FSM template

1
"Man often becomes what he believes himself to
be. Mahatma Gandhi 1869-1948, Indian Political
Leader
2
Atherosclerosis
Dr. Venkatesh M. Shashidhar Senior Lecturer in
Pathology Fiji School of Medicine
3
Introduction

• Disease of blood vessels large arteries.
• Modern life style disease
• Major cause of IHD, MI, Stroke Aortic disease
  - Major cause of death disability.
• Incidence is decreasing since 1995 - West
• Better understanding Change in life style.

4
Definition

• Chronic inflammatory disorder of intima of large
  arteries characterised by formation of fibrofatty
  plaques called atheroma.
• Hardening of arteries - Arteriosclerosis

5
(No Transcript)
6
"I kept six honest serving men. They taught me
all I knew. Their names are.. - Rudyard Kipling
Who, What, Why, When, How Where?
7
Etiology

• Exact cause is unknown
• Variation in severity distribution.
• Starts with endothelial injury.
• Genetic/Familial
• Risk Factors
• Age, Htn, DM, Smoking endothelial damage.
• Obesity, lifestyle, economic status, - lipid.
• Activation of Platelet / Coagulation.
• Oxidised LDL.

8
Lipoprotiens - LDL HDL

• Good and Bad Fats?
• Lower LDL, Increase HDL
• Mono unsaturated fats
• Poly unsaturated fats
• Omega-3 fatty acids (Fish)
• LDL indicate Positive lipid balance, HDL
  negative.
• No Cholesterol in any vegetable oil?

9
Risk Factors

• Non modifiable
• Age
• Male Sex,
• Genetic - Hyperchol.
• Family history

• Potentially Modifiable
• Hyperlipidemia HDL/LDL ratio.
• Hypertension.
• Smoking.
• Diabetes.

10
Pathogenesis

• intimal injury
• Inflammation, Necrosis
• Lipid Cholesterol accumulation (soft.a)
• Fibrosis, smooth muscle proliferation (hard.a)
• Extension of lesion and destruction of vessel
• Complications - Thrombosis, embolism, aneurism,
  dissection rupture.

11
Structure of Atheroma
Fibrous Cap Necrotic center Cholesterol
Cry. Macrophages
12
Pathogenesis-stages

• Type I Fatty dots - Foam cells
• Type II Fatty streak
• Type III Extracellular lipid pool
• Type IV Atheroma Core of lipid
• Type V Fibroatheroma Fibrotic layer
• Type VI Complicated Ulcer, Ca
• Hemorrhage, thrombus, embolism, aneurysm.

13
Morphologic types
Fatty dots F.Atheroma Plaques Complicated
14
Stages of Atheroma - Aorta
Stage VI III II
15
Development of Coronary Atherosclerosis
16
Common Sites

• Large BV Aorta, Carotid Iliac. (large
  vessels)
• Medium BV Coronary, Cerebral, Limbs.
• Small BV Veins Never affected.

17
Coronary Atherosclerosis
18
Atheroma Aorta
19
Atheroma Aorta
20
Atheroma Coronary Artery
21
Atheroma Coronary Artery
Calcification
22
Atheroma Coronary Artery
23
Atheroma with Thrombosis
24
The greatest thing in this world is not so much
where we are, but in which direction we are
moving. - Oliver Wendell Holmes, Jr.
25
Complications

• Thrombosis, Thrombo-embolism
• Rupture Haemorrhage
• Aneurism Fusiform, dissecting, berry etc.
• Fibrosis Calcification
• Ischemia / Infarction end organ damage.
• Stroke, Myocardial Infarctions, Renal infarction,
  Mesentric vein thrombosis, intermittent
  claudication, gangrene etc.

26
Coronary Atheorsclerosis
LCx LAD

• Left Coronary Artery.
• Anterior Descending (LAD)
• Left Circumflex (LCx)
• Right Coronary Artery.

27
Coronary Thrombosis With Infarction
28
Coronary Narrowing in Atherosclerosis
29
Angiogram - Embolism Infarction
30
AG41 Atherosclerosis Aorta, Ruptured aneurism.
31
Aorta Dissecting Aneurisms AG-9
32
Thrombo-embolism
33
Subarachnoid Haemorrhage
34
Summary

• Disease of large muscular arteries
• Fatty dots, streaks, plaques complicated.
• Risk factors Males, age, HPTN, smoking, DM,
  life style.
• High LDL, Fibrinogen, FVII low HDL.
• Major cause of ischemic organ damage death.
  Stroke, MI, Aneurysms, Gangrene

35
Coronary Angioplasty
36
Cholesterol Transport