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Describe the Pathogenesis of Atherosclerosis (i.e. "hardening of the arteries").
An endothelial injury leads to LDL infiltration into the vessel wall. The LDL is modified/oxidized leading to uptake and accumulation within Macrophages (foam cells). Once activated, the macrophages release inflammatory cytokines leading to activated T cells, monocyte recruitment and intimal migration of smooth muscle cells (atheroma formation). With accumulation in the tunica intima, there is progressive weakening of the tunica media.
IL6 is produced by (blank) during atherosclerosis leading to CRP and othe acute phase reactants.
Activated T Cells
Why do we fear plaque rupture?
Rupture can produce a thrombus leading to occlusion then ischemia.
What is the difference between a Risk Factor and a Risk Marker?
Risk Factor is causally linked to the disease, while a Risk Marker can be just a measure of the process and not causally linked.
Name Some Common Risk Factors for Heart Disease.
Cigarrettes, Cholesterol Level, EKG Abnormality, Lack of Exercise, Obesity, Age, Male Gender, Diabetes, BP, Menopause
Using the Framingham Risk Study, What 3 characteristics require intensive risk factor intervention?
High Risk is determined by Established CAD, DM, or >20% calculated risk.
Describe the lab values, doctors shoot for in managing these risk factors: LDL, BP and Glucose.
LDL <160; BP <140/90; Glucose FBS <110 mg/dl / HbA1c <7%
TRUE/FALSE - Arteriosclerosis is a generic term that encompasses atherosclerosis, a disease of large and medium arteries, & arterioloscelerosis, a disease of small arteries.
True
Describe the pathologic changes in Arterioloscerosis.
Hyaline and collagen deposition along with hyperplastic changes lead to loss of elasticity in the vessel wall and can lead to luminal narrowing.
Atherosclerosis is most prevalent in what 2 anatomical location?
abdominal aorta and coronary arteries
TRUE/FALSE - Aortic fatty streaks seen in virtually all children by age 10, regardless of geography, race, sex or environment
TRUE
Reference to several conditions including erosion, ulceration or fissuring, plaque hemorrhage, mural thrombosis, calcification, and aneurysm.
What does the term "complicated" plaque in advanced lesions imply?
What are the 3 predominant major complications in atherosclerosis?
The 3 predominant major complications are myocardial infarction, cerebral infarction and aortic aneurysm