Cardiology Chapter on Atherosclerosis
47 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What term refers to the hardening of the arteries?

  • Angiopathy
  • Atherogenesis
  • Arteriosclerosis (correct)
  • Ischemia

    • Atherosclerosis is characterized by the calcification of the medial walls of muscular arteries.

    False

    Name one anatomical variant of arteriolosclerosis.

    Hyaline arteriolosclerosis or Hyperplastic arteriolosclerosis

    Mönckeberg medial sclerosis typically affects adults over the age of _____ and is characterized by calcifications of the medial walls of muscular arteries.

    <p>50</p> Signup and view all the answers

    Match the following types of arteriosclerosis with their characteristics:

    <p>Arteriolosclerosis = Affects small arteries and arterioles leading to ischemic injury Mönckeberg medial sclerosis = Characterized by calcifications of medial walls without lumen advancement Fibromuscular intimal hyperplasia = Thickening of arterial walls due to smooth muscle cell proliferation Atherosclerosis = Plaque buildup in arteries affecting blood flow</p> Signup and view all the answers

    What is a major long-term limitation of organ transplants due to vascular changes?

    <p>In-stent restenosis</p> Signup and view all the answers

    Atherosclerosis is solely caused by inherited risk factors.

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

    What is the primary component of the soft core in an atheroma?

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

    Fibromuscular intimal hyperplasia is caused by inflammation or ______ injury.

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

    Match the risk factors to their categories:

    <p>Familial hypercholesterolemia = Inherited risk factor High cholesterol levels = Acquired risk factor Smoking = Acquired risk factor Age = Gender- and age-associated risk factor</p> Signup and view all the answers

    Which of the following is considered a significant manifestation of atherosclerosis?

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

    What happens when atherosclerotic plaques rupture?

    <p>Catastrophic obstructive vascular thrombosis</p> Signup and view all the answers

    Age is a contributing factor to increased incidence of myocardial infarction.

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

    What is a significant consequence of atherosclerotic disease?

    <p>Cerebral infarction</p> Signup and view all the answers

    Atherosclerotic stenosis can lead to ischemic injury when blood flow is compromised.

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

    What percentage decrease in luminal cross-sectional area indicates critical stenosis?

    <p>70% to 75%</p> Signup and view all the answers

    Intermittent claudication occurs due to muscle ischemia during exercise caused by obstruction to _______.

    <p>arterial flow</p> Signup and view all the answers

    Match the atherosclerotic consequences with their descriptions:

    <p>MI = The medical term for a heart attack Cerebral infarction = Results in a stroke Aortic aneurysms = Bulge in the wall of the aorta Peripheral vascular disease = Compromise of blood flow to extremities</p> Signup and view all the answers

    Which of the following is NOT a major target of atherosclerosis?

    <p>Pulmonary arteries</p> Signup and view all the answers

    Atheromas primarily develop in small arteries.

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

    What is described as a pain in the calf, thigh, and buttock induced by exercise?

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

    Which of the following is NOT a risk reduction measure for coronary risk prediction (CRP)?

    <p>Increased salt intake</p> Signup and view all the answers

    Hyperhomocysteinemia is characterized by serum homocysteine levels above 15 μmol/L.

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

    What metabolic syndromes are associated with central obesity?

    <p>Insulin resistance, hypertension, dyslipidemia, and hypercoagulability.</p> Signup and view all the answers

    Lipoprotein (a) [Lp(a)] is an altered form of LDL that contains apolipoprotein ___.

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

    Match the following components with their respective roles in atherosclerosis progression:

    <p>LDL = Accumulation in vessel wall Macrophages = Monocyte transformation Platelets = Factor release Smooth Muscle Cells (SMCs) = Proliferation and ECM production</p> Signup and view all the answers

    What effect does the growth of plaque have on blood flow?

    <p>Compromises blood flow</p> Signup and view all the answers

    Which of the following statements about homocystinuria is correct?

    <p>Circulating homocysteine levels exceed 100 μmol/L.</p> Signup and view all the answers

    Systemic hypercoagulability is a characteristic of metabolic syndrome.

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

    Oxidized LDL can lead to the activation of subendothelial macrophages.

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

    What are the components involved in the NLRP3 inflammasome?

    <p>NLRP3 protein, pro-caspase-1, ASC</p> Signup and view all the answers

    What factor is primarily inhibited by PAI-1?

    <p>Tissue-type plasminogen activator (tPA)</p> Signup and view all the answers

    The process of cell migration and proliferation in response to cytokines and chemokines occurs in _____ cells.

