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Semester 2-PP > Session 6-Atherosclerosis > Flashcards

Session 6-Atherosclerosis Flashcards

1
Q

Define atherosclerosis

A

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

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2
Q

Define arteriosclerosis

A

Thickening of walls of arteries and arterioles usually as a result of hypertension or diabetes mellitus

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3
Q

What are the three macroscopic features of atherosclerosis?

A

1) fatty streak
2) simple plaque
3) complicated plaque

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4
Q

Describe the fatty streak macroscopic feature of atherosclerosis

A
  • Lipid deposits in intima

- Yellow, slightly raised

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5
Q

Describe the simple plaque macroscopic feature of atherosclerosis

A
  • Raised yellow/white
  • Irregular outline
  • Widely distributed
  • Enlarge and coalesce
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6
Q

What happens to the complicated plaque macroscopic feature of atherosclerosis?

A
  • thrombosis
  • haemorrhage into plaque
  • calcification
  • aneurysm formation
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7
Q

What are the common sites of atherosclerosis?

A
  • aorta
  • coronary arteries
  • carotid arteries
  • cerebral arteries
  • leg arteries
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8
Q

Which vessel has the most elastic tissue?

A

Aorta

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9
Q

What are the early microscopic changes in atherosclerosis?

A
  • proliferation of smooth muscle cells
  • accumulation of foam cells
  • extracellular lipid
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10
Q

What are the later microscopic changes in atherosclerosis?

A
  • fibrosis
  • necrosis
  • cholesterol clefts
  • inflammatory cells
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11
Q

What are the latest microscopic changes in atherosclerosis?

A
  • disruption of internal elastic lamina
  • damage extends into media
  • ingrowth of blood vessels
  • plaque fissuring
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12
Q

What is plaque fissuring?

A

Allows blood into plaque and exposes substances that will lead to thrombosis

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13
Q

What are the clinical effects of atherosclerosis?

A
  • ischaemic heart disease
  • cerebral ischaemia
  • mesenteric ischaemia
  • peripheral vascular disease
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14
Q

What can ischaemic heart disease lead to?

A
  • sudden death
  • myocardial infarction
  • angina pectoris
  • arrhythmias
  • cardiac failure
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15
Q

What can cerebral ischaemia lead to?

A
  • transient ischaemic attack
  • cerebral infarction (stroke)
  • multi-infarct dementia
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16
Q

What is transient ischaemic attack?

A

Mini stroke - resolved in 24 hours

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17
Q

What can mesenteric ischaemia lead to?

A
  • ischaemic colitis
  • malabsorption
  • intestinal infarction
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18
Q

What can peripheral vascular disease lead to?

A
  • intermittent claudication
  • leriche syndrome
  • ischaemic rest pain
  • gangrene
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19
Q

What is intermittent claudication?

A

Pain in calves on walking, resolves after rest

20
Q

What is Leriche syndrome?

A

Pain in bum

21
Q

What are the factors affecting the onset of atherosclerosis?

A
  • age
  • gender
  • hyperlipidaemia
  • cigarette smoking
  • hypertension
  • diabetes mellitus
  • alcohol
  • infection
22
Q

True or false: high plasma cholesterol is associated with atherosclerosis

23
Q

What do lipoproteins carry?

A

Cholesterol and triglycerides

24
Q

What do chylomicrons transport?

A

Lipid from intestine to liver

25
What do VLDLs transport?
Cholesterol and triglycerides from liver
26
What do LDLs carry?
Cholesterol to non-liver cells
27
What do HDLs carry?
Cholesterol from periphery back to liver
28
What can be used as risk markers for atherosclerosis?
Polymorphisms of genes involved in genetic variations in ApoE
29
What are the physical signs of familial hyperlipidaemia?
Arcus Tendon xanthomas Xanthelasma
30
What are risk factors of atherosclerosis?
- lack of exercise - obesity - soft water - oral contraceptives - stress
31
What is the thrombogenic theory?
- Plaques formed by repeated thrombi | - Lipid derived from thrombi with an overlying fibrous cap
32
What is the insudation theory?
- endothelial injury - inflammation - increased permeability to lipid from plasma
33
What is the reaction to injury hypothesis?
- plaques form in response to endothelial injury - hypercholesterolaemia leads to endothelial damage - injury increases permeability and allows platelet adhesion - monocytes penetrate endothelium - smooth muscle cells proliferate and migrate
34
What is the monoclonal hypothesis?
- smooth muscle proliferation - each plaque is monoclonal - abnormal growth control
35
What is the role of endothelial cells in atherosclerosis?
- haemostasis - altered permeability to lipoproteins - production of collagen - stimulation of proliferation and migration of smooth muscle cells
36
What is the role of platelets in atherosclerosis?
- haemostasis | - stimulate proliferation and migration of smooth muscle cells (PDGF=platelet derived growth factor)
37
What is the role of smooth muscle cells in atherosclerosis?
- take up LDL and other lipid to become foam cells | - synthesise collagen and proteoglycans
38
What is the role of macrophages in atherosclerosis?
- oxidise LDL - take up lipids to become foam cells - secrete proteases which modify matrix - stimulate proliferation and migration of smooth muscle cells
39
What is the role of lymphocytes in atherosclerosis?
- TNF may affect lipoprotein metabolism | - stimulate proliferation and migration of smooth muscle cells
40
What is the role of neutrophils in atherosclerosis?
-secrete proteases leading to continued local damage and inflammation
41
What can endothelial injury be due to?
- raised LDL - toxins eg cigarette smoke - hypertension - haemodynamic stress
42
What can endothelial injury cause?
- platelet adhesion, PDGF release, smooth muscle cells proliferation and migration - insudation of lipid, LDL oxidation, uptake of lipid by smooth muscle cells and macrophages - migration of monocytes into intima
43
How can atherosclerosis be prevented?
- no smoking - reduce fat intake - treat hypertension - not too much alcohol - regular exercise/weight control
44
What is the name of the uncommon disease where there is calcification of the media of large arteries?
Monkeberg's disease
45
Complete the sentences: Atheroma is the _________ core of the atherosclerotic plaque. It consists of _______ cells, _______ and _______________ crystals.
Necrotic Dead Debris Cholesterol

Semester 2-PP (13 decks)

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