Atherosclerosis: Definition and Risk Factors
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Atherosclerosis: Definition and Risk Factors

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Questions and Answers

What characterizes atherosclerosis?

  • Formation of calcium deposits in arteries
  • Formation of fibro-fatty plaques (correct)
  • Inflammation of the vessel wall
  • Thrombosis in small blood vessels

    • Which factor is not considered a non-modifiable risk factor for atherosclerosis?

  • Family history
  • Cigarette smoking (correct)
  • Increasing age
  • Male gender

    • At which point does the incidence of atherosclerosis between genders change?

  • At puberty
  • Before menopause
  • After menopause (correct)
  • During middle age

    • Which of the following organs is least likely to be affected by atherosclerosis?

    <p>Skin</p> Signup and view all the answers

    What initiates the development of atherosclerosis in blood vessels?

    <p>Chronic endothelial cell injury</p> Signup and view all the answers

    Which lipoproteins are involved in the entry into the intima during atherosclerosis development?

    <p>VLDL and LDL</p> Signup and view all the answers

    What is the end result of the lipid accumulation in atherosclerosis?

    <p>Creation of fibrous cap</p> Signup and view all the answers

    What role do monocytes play in the development of atherosclerosis?

    <p>They become macrophages and foam cells.</p> Signup and view all the answers

    What characterizes a fatty streak in terms of its gross appearance?

    <p>Smooth yellowish fatty dots</p> Signup and view all the answers

    What components are found in the central core of an uncomplicated atheroma?

    <p>Foam cells and cholesterol esters</p> Signup and view all the answers

    Which of the following is NOT a characteristic of complicated atheroma?

    <p>Smooth yellowish fatty dots</p> Signup and view all the answers

    What pathological change is associated with chronic ischemia due to atherosclerosis?

    <p>Narrowing of vascular lumen</p> Signup and view all the answers

    What is a potential consequence of ulceration of an atheroma?

    <p>Release of fatty core leading to fat emboli</p> Signup and view all the answers

    Which of the following findings is characteristic of a microscopic examination of a fatty streak?

    <p>Presence of lipid-laden foam cells</p> Signup and view all the answers

    What impact does thrombosis have in the context of atherosclerosis?

    <p>Results in acute ischemia and potential infarction</p> Signup and view all the answers

    What is the role of neovascularization in the context of uncomplicated atheroma?

    <p>To increase oxygen supply to the tissue</p> Signup and view all the answers

    What is the major characteristic of atherosclerosis?

    <p>Formation of fibro-fatty plaques</p> Signup and view all the answers

    Which of the following is NOT a common modifiable risk factor for atherosclerosis?

    <p>Genetic abnormalities</p> Signup and view all the answers

    What initiates the migration of smooth muscle cells in atherosclerosis?

    <p>Platelet-derived growth factor</p> Signup and view all the answers

    Which of these areas is least commonly affected by atherosclerosis?

    <p>Internal jugular vein</p> Signup and view all the answers

    What happens to monocytes during the development of atherosclerosis?

    <p>They transform into macrophages and foam cells.</p> Signup and view all the answers

    Which of the following is a symptom of severe atherosclerosis?

    <p>Intermittent claudication</p> Signup and view all the answers

    In which scenario is the incidence of atherosclerosis among genders equal?

    <p>After menopause</p> Signup and view all the answers

    Which type of lipoproteins are involved in the entry into the intima during the process of atherosclerosis?

    <p>LDL and VLDL</p> Signup and view all the answers

    What is a key feature of a complicated atheroma?

    <p>Ulceration with liberation of fatty core</p> Signup and view all the answers

    Which of the following best describes the gross appearance of an uncomplicated atheroma?

    <p>Grayish-white and firm with a soft center</p> Signup and view all the answers

    Which pathological change is associated with atherosclerosis and contributes to vascular lumen narrowing?

    <p>Pressure atrophy of the media</p> Signup and view all the answers

    What type of infiltrate is typically found in the microscopic examination of a fatty streak?

    <p>Lymphoplasmacytic infiltrate</p> Signup and view all the answers

    Which of the following factors is NOT typically associated with the formation of an atheroma?

