atherosclerosis please read robbins p 515-524
DESCRIPTION
Arteriosclerosis- 3 types Atherosclerosis - intimal fibrous plaques with a central core rich in lipid Monckeberg medial calcific sclerosis - calcifications in media Arteriolosclerosis - thickening of media - hypertension and diabetesTRANSCRIPT
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Atherosclerosis• Please read Robbins p 515-524
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Arteriosclerosis- 3 types
• Atherosclerosis - intimal fibrous plaques with a central core rich in lipid• Monckeberg medial calcific sclerosis
- calcifications in media• Arteriolosclerosis - thickening of
media - hypertension and diabetes
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Atheromatous Plaque
• 0.3 to 1.5cm, yellow• May coalesce• Cells - smooth muscle & macrophages• Connective tissue extra cellular matrix• Intracellular and extracellular lipid
deposits• Neovascularization
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Typical atheroma
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Pathogenesis
• Chronic endothelial injury• Insudation of lipoproteins• Adhesion of blood monocytes• Adhesion of platelets• Release of factors from activated platelets• Proliferation of smooth muscle cells• Enhanced accumulation of lipids
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1)Chronic endothelial injury. 2)Insudation of lipoproteins. 3)Adhesion of blood monocytes4) Adhesion of platelets. 5) Release of factors from activated platelets. 6)Proliferation of smooth muscle cells. 7) Enhanced accumulation of lipids
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Complicated lesion
• Calcification• Rupture or ulceration - discharge of
debris - micro embolus• Hemorrhage• Thrombosis• Weakening of wall, aneurysmal
dilation
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19 y/o man killed in a auto crash-- early fatty streaks-- oil red O stain
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Lower- 30 y/o fatty streaks & early atheroma, Upper 50 y/o
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Early complex lesions
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Severe atherosclerosis in a 70 y/o man many ulcerated complex plaques
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Recent thrombus well developed plaque
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Early intimal hyperplasia
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Early intimal hyperplasia
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Well developed plaque
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Complicated plaquelipid corecalcification
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Severe occlusion, coronary art. lumen
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Cholesterol crystals calcification
lumen
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Risk factors
• Non-modifiable• Increasing age• Male gender• Family history• Genetic abnormalities
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Potentially Controllable
• Hyperlipidemia• Hypertension• Cigarette smoking• Diabetes
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Lesser or Uncertain
• Obesity• Physical inactivity• Homocysteine• Postmenopausal estrogen deficiency• Alcohol• Lipoprotein (a)• Chlamydia pneumoniae
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Other Factors
• Smooth muscle proliferation - oligoclonality • Infection• Viruses - herpesvirus + CMV in plaque• Chlamydia pneumoniae