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Atherosclerosis: Jason Ryan, MD, MPH

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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87 views23 pages

Atherosclerosis: Jason Ryan, MD, MPH

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.

Uploaded by

asd
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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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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