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Flashcards in Atheroma Deck (15)
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1

Define atheroma

a build up of fatty material on the inside wall of an artery
initiated by chronic injury to endothelium by smoking/hypertension/hyperlipidaemia = chronic inflammation
progresses as WBC, fat and blood infiltrate injury

2

Define atherosclerosis

the progressive narrowing and hardening within an artery potentially resulting in complete blockage

3

Clinical manifestation

can occur in any artery:
- coronary artery = heart attacks/angina
- aorta = aneurysm due to weakening of walls
- carotid = narrowing causes strokes
- peripheral vascular disease

4

Ischaemic heart disease

imbalance between supply and demand of the heart for oxygenated blood
- decrease O2 and nutrients substrates and inadequate metabolite removal

5

Causes of IHD

decrease flow/no flow of oxygenated blood = atheroma, spasm, embolism
increased demand for O2 = thyrotoxicosis, myocardial hypotrophy

6

Fixed and reversible risk factors of IHD

Fixed:
positive family history
male sex
age
genetic factors
Potentially reversible with treatment:
hyperlipidaemia
smoking
hypertension
diabetes
lack of exercise
obesity
alcohol consumption

7

Signs and symptoms of IHD

chest pain (central, crushing, radiating to L arm/jaw)
shortness of breath
palpitations
nausea, sweating, pale

8

Clinical presentation & diagnosis

Stable Angina - plaque disruption & spasm, induced by effort, resolved by rest/GTN
Unstable angina - + partial thrombosis, possible emboli, occurs at rest, lasts longer
NSTEMI, STEMI & sudden death- plaque rupture, thrombosis

9

Investigations for IHD

obs = BP, pulse, sats, resp rate
bloods (inc cardiac enzymes)
chest X-ray
ECG
exercise tolerance test

10

Consequences of MI

cardiac arrest, arrhythmias, pericarditis, valvular defects, deep vein thrombosis, pulmonary embolus

11

Treatment of IHD

oxygen, aspirin, pain relief
Angina = lifestyle, nitrates, B-blockers
Acute coronary syndromes = thrombolytic therapy
angioplasty & stenting
coronary heart bypass graft

12

Hyperlipidaemia

LDL = bad cholesterol that is delivered to tissues
HDL = good cholesterol, mobilizes cholesterol from tissues and transports it to liver to be excreted in bile

13

How to prevent/modify an atheroma?

Stop smoking
Control hypertension
Weight reduction
Increase exercise
Moderation of alcohol
Increase HDL, decrease LDL

14

What is stable angina?

plaque disruption and spasm, induced by effort, resolved with rest, GTN

15

What is unstable angina?

plaque disruption, spasm, partial thrombosis and embolism, occurs at rest