PP: Atherosclerosis

Question 1

Define arteriosclerosis.

Answer 1

The thickening of the walls of the arteries and arterioles usually as a result of hypertension or diabetes.

Question 2

Define atherosclerosis.

Answer 2

The accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries.

Question 3

Define atheroma.

Answer 3

degeneration of the walls of the arteries caused by accumulated fatty deposits

Question 4

Describe the macroscopic appearance of atherosclerosis.

Answer 4

• Fatty streak
• Simple plaque
• Leads to complicated plaque

Question 5

Describe the appearance of a fatty streak.

Answer 5

Lipid deposits in the intima results in a yellow slightly raised area.

Question 6

Describe the appearance of a simple plaque.

Answer 6

Raised yellow/white area which is widely distributed with an irregular outline.

Question 7

What might happen to a simple plaque which leads to complicated plaque formation?

Answer 7

• Thrombosis
• Haemorrhage into plaque
• Calcification
• Aneurysm formation

Question 8

Describe the microscopic appearance of atherosclerosis.

Answer 8

• Early changes: proliferation of smooth muscle cells, accumulation of foam cells, extracellular lipid disposition
• Later changes: fibrosis, plaque fissuring, necrosis, cholesterol clefts, disruption of internal elastic lamina, damage extends into media, ingrowth of blood vessels

Question 9

List the common sites for atherosclerosis.

Answer 9

• Abdominal aorta
• Coronary arteries
• Carotid arteries
• Cerebral arteries
• Leg arteries

Question 10

Describe the complications of ischaemic heart disease.

Answer 10

• Sudden death
• MI
• Angina
• Arrhythmias
• Cardiac failure

Question 11

Name some clinical effects of severe atherosclerosis.

Answer 11

• Ischaemic heart disease
• Cerebral ischaemia
• Meseneteric ischaemia
• Peripheral vascular disease
• Abdominal aortic aneurysm

Question 12

What are the clinical effects of cerebral ischaemia?

Answer 12

• Transient ischaemia attack
• Stroke
• Multi-infarct dementia

Question 13

What are the clinical effects of mesenteric ischaemia?

Answer 13

• Ischaemic colitis
• Malabsorption
• Intestinal infarction

Question 14

What are the clinical effects of peripheral vascular disease?

Answer 14

• Intermittent claudication (intermittent pain when walking)
• Leriche syndrome (pain in the bum, aka vibha)
• Ischaemic rest pain
• Gangrene

Question 15

Name some risk factors of atherosclerosis.

Answer 15

• Smoking
• Hypertension
• Impaired glucose tolerance
• hyperlipidaemia
• Alcohol
• Apolipoprotein E genotype
• Familial hyperlipidaemia
• Geography

Question 16

What advise would you give to a patient that wished to reduce their risk of atherosclerosis?

Answer 16

• Stop smoking m8
• Decrease your fat intake fatty
• Lets treat your hypertension yeh?
• Want some aspirin?
• Think you need to cut back on the drinkys
• Meet me at piyo, you need exercise
• Treat diabetes
• Lipid lowering drugs (if needed)

Question 17

Describe the cellular events which lead to the formation of a atherosclerotic lesion.

Answer 17

1. Chronic endothelial injury
2. Endothelial dysfunction with platelet adhesion
3. Monocytes accumulate and release growth factors and cytokines
4. Smooth muscle migrates from media to intima
5. Macrophages and smooth muscle cells engulf lipid to form foam cells
6. Smooth muscle proliferation, collagen and matrix deposition, extracellular lipid deposition, neurovascularisation

Question 18

Describe some of the mechanisms of atherogenesis.

Answer 18

1. Atherosclerosis is due to injury
2. Atherosclerosis is something to do with monoclonal devision as some are seen to have cells of the same origin (a bit like a tumour)

Question 19

Name the cells involved in atherosclerosis.

Answer 19

• Endothelial
• Platelets
• Smooth muscle cells
• Macrophages
• Lymphocytes
• Neutrophils

Question 20

What is the role of endothelial cells in atherosclerosis?

Answer 20

• Alter permeability to lipoproteins
• Collagen production
• stimulation and proliferation and migration of smooth muscle cells

Question 21

What is the role of platelets in atherosclerosis?

Answer 21

Stimulation, proliferation and migration of smooth muscle cells

Question 22

What is the role of smooth muscle cells in atherosclerosis?

Answer 22

• Take up LDL and other lipids to become foam cells

- Synthesise collagen and proteoglycans

Question 23

What is the role of macrophages in atherosclerosis?

Answer 23

• Oxidise LDL
• Take up lipids to become foam cells
• Secretes proteases with modify the matrix
• Stimulate proliferation and migration of smooth muscle cells

Question 24

What is the role of lymphocytes in atherosclerosis?

Answer 24

Stimulate proliferation and migration of smooth muscle cells

Question 25

What is the role of neutrophils in atherosclerosis?

Answer 25

Secrete proteases leading to continued local damage and inflammation