Atheroma and Atherosclerosis Overview
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Questions and Answers

What is the primary component of the soft, yellow core of an atheroma?

  • Fatty acids
  • Triglycerides
  • Cholesterol esters (correct)
  • Phospholipids
  • Which statement best describes arteriosclerosis?

  • It solely affects small arteries.
  • It represents a specific type of atherosclerosis.
  • It is characterized by the accumulation of plaque in the arteries.
  • It involves the thickening and loss of elasticity of arterial walls. (correct)
  • Which of the following is NOT a cellular event leading to atherosclerotic lesions?

  • Inflammatory response
  • Vasoconstriction of small arteries (correct)
  • Formation of fibrous cap
  • Accumulation of lipids
  • What role do cytokines such as platelet-derived growth factor (PDGF) play in atherogenesis?

    <p>They promote inflammation and cell proliferation. (B)</p> Signup and view all the answers

    Which of the following is considered a risk factor for atherogenesis?

    <p>Hypertension (C)</p> Signup and view all the answers

    What characterizes Mönckeberg medial calcific sclerosis?

    <p>Calcific deposits in muscular arteries (D)</p> Signup and view all the answers

    Which cell type is primarily involved in the initial stages of atherosclerotic lesion formation?

    <p>Endothelial cells (C)</p> Signup and view all the answers

    Which of the following processes is NOT involved in the formation of atheroma?

    <p>Increased oxygenation of tissues (C)</p> Signup and view all the answers

    What is the primary function of macrophages in atheroma formation?

    <p>Oxidize LDL and become foam cells (A)</p> Signup and view all the answers

    Which of these motifs describes the composition of fatty streaks in atherosclerosis?

    <p>Dominated by lipid-filled foam cells (B)</p> Signup and view all the answers

    Which role do smooth muscle cells play in the context of vascular injury?

    <p>They proliferate and migrate to form a neointima. (A)</p> Signup and view all the answers

    What stimulates the proliferation and migration of smooth muscle cells during atheroma formation?

    <p>Platelet-derived growth factor (PDGF) (D)</p> Signup and view all the answers

    Which morphological appearance is associated with the earliest stage of atherosclerosis?

    <p>Fatty streaks (B)</p> Signup and view all the answers

    Which condition is caused by the accumulation of lipoproteins in the arterial wall?

    <p>Atherosclerosis (B)</p> Signup and view all the answers

    What are the primary sites of development for atherosclerotic plaques?

    <p>Elastic arteries and large muscular arteries (B)</p> Signup and view all the answers

    What is the most significant type of lipoprotein associated with atheroma formation?

    <p>LDL (B)</p> Signup and view all the answers

    Which of the following is a major consequence of atherosclerosis?

    <p>Peripheral vascular disease (B)</p> Signup and view all the answers

    Which of the following is a protective lipoprotein against atheroma?

    <p>HDL (A)</p> Signup and view all the answers

    What is the term for early changes in atherosclerosis characterized by smooth muscle proliferation?

    <p>Proliferation of smooth muscle cells (C)</p> Signup and view all the answers

    What is the primary reason women experience relatively lower atheroma risk before menopause?

    <p>Hormonal protection (B)</p> Signup and view all the answers

    Which factor significantly increases the risk of ischemic heart disease (IHD)?

    <p>High plasma cholesterol (C)</p> Signup and view all the answers

    During the progression of atheromas, which of the following is considered a late change?

    <p>Cholesterol clefts (B)</p> Signup and view all the answers

    What is a key feature of complicated plaques?

    <p>Presence of thrombosis (D)</p> Signup and view all the answers

    What is a common complication associated with chronic hypertension?

    <p>Aneurysm formation (A)</p> Signup and view all the answers

    Which condition is caused by atherosclerosis affecting coronary arteries?

    <p>Ischaemic heart disease (D)</p> Signup and view all the answers

    Which of the following is not typically a risk factor for atheroma formation?

    <p>Regular physical exercise (B)</p> Signup and view all the answers

    Fatty streaks can be found in the aortas of children older than what age?

    <p>Older than 10 years (B)</p> Signup and view all the answers

    Which hypothesis views atherosclerosis as a chronic inflammatory response to endothelial injury?

    <p>Response-to-injury hypothesis (A)</p> Signup and view all the answers

    The accumulation of foam cells in atherosclerosis is primarily due to the activity of what type of cell?

