questions 7

Atherosclerosis

Author:
Topic updated on 05/10/17 6:03pm

Introduction
  • Endothelial cell damage
    •  to elastic arteries and large and medium-sized muscular arteries 
    • resulting in fibrous plaques and atheromas formed in the intima
  • Epidemiology
    • Risk factors
      • blood chemistry abnormalities (↑ LDL, ↑ homocysteine)
      • hypertension, smoking, diabetes
      • genetic
  • Pathophysiology
    • endothelial cell dysfunction as a result of injurious stimuli 
    • macrophages and LDL adhere to damage
      • macrophages may phagocytose LDL and become lipid-laden foam cells 
      • now a fatty streak
    • macrophages/endothelial cells/platelets stimulate smooth muscle hyperplasia via cytokine release (PDGF and TGF-β
    • smooth muscle cells of vessel wall migrate into intima 
    • ↑ extracellular matrix (fibrous cap) produced as result of cytokines released by smooth muscle cells
      • has a necrotic center with cholesterol crystals and foam cells
    • stable plaques have a thick fibrous cap, unstable plaques have a thin fibrous cap
      • ↑ expression of matrix metalloproteinases may result in cap degradation and rupture
      • slow forming plaques allow for formation of collateral circulation
        • less likely to result in MI if plaque ruptures 
Presentation
  • Symptoms
    • angina
      • if >75% obstruction 
    • claudication
    • can be asymptomatic
  • Location
    • abdominal aorta > coronary artery > popliteal artery > internal carotid artery
Studies
  • Labs
    • ↑ in C-reactive protein
      • strong predictor of disrupted plaques
Complications
  • Result of sudden ↓ in perfusion
    • presenting as ischemia/infarction
    • thrombus
      • rupture of fibrous cap resulting in immediate clot formation at site of rupture
    • emboli
      • ↓ in lumen size plugged by embolus from another source in body
      • may give rise to emboli that propagate forward
  • Result of chronic ↓ in perfusion
    • peripheral vascular disease
      • ↑ risk of gangrene
    • atrophy
      • cerebral atrophy when cerebral vessels are involved


  RATE CONTENT
5.0
AVERAGE 5.0 of 4 RATINGS

Qbank (5 Questions)

TAG
(M1.CV.33) A 65-year-old Caucasian male presents to the emergency room with chest pain. Coronary angiography reveals significant stenosis of the left anterior descending (LAD) artery. Which of the following characteristics of the atheroma is the most important physiologically plausible predictor of myocardial necrosis in this patient? Topic Review Topic

1. Cholesterol crystal presence
2. Rate of formation
3. Calcium content
4. Presence of cytokines
5. Amount of foam cells

PREFERRED RESPONSE ▶
TAG
(M1.CV.38) A 50-year-old Caucasian male notices substernal chest pain while walking his dog uphill in Central Park on a sunny Saturday morning. The pain disappears after 5 minutes of rest, and he continues to enjoy his weekend. As he smokes a cigarette later in the day, he wonders: which of the following pathologies were most likely responsible for his chest pain that morning? Topic Review Topic

1. A fixed atherosclerotic plaque obstructing 80% of one of his coronary arteries
2. A fixed atherosclerotic plaque obstructing 50% of one of his coronary arteries
3. An ulcerated fibrous plaque in one of his coronary arteries
4. A pulmonary embolism
5. A ruptured atherosclerotic plaque in one of his coronary arteries

PREFERRED RESPONSE ▶
TAG
(M1.CV.47) A 65-year-old man presents to the Emergency Department complaining of substernal chest pain. An acute coronary event is suspected and a coronary catheterization procedure reveals an atherosclerotic plaque in the patient's left anterior descending artery. In the formation of an atherosclerotic plaque, which of the following pairings is correct? Topic Review Topic

1. Fibroblasts -- Foam Cells
2. Smooth Muscle Cells -- ECM deposition
3. Endothelial Cells -- Downregulation of VCAM-1
4. Smooth Muscle Cells -- Migration from intima to media
5. LDL chemical reduction -- Endothelial dysfunction

PREFERRED RESPONSE ▶
TAG
(M1.CV.53) A 60-year-old male painter with severe chest pain is found to have atherosclerosis of his coronary arteries. What type of cells were most likely injured in the initial stage of his disease?
Topic Review Topic

1. Myocytes
2. Fibroblasts
3. Neutrophils
4. Endothelial cells
5. Smooth muscle cells

PREFERRED RESPONSE ▶
TAG
(M1.CV.76) A 14-year-old Caucasian female commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types initially predominate in these yellow spots? Topic Review Topic

1. Fibroblasts
2. Macrophages
3. Endothelium
4. T-cells
5. Neutrophils

PREFERRED RESPONSE ▶
Sorry, this question is only available for Study Plan members.
Access to 600+ Questions not available in Free Qbank

This is a Never-Been-Seen Question that can only be seen in Study Plan Mock Exams.
Access to 600+ Questions not available in Free Qbank


Recent Videos

video
This video provides a detailed explanation of atherosclerosis.
2/14/2015
211 views
5

Evidence & References Show References




Topic Comments

Subscribe status: