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    Atherosclerosis: Jason Ryan, MD, MPH

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    Atherosclerosis is a disease characterized by plaque buildup within arteries. It is a chronic inflammatory response where macrophages accumulate within the arterial wall due to risk factors like smoking, high blood pressure, and high cholesterol. Over time, plaque growth can lead to complications like ischemia, plaque rupture, or aneurysm which can cause heart attacks, strokes, or other vascular issues. The pathology and locations of atherosclerosis are described.

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    Atherosclerosis: Jason Ryan, MD, MPH

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    52 views23 pages
    Atherosclerosis is a disease characterized by plaque buildup within arteries. It is a chronic inflammatory response where macrophages accumulate within the arterial wall due to risk factors like smoking, high blood pressure, and high cholesterol. Over time, plaque growth can lead to complications like ischemia, plaque rupture, or aneurysm which can cause heart attacks, strokes, or other vascular issues. The pathology and locations of atherosclerosis are described.

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    Atherosclerosis is a disease characterized by plaque buildup within arteries. It is a chronic inflammatory response where macrophages accumulate within the arterial wall due to risk factors like smoking, high blood pressure, and high cholesterol. Over time, plaque growth can lead to complications like ischemia, plaque rupture, or aneurysm which can cause heart attacks, strokes, or other vascular issues. The pathology and locations of atherosclerosis are described.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    52 views23 pages

    Atherosclerosis: Jason Ryan, MD, MPH

    Uploaded by

    asd
    Atherosclerosis is a disease characterized by plaque buildup within arteries. It is a chronic inflammatory response where macrophages accumulate within the arterial wall due to risk factors like smoking, high blood pressure, and high cholesterol. Over time, plaque growth can lead to complications like ischemia, plaque rupture, or aneurysm which can cause heart attacks, strokes, or other vascular issues. The pathology and locations of atherosclerosis are described.

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    Atherosclerosis

    Jason Ryan, MD, MPH


    Vocabulary
    • Arteriosclerosis
    • Hardening of arteries
    • Hyaline
    • Hyperplastic
    • Atherosclerosis
    • Form of arteriosclerosis
    • Most common type
    Atherosclerosis
    • Plaque accumulation in arterial walls
    • Chronic inflammatory process
    • Involves macrophages, T-cells
    • Accumulation of lipoproteins especially LDL
    • Underlying cause of many diseases
    • Myocardial infarction
    • Stroke
    • Peripheral vascular disease

    A. Rad et al./Wikipedia
    Nephron/Wikipedia

    OpenStax College/Wikipedia
    Arterial Structure
    • Intima
    • Single layer of endothelial cells
    • Basement membrane
    • Media
    • Smooth muscle cells
    • Elastin
    • Adventicia Bruce Blaus/Wikipedia

    • Connective tissue
    • Vasa vasorum (blood supply to artery wall)
    • Nerve fibers
    Type of Arteries
    • Elastic
    • Large amounts of elastin in media layer
    • Expansion in systole, contraction in diastole
    • Aorta, carotid arteries, iliac arteries
    • Muscular
    • Layers of smooth muscle cells
    • Vasoconstriction/vasodilation to modify blood flow
    • Arterioles: smallest muscular vessels (most flow resistance)
    Atherosclerosis
    • Large elastic arteries
    • Aorta, carotid arteries, iliac arteries
    • Medium-sized muscular arteries
    • Coronary, popliteal

    Luke Guthman/Wikipedia
    Atherosclerosis
    Pathogenesis

    • Endothelial injury or dysfunction


    • Details incompletely understood
    • Believed to be related to risk factors
    • Cigarette smoke
    • High blood pressure
    • High cholesterol
    Atherosclerosis
    Pathogenesis

    • Branch points and vessel origins (ostia)


    • Common sites of plaque
    • Turbulent flow → endothelial stress
    Atherosclerosis
    Pathogenesis

    • Lipids
    • LDL accumulation in intima
    • Oxidized by free radicals
    • Oxidized LDL scavenged by macrophages
    • Cannot be degraded
    • Macrophages become foam cells

    Public Domain
    Atherosclerosis
    Pathogenesis

    • Chronic inflammation
    • LDL oxidized from free radicals
    • Damages endothelium, smooth muscle
    • Macrophages release cytokines
    Atherosclerosis
    Pathogenesis

    • Smooth muscle cells proliferate in intima


    • Lay down extracellular matrix
    • Key growth factor: PDGF
    • Platelet-derived growth factor

    OpenStax College/Wikipedia
    Atheroma Growth
    • Fatty streaks
    • Macrophages filled with lipids
    • Form line (streak) along vessel lumen
    • Do not impair blood flow
    • Can be seen in children, adolescents
    • Not all progress

    Npatchett/Wikipedia
    Atheroma Growth
    • Atherosclerotic plaques
    • Intima thickens
    • Lipids accumulate
    • Usually patchy along vessel wall
    • Rarely involve entire vessel wall
    • Usually eccentric

    Npatchett/Wikipedia
    Npatchett/Wikipedia
    Locations
    • Abdominal aorta (large vessel)
    • Coronary arteries
    • Popliteal arteries
    • Internal carotid
    • Circle of Willis

    Public Domain
    Atherosclerosis Complications
    • Ischemia
    • Plaque rupture
    • Exposes thrombogenic substances
    • Clot formation
    • May cause acute vessel closure (STEMI)
    • Thrombus may embolize (stroke from carotid plaque)
    Atherosclerosis Complications
    • Hemorrhage into plaque
    • Lesions: proliferating small vessels (“neovascularization”)
    • Contained rupture may suddenly expand lesion
    • Aneurysm
    • Lesions may damage underlying media
    • Plaque associated with abdominal aortic aneurysms

    Public Domain
    Dystrophic Calcification
    • Commonly seen in atheroma
    • Result of chronic inflammation
    • Basis for “coronary CT scans”
    Infarction
    • Area of ischemic necrosis
    • Two types: white and red
    • White infarcts
    • Occlusion of arterial supply to a solid organ
    • Common in heart, kidneys, spleen
    • Limited blood seepage from healthy tissue
    • Tissue becomes pale (white)
    White Infarct
    Renal Infarction

    Ryan Johnson/Flikr
    Red Infarcts
    Hemorrhagic Infarct

    • Blood enters ischemic tissue


    • Blockage of venous drainage
    • Testicular torsion
    • Tissues with dual circulation
    • Blood flow from 2nd supply floods ischemic area
    • Classic location: Lung (diffuse blood supply)
    • Small intestine
    • Flow re-established to necrotic area
    • Angioplasty restores flow in coronary artery
    Red Infarct
    Lung Infarction

    Yale Rosen/Wikipedia

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