2What is the difference between: ArteriosclerosisAtherosclerosisAtheroma
3Answer: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.
4Histopathological Changes Injury to the endothelium allows LDL into the intima, this LDL starts to oxidize.Macrophage invade the intima and ingest the oxidized LDL, becoming pathological foam cells because they can not break it down.Foam cells recruit other white blood cells and activate a generalised immune response, causing inflammation.Foam cells release growth factors which cause smooth muscle infiltration from the media into the intima, further narrowing the artery.Smooth muscle can begin to calcify and become brittle, leading to rupture and embologenesis.
61) Fatty Streaks Irregular patches Matter is beneath intima (fibrous cap)Mostly foam cells at this pointSmooth muscle cell infiltration has also begun
72) Fibrofatty Plaque Atheroma now much more widespread Lots of smooth muscle infiltrationFilled with lots of other stuff like fibrin, collagen and bits of cells.Calcification may have begun.
83) Complicated/Advanced Plaque Presence of one or more of:Cracking of fibrous capBleeding into the atheromaSuperimposed thrombusVery large fibrous cap
9Complications of Atherosclerosis - CHEAT Critical Stenosis – e.g. Peripheral Vascular DiseaseHaemorrhage – i.e. Burst VesselEmbolismAneurysm – Can then develop into lots of problemsThrombosis in situ
10Diagnosis 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.