    <p>smooth muscle</p> Signup and view all the answers

    Endothelial injury is the cornerstone of the response-to-injury hypothesis and begins with increased ___ and altered gene expression.

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

    Which of the following is a potential consequence of plaque erosion or rupture?

    <p>Thrombus formation</p> Signup and view all the answers

    What is a common cause of endothelial dysfunction?

    <p>Hemodynamic disturbances</p> Signup and view all the answers

    Match the following conditions with their related processes:

    <p>Cholesterol crystallization = Assembly of inflammasome complex Mitochondrial dysfunction = NLRP3 inflammasome activation Hyperlipidemia = Endothelial dysfunction Smooth muscle cells = Extracellular matrix production</p> Signup and view all the answers

    Inhibiting the activation of the NLRP3 inflammasome has no impact on cardiovascular diseases.

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

    What triggers the release of proinflammatory mediators in the mechanism of inflammasome activation?

    <p>Activation of NF-κB transcription factor</p> Signup and view all the answers

    What is a primary therapeutic effect of statins?

    <p>Reduce cholesterol levels</p> Signup and view all the answers

    Intense emotional stress can contribute to plaque disruption.

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

    What is thrombosis associated with in acute coronary syndromes?

    <p>Disrupted plaque</p> Signup and view all the answers

    ____ is the substance primarily responsible for the growth of lesions related to thrombosis.

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

    Match the following terms with their descriptions:

    <p>Statins = Lower cholesterol levels Vasoconstriction = Decreases lumen size Atherogenesis = Formation of atheromatous plaques Plaque constituents = Smooth muscle cells, lipids, and debris</p> Signup and view all the answers

    What time of day do acute myocardial infarction (MI) events typically peak?

    <p>6 a.m. to 12 noon</p> Signup and view all the answers

    Vasoconstriction increases the lumen size of a blood vessel.

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

    What role does adrenergic stimulation play in the onset of myocardial infarctions?

    <p>It causes blood pressure spikes.</p> Signup and view all the answers

    Study Notes

    Atherosclerosis Pathology

    • Atherosclerosis is a significant cause of morbidity and mortality.
    • Arteriosclerosis is a generic term for arterial wall thickening and loss of elasticity. Four general patterns with different consequences include arteriolosclerosis, Mönckeberg medial sclerosis, fibromuscular intimal hyperplasia, and atherosclerosis.
    • Three main types of arteries are elastic arteries, muscular arteries, and arterioles.
    • Elastic arteries have more elastic tissue, and are close to the heart (e.g., aorta and pulmonary artery).
    • Muscular arteries distribute blood to various parts of the body and have a lot of smooth muscle (e.g., femoral and coronary arteries).
    • Arterioles are small arteries that deliver blood to capillaries and are crucial in determining blood pressure.
    • Arteriolosclerosis affects small arteries and arterioles, causing downstream ischemic injury. Two anatomic variants are Hyaline arteriolosclerosis and Hyperplastic arteriolosclerosis.
    • Mönckeberg medial sclerosis is characterized by calcifications in the medial walls of muscular arteries, typically beginning along the internal elastic membrane. This condition is primarily seen in adults over 50 and, usually, is not clinically significant.
    • Fibromuscular intimal hyperplasia occurs in muscular arteries larger than arterioles and is caused by inflammation (e.g., healed arteritis or transplant-associated arteriopathy) or mechanical injury to the vessel (e.g., from stents or angioplasty). It impacts organ transplants.
    • Atherosclerosis is a disease that causes more morbidity and mortality than any other disease. Coronary artery disease is a notable manifestation. Atherosclerotic disease in the aorta, carotid arteries, and stroke also contribute to morbidity and mortality.
    • Factors influencing atherosclerosis include acquired risk factors (e.g., cholesterol levels, smoking, hypertension), inherited risk factors (e.g., LDL receptor gene mutations), and gender and age-associated risk factors.

    Atheroma

    • Atheroma, also known as atherosclerotic plaque, are intimal lesions that protrude into vessel lumens.
    • Atheromas consist of a raised lesion with a soft core of lipid (primarily cholesterol and cholesterol esters), covered by a fibrous cap.
    • The basic structure of an atherosclerotic plaque is intimal-based with complex interplay of cells and extracellular materials.
    • The plaque has a fibrous cap of smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans.
    • The plaque has a necrotic center containing cell debris, cholesterol crystals, foam cells, and calcium.
    • Atherosclerotic plaques can cause mechanical obstruction, rupture leading to obstructive vascular thrombosis, and increase the diffusion distance impacting the vessel wall, which can lead to aneurysm formation.

