Pathophysiology of Atheroma Flashcards Preview

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Flashcards in Pathophysiology of Atheroma Deck (25)
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1
Q

What is Atheroma?

A

Formation of focal elevated lesions (plaques) in intima of large and medium sized arteries

2
Q

What does atheroma in coronary arteries cause?

A

Ischaemia

3
Q

What is arteriosclerosis?

A

Age-related thickening, hardening and loss of elasticity in muscular arteries

4
Q

What is the earliest significant lesion in atheroma?

A

A fatty streak

5
Q

What is a fatty streak?

A

A yellow linear elevation of intimal lining comprised of masses of lipid-laden macrophages with no clinical significance

6
Q

What can a fatty streak develop into?

A

Early atheromatous plaque

7
Q

What is an early atheromatous plaque?

A

Smooth yellow patches in the intimal which is made of lipid-laden macrophages

8
Q

What does an early atheromatous plaque develop into?

A

Established plaques

9
Q

What is a fully developed atheromatous plaque?

A

Central lipid core with fibrous tissue cap, covered by arterial endothelium

10
Q

What resides inside the fibrous cap of an atheromatous plaque?

A

Inflammatory cells recruited from arterial endothelium

11
Q

What occurs in late stage plaque development?

A

Dystrophic calcification

12
Q

Where do plaques form?

A

At arterial branching points (bifurcations)

13
Q

What are the characteristics of a complicated atheroma?

A

Haemorrhage into the plaque
Plaque rupture
Thrombosis

14
Q

What is the most important risk factor of atheroma?

A

Hypercholesterolaemia

15
Q

What are the major signs of hyperlipidaemia?

A

Corneal arcus
Tendon xanthomata
Xanthelasmata
Biochemical evidence

16
Q

What are the high risk factors of atheroma?

A
Smoking 
Hypertension 
Diabetes mellitus 
Male 
Elderly 
Accelerated process of plaque formation driven by lipids
17
Q

What are the less strong risk factors of atheroma?

A

Obesity
Sedentary lifestyle
Low socio-economic status
Low birthweight

18
Q

What are the two steps involved in the formation of atheromatous plaque?

A
  1. Injury to the endothelial lining of the artery
  2. Chronic inflammatory and healing response of vascular wall to agent causing injury

It is the chronic exposure of the arterial wall to these processes that cause the atheromatous plaque to form

19
Q

What are the most important causes of endothelial injury in atheromatous plaque formation?

A

Haemodynamic disturbance

Hypercholesterolaemia

20
Q

How does injury to the endothelial cells cause plaque formation?

A

There is a change to the endothelial cells functionally so there is enhanced expression of cell adhesion molecules. This causes high permeability for LDL and increased thrombogenicity

21
Q

How do plaques grow?

A

The established plaques growth is initiated by small areas of endothelial loss

22
Q

What is the clinical significance of atheroma?

A

Progressive lumen narrowing due to high grade plaque stenosis
Acute atherothrombotic occlusion
Embolisation of distal arterial bed
Ruptured atheromatous abdominal aortic aneurysm

23
Q

What does an acute atherothrombotic occlusion cause?

A

Myocardial infarction
Stroke
Lower limb gangrene

24
Q

What are the preventative and therapeutic approaches to atheroma?

A
Stop smoking 
Control blood pressure 
Weight-loss 
Regular exercise  
Dietary modifications
25
Q

What are the secondary preventative methods for atherma?

A

Cholesterol lowering drugs and aspirin