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Pathology
artherosclerosis
75
Science
Professional
10/28/2007

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Term
What is atherosclerosis?
Definition
is a type of inflammation or cell injury process

1. stimuli causing cell injury can induce a complex rxn. in the vascularized connective tissue
Term
What are the characteristic of the heart?
Definition

size of the fist

weighs 1 lb

located slightly to the left of the breastbone

pumps 5 quarts

Term
What is the function of the heart? what removes CO2? where is oxgenated blood is pumped to?  what are coronary arteries?
Definition
to circulate blood thru the body

pumping blood thru the lungs and refreshes the blood with oxygen

to the body to provide oxygen and nutrients and to remove waste products

the blood vessels that supply blood and oxyen to the heart muscle
Term
What are the signs and symptoms where you dont get blood to the coronary arteries?
Definition
chest pain,

SOB
MI
Term
What 3 types of problems can you get with coronary arteries?
Definition
spasm- narrowing of vessels

atherosclerosis- plaque buildup

atherosclerosis with blood clot-- narrowing of lumen
Term
What is the purpose of stenting?
Definition

it holds the vessel open and improving the flow of blood

Term
what is angioplasty?
Definition
a balloon catheter is passed thru the guiding catheter to the area near the narrowing.

compressing the plaque

easily to have stroke
Term

what is bypass surgery?

Definition
blood vessel is used to create new blood flow path in your heart
Term
What is aorta? characteristics?
Definition
coronary arteries branch from it

carry about 130 gallons of blood thru the heart muscle daily
Term
What is the coronary artery DZ?
Definition
is one of the most common and serious effects of aging

fatty deposits build up in blood vessel walls and narrow the passageway for the moviment of blood

leads to artherosclerosis
Term

what percentage of stroke? ischemic stroke?

Definition

15%

80%

Term
What is the common disorder of the arteries?

larger accumulations?
Definition
Fat ,cholesterol, and other substances collect in the walls of arteries

atheromas or plaques
Term
What is arteriosclerosis?
Definition
hardening of the arteries frequently accompanies atherosclerosis
involves deposits along the arteries which often contain calcium
Term
What age group does arteriosclerotic affect?ASHD
Definition
middle ages
Term
What are the 3 main risk factors?
Definition
smoking 
 
high bp
high cholesterol
Term
What is intermittent claudication?
Definition
pain in calf or leg brought on by exercise and relieved by rest

is most common early sign of ateriosclerosis
Term
Lack of hair on legs and feet is a sign of heart DZ. T/F
Definition
true
Term
What is raynaund phenomenon? symptoms? tx it with?
Definition
episodes of arterial spasm- usually in hands

in women 20-40

cold
numbness
paleness and pain in one or more fingers or toes

it's bilateral
smoking and cold makes it worse

Calcium Blockers
Term

what is the drug of choice of angina

Definition
Nitroglycerin
Term

what does nitroglycerin cause?

Definition
1. relaxes smooth muscle tissue of the vascular system

2. acts to dilate coronary arteries
3. increases blood flow to cardiac tissue
4. increases oxygenation of cardiac muscle
Term

What are the common side effect?

Definition
headaches, dizziness, hypotension
Term
which of the following is a non-modified risk factor for ASHD?

a. smoking
b. obesity
c. family hx
d. hypertension
Definition
family hx
Term
What type of disease cause thickening and loss of elasticity of aterial walls, hardening of the arteries?
Definition
arteriosclerosis
Term
What are the non modifiable risk factors?
Definition
age, gender, family hx
Term
What are the modifiable risk factors?
Definition
hyperlipidemia
HTN
smoking
DM
elevated homocysteine
affect hemostasis and thrombosis
infection
obesity
stress
sedentary lifestyle
Term

What is the pathophysiology of atherosclerosis? 4 stages

Definition
endothelial dysfunction

initial lesion (fatty streak)

characteristic lesion (atheroma)

complicated lesion: lesion becomes unstable, plaque ruptures, thromboembolism, results in MI
   
Term

What are the response to injury hypothesis?

Definition
injury to the endothelium

chronic inflammation response

migration of SMC from media to iniima

proliferation of SMC in intima

excess production of ECM

Enhanced lipid acculumation
Term
What are the causes of chronic endothelial injury?
Definition
hyperlipidemia

HTN
smoking
homocysteine
hemodynamic factors
toxins
viruses
immune rxns
Term

What causes endothelial Dysfunction?

Definition
increased permeability
leukocyte adhesion
monocyte adhesion
emigration
Term
What causes initiation of Fatty Streak?
Definition
Smooth muscle emigration from media to intima.
macrophage activation
Term
What causes Fatty Streak?
Definition
macrophages and smooth muscle cells engulf lipid
Term
What causes fibro fatty atheroma?
Definition
Smooth muscle proliferation, collagen , and other ECM deposition, EC lipids
Term
What is the first step in atherosclerosis?
Definition
Endothelial injury
Term
What are the steps of pathophysiology of atherosclerosis?
Definition
endotheial dysfunction

initial lesion ( fatty streak)

characteristic lesion ( atheroma)
 
complicated  lesion (unstable plaque)
Term

What does injured endothelial consists?

