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WEEK 20:

Vascular disease: atheroma and its complication:

QuestionAnswer
arteriosclerosis thickening and hardening of artery wall
arteriolosclerosis thickening and hardening of arteriole wall
atheroma disease with accumulatio of material (fatty) in wall of large and medium arteries
atherosclerosis arteriosclerosis due to atheroma
most common cause of arteriosclerosis in large and medium arteries atheroma
most common cause of thickening and hardening of walls of small arteries and arterioles high blood pressure
hypertensive arteriosclerosis includes 3 changes: hypertrophy of media, fibroelastic thickening of intima, and elastic lamina reduplication
hypertensive arteriolosclerosis in 1 change: replacement of wall structures by amorphous hyaline material
consequences of hypertensive vascular changes reduction of vessel lumen -> reduced flow -> ischaemia in supplied tissue where there is an increased rigidy of vessel wall -> loss of elasticity and contractility -> unresponsible to normal vessel agents eg vasodilators
where does atheroma occur large and medium arteries in only high pressure systems eg systemic arterials ot venous systems
stages of atheroma development (4) fatty streak, lipid plaque, fibrolipid plaque, and complication atheroma
stage 1 - how does blood lipids enter intima through damaged endothelium
stage 2- lipids are phagocytosed to (2) macrophages in intima to make raised fatty acid
stage 3- explain the roles of macrophages some lipid is released by macrophages (lipid plaque) and macrophages secrete cytokines which stimulate myofibroblasts to secrete collagen. There is early damage to elastic lamina and media
stage 4- role of collagen collagen covers plaque surface (fibrolipid plaque) and media thins with replacement of muscle fibres by collagen
stage 5- hardening lipids in intima become calcified and surface of fibro-lipid plaque ulcerates. Thinning of media leads to weakness and inelasticity (complicated atheroma)
simplified phases of atheroma formation fatty streak -> lipid plaque -> fibrolipid plaque -> complicated atheroma
risk factors and biology leading to atheroma (8) smoking, genetics, diet (saturated fats), hypertension, diabetes, overweight/ obesity, hypercholesterolaemia, and sedentary lifestyle/ lack of exercise
complications of atheroma (4) expansion of intima, ulceration of atheromatous intima, plaque fissure formation and haemorrhage, and replacement of muscle and elastic fibres in media
expansion of intima leads to reduction of lumen size -> reduced blood flow and hence oxygenation of tissue reduced too
ulceration of atheromatous intima leads to predisposition to thrombus formation -> vessel occlusion
replacement of muscle and elastic fibres in media leads to loss of elasticity -> thinning and stretching (aneurysm)
reduction of lumen leads to reduced blood flow thus reduced oxygenation of tissues thus ischaemic damage to tissues
reduction in lumen in coronary arteries leads to angina
reduction in lumen in leg arteries leads to intermittent claudication
reduction in lumen in mesenteric arteries leads to ischaemic colitis
reduction in lumen in cerebral and vertebral arteries leads to cerebral ischaemic events
explain plaque fissure formation blood seeps into atheromatous plaque and expands it OR blood seeps into plaque and undergoes thrombosis (both acutely occluding vessel lumen)
complications of atheroma enlarging intimal atheroma plaque -> media atrophy where media muscle + elastic fibres replaced by collagen (no contractility/recoil) so each systolic pulse = artery wall stretches/ thins (especially when high BP commonly in abdominal aorta)
damage to media may lead to aneurysm
aneurysm abnormal permanent focal dilation of artery
most common type of aneurysm most common type of aneurysm (in abdominal aorta) is secondary to atherosclerosis
mycotic aneurysm uncommon - mostly caused by endocarditis (infection of heart valve), bacteria septicaemia, infection of arterial wall, and weakening and dilation which all lead to aneurysm and risk of bleeding
Created by: kablooey
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