Ortega RN MSN, CNS - Los Angeles Harbor College pathology.pdf · ATHEROSCLEROSIS DISEASE...
Transcript of Ortega RN MSN, CNS - Los Angeles Harbor College pathology.pdf · ATHEROSCLEROSIS DISEASE...
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ATHEROSCLEROSIS PATHOLOGY
Ortega RN MSN, CNS
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ATHEROSCLEROSIS DISEASE
Atherosclerosis: Type of blood vessel disorder
Begins as soft deposits of fat that harden with age
Referred to as “hardening of arteries”
Involves progressive narrowing and degeneration of
arteries of heart, carotid, abdomen, and extremities.
Atherosclerosis is the leading cause in majority of cases.
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ATHEROSCLEROSIS
Common Terms:
• Arteriosclerotic heart disease
• Cardiovascular heart disease
• Coronary artery disease (CAD)
• Peripheral vascular disease (PAD)
• Carotid Disease
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DESCRIPTION
Typically appears at ages 60s to 80s
Largely undiagnosed
Risk factors
Cigarette smoking
Hyperlipidemia
Hypertension
Diabetes mellitus
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Inc., an affiliate of Elsevier Inc.
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ETIOLOGY
Characterized by a focal deposit of cholesterol and lipid,
primarily within the intimal wall of the artery
Endothelial lining altered as a result of inflammation and
injury
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PATHOGENESIS OF ATHEROSCLEROSIS
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Fig. 34-1. Pathogenesis of atherosclerosis. A, Damaged endothelium. B, Diagram of fatty streak and
lipid core formation. C, Diagram of fibrous plaque. Raised plaques are visible: some are yellow, others
are white. D, Diagram of complicated lesion: thrombus is red, collagen is blue. Plaque is complicated by
red thrombus deposition.
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PATHOPHYSIOLOGY
+ C-reactive protein (CRP)
Non-specific marker of inflammation
Increased in many patients with CAD
Chronic exposure to CRP associated with unstable
plaques and oxidation of LDL cholesterol
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PATHOPHYSIOLOGY
B. Developmental stages: Fatty
streaks
Earliest lesions
Characterized by lipid-filled smooth
muscle cells
Potentially reversible
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PATHOPHYSIOLOGY
C. Developmental stages: Fibrous plaque
Beginning of progressive changes in the
arterial wall
Lipoproteins transport cholesterol and other
lipids into the arterial intima.
Fatty streak is covered by collagen, forming a
fibrous plaque that appears grayish or
whitish.
Result = Narrowing of vessel lumen
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Mosby, Inc., an affiliate of
Elsevier Inc.
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PATHOPHYSIOLOGY
D. Developmental stages: Complicated lesion
Continued inflammation can result in plaque
instability, ulceration, and rupture.
Platelets accumulate and thrombus forms.
Increased narrowing or total occlusion of lumen
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COMMON SITES IN THE CORONARIES: CAD
• Affinity for coronaries
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COMMON SITES OF ATHEROSCLEROTIC
LESIONS
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Inc., an affiliate of Elsevier Inc.
Fig. 38-1. Common anatomic locations of atherosclerotic lesions
(shown in yellow) of the abdominal aorta and lower extremities.
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COMMON LESION: CAROTID VESSELSC
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Fig. 58-2. Common sites for the development of atherosclerosis in extracranial and intracranial arteries. The
main locations are just above the common carotid bifurcation (most common site) and the start of the
branches from the aorta, innominate, and subclavian arteries.
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MAJOR TYPES OF STROKE
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Fig. 58-3. Major types of stroke.
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ISCHEMIC STROKE
Ischemic strokes result from
Inadequate blood flow to the brain from partial or complete
occlusion of an artery
80% of all strokes are ischemic strokes.
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