Definition

decrease vasodilatory substances
decrease amounts of antithrombotic and anti-adhension
increase adhesion molecules

Term
What does the initial lesion ( fatty streak ) consist of ?
Definition
foam cells
macrophage
lipids in macrophage become oxidized forming = fatty streak
Term

What does fatty streak produce?

Definition
free radicals and inflammatory cytokines
Term

What does atheroma consist?

Definition
fibrous cap
the plaque may have a thick fibrous cap and may be stable
Term
What does complicated lesion (unstable plaque)?
Definition
fibrous cap may becomes thin and weak, forming a vulnerable plaque
Term

What is the earliest recognizable lesion of atherosclerosis?

Definition
fatty streaks
Term
What is fatty streak?
Definition
aggregation of lipid-rich macrophages
T lymphocytes
precedes the development of intermediate lesions which are composed of layers of macrophages and smooth muscle cells
Term
What are the sudden deaths from MI are due to?
Definition
Ruptures or fissure :

results in hemorrhage into the plaque, thrombosis, and occlusion of the artery
Term
What are the three processes involved in the formation of atherosclerotic lesion?
Definition
proliferation of smooth muscle cells and macrophages

formation by smooth muscle cells of connective tissue matrix

accumulation of lipid and mostly free and esterified cholesterol in the surrounding matrix

Progression = accumulation of alternating layers of SMC and lipid-laden macrophage
Term
All of the following are steps in the pathophysiology of atherosclerosis EXCEPT:

a. endothelial dysfxn
b. stable plaque
c. fatty streak
d. atheroma
Definition
stable plaque
Term
What role does oxidized LDL play?
Definition
directly injure the endothelium  and increases adherence and migration of monocytes and T lymphocytes

once monocytes and lymphocytes enter into the intima of the artery,
uptake of oxLDL by the macrophages will lead to foam cell formation
Term
What are FOAM CELLS ?
Definition
when the macrophage become engorged with lipid

acccumulation of these foam cells in the subendothelial space of blood vessels forms the earliest gross evidence of a developing atherosclerotic plaque known as a FATTY STREAK
Term
What is the early response? late respone
Definition
neutrophils--acute inflammation
lymphocytes and macrophages
Term

Can atherosclerosis be considered a form of chronic inflammation of arterial walls. T/F

Definition
T
Term
What does inflammation results in ?
Definition
lipid filled plaques

plaque rupture and thrombosis caused MI and strokes
Term
What does oxidized LDL trigger?
Definition
promote platelet aggregation
Term
What are some key roles of Vascular Endothelium?
Definition
controls vascular tone

NO important
provides nonthrombogenic surface

acts as permability barrier
Term

What processes does endothelial injury promote atherosclerosis?

Definition
migration of monocytes thru endothelium

proliferation of macrophages and SMC

formation of Connective tissue matrix

accumulation of free and esterified cholesterol in macrophages and in surrounding tissue spaces upon cell death
Term

What is stable plaque?

Definition

thick fibrous cap
smaller lipid pool
few inflammatory cells
dense extracellar matrix

Term

What is vulnerable plaque (stable plaque)?

Definition
thin fibrous cap
large lipid pool
many  inflammatory cells
few SMC
Term

Is insulin resistance and atherosclerosis are related. T/F

Definition
T
Term
What is LDL?
Definition
bad cholesterol
major cholesterol carrier in the blood

increases the risk of heart DZ
Term
what is HDL ?
Definition
good cholesterol
high level of HDL reduces the risk of heart DZ
it removes excess cholesterol from arterial plaques and carriers it back to the liver
Term
Does adipose tissue make hormones. T/F
Definition
t
Term
What is made in fat cells that is a hormone?
Definition
Adiponectin
Term
What is desirable blood lipid profile? total Cholesteral, LDL, HDL, TG
Definition

< 200
<135
> 35

Term
What is produced in intestinal epithelium from dietary fat and carries TG in the blood?
Definition
Chlymicrons
Term
What is produced in liver mainly from dietary Carbs
and carries TG in blood ?
Definition
VLDL
Term
WHat is  produced in blood (remains of VLDL TG digestion) and endocytosed by liver or converted to LDL?
Definition
IDL
Term
What is produced in blood and high cholesterol?
Definition
LDL
Term
What is produced in liver and intestine and exchange of proteins and lipids with lipoproteins?
Definition
HDL
Term
High levels of LDL reduce the risk of Heart DZ. T/F
Definition
F
Term

What is the major blood supply is in contact with only what?

Definition
Endothelial cells in the intima
Term

What is insulin resistance?

Definition
the decreased responsiveness of tissues to insulin
Term
How much blockage is needed to cause symptoms?
Definition
80%
Term
All of the following are cells within a plaque except:

a. T lymphocytes
b. macrophage
c. RBC
Definition
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