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Semester 2 - Mechanisms of Disease > Session 6 - Atheroma formation > Flashcards

Session 6 - Atheroma formation Flashcards

1
Q

Define atheroma

A

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

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2
Q

Define atherosclerosis

A

The thickening and hardening of arterial walls 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 hypertesnion or diabetes mellitus

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4
Q

What are the three types of atheroma?

A

Fatty streak
Simple plaque
Complicated plaque

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5
Q

What is a fatty streak atheroma?

What does it look like?

A

Lipid deposits in intima

Yellow, slightly raised

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6
Q

What does a simple plaque atheroma look like?

A

Raised yellow/white
Irregular outline
Widely distributed
Enlarge and coalesce

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7
Q

What is another name for a complicated plaque?

A

Thrombosis

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8
Q

How is complicated plaque caused?

A

Haemorrhage into plaque with subsequent calcification

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9
Q

What can a complicated plaque cause?

A

Aneurysm formation

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10
Q

Name five common sites of atheroma formation

A 
Aorta
Coronary arteries
Carotid arteries
Cerebral arteries
Leg arteries
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11
Q

What is this image?

A

**** Fatty streak atheroma

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12
Q

What is this an image of?

A

****Simple plaque

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13
Q

What is this an image of?

A

**** Complicated plaque

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14
Q

Give structure of normal artery

A 
Endothelium 
Sub endothelial ct
Internal elastic lamina
Muscular media
External elastic lamina
Adventitia

ESIMEA
Even sexy idiots make ellen angry

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15
Q

What are the early microscopic changes in atheroma?

A

Proliferation of smooth muscle cells
Accumulation of foam cells
Extracellular lipid

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16
Q

What are later micrscopic changes involved in atheroma?

A

Fibrosis
Necrosis
Cholesterol clefts
Change in number of inflammatory cells

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17
Q

What are the clinical effects of atheroma formation?

A

Ischaemic heart disease
Cerebral ischaemia
Mesenteric ischaemia
Peripheral vascular disease

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18
Q

What five conditions are associated with ischaemic heart disease?

A 
Sudden death
MI
Angina pectoris
Arrhythmias
Cardiac failure
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19
Q

What are three effects of cerebral ischaemia?

A

Transient ischaemic attack
Cerebral infarction ( stroke)
Multi-infarct dementia

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20
Q

What are three effects of mesenteric ischaemia?

A

Ischaemic colitis
Malabsorption
Intestinal infarction

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21
Q

What are the four effects of peripheral vascular disease?

A

Intermittent claudication
Leriche syndrome
Iscaemic rest pain
Gangrene

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22
Q

Give eight risk factors for atheroma formation

A 
Age
Gender
Hyperlipidaemia
Cigarette smoking
Hypertension
Diabetes mellitus
Alcohol 
Infection
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23
Q

How does age affect the risk of having an atheroma form?

A

Slow increase in risk as you age

Risks factors accumulate over the course of your life

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24
Q

How does gender effect your risk of atheroma formation?

A

Women protected before menopause due to hormones

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25
Q

How does hyperlipidaemia cause atheroma?

A

High plasma cholesterol associated with atheroma

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26
Q

What are the most significant factors in hyperlipidaemia?

A

LDL levels are dangerous

High HDL are protective

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27
Q

How are lipids carried in the blood?

A

Lipoproteins

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28
Q

What do lipoproteins carry (be specific)

A

Cholesterol, triglycerides, phospholipids and apolipoprotein, to be precise

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29
Q

What is the structure of a lipoprotein

A

Hydrophobic lipid core, hydrophillic outer layer of phospholipid and apolipoprotein

30
Q

Name four different types of lipid

A

Chylomicrons
LDL
VLDL
HDL

31
Q

What is the role of chylomicrons?

A

Transport lipid from intestine to liver

32
Q

What is the role of LDL’s?

A

Carry cholesterol to non-liver cells

33
Q

What is the role of VLDL’s?

A

Carry cholesterol and TG from liverr

34
Q

What is the role of HDL?

A

Carry cholesterol from adipose tissue to the liver

35
Q

What apolipoprotein are atheromas linked to?

A

Apo E

Polymorphisms of genes involved lead to at least 6 Apo E phenotypes

36
Q

What can polymorphisms of genes causing increased Apo E be used for?

A

Risk markers for atherome

37
Q

What is familial hyperlipidaemia?

A

Genetically determined abnormalities of lipoproteins which leads to early development of atheroma

38
Q

What are the associated physical signs of familial lipidaemia?

A
  • Corneal arcus
  • Tendon xanthomas
  • Xanthelasma
39
Q

What is cigarette smoking a powerful risk factor for, other than atheroma? (Vascular disease)

A

Ischaemic Heart Disease

40
Q

Give three possible modes of action of cigarette smoking causing atheromas

A

Coagulation system
Reduced prostacyclin (PGI2, eicosanoids)
Increased platelet aggregation

41
Q

What is hypertension linked to? How does it cause damage?