    <p>Macrophages (D)</p> Signup and view all the answers

    Which factor is not typically associated with the development of endothelial dysfunction?

    <p>High levels of HDL cholesterol (D)</p> Signup and view all the answers

    What is a primary consequence of endothelial injury in atherosclerosis?

    <p>Platelet adhesion and PDGF release (A)</p> Signup and view all the answers

    Which lifestyle modification is least effective in preventing atheroma?

    <p>Increasing saturated fat intake (A)</p> Signup and view all the answers

    Which of the following is a common risk factor for Coronary Heart Disease (CHD)?

    <p>Smoking (C)</p> Signup and view all the answers

    What role do foam cells play in atheromas?

    <p>Secrete cytokines promoting inflammation (D)</p> Signup and view all the answers

    Which of the following is not an etiologic factor contributing to early atherosclerosis?

    <p>Low vitamin D levels (B)</p> Signup and view all the answers

    Which condition is characterized by increased risk of ischemic heart disease due to high blood sugar levels?

    <p>Diabetes mellitus (B)</p> Signup and view all the answers

    Which lipoprotein abnormality is typically associated with myocardial infarction survivors?

    <p>Increased LDL cholesterol levels (A)</p> Signup and view all the answers

    Flashcards

    Atheroma

    A build-up of lipids (like cholesterol) inside and outside the artery wall, mainly in the inner layers (intima and media). The lesion is characterized by a soft, yellowish core and a firm, white fibrous covering, which can obstruct blood flow and weaken the artery wall.

    Arteriosclerosis

    A general term for hardening and thickening of artery walls, making them less elastic.

    Atherosclerosis

    A type of arteriosclerosis characterized by the formation of atheromas (fatty plaques) in artery walls.

    Atherogenesis

    The process by which atheromas develop in arteries.

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    Response to injury hypothesis

    The hypothesis that damage to the inner lining of arteries (intima) triggers a series of events that lead to atheroma formation.

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    What is Atherosclerosis?

    Atherosclerosis is a type of arteriosclerosis where plaque builds up inside the arteries, narrowing them and reducing blood flow.

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    What is Mönckeberg medial calcific sclerosis?

    Mönckeberg medial calcific sclerosis affects muscular arteries in older people, causing calcification within their walls.

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    What is Arteriolosclerosis?

    Arteriolosclerosis affects small arteries and arterioles, causing thickening and narrowing of their walls. It's often associated with high blood pressure.

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    What is the role of Endothelial cells in atherosclerosis?

    Endothelial cells play a crucial role in blood clotting, maintaining a smooth blood flow surface, and regulating blood vessel permeability. They can be damaged by factors like high cholesterol.

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    What is the role of Smooth muscle cells in atherosclerosis?

    Smooth muscle cells can migrate to the inner layer of the artery and proliferate, contributing to plaque formation. They can also take up cholesterol and become foam cells.

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    What is the role of Macrophages in atherosclerosis?

    Macrophages engulf oxidized LDL and become foam cells, which are a key component of plaque. They also release substances that can damage the artery walls.

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    What is the role of Platelets in atherosclerosis?

    Platelets contribute to blood clotting and can also stimulate smooth muscle cell growth, further contributing to plaque formation. They can also release growth factors that promote inflammation.

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    What is the role of Lymphocytes in atherosclerosis?

    Lymphocytes are white blood cells that release inflammatory mediators like TNF, which can affect cholesterol metabolism and promote inflammation.

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    Mesenteric Ischaemia

    A condition where blood flow to the intestines is reduced, causing pain, nausea, and vomiting.

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    Intermittent Claudication

    A condition where blood flow to the legs is reduced, causing pain and cramping during exercise.

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    Multi-infarct Dementia

    A type of dementia caused by multiple small strokes in the brain.

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    Ischaemic Colitis

    A condition where the blood flow to a part of the colon is reduced, causing pain, bleeding, and diarrhea.

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    Familial Hyperlipidaemia

    A type of hyperlipidemia where the body produces too much cholesterol.

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    Xanthalasma

    A waxy yellow deposit under the skin, often found around the eyelids, that can be a sign of high cholesterol.

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    Fatty Streak

    A thin, yellow, slightly raised area in the inner lining of arteries, caused by lipids accumulating in the intima. They are common in kids and can progress to more serious lesions.