    Risk Factors

    • Non-modifiable risk factors include genetic abnormalities, family history, increasing age, and male gender.
    • Modifiable risk factors include hyperlipidemia, hypertension, cigarette smoking, diabetes, and inflammation.
    • Genetics, age, and gender also play a role. Genetics are often a family history of atherosclerosis or ischemic heart disease. Age increases the risk factor, especially after 40 and 60. Pre-menopausal women, unless with one or more of risk factors, are less prone to MI or other complications of atherosclerosis. After menopause, the incidence rises.
    • Hyperlipidemia, is associated with increased LDL cholesterol (“bad cholesterol”) risk. Higher levels of HDL (“good cholesterol”) lower the risk.
    • Hypertension increases risk of ischemic disease by 60 percent and is a common cause of left ventricular hypertrophy.
    • Cigarette smoking doubles the death rate of ischemic disease.
    • Diabetes has a significant risk of atherosclerosis, and the risk is twice as high in diabetics.

    Inflammatory Factors

    • Inflammation is present in all stages of atherogenesis.
    • Assessing systemic inflammation is important.
    • Inflammation is linked with atherosclerotic plaque formation and rupture.
    • CRP is a measure of inflammation and can help in risk stratification.
    • Hyperhomocysteinemia is associated with cardiovascular diseases and venous thrombosis. Elevated serum homocysteine levels of over 15 umol/L associate with this condition.
    • Metabolic syndrome is linked to central obesity, and is a pro-inflammatory state marked by insulin resistance, hypertension, dyslipidemia, and hypercoagulability.
    • High lipoprotein a [Lp(a)] is associated with increased coronary and cerebrovascular disease risk. The target level of Lp(a) is less than 14mg/dL. Levels greater than or equal to 32 mg/dL are at high risk.
    • Factors affecting hemostasis, such as elevated plasminogen activator inhibitor 1, are risk factors for myocardial infarction and stroke.

    Mechanisms

    • Atherosclerosis is considered a response to injury.
    • Modified LDL, impaired endothelial function, and inflammation contribute to atherogenesis.
    • Inflammation is triggered by the accumulation of cholesterol crystals and free fatty acids in macrophages. The inflammasome contributes to the process. The NLRP3 protein is part of the inflammasome.
    • Inflammatory factors, such as IL1, activate macrophages and T lymphocytes leading to a local production of cytokines and chemokines. Activated macrophages and T lymphocytes contribute to plaque growth.
    • SMC proliferation and ECM deposition converts a fatty streak to a mature atheroma.
    • Growth factors (e.g., PDGF, TGF-α) and cytokines are important in the process of SMCs/ ECM production.
    • Statins can reduce cholesterol levels, which reduces the effect of inflammation and can stabilize plaque.
    • Adrenergic stimulation, and intense emotional stress are often extrinsic factors that contribute to acute plaque changes. Physical stresses (e.g., blood pressure and vessel spasm) contributes to sudden events.

    Atherosclerotic Plaque

    • The plaque has a fibrous cap, a necrotic core, cellular components (e.g. SMCs, macrophages, T lymphocytes), matrix components (e.g. ECM), and lipid material.
    • With progression, the atheromatous material (i.e., lipid-laden cells, fatty debris) in the core may calcify.
    • Plaque growth and advance to the lumen compromises blood flow.
    • Thickening of the intima, lipid accumulation, and presence of thrombus (blood clot) are some of the key features.
    • The degree of stenosis (i.e., narrowing) is also important. Critical stenosis occurs when occlusion increases to 70-75 percent and causes ischemia (i.e., restriction of blood supply to tissue).
    • Local flow disturbances, such as turbulence at branch points, makes certain portions of the vessel wall more susceptible to atherosclerosis and enlarges the lesion(s).

    Consequences of Atherosclerosis

    • Major targets are the large elastic arteries and the large and medium-sized muscular arteries (e.g. aorta, carotid, iliac, coronary, popliteal arteries).
    • Clinically, atherosclerotic stenosis can compromise blood flow that causes myocardial infarction (MI), cerebral infarction (stroke), aortic aneurysms, and peripheral vascular disease.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Pathology of Atherosclerosis PDF

    Description

    Test your knowledge on the key concepts of atherosclerosis and arteriosclerosis. This quiz covers anatomical variants, risk factors, and the consequences of these vascular diseases. Perfect for medical students or anyone interested in cardiovascular health.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser