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Path Athlerosclerosis
KYCOM Block 11
68
Pathology
Graduate
11/08/2013

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Cards

Term
what is the number one complication of athlerosclerosis, why is this so important
Definition
cardiovascular disease
it is the number one killer in the world
Term
where does athlerosclerosis like to form, give 4 examples
Definition
large and medium arteries
aorta, coronary, popliteal, cerebral
Term
what are the two major complications of athlerosclerosis
Definition
MI (heart attack)
stroke
Term
what are 10 risk factors for athlerosclerosis
Definition
age 40+
male (estrogen protects)
FH- hyperlipidemia, cholesteromeia
smoking
hyperlipidemia - diet
hypertension causing vessel stress
diabetes increases lipids in blood
no exercise
obesity
stress
Term
what is the major indicator for athlerosclerosis under 40
Definition
hyperlipidemia - poor diet
Term
why does hyperlipidemia/ hypercholestolemia increase athlerosclerosis
Definition
plaque contains cholesterol so increases in the blood increase chance of plaque formation
Term
what are 4 causes of hyperlipidemia/ hypercholesterolemia
Definition
diabetes
myededma
nephrotic syndrome
familial
Term
what is the treatment of hyperlipidemia/ hypercholesterolemia
Definition
diet and exercise
cholesterol decreasing drugs
Term
other than a general increase in cholesterol for plaque formation, why is hyperlipidemia one of the MAJOR causes for athlerosclerosis
Definition
it can cause athlerosclerosis all alone. it dosent need other factors to help
Term
what type of dietary fat increases cholesterol and athlerosclerosis risk
Definition
trans fat
Term
what type of dietary fat decreases/dosent change cholesterol and decreases/dosent change athlerosclerosis risk
Definition
omega 3 FA
polyunsaturated fats
Term
what is the function of LDL, what is its impact on athlerosclerosis
Definition
delivers cholesterol to tissues
increases athlerosclerosis risk
Term
what is the function of HDL, what is its impact on athlerosclerosis
Definition
transports cholesterol to the liver for bile excretion
decreases athlerosclerosis risk when >60mg/dL
Term
in what 5 ways does smoking increase risk for athlerosclerosis
Definition
decreases HDL

increases CO which causes COHb which causes hypoxia which increases risk

increases platelet adhesion

inncreases permeability of endothelium

nicotine increases sympathetic nervous system
Term
what is the most midifable risk factor for athlerosclerosis
Definition
hypertension
Term
what happens if hypertension goes untreated
Definition
50% die of ischemic heart disease and CHF
Term
what is a sign of long term hypertension
Definition
LV hypertrophy
Term
why does diabetes cause hypertension
Definition
increases platelet aggregation
increases LDL
decreases HDL
Term
where does homocystine comes from
Definition
methionine metabolism
Term
how does homocystine cause athlerosclerosis
Definition
inhibits anti-coagulants
causes epithelial damage
Term
where is CRP made, by what stimulation
Definition
intima of athelosclerosis
released by inflammation
Term
what levels of CRP are a concern
Definition
1-3mg/L
Term
what can CRP perdict
Definition
MI, stroke, peripherial artery disease, sudden cardiac death (even in healthy people)
Term
how does CRP cause athlerosclerosis
Definition
released from plaque
causes adhesion and thrombus
Term
why do we know CRP has to do with athlerosclerosis
Definition
it decreases with less smoking, exercise, and statins
Term
what three microbes cause athlerosclerosis
Definition
chalmydia pneumonia
herpes
CMV
Term
how do microbes cause athlerosclerosis
Definition
initiate inflammatory response
Term
what are the three layers of an athlerosclerosis
Definition
intima: fibrous cap then necrotic center
media
Term
what is in the fibrous cap of a athlerosclerosis
Definition
smooth muscle
macrophages
foam cells
WBC
collagen
elastin
neurovascularization
Term
what is in the necrotic center of an athlerosclerosis
Definition
cell debris
cholesterol
foam cells
calcium
Term
what are three stages of athlerosclerosis , which cause disease
Definition
1. fatty streak
2. fibrous plaque - disease
3. complex lesion - disease
Term
what are the three stages in the formation of a fatty streak
Definition
initial lesion
fatty streak
intermediate lesion
Term
what occurs in an initial lesion
Definition
some macrophages and foam cells gather
Term
what occurs in a fatty streak
Definition
lipid addition intracellulary in intima
increase in macrophages and foam cells
Term
what is a foam cell
Definition
smooth muscle filled with lipid
Term
what occurs in a initial lesion
Definition
increased intracellular lipid and addition of extracellular lipid
stays here for 20 years and digresses or pauses
Term
what are the two stages of fibrous plaque formation
Definition
atheroma
fibrous atheroma
Term
what occurs in an atheroma
Definition
increased intracellular lipids
formation of core of extracellular lipids
Term
what occurs in a fibro atheroma
Definition
many extracellular lipid cores corm
fibrotic, Ca, collagen, SM covering accumulation
Term
what are the complications of a complex lesion
Definition
surface defect: ulcer
hematoma
hemoorrhage
thrombus
scar tissue formation
occlusion
Term
what are the 10 complications of athlerosclerosis
Definition
hemorrhage
ulceration
scar tissue
narrowing
ischemia
thrombosis
emboli
weakening of lg arteries (aorta)
coronary artery disease
peripherial artery disease
Term
what starts the athlerosclerosis process
Definition
endothelial unjiry
smooth muscle migration and proliferation
macrophages eating lipids
Term
what causes endothelial injury
Definition
smoking
immune system
mechanical stress: hypertension
Term
what type of disease is athlerosclerosis classified as
Definition
VISCOUS INFLAMMATORY PROCESS
Term
why does athlerosclerosis cause hemorrhage
Definition
sudden obstruction
Term
what does athlerosclerosis cause thrombosis
Definition
turbulence, slowing
Term
what vessels does athlerosclerosis usually infarct
Definition
heart
extremities
kidney
SI
brain
Term
what is the normal outcome of athlerosclerosis in a medium size vessel
Definition
ischemia, infarct, occlusion
Term
what is the normal outcome of athlerosclerosis in a large vessel
Definition
weakening of vessel wall
Term
how is LDL removed
Definition
LDL recepors in liver
scavenger receptors on macrophages and monocytes
Term
what stimulates for macro and mono to eat LDL
Definition
damaged (oxidixation or modification)of LDL
Term
what happens when lots of LDL is dammaged and macrophages and monocytes keep eating it
Definition
cholesterol ester formation inside them makes them a foam cell
Term
plaque formation at the fatty streak level beins with monocyte attachment, then what do they do to cause propogation
Definition
migrate to subendothelium
mature to macrophages
release ROS...

ROS oxidizes LDL so it cannot be taken into liver
macrophages eat LDL making more foam cells

LDL/ROS cause endothelial damage which causes platelet adhesion which releases growth factors which increases collagen, elastin, and proteoglycens

endotheliam damage causes endothelium derived releasing factor inhibition and LDL antibody production which causes vasospasm

lymphocyte and monocyte chemotaxis due to damage
Term
what determines if there will be ulceration of a plaque
Definition
strength and Ca content of outer layer stimulated by GF release from adhering platelets
Term
why do lymphocytes and monocytes come to plaque
Definition
damage to endothelium
Term
why does the immune system make antibodies to the plaque
Definition
endothelial damage
Term
why is there vasospasm around a plaque
Definition
anti-LDL antibodies
decrease in endothelium derived releasing factor

due to endothelial damage
Term
define coronary artery disease
Definition
cardiac disease caused by impaired coronary flow
Term
what are 5 causes of coronary artery disease, which is the most common
Definition
1. athlerosclerosis
MI
dysarrhythmia
cardiac failure
suddent cardiac death
Term
what is the most common cause of Mi, why
Definition
athlerosclerotic plaque deposits
Term
what is the cut off point for coronary a disease diagnosis, why
Definition
at 75% occlusion vasodilation cannot compensate anymore
Term
what are the two types of coronary artery disease and their mechanism
Definition
stable/fixed lesion: chronic disease. silent MI, etc

unstable/vulnerable lesion: can rupture (plaque dysruption) causing platelet adhesion and thrombosis
Term
what is the tx for coronary a disease
Definition
antiplatlet drugs avoid formation of blockage after rupture avoiding thrombosis (asprin)
Term
define peripherial artery disease
Definition
obstruction of large arteries not within coronary, aorta, or brain
Term
what are causes of peripherial artery disease
Definition
athlerosclerosis blockage
inflammation
embolism
thrombus
Term
what is the mechanism causing problems in peripherial artery disease
Definition
acute or chronic ischemia
Term
what are the risk factors for PAD
Definition
same as athlerosclerosis
Term
PAD symptoms
Definition
pain
weakness
numbness
cramping
sores
wounds
ulcers
slow healing
bluness, paleness
coolness
less hair and nail growth
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