w23 cardiovascular pathology Flashcards
LO
To understand the pathogenesis and clinical consequences of atherosclerosis
To learn about myocardial infarction and its management.
to fix w lec notes slide 13,14, 15 16 18 make cards & 23 onwards - lol
rigidity (sclerosis)
and often thickening of blood vessel) is known as
Arteriosclerosis
Whats the diff bw arteriosclerosis and arteriolosclerosis
arteriosclerosis - rigid & thicken. BV
arteriOLOsclerosis - small BVs ; fully thick ; hypertension & diabetes
- kidneys affected
What is medial calcific sclerosis
Medium size arteries
Tunica media involved
No obstruction to blood
flow
Define Atherosclerosis
Chronic inflamm. disorder of intima of L & Medium arteries
characterised by fibrofatty plaque called atheroma
atherosclerosis is a disease of what sized arteries
large and medium
3 Major causes of atherosclerosis are
Major cause of ischemic heart disease, Myocardial infarction, hypertension
modern lifestyle ?
How long does primary atherosclerosis take to produce clinical manifestations?
Duration of dvpmt in decades (longest)
How long does TRANSPLANT atherosclerosis take to produce clinical manifestations?
Narrowing of arteries at the points of engraftment of transplanted organs - Duration of dvpmt in mths –years
How long does Re-stenosis after coronary bypass take to produce clinical manifestations?
(atherosclerosis)
duration of dvpmt in mths - yrs
name the 2 hypothesis for possible causes of atherosclerosis
lipid hypothesis
injury hypothesis
what is the lipid hypothesis for atherosclerosis
potential cause ; Lipid hypo:
- Diabetes
- Familial hyperlipidemia
- Hyperlipedemia due to life style
- Raised LDL in blood
whats injury hypothesis for atherosclerosis
- Hypertension
- Oxidised LDL
- infections e.g .cytomegalovirus, herpes simplex viruses, enteroviruses, hepatitis A and chlamydia pneumoniae
- Smoking
what is familial hypercholesterolemia
Familial Hypercholesterolemia (FH)is a genetic disease which results in the reduced clearance of atherogenic LDL-cholesterol (“bad cholesterol”) in the blood, and an increased risk of early heart disease.
Ppl w FH - elevated LDL cholesterol levels from birth
children with FH show an increased thickness of arteries compared to their non-FH siblings by age of 11,
showing the process of atherosclerosis development starts early in life.
As a result of their FH, the incidence of fatal or non-fatal myocardial infarction without treatment is about 50% by the age of 50 years in men and about 30% by the age of 60 years in women.
Name 4 uncontrollable risk factors of atherosclerosis
Sex (M > F)
Hereditary
Race
Age
Name some controllable RFactors for atherosclerosis
High blood pressure
High blood cholesterol
Smoking
Physical activity
Obesity
Diabetes
Stress and anger
Diet
Who discovered the lipid hypothesis for atherosclerosis
Rudolf Virchow 1856
what does the lipid hypothesis for atherosclerosis propose
- proposes that infiltration of intima with lipid is the primary atherogenic event due to raised blood lipid levels
- Increased cholesterol level is associated with a ________ ___________ of heart diseases
higher incidence of heart diseases
define sources of triglycerides
saturated fat such as dairy products,
animal fat, vegetable oils
name sources of cholesterol
Liver, kidneys, eggs and prawns are higher in dietary cholesterol than other foods.
describe composition of a fatty acid (2 things)
Fatty acid is composed of a hydrocarbon chain with one terminal carboxyl group (COOH).
whats the diff bw unsaturated Facids & saturated FAs
Unsaturated fatty acids have one or more carbon-carbon double bonds, whereas saturated fatty acid has no double bond in its hydrocarbon chain.
whats oleic acid (example of smthn not needed)
Oleic acid is an example of a monounsaturated fatty acid. The most common polyunsaturated fatty acids are linoleic and arachidonic. Arachidonic acid (C20) is of particular interest as the precursor of a family of molecules, known as eicosanoids (from Greek eikosi, “twenty”), that includes prostaglandins, thromboxanes, and leukotrienes.
in lipid metabolism how many pathways of ‘frwd’ lipid transport move from liver > peripheral tissues
two major pathways of “forward” lipid transport in which lipids move from the liver to the peripheral tissues.
