1. Atherosclerosis
Please read Robbins p

2. Arteriosclerosis- 3 types
Atherosclerosis - intimal fibrous plaques with a central core rich in lipid
Monckeberg medial calcific sclerosis - calcifications in media
Arteriolosclerosis - thickening of media - hypertension and diabetes

4. Atheromatous Plaque 0.3 to 1.5cm, yellow May coalesce
Cells - smooth muscle & macrophages
Connective tissue extra cellular matrix
Intracellular and extracellular lipid deposits
Neovascularization

5. Typical atheroma

7. Pathogenesis Chronic endothelial injury Insudation of lipoproteins
Adhesion of blood monocytes
Adhesion of platelets
Release of factors from activated platelets
Proliferation of smooth muscle cells
Enhanced accumulation of lipids

8. 1)Chronic endothelial injury. 2)Insudation of lipoproteins
1)Chronic endothelial injury. 2)Insudation of lipoproteins. 3)Adhesion of blood monocytes
4) Adhesion of platelets. 5) Release of factors from activated platelets. 6)Proliferation of smooth
muscle cells. 7) Enhanced accumulation of lipids

10. Complicated lesion Calcification
Rupture or ulceration - discharge of debris - micro embolus
Hemorrhage
Thrombosis
Weakening of wall, aneurysmal dilation

11. 19 y/o man killed in a auto crash-- early fatty streaks--
oil red O stain

12. Lower- 30 y/o fatty streaks & early atheroma, Upper 50 y/o

13. Early complex lesions

14. Severe atherosclerosis in a 70 y/o man many ulcerated
complex plaques

15. Recent thrombus well developed plaque

16. Early intimal hyperplasia

17. Early intimal hyperplasia

18. Well developed plaque

19. Complicated plaque
lipid core
calcification

20. Severe occlusion, coronary art.
lumen

21. lumen
Cholesterol crystals calcification

23. Risk factors Non-modifiable Increasing age Male gender Family history
Genetic abnormalities

24. Potentially Controllable
Hyperlipidemia
Hypertension
Cigarette smoking
Diabetes

25. Lesser or Uncertain Obesity Physical inactivity Homocysteine
Postmenopausal estrogen deficiency
Alcohol
Lipoprotein (a)
Chlamydia pneumoniae

26. Other Factors Smooth muscle proliferation - oligoclonality Infection
Viruses - herpesvirus + CMV in plaque
Chlamydia pneumoniae