A

Strong link to IHD? Endothelial damage caused by raised blood pressure

42
Q

What affect does DM have on IHD risk?

A

Doubles the chance

43
Q

What effect does DM have on premenopausal women?

A

Lose their protected status

44
Q

What three atheroma related diseases are associated with DM?

A

IHD, cebrovascular and peripheral vascular disease,.

45
Q

What two other risk factors is DM related to?

A

Hyperlipidaemia and hypertension

46
Q

How many units of alcohol per day must be consumed for their to be increased risk IHD

A

> 5

47
Q

Why is alcohol so potent a risk factor?

A

Often associated with other lifestyle related risk factors

48
Q

What is interesting about alcohol consumption?

A

Smaller amounts are protective of atheroma

49
Q

Give five more risk factors of atheroma formation

A 
Lack of exercise
Obesity
Soft water
Oral contraceptive
Stress and personality
50
Q

What two variations in phenotype can account for increased genetic predisposition

A

Variations in apolipoprotein metabolism

Variations in apolipoprotein receptors

51
Q

What are the four theories concerning atheroma pathogenesis?

A

Thrombogenic theory
Insudation theory
Monoclonal hypothesis
Reaction to injury hypothesis

52
Q

What is the insudation theory of atheroma formation?

A

Endothelial injury
Inflammation
Increased permeability to lipid from plasma

53
Q

What is the reaction to injury hypothesis?

A

Plaques form in response to endothelial injury as a result of hypercholesterolaemia
Injury increases permeability and allows platelet adhesion
monocytes penetrate endothelium
Smooth muscle cells proliferate and migrate

54
Q

How does hypercholesterolaemia damage endothelium?

A

Oxidised LDL can cause subtle and undetectable injury

55
Q

What is the monoclonal hypothesis?

A

Belief that artheroma may have viral aeitology, stemming from the observation that each plaque is monoclonal, and may thus represent abnormal growth control .

56
Q

What is given a crucial role in the monoclonal hypothesis?

A

Smooth muscle prolifeation

57
Q

What are the four processes involved in atheroma formation?

A

Thrombosis
Lipid accumulation
Production of intercellular matrix
Interactions between cell types

58
Q

What are the six cells involved in atheroma?

A 
Endothelial cells
Platelets
Smooth muscle cells
Macrophages
Lymphocytes
Neutrophils
59
Q

What the four roles of endothelial cells in atheroma formation?

A

Key role in haemostasis
Altered permeability to lipoprotein
Secretion of collagen
Stimulation of proliferation and migration of smooth muscle cells

60
Q

What are the two rolls of platelets in atheroma formation?

A

Key role in haemostasis

Stimulate proliferation and migration of smooth muscle cells (PDGF - platelet derived growth factor)

61
Q

What are the two roles of smooth muscle cells

A

Take up LDL and other lipid to become foam cells

Synthesis collagen and proteoglycans

62
Q

What are the four roles of atheroma formation of macrophages?

A

Oxidise LDL
take up lipids to become foam cells
Secrete proteases which modify matrix
Stimulation proliferation and migration of smooth muscle cells

63
Q

How are lymphocytes involved in atheroma formation?

A

Tumour necrosis factor (TNF) may affect lipoprotein metabolism
Stimulate proliferation and migration of smooth muscle cells

64
Q

What is the role of neutrophils in atheroma formation?

A

Secrete proteases leading to continues local damage and inflammation

65
Q

What are the two steps of the unifying hypothesis?

A

Endothelial injury

Results of endothelial injury

66
Q

What causes endothelial injury under the unifying hypothesis?

A

Raised LDL
Toxins
Hypertension
Haemodynamic stress

67
Q

What does endothelial injury result in under the unifying hypothesis?

A
  • Platelet adhesion, PDGF release, smooth muscle cells (SMC) proliferation and migration
  • Insudation of lipid, LDL oxidation, uptake of lipid by SMC and macrophages
  • Migration of monocytes into intima
  • Stimulated SMC produce matrix material
  • Foam cells secrete cytokines
68
Q

What does the secretion of cytokines by foam cells cause in atheroma formation?

A

Further SMC stimulation

Recruitment of other inflammatory cells

69
Q

What are the five ways of reducing risk of atheroma formation?

A 
No smoking
Reduce fat intake
Treat hypertension
Not too much alcohol
Regular exercise/weight control
70
Q

What are five interventions to halt atheroma formation?

A 
Stop smoking
Modify diet
Treat hypertension
Treat diabetes
Lipid lowering drugs

Semester 2 - Mechanisms of Disease (16 decks)

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