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    Simple Atherosclerotic Plaque

    A buildup of lipid deposits, smooth muscle cells, and other materials in the arterial walls, forming a raised, yellow-white structure. Can progress to complicated plaque form.

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    Complicated Atherosclerotic Plaque

    A complex, unstable form of plaque with features like thrombosis, hemorrhage, calcification, and aneurysm formation. These can be more dangerous as they can rupture and cause major problems.

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    Early changes in plaque formation

    Initial stages of atherosclerotic plaque formation involve the proliferation of smooth muscle cells in the intima, accumulation of lipid deposits, and the presence of foam cells.

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    Later changes in plaque formation

    Late stages of plaque formation involve the formation of fibrous tissue, necrosis, and cholesterol clefts. The plaque can also extend into the media, causing damage to the artery wall, and may even fissure.

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    Cellular events in plaque formation

    A process involving endothelial damage, platelet activation, and smooth muscle cell proliferation and migration. Macrophages also play a role by engulfing lipids and becoming foam cells.

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    Ischemic heart disease

    The most common cause of heart disease, arising from atherosclerosis affecting the coronary arteries. It can lead to chest pain (angina), heart attacks (MI), arrhythmias, cardiac failure, and sudden death.

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    Cerebral Ischemia

    A blockage of an artery supplying the brain, leading to brain damage. Can manifest as transient ischemic attacks (mini-strokes) or full-blown strokes.

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    Hypertension

    Increased pressure on the blood vessels due to excess force exerted by blood flowing through them. Often associated with atherogenesis as it contributes to endothelial injury.

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    Endothelial Injury

    Damage to the endothelial lining of the blood vessels. It's a key trigger in the formation of atheromas.

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    Platelet Adhesion and Smooth Muscle Cell Proliferation in Atherogenesis

    The process involves platelets sticking to the injured endothelial lining, releasing platelet-derived growth factor (PDGF). This in turn stimulates smooth muscle cells to multiply and migrate to the site of the injury, eventually forming a plaque.

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    Hyperlipidemia

    The presence of more LDL (bad cholesterol) in the bloodstream than HDL (good cholesterol). This can contribute to atherogenesis by promoting the build-up of cholesterol in the artery walls.

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    Foam Cell Formation

    The process where macrophages engulf excess lipids in the artery wall, becoming 'foam cells' and contributing to atheroma formation.

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    Inflammatory Cytokines in Atherogenesis

    Inflammatory substances released by cells like foam cells, which can further stimulate smooth muscle cell growth, recruitment of other inflammatory cells, and the development of atheroma.

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    Study Notes

    Atheroma, Atherosclerosis, Arteriosclerosis

    • Atheroma is the accumulation of intracellular and extracellular lipid in the intima and media of large and medium-sized arteries.
    • Atheroma forms a raised, focal lesion within the intima, with a soft, yellow lipid core (mainly cholesterol) covered by a firm, white fibrous tissue.
    • Arteriosclerosis is a general term for thickening and loss of arterial wall elasticity.
    • Three types of arteriosclerosis exist: atherosclerosis, Mönckeberg medial calcific sclerosis (calcification in muscular arteries after age 50), and arteriolosclerosis (affects smaller arteries and arterioles).

    Intended Learning Outcomes

    • Understanding definitions of atheroma, atherosclerosis, and arteriosclerosis.
    • Knowledge of cellular processes leading to atherosclerotic lesions.
    • Awareness of the macroscopic and microscopic appearances of atheromas.
    • Effects of severe atherosclerosis at specific anatomical sites.
    • Mechanisms of atherogenesis, including the role of growth factors, cytokines (e.g., platelet-derived growth factor [PDGF]), the response to injury hypothesis, and dyslipidaemias.
    • Epidemiology of coronary heart disease, including description of the role of coronary risk factors in atherogenesis and genetic, geographic, and ethnic susceptibility.

    Cells Involved in Atheroma Formation

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

    Cellular Events Leading to Atherosclerotic Lesions (Endothelial Cells)

    • Play a key role in haemostasis, modulating blood flow and vascular resistance.
    • Exhibit altered permeability to lipoproteins.
    • Secrete collagen.
    • Stimulate proliferation and migration of smooth muscle cells.
    • Loss of endothelial cells (denudation) triggers thrombosis and smooth muscle cell proliferation.

