Hardening and thickening of artery walls
• 3 types
– Atherosclerosis
– Medial Calcification
– Arteriolarsclerosis
Atherosclerosis
• Aorta - common
• Coronary Arteries - common
• Cerebral arteries - basilar and middle cerebral most affected
• Carotid arteries
• Abdominal arteries
– Splenic artery
• Peripheral arteries
• Pulmonary arteries - least common
Pathogenesis of Atherosclerosis
• Intimal injury - injury - markers for LDL.
– Aging
– Hemodynamic factors - turbulence; e.g., HTN
– High cholesterol
• Inflammation
– Monocyte adhesion and migration - turn into macrophages - eats debri = becomes foamy mac
– Oxidation of LDL
– Inflammatory response
monocytes become foamy macrophages after combining with LDL in plasma
Risk Factors
• Not changeable
– Age, Sex, Genetics
• Major reversible
– Smoking** Diabetes, HBP*, Hyperlipidemia
• Minor reversible
– Obesity, Life Style, Personality
*Hypertension
• Increases the severity of atherosclerosis at any age
• Mechanism is mechanical stress on arteries
– Intimal injury
– Medial degeneration
**smoking doubles or triples risk of sudden death
Clinical Effects of Atherosclerosis
• Arterial narrowing
- Bulging plaques
- Calcification
- Hemorrhage
• Thrombosis
- Acute change in plaque
- – Erosion or ulceration
- – Plaque hemorrhage
- – Plaque rupture
- Vulnerable plaque
- – Moderate luminal narrowing
- – Lipid rich center
- – Thin fibrous cap
• Embolism
- Initiated by rupture or erosionof plaque
- Most from aorta
- – To Kidneys, Pancreas and Spleen
- – To Lower limbs
- Dry gangrene
• Aneurysm - cystic medial degeneration - proteoglycan deposition - weakens walls
- Atherosclerotic Aneurysm
- • Abdominal aorta belo w renal arteries
- • Iliac arteries
- • Usually over age 60
- • Men > women
- • Clinically significant when > 5 cm. in diameter
2. Dissecting Aneurysm
- Hypertensive
- Genetic
- – Marfan Syndrome
- Both types have cystic medial degeneration -
- Dissection usually starts in arch of aorta
Coronary Artery Artherosclerosis
Myocardial Ischemia
- • Amount of coronary flow
- – Size/narrowing of coronary artery
- – Hypotension
- – Collaterals
- – Arrhythmias
- • Myocardial oxygen requirements
- – Anemia
- – Exercise/Excitement/Fever/Hyperthyroidism
Infarct Location
• Left anterior
descending: Anterior
wall, apex and
septum
• Right: Posterior base
and posterior septum
• Left Circumflex:
lateral wall
Sequela of Infarct
• Death from arrhythmia or CHF
• Healing
• Aneurysm
• Rupture
• Postmyocardial syndrome
Sudden Cardiac Death
• Usually not Myocardial Infarct
• Mechanism is cardiac arrhythmia
• Thrombus not usually present
• Severe coronary narrowing
• Previous myocardial infarcts
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