric ischaemia
Peripheral vascular disease

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Name two potential consequences of ischaemic heart disease as a result of atherosclerosis

Angina

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Name two potential consequences of cerebral ischaemia as a result of atherosclerosis

Transient ischaemic attack

Cerebral infarction

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Give the colloquial name for a transient ischaemic attack

Give the colloquial name for a cerebral infarction

Mini-stroke

Stroke

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Name a potential consequence of mesenteric ischaemia as a result of atherosclerosis

Ischaemic colitis

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Name two potential consequences of peripheral vascular disease

Gangrene

Intermittent claudication

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What is the main symptom of intermittent claudication

Pain in the calves when walking

What is a plaque?

A raised patch on or within the body resulting from local damage of deposition of material

E.g. Fatty deposit on an artery wall in atherosclerosis

List some predisposing factors for atherosclerosis

Age
Gender
Hyperlipidaemia 
Cigarette smoking 
Hypertension 
Diabetes 
Alcohol 
Infection 
Lack of exercise
Obesity 
Soft water
Oral contraceptives

How does age work as a predisposing factor for atherosclerosis?

Slowly progressive throughout adult life

How does gender work as a predisposing factor for atherosclerosis?

Women are generally protected before the menopause

How does hyperlipidaemia work as a predisposing factor for atherosclerosis?

High plasma cholesterol associated with atherosclerosis

Which lipoprotein is most significant in contributing to atherosclerosis? Which lipoprotein is protective against hyperlipidaemia?

LDL HDL

What is the most powerful risk factor for atherosclerosis/Ischaemic Heart Disease?

Cigarette smoking

> __ units a day of alcohol is associated with increased risk of IHD?

Is there genetic predisposition for the onset of atherosclerosis?

Yes

Name the 4 theories of atherosclerosis pathogenesis

Thrombogenic theory Insudation theory Monoclonal hypothesis Reaction to injury hypothesis

Describe the thrombogenic theory of atherosclerosis pathogenesis Describe the insudation theory of atherosclerosis pathogenesis

Plaques formed by repeated thrombi, with the lipid derived from thrombi and an overlying fibrous cap Considered the role of endothelial injury/inflammation in the formation of atherosclerotic plaques. Stated that the plaque gained lipid from the circulating plasma.

Describe the monoclonal hypothesis of atherosclerosis pathogenesis

Hypercholesterolaemia leads to endothelial damage and as a result plaque formation. Injury increases permeability and allows platelet adhesion. Monocytes penetrate the endothelium. Smooth muscle cells proliferate and migrate.

How does the reaction to injury hypothesis further explain atherosclerosis pathogenesis?

Has a crucial role for smooth muscle proliferation with each plaque being composed of monoclonal smooth muscle cells

Name the 4 main processes involved in atherosclerosis

Thrombosis Lipid accumulation Production of extracellular matrix Interactions between cell types

List 6 cells that are involved in atherosclerosis

``` Endothelial cells Platelets Smooth muscle cells Macrophages Lymphocytes Neutrophils ```

Describe the role of endothelial cells in atherosclerosis

Important role in haemostasis Have altered permeability to lipoproteins Produce collagen Stimulate proliferation/migration of smooth muscle cells

What role do platelets play in atherosclerosis?

Important role in haemostasis | Stimulate proliferation/migration of smooth muscle cells

How do platelets stimulate the proliferation/migration of smooth muscle cells?

Through the production of PDGF

What role do smooth muscle cells play in atherosclerosis?

Take up LDL and other lipid to become foam cells | Synthesise collagen and proteoglycans

What role do macrophages play in atherosclerosis?

Oxidise LDL Take up lipids to become foam cells Secrete proteases which modify the matrix Stimulate the proliferation/migration of smooth muscle cells

What role do lymphocytes play in atherosclerosis?

Produce TNF which can affect lipoprotein metabolism | Stimulate proliferation/migration of smooth muscle cells

What do lymphocytes produce that can affect lipoprotein metabolism?

TNF

What role do neutrophils play in atherosclerosis?

Secrete proteases leading to continued local damage and inflammation

In a unifying hypothesis of atherosclerosis, endothelial injury occurs which is due to... (4)

Raised LDL Toxins - e.g. Cigarette smoke Hypertension Haemodynamic stress

In a unifying hypothesis of atherosclerosis, endothelial injury occurs which causes... (3)

Platelet adhesion, PDGF release and smooth muscle cell proliferation/migration Accumulation of lipid, LDL oxidation, uptake of lipid by smooth muscle cells/macrophages Migration of monocytes into the intima

State two cells that can take up lipid in atherosclerosis

Smooth muscle cells | Macrophages

In atherosclerosis, stimulated smooth muscle cells produce...

Matrix material

What do foam cells secrete in atherosclerosis? What does this result in? (2)

Cytokines Further smooth muscle stimulation Recruitment of other inflammatory cells

List 5 preventative measures of atherosclerosis

``` No smoking Reduced fat intake Treat hypertension Not too much alcohol Regular exercise Weight control ```