    Vascular Smooth Muscle Cells

    • Migrate to intima and proliferate following vascular injury.
    • Crucial in normal vascular repair and pathological processes such as atherosclerosis.
    • Take up LDL and other lipids, transforming into foam cells.
    • Synthesize collagens and proteoglycans.
    • Vascular injury triggers smooth muscle cell growth and formation of a neointima.

    Lymphocytes

    • TNF may affect lipoprotein metabolism.
    • Stimulate smooth muscle cell proliferation and migration.

    Platelets

    • Key role in haemostasis.
    • Stimulate smooth muscle cell proliferation and migration (e.g., PDGF).

    Macrophages

    • Oxidize LDL, taking up lipid to become foam cells.
    • Secrete proteases to modify the matrix.
    • Stimulate smooth muscle cell proliferation and migration.

    Processes Involved in Atheroma Formation

    • Thrombosis
    • Lipid accumulation.
    • Production of intercellular matrix.
    • Interactions between different cell types.

    Nomenclature and Main Histology of Atheroma

    • Different stages of atheroma development are detailed, with specific histological descriptions & types (e.g., Type I, Type II, Type III, etc.).
    • Progression of lesions, categorized by factors such as growth mechanism, earliest onset, and correlation with clinical presentation are indicated.

    Morphological Appearance of Atheroma

    • Fatty streaks: initial lesion of atherosclerosis, composed of lipid-filled foam cells.
    • Simple plaque: raised yellow/white, irregular, widely distributed, and coalesced.
    • Complicated plaque: advanced lesion features, including thrombosis, hemorrhage, calcification, and aneurysm formation.

    Atherosclerotic Plaques

    • Develop primarily in elastic arteries and large/medium-sized muscular arteries.
    • Leading consequences include myocardial infarction, stroke, aortic aneurysms, and peripheral vascular disease.
    • Other consequences include mesenteric occlusion, sudden cardiac death, chronic ischemic heart disease, and ischemic encephalopathy.

    Effects of Severe Atherosclerosis at Specific Sites

    • Coronary artery disease, ischemic heart disease, sudden death, myocardial infarction, angina pectoris, arrhythmias, and cardiac failure.
    • Cerebral ischaemia, transient ischaemic attack, cerebral infarction, multi-infarct dementia.
    • Mesenteric ischaemia, ischemic colitis, malabsorption, intestinal infarction.
    • Peripheral vascular disease, intermittent claudication, Leriche syndrome, ischemic rest pain, gangrene..

    Risk Factors for Atheroma

    • Age: slowly progressive from adulthood, women generally protected until menopause.
    • Hyperlipidaemia: high plasma cholesterol is strongly linked to atheroma, with LDL cholesterol being a major factor.
    • Hypertension: strong link; endothelial damage is a consequence.
    • Smoking: significant risk factor.
    • Diabetes Mellitus: doubles risk of IHD.
    • Alcohol: high consumption increases IHD risk.
    • Infection (e.g., Helicobacter pylori): recent evidence indicates an association.

    Risk Factors (Continued)

    • Specific genetic disorders, Family Hypercholesterolemia.
    • Geographical factors, often influenced by diet.
    • Ethnicity, with higher risk in some groups
    • Other risk Factors: homocysteine, toxins from cigarettes.

    Pathogenesis (Response-to-Injury Hypothesis)

    • Atherosclerosis is a chronic inflammatory and healing response to arterial wall injury.
    • Lesion progression is connected to the interaction of modified lipoproteins, macrophage, and T lymphocytes with normal arterial wall structure.
    • Endothelial injury leads to increased vascular permeability, leukocyte adhesion, and thrombosis; leading to lipoprotein accumulation, especially oxidized LDL cholesterol.

    Prevention of Atheroma

    • Modification of established risk factors.
    • Lifestyle changes, such as stop smoking, diet modification, treatment of hypertension, and diabetes, along with lipid-lowering drugs.
    • Treating genetic predisposition, such as familial hypercholesterolemia..

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    This quiz covers the definitions and characteristics of atheroma, atherosclerosis, and arteriosclerosis. It also explores the cellular processes involved in atherogenesis and the implications of severe atherosclerosis on anatomical sites. Test your understanding of these important cardiovascular concepts.

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