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Vascular disease

vascular-disease

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Define atheroma

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define arteriosclerosis

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3 patterns of ateriosclerosis

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define atherosclerosis

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Vascular response to injury

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cytokine and growth factor release from inflammatory cells
further macrophage activation
smooth muscle cells migrate to intima
platelet adhesion, recruitment of monocytes and T cells
smooth muscle cell migration and proliferation
foam cells in the plaque are derived from macrophages or smooth muscle cells filled with lipids
endothelial dysfunction

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endothelial activation can be caused by cytokines, bacterial products, viruses, hypoxia, lipids, cigarette smoke, hypertension, turbulent flow

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cytokines

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bacterial products

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hypoxia

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cigarette smoke

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activated endothelium: increased expression of adhesion molecules, cytokines, chemokines and groeth factors

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plaque progression

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Explanation

fatty streak: mainly intracellular lipid accumulation, early disease. simple plaque: intermediate lesion, intacellular lipid build up plus core of extracellular lipid, may have calcific layers. complicate plaque: all the previous pluus surface defect, hae

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fatty streak
complicated plaque
simple plaque

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endothelial dysfunction is
endothelial dysfunction stimulates
repair of intimal thickening results in
neointimal smooth muscle is more
neointimal cells eventually

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neointimal smooth muscle
smooth muscle cell recruitment and proliferation leading to intimal thickening
settle in a non proliferative state
proliferative which leads to further thickening
seen in many condition, usually prothrombotic and proinflammatory, resposible for initiation of thrombus, atherosclerosis etc

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fibrous cap of atheroscleotic plaque consists of

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low oxygen

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hypoxia
hypoxaemia
hypoxic hypoxia
circulatory hypoxia
anaemic hypoxia
histotoxic hypoxia

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hypoxia due to inadequate blood flow to the tissue- if this happens to whole body it results in cardiogenic shock
low tissue O2 levels that causes adverse effects on tissue function
abnormally low O2 level in blood
hypoxia due to low Hb- caused by anaemia or CO poisoning
hypoxia due to inability of cells to utilise O2 caused by cyanide poisoning
hypoxia due to insufficient oxygen available in lungs

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lipids

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stable plaque
vulnerable plaque
Necrotic centre of athersclerotic plaque contains
Xanthelasma is
Arcus senislis is
Arcus senilis is a sign of

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small lipid core, thick fibrous cap, low macrophage content, low microvessel density, no intraplaque haemorrhage, no cap rupture
thin fibrous cap, high microvessel density, large lipid core, high macrophage density, intraplaque haemorrhage, cap rupture and superimposed thrombus
the fat deposits under the skin seen on eye lids- sign of hypercholesterolaemia
foam cells, cell debris, cholesterol, calcium
normal in elderly
hypercholesterolaemia in younger patients

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