Exogenous path
endogenous path
in depth q of two lipid metabolism paths
name the 3 lipid types in the blood
very low density lipoprotein (VLDL)
low density lipoprotein
high density lipoprotein
Describe Very low density lipoprotein (VLDL)
where made ? hwo it travels ? what it contains ? function?
Made in the liver
- Secreted into the bloodstream
- Contain triglycerides (TGs) mainly but also cholesterol
Function: deliver TGs to body cells
describe Low density lipoprotein (LDL)
Made in the Liver as VLDL
- Arise from VLDL once it has lost a lot of its TG’s
- Present in the bloodstream
- Rich in cholesterol (contain 75% of cholesterol)
Function: Deliver cholesterol to all body cells
describe high density lipoprotein
- Made in the Liver and Small Intestine
- Secreted into the bloodstream
Function: pick up cholesterol from body cells and take it back to the liver = “reverse cholesterol transport”
Potential to help reverse heart disease
describe high density lipoprotein
- Made in the Liver and Small Intestine
- Secreted into the bloodstream
Function: pick up cholesterol from body cells and take it back to the liver = “reverse cholesterol transport”
Potential to help reverse heart disease
High risk for coronary diseases = high for VLDL high for LDL and is it high or low for HDL ?
low level risk for coronary diseases for HDL
slide 13 to do
name some lifestyle causes of hypercholesterolemia
Being overweight
● Heavy alcohol use
● Lack of exercise,
inactive lifestyle & diet
name some medical conditions that could contribute to causing hypercholesterolemia
Diabetes
● Hypothyroidism
● Familial hypercholesterolemia
(LDL receptor mutations and ApoB mutations have detected in bw 50- 80% cases of FH)
● Polycystic ovary syndrome
description of physical characteristics of hypercholestrolemia
Xanthelasma palpebrarum, yellowish patches consisting of cholesterol deposits.
These are more common in people with familial hypercholesterolemia
what age does arteriosclerosis start
10-14 young
name the 3 stages of arteriosclerosis
endothelial damage
fatty streaks
advanced lesions
describe what happens in the endothelial damage stage of arterosclerosis
lipid enters into intima
describe what looks like in the fatty streaks stage of arteriosclerosis
pale yellow, smooth surface, defined border that protrude into the lumen containing macrophages filled with lipid
describe composition of the advncd lesions stage of arteriosclerosis
fibro fatty plaques
(connective tissues, smooth muscle cells proliferation , accumulated lipids and lipid laden macrophages -foam cells, lymphocytes, lesion covered by fibrous cap)
Name 3 clinical manifestations of atherosclerosis
CHeartDisease
Cerebrovascular disease
peripheral arterial disease
Describe symptoms of coronary heart disease (rel. to atherosclerosis)
Stable angina, acute myocardial infarction, sudden death, unstable angina
what clinical manifestation of atherosclerosis causes gangrene and intermittent claudication
peripheral arterial disease
the 3rd clinical manifestation of atherosclerosis is cerebrovascular disease AKA ______
stroke
what is gangrene
death of tissue in body
foul smellin discharge of black foot ; surface & subsurface discolouration
5 consequences of atheroma are..
Narrowing of lumen
Plaques undergo changes:
ulceration
- fissuring
haemorrhage into plaque
- thrombus
3) Thrombus formation –> ischemia –> infarct
4) Embolism: thrombus can break away to become emboli
5) Atrophy of media –> weakening of wall –>
aneurysm (abnormal dilatation of a vessel wall–>
- rupture
- thrombus
complications of atherosclerosis
Thrombosis, thrombo-embolism
Rupture – haemorrhage
Aneurism – fusiform, dissecting, berry etc.
Fibrosis and Calcification
Ischemia: Angina/infarction
Stroke, myocardial infarction, renal infarction
Intermittent claudication, gangrene etc.
2 diagnostic methods for atherosclerosis
Angiography
Ultrasound
what is angiography
guidewire w catheter inserted into femoral artery. It is moved into aorta and when it reaches opening of coronary arteries, contrast dye inj. to visualise the coronary arteries.
