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Questions and Answers
Which of the following correctly describes the etiology of atherosclerosis?
Which of the following correctly describes the etiology of atherosclerosis?
What characterizes the fatty streak in the pathogenesis of atherosclerosis?
What characterizes the fatty streak in the pathogenesis of atherosclerosis?
Which option describes a major difference between the fibrous atheromatous plaque and the complicated lesion?
Which option describes a major difference between the fibrous atheromatous plaque and the complicated lesion?
Which factors are considered traditional cardiovascular risk factors for atherosclerosis?
Which factors are considered traditional cardiovascular risk factors for atherosclerosis?
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What is a key characteristic of atherosclerosis that makes its clinical manifestations often delayed?
What is a key characteristic of atherosclerosis that makes its clinical manifestations often delayed?
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Which statement about non-modifiable risk factors for atherosclerosis is accurate?
Which statement about non-modifiable risk factors for atherosclerosis is accurate?
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Which of the following infectious agents is associated with a heightened risk of vascular disease?
Which of the following infectious agents is associated with a heightened risk of vascular disease?
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What component of the fibrous atheromatous plaque is primarily responsible for its formation?
What component of the fibrous atheromatous plaque is primarily responsible for its formation?
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Which factor does NOT contribute to endothelial cell injury in the development of atherosclerosis?
Which factor does NOT contribute to endothelial cell injury in the development of atherosclerosis?
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What process occurs after monocytes adhere to the endothelium during atherosclerosis development?
What process occurs after monocytes adhere to the endothelium during atherosclerosis development?
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Which outcome is NOT a result of SMC proliferation in atherosclerosis?
Which outcome is NOT a result of SMC proliferation in atherosclerosis?
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What is the result of activated macrophages ingesting oxidized LDL?
What is the result of activated macrophages ingesting oxidized LDL?
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Which statement best describes the role of inflammation in the development of atherosclerotic lesions?
Which statement best describes the role of inflammation in the development of atherosclerotic lesions?
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What is the final structure formed during the progression of atherosclerosis?
What is the final structure formed during the progression of atherosclerosis?
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Which of the following best describes the composition of the atheromatous plaque?
Which of the following best describes the composition of the atheromatous plaque?
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Which of the following agents contributes to endothelial cell injury during atherosclerosis development?
Which of the following agents contributes to endothelial cell injury during atherosclerosis development?
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Study Notes
Atherosclerosis
- Atherosclerosis is a type of arteriosclerosis, hardening of the arteries.
- The term comes from Greek words: atheros ("gruel" or "paste") and sclerosis ("hardness").
- It involves the formation of fibro fatty lesions in the inner lining (intima) of large and medium-sized arteries.
- Affected arteries include the aorta and its branches, coronary arteries, and vessels supplying the brain.
Atherosclerosis: Objective
- The objective is to describe the etiology (cause) and pathogenesis (development) of atherosclerosis.
Atherosclerosis: Etiology and Risk Factors
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Modifiable:
- Hypercholesterolemia (high cholesterol) is a major risk factor.
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Non-modifiable:
- Increasing age (men ≥ 45 years, women ≥ 55 years)
- History of premature coronary heart disease (CHD)
- Male sex
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Traditional Cardiovascular Risk Factors:
- Cigarette smoking
- High LDL (low-density lipoprotein) levels
- Obesity and visceral fat
- Hypertension (increases incidence by two-fold)
- Type 2 diabetes mellitus (increases incidence by two-fold)
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Non-traditional Cardiovascular Risk Factors:
- C-reactive protein levels (increased in vascular disease)
- Serum homocysteine levels
- Serum lipoprotein levels
- Infectious agents: Chlamydia pneumoniae, Herpes virus, Cytomegalo virus (increases risk of vascular disease).
Atherosclerosis: Pathogenesis
- Atherosclerosis develops in stages. Clinical manifestations (symptoms) often take 20-40 years to become evident.
- Three types of lesions: fatty streaks, fibrous atheromatous plaque, and complicated lesions.
- Later two are responsible for clinically significant manifestations of the disease.
The Fatty Streaks
- Thin, yellow, flat discolorations in the inner lining
- Progressively enlarge by becoming thicker and slightly elevated.
The Fibrous Atheromatous Plaque
- Accumulation of intracellular and extracellular lipids
- Proliferation of vascular smooth muscle cells
- Formation of scar tissue
The Complicated Lesion
- Contains hemorrhage, ulceration, and scar tissue deposits.
Atherosclerosis: Pathogenesis – Development
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Endothelial cell injury (1):
- Endothelium (inner lining) usually protects sub-endothelial layers from blood cells.
- Smoking, elevated LDL, immune mechanisms, and mechanical stress (from hypertension) can cause damage and/or adhesion of monocytes and platelets.
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Migration of inflammatory cells (2):
- Endothelial cells express adhesion molecules that bind monocytes and other inflammatory cells.
- Monocytes migrate, become macrophages, and engulf lipoproteins (mostly LDL)
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SMC Proliferation and Lipid Deposition (3):
- Macrophage activation releases toxic oxygen species that oxidize LDL. Oxidized LDL ingested to become foam cells.
- Smooth muscle cells (SMCs) migrate and proliferate. Extracellular matrix (ECM) is elaborated.
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Development of the atheromatous plaque with a lipid core (4):
- Plaques include smooth muscle cells, macrophages, other leukocytes, ECM (collagen and elastic fibers), intracellular & extracellular lipids.
- Superficial fibrous cap composed of SMCs and dense ECM.
- Cellular area (the shoulder) beneath the fibrous cap with macrophages, SMCs and lymphocytes.
- Inner core made of lipid-laden foam cells and fatty debris.
- Rupture, ulceration, erosion can cause hemorrhage or thrombosis (blood clot) in the vessel.
Atherosclerosis: Diagram of Normal and Plaque-Obstructed Artery
- Diagram shows a normal artery versus an artery with plaque build-up, which narrows the artery lumen.
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Description
This quiz explores the etiology and pathogenesis of atherosclerosis, a significant condition involving the hardening of arteries. It examines modifiable and non-modifiable risk factors associated with this disease, particularly focusing on cholesterol levels, age, and lifestyle choices. Test your knowledge and understanding of this crucial cardiovascular topic.
