Atherosclerosis

Atherosclerosis


ATHEROSCLEROSIS

  • Atherosclerosis is an thickening & hardening muscular arteries which is characterised by soft gramous lipid cores (atheromatous plaque).
  • It is the commonest & most important arterial disease.
  • Most commonly affected are aorta, coronaries & cerebral arterial system.
  • Most commonly coronoary circulation affected is – Left anterior descending artery

Etiology

Pathogenesis-

  • Most widely accepted theory for atherosclerosis is inflammatory response to endothelial injury.
  • According to this hypothesis, atherosclerosis is a chronic inflammatory response of the arterial wall initiated by injury to endothelium.
  • Hyperlipidemia, hypertension, smoking can cause endothelial injury.
  • Foam cells are formed when macrophages & smooth muscle cells accumulated oxidised LDL.
  • Chlamydia Pneumoniae presents the strongest association with human atherosclerosis.

Morphological features-

1. Fatty streaks & Dots- are the earliest lesions composed of intimal collections of foamy macrophages & smooth muscle cells.

  • Prominent in the aorta (often in posterior wall)

2. Gelatinous lesions- develop in the intima of the aorta.

3. Artheromatous plaques (arthemaous lesions/ fibrous plaque)-

  • Most severely affected is the abdominal aorta.
  • Involves iliac, femoral, carotid, coronary & cerebral arteries.
  • Superficial luminal part of the fibrous cap (convex) composed by smooth muscle cells.
  • Cellular area under fibrous cap composed of macrophages, foam cells, lymphocytes.
  • Deeper central soft core consists of cholesterol clefts, fibrin, necrotic debris & lipid- laden foam cells.

4. Complicated plaques-

  • Calcification- occurs more commonly in advanced athermatous plaques.
  • Ulceration
  • Thrombosis- superimposed thrombi
  • Haemorrhage

Clinical features-

Major clinical effects of atheroscelrosis are-

  1. Heart (coronary artery disease, IMD, MI)
  2. Brain (stroke)
  3. Aorta (aneurysmal dilatation)
  4. Intestine (ischaemia, infarct)
  5. Lower extremities (gangrene)
  • Blood vessels affected by atherosclerosis- abdominal aorta (most commonly), Circle of Willis (least commonly affected)

Exam Important

  • Most commonly affected are aorta, coronaries & cerebral arterial system.
  • Most commonly coronoary circulation affected is – Left anterior descending artery

Etiology

Pathogenesis-

  • Most widely accepted theory for atherosclerosis is inflammatory response to endothelial injury.
  • According to this hypothesis, atherosclerosis is a chronic inflammatory response of the arterial wall initiated by injury to endothelium.
  • Hyperlipidemia, hypertension, smoking can cause endothelial injury.
  • Foam cells are formed when macrophages & smooth muscle cells accumulated oxidised LDL.
  • Chlamydia Pneumoniae presents the strongest association with human atherosclerosis.

Morphological features-

1. Fatty streaks & Dots- are the earliest lesions composed of intimal collections of foamy macrophages & smooth muscle cells.

  • Prominent in the aorta (often in posterior wall)

2. Gelatinous lesions- develop in the intima of the aorta.

3. Artheromatous plaques (arthemaous lesions/ fibrous plaque)-

  • Most severely affected is the abdominal aorta.
  • Involves iliac, femoral, carotid, coronary & cerebral arteries.
  • Superficial luminal part of the fibrous cap (convex) composed by smooth muscle cells.
  • Cellular area under fibrous cap composed of macrophages, foam cells, lymphocytes.
  • Deeper central soft core consists of cholesterol clefts, fibrin, necrotic debris & lipid- laden foam cells.

4. Complicated plaques-

  • Calcification- occurs more commonly in advanced athermatous plaques.
  • Ulceration
  • Thrombosis- superimposed thrombi
  • Haemorrhage
  • Blood vessels affected by atherosclerosis- abdominal aorta (most commonly), Circle of Willis (least commonly affected)
Don’t Forget to Solve all the previous Year Question asked on Atherosclerosis

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