    <p>Inflammatory response with acute neutrophils</p> Signup and view all the answers

    Which component of the atheroma's structure is formed from proliferated smooth muscle cells?

    <p>Subendothelial fibrous cap</p> Signup and view all the answers

    What is the consequence of neovascularization in atheromatous plaques?

    <p>Induces further inflammation within the plaque</p> Signup and view all the answers

    What is a likely consequence of significant media atrophy associated with atherosclerosis?

    <p>Weakening of the arterial wall and potential aneurysm</p> Signup and view all the answers

    Study Notes

    Atherosclerosis - Definition and Incidence

    • Atherosclerosis is a chronic progressive multifocal disease of the vessel wall that is characterized by the formation of fibro-fatty plaques.
    • It is more prevalent in males than females before menopause, but after menopause, the incidence rate equalizes.
    • Atherosclerosis is more common in developed countries.

    Atherosclerosis - Risk Factors

    • Non-Modifiable:
      • Increasing age
      • Male gender
      • Family history
      • Genetic abnormalities
    • Modifiable:
      • High carbohydrate intake
      • Obesity
      • Physical inactivity
      • Stress
      • Postmenopausal
      • Alcohol
      • Lipoprotein Lp(a)
      • Unsaturated fat intake
      • Hyperlipidemia
      • Hypertension
      • Cigarette smoking
      • Diabetes

    Atherosclerosis - Common Sites

    • Aorta, especially descending
    • Coronary arteries
    • Cerebral and internal carotids
    • Femoral, renal, and superior mesenteric arteries

    Atherosclerosis - Pathogenesis

    • The development of atherosclerosis begins with focal chronic endothelial cell injury caused by factors such as endotoxins, hypoxia, cigarettes, viruses, and stress.
    • This injury allows lipoproteins, such as LDL and VLDL, to enter the intima of the vessel.
    • Monocytes migrate into the intima and transform into macrophages, engulfing lipids and becoming foam cells.
    • Platelets adhere to the injured endothelium and release platelet-derived growth factor (PDGF).
    • Activated platelets, macrophages, and endothelial cells also release mitogenic factors that stimulate smooth muscle cell migration.
    • Smooth muscle cells proliferate in the intima, depositing extracellular matrix, collagen, and proteoglycans.
    • Lipid accumulates, both extra- and intra-cellularly, within macrophages and smooth muscle cells, further contributing to foam cell formation.
    • A fibrous cap forms, separating the lesion from the lumen.

    Atherosclerosis - Gross Appearance

    • Fatty Streak:
      • Multiple, smooth, yellowish fatty dots that are not raised above the endothelial surface
      • Coalesce to form larger units
    • Uncomplicated ATHEROMA:
      • Disc-like patches
      • Color ranges from yellow to white depending on the relative amounts of fat and fibrous tissue
      • Covered by a glistening intima
      • More common around the mouths of branches
      • Grayish white and firm
    • Complicated ATHEROMA:
      • Cut surface reveals a fibrous coat and a yellow soft center
      • May exhibit calcification, ulceration, and thrombosis

    Atherosclerosis - Microscopic Appearance

    • Fatty Streak:
      • Exhibits cholesterol clefts, lipid-laden foam cells, extracellular lipid, and lymphoplasmacytic infiltrate
    • Uncomplicated ATHEROMA:
      • A subendothelial fibrous cap is observed, composed of proliferated smooth muscle cells, foam cells, and extracellular matrix
      • A central core is present, containing cholesterol and cholesterol esters, lipid-laden macrophages (foam cells), necrotic debris, and calcification
      • Neovascularization is observed around the periphery
      • The media exhibits disruption of the elastic lamina and atrophy deep to the plaque

    Atherosclerosis - Complications

    • Narrowing of the vascular lumen leads to chronic ischemia
    • Superimposed thrombosis can result in acute ischemia and infarction
    • Ulceration with liberation of the fatty core can cause acute ischemia, fat emboli, and infarction
    • Pressure atrophy of the media with fibrosis weakens the wall, increasing the risk of aneurysm
    • Dystrophic calcification can occur

    Atherosclerosis - Illustrations

    • Images depict a normal coronary artery and a coronary artery affected by atherosclerosis (uncomplicated atheroma)

    Atherosclerosis

    • Chronic, progressive, multifocal disease affecting vessel walls.
    • Characterized by fibro-fatty plaques.
    • Males are at a greater risk before menopause, while females are more at risk after menopause.
    • Found more often in developed countries.

