PT13

Define atherosclerosis?

Progressive disease of large and medium muscular arteries, inflammation and dysfunction of the lining of BV, build up of cholesterol, lipid, cellular debris

What is the consequences of atherosclerosis?

Formation of plaque, obstruction of blood flow and decreased oxygen supply to target organs

What can happen is carotid arteries become blocked?

Stroke or brain damage

What can coronary heart disease lead to?

Angina, ACS, MI

What can Cerebrovascular atherosclerotic disease lead to?

Transient ischaemic attack (mini stroke)

Define Renovascular disease?

Narrowing of the arteries to one or both of the kidney’s

What may Peripheral artery disease lead to?

Pain in legs, ulcers digital necrosis, impotence and amputations

What may Abdominal aortic aneurysm cause?

Vessel rupture and sudden death

What are some modifiable factors for atherosclerosis?

Due to weakening of the endothelial cells, hypertension, Diabetes, smoking, alcohol, high fat dies, lack of exercise, obesity

What are some non modifiable factors for atherosclerosis?

Gender, age, genetics

What can secondary Dyslipidaemias be caused by?

Liver diseases, nephrotic syndrome, anorexia, Hypothyroidism, certain drugs

Which drugs can cause secondary Dyslipidaemias?

Anabolic steroids, diuretics, immunosuppressants, beta blockers

What are the indicators/plasma markers of atherosclerosis?

CRP, homocysteine, coagulation factors, lipoprotein (a)

What is the normal levels of total cholesterol?

Equal or below 5 mmol/L no fasting

What is the normal levels of total triglycerides ?

equal to or below 2mmol/L fasting

Describe LDL (Low-Density Lipoprotein)?

Core of 1500 cholesterol esters

Describe HDL (High-Density Lipoprotein)?

enriched with non-esterified cholesterol

What is the first step in formation of atheromatous plaque?

Endothelial dysfunction via one of the mechanisms causing increased permeability to LDL particles

What is the second step in formation of atheromatous plaque?

Lipid accumulation, LDL in sub endothelia space, then can become oxidised forming foreign particles and trigger immune response

The infiltration of immune cells formation of fatty streaks and foam cells

Increased IL-1B

Production of more inflammatory mediators

What is the third step in formation of atheromatous plaque?

Migration of smooth muscle cells into sub endothelial space to try to repair and stabilise , formation of stable fibrous plaque, narrowing blood vessel can lead to angina

What is the forth step in formation of atheromatous plaque?

Unstable atheromatous plaque Increased cell apoptosis, calcification, rupture of cap, thrombus formation activation of coagulation cascade

Describe lipoprotein a characteristics?

LDL with attached protein via disulphide bond, structural homology with plasminogen but does not destroy thromboses, competes with plasminogen

What does lipoprotein a contribute to?

When oxidised, foam cell formation, CV risk factor, proatherogenic marker

What are the signs of Familial Hypercholestolaemia (FH)?

Corneal arcus, xanthoma