SFP: atherosclerosis

Question 1

what is atherosclerosis

Answer 1

hardening of medium and large arteries

Question 2

what is arteriosclerosis

Answer 2

hardening of arteries in general

Question 3

what is monckeberg medial calcific sclerosis

Answer 3

Hardening of muscular arteries. It does not have attached clinical significance that we know of

Question 4

what is arteriosclerosis

Answer 4

Hardening of small arteries and arterioles; often secondary to conditions like diabetes, hypertension, etc. this causes vascular changes that can further cause hypertension

Question 5

What is the defining outcomes of atherosclerosis?

Answer 5

A mature plaque with a necrotic center containing cellular debris, solid cholesterol, (foamy) macrophages. There will also be a fibrous cap of smooth muscle cells, ECM, and new vessels via angiogenesis

Question 6

What does it mean when a plaque becomes unstable? What is the concern with this?

Answer 6

The plaque becomes unstable when the cap deteriorates; this can lead to rupture of the plaque and hemorrhage or thrombogenesis, which can cause immediate occlusion and cell death

Question 7

How does a plaque in atherosclerosis impact the surrounding vessel?

Answer 7

It can weaken adjacent tunica media and lead to aortic dissection or aneurysm

Question 8

Atherosclerosis accounts for __% of deaths in the western world

Answer 8

50

Question 9

Atherosclerosis can lead to which to conditions

Answer 9

MI and stroke

Question 10

What is a large genetic risk factor for atherosclerosis

Answer 10

Hypercholesterolemia

Question 11

In terms of cholesterol, what is found in cells of an atheroma?

Answer 11

Oxidized LDL

Question 12

What is the structure that develops before an atheroma called?

Answer 12

Fatty streak

Question 13

describe the formation of a fatty streak

Answer 13

Endothelial injury occurs, leading to endothelial dysfunction. This attracts monocytes and platelets. Smooth muscle cells also start to enter. The monocytes will become activated macrophages and begin to ingest lipids, giving them a foamy appearance

Question 14

describe formation of an atheroma

Answer 14

The smooth muscle cells proliferate and produce more extracellular matrix, creating a stable wall around the plaque. angiogenesis also occurs and more lipids also accumulate

Question 15

Describe endothelial injury and activation in the formation of a fatty streak

Answer 15

-Injury occurs to the endothelium, increasing its permeability
-LDL enters the intima, is oxidized, and forms various ROS and phospholipids. NO vasodilation is prevented.
-The oxidized LDL activates platelets and adhesion molecules
-Platelets bind to endothelial cells
-Macrophages ingest LDL to form foam cells

Question 16

How do macrophages recruit more monocytes

Answer 16

Release of cytokines, chemokines, and free radicals. These further damage the endothelial system

Question 17

Describe the role of T cells in forming an atheroma

Answer 17

Macrophages present antigens to T cells, causing them to release interferon gamma. This recruits more macrophages and c reactive protein

Question 18

Why do cholesterol crystals form?

Answer 18

The macrophages and smooth muscle cells die, and when they do they release the LDL cholesterol they had ingested. This forms cholesterol crystals in the necrotic core of the atheroma

Question 19

What medication class is thought to stabilize the plaque?

Answer 19

Statins; it is thought that they stabilize the fibrous cap

Question 20

Describe hyaline arteriosclerosis

Answer 20

The lumen of the arteriole is narrowed, and the wall lacks detail. This is caused by leakage of plasma through the endothelial wall and excess ECM production. this impacts the ability of these vessels to modify their diameter. This can be seen in benign hypertension, diabetes, and elderly patients

Question 21

Describe hyperplastic arteriosclerosis

Answer 21

Often seen in malignant hypertension. There is luminal narrowing and lamination of the vessel wall with layers of smooth muscle and thickened basement membrane. There will also be necrosis of the wall and fibrinoid deposits. These are typically known as onion skin lesions

Question 22

what kind of arteriosclerosis is associated with benign hypertension

Answer 22

hyaline arteriosclerosis

Question 23

what kind of arteriosclerosis is associated with metastatic hyperplasia

Answer 23

hyperplastic arteriosclerosis

Question 24

what kind of arteriosclerosis is associated with “onion skin” lesions

Answer 24

hyperplastic arteriosclerosis