    Atherosclerosis - Risk Factors

    • Non-Modifiable Risk Factors:
      • Increasing age
      • Male gender
      • Family history
      • Genetic abnormalities
    • Modifiable Risk Factors:
      • Hyperlipidemia
      • Hypertension
      • Cigarette smoking
      • Diabetes
      • High carbohydrate intake
      • Obesity
      • Physical inactivity
      • Stress (Type A personality)
      • Postmenopausal
      • Alcohol
      • Lipoprotein Lp(a)
      • Unsaturated fat intake

    Atherosclerosis - Locations

    • Aorta, especially the descending aorta.
    • Coronary arteries
    • Cerebral and internal carotid arteries
    • Femoral, renal, and superior mesenteric arteries

    Atherosclerosis - Development

    • Focal chronic endothelial cell injury:
      • Caused by endotoxins, hypoxia, cigarette smoke, viruses, or stress
    • Entry of lipoproteins into the intima of the vessel:
      • LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein) are the main contributors
    • Migration of monocytes into the intima:
      • Monocytes differentiate into macrophages and foam cells by engulfing lipids, leading to lipoprotein oxidation.
    • Platelet adhesion:
      • Platelets adhere and release platelet-derived growth factor (PDGF).
    • Smooth muscle migration:
      • Mitogenic factors released by activated platelets, macrophages, and endothelial cells lead to smooth muscle migration.
    • Proliferation of smooth muscle cells:
      • Smooth muscle cells proliferate in the intima, depositing extracellular matrix, collagen, and proteoglycans.
    • Lipid accumulation:
      • Lipids accumulate both intracellularly and extracellularly in macrophages and smooth muscle cells, forming foam cells.
    • Formation of a fibrous cap:
      • A fibrous cap separates the lesion from the lumen.

    Atherosclerosis - Gross Morphology

    • Fatty Streak:
      • Multiple, smooth, yellowish fatty dots.
      • Not raised above the endothelial surface (flat).
      • Coalesce to form larger streaks.
    • Uncomplicated ATHEROMA:
      • Disc-like patches.
      • Color ranges from yellow to white due to the relative amount of fat and fibrous tissue.
      • Covered by glistening intima.
      • More frequently found around the mouths of branches.
      • Grayish-white and firm.
      • On cut surface, shows a fibrous coat and a yellow soft center.
      • May contain calcification.
    • Complicated ATHEROMA:
      • Ulcerated.
      • May have superimposed thrombosis.

    Atherosclerosis - Microscopic Morphology

    • Fatty Streak:
      • Cholesterol clefts
      • Lipid-laden foam cells
      • Extracellular lipid
      • Lymphoplasmacytic infiltrate
    • Uncomplicated ATHEROMA:
      • Subendothelial fibrous cap: formed of proliferated smooth muscle cells, foam cells, and extracellular matrix.
      • Central core: composed of cholesterol, cholesterol esters, lipid-laden macrophages (foam cells), necrotic debris, and calcification.
      • Neovascularization: occurs around the periphery of the plaque.
      • Media:
        • Disrupted elastic lamina
        • Atrophy of the media deep to the plaque

    Atherosclerosis - Complications

    • Narrowing of the vascular lumen:
      • Leads to chronic ischemia.
    • Superimposed thrombosis:
      • Leads to acute ischemia and infarction.
    • Ulceration:
      • Liberation of fatty core leads to acute ischemia, fat emboli, and infarction.
    • Pressure atrophy of the media with fibrosis:
      • Weakening of the vessel wall, leading to aneurysm formation.
    • Dystrophic calcification:
      • May occur.

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    Description

    Explore the multifaceted disease of atherosclerosis in this quiz, covering its definition, incidence, risk factors, and common sites affected. Delve into both modifiable and non-modifiable factors that contribute to this chronic condition, making it vital for understanding cardiovascular health.

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