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Arteriosclerosis (Pathoma) (hardening of the arterial wall (thickening of…

- - - - Atherosclerosis
        
        thickening of Intima
        
        usually occurs: medium or L vessels
        
        abdominal aorta
        
        Coronary
        
        Popliteal
        
        Internal carotid
        
        intimal plaque
        
        plaque has necrotic lipid core (cholesterol)
        
        lipid core can undergo dystrophic calcification
        
        fibromuscular cap
        
        Risk factors
        
        Modifiable
        
        HTN
        
        Hypercholesterolemia
        
        LDL increases risk: HDL decreases
        
        Smoking
        
        Diabetes
        
        Nonmodifiable
        
        Age
        
        Gender
        
        males and postmenopausal females (estrogen is protective)
        
        Family Hx (genetics)
        
        Pathogenesis
        
        Endothelial damage in intima
        
        lipid enters intima and is oxidized
        
        macrophages eat lipids
        
        forms initial lesion: fatty streak
        
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        Complications
        
        accounts for 50% of disease in western world
        
        Stenosis of medium sized vessels
        
        Peripheral vascular disease (popliteal)
        
        Angina (coronary artery)
        
        Ischemic bowel disease (mesenteric arteries)
        
        asymptomatic until 75% stenosis
        
        Plaque rupture w/ stenosis
        
        blood vessel rupture of plaque at the neck activates coag cascade, rapidly developing thrombus
        
        infarction
        
        MI (coronary a)
        
        Stroke (middle cerebral a)
        
        Plaque rupture w/ embolization
        
        free plaque embolizes in blood supply and lodges in distal site
        
        results in atherosclerotic embolism
        
        characteristic: cholesterol clefts
        
        Weakening of vessel wall
        
        results in aneurysm (eg abdominal aorta)
        
        all aspects of wall need O2
        
        thickening intima blocks diffusion
        
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      - Arteriolosclerosis
        
        narrowing occurs in small (arterioles)
        
        thickening due to deposit. of protein (hyaline) or hyperplasia or smooth muscle (hyper plastic)
        
        Hyaline arteriolosclerosis
        
        proteins leaking into vessel wall
        
        produces vascular thickening
        
        seen as pink hyaline on microscopy
        
        pathogenesis: 2 things!
        
        benign HTN
        
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        diabetes
        
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        Consequence:
        
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        Hyperplastic arteriolosclerosis
        
        involves thickening of vessel wall by hyperplasia of smooth muscle
        
        Onion skin appearance
        
        layer after layer reduces lumen caliber and blood flow
        
        Pathogenesis
        
        Malignant HTN
        
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      - Monckeberg medial sclerosis
        
        calcification of the media
        
        not clinically significant
        
        non obstructive
        
        doesn't involve lumen caliber or blood flow restriction
        
        may be mistaken for cancer
        
        incidental finding on Xray or mammography