Atherosclerosis
What is the difference between:•Arteriosclerosis•Atherosclerosis•Atheroma
Answer:• Arteriosclerosis: A group of diseases related by hardening
arteries, of which atherosclerosis is one.• Atherosclerosis: A disease involving hardening, narrowing
and weakening of the arterial wall, characterised by the presence of atheromas. • Atheroma: A chronic lesion in the intima tunica of the artery,
characterised by the pathological build-up of lipids, inflammatory cells and smooth muscle.
Histopathological Changes 1) Injury to the endothelium allows LDL into the intima, this LDL starts to
oxidize.2) Macrophage invade the intima and ingest the oxidized LDL, becoming
pathological foam cells because they can not break it down.3) Foam cells recruit other white blood cells and activate a generalised
immune response, causing inflammation. 4) Foam cells release growth factors which cause smooth muscle
infiltration from the media into the intima, further narrowing the artery. 5) Smooth muscle can begin to calcify and become brittle, leading to
rupture and embologenesis.
What are the macroscopic stages?
1) Fatty Streaks• Irregular patches• Matter is beneath intima
(fibrous cap)• Mostly foam cells at this
point• Smooth muscle cell
infiltration has also begun
2) Fibrofatty Plaque• Atheroma now much more
widespread• Lots of smooth muscle
infiltration• Filled with lots of other stuff like
fibrin, collagen and bits of cells.• Calcification may have begun.
3) Complicated/Advanced PlaquePresence of one or more of:• Cracking of fibrous cap• Bleeding into the atheroma• Superimposed thrombus• Very large fibrous cap
Complications of Atherosclerosis - CHEAT•Critical Stenosis – e.g. Peripheral Vascular Disease
•Haemorrhage – i.e. Burst Vessel
•Embolism•Aneurysm – Can then develop into lots of problems
•Thrombosis in situ
Diagnosis• Usually secondary to whatever the complication is.• Angiography is the gold standard.• High cholesterol does not necessarily mean atherosclerosis, but there
is a strong link.• Look for signs and history to screen for hyperlipidaemia.• Patient history of hypertension, family history of familial
hypercholesterolaemia, social history of poor diet and smoking. • Xanthelasma – well-defined lumps of fat around eyes.
Treatments• Stop health-damaging behaviours –
smoking, fatty diet, low exercise • Treat hypertension and
hyperlipidaemia • Stenting (Percutaneous)•Coronary Artery Bypass Graft (CABG)