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Pathology- Arteriosclerosis

Arteriosclerosis can be defined as a group of diseases that result in arterial wall thickening.

1. Monckeberg medial calcific sclerosis:
  • Medial calcification of medium sized arteries
  • Femoral, tibial, radial and ulnar arteries are affected mostly.
  • It is mostly asymptomatic and can be detected by X ray
2. Arteriosclerosis:
  • Occurs in diabetes, hypertension and aging
  • Affects small arteries and arterioles
  • Microscopic appearance-
  • Hyaline arteriosclerosis- pink, glossy arterial wall thickening with luminal narrowing is noted. Hyperplastic arteriosclerosis- Smooth muscle proliferation resulting in concentric (onion skin) wall thickening and luminal narrowing.
3. Atherosclerosis:
  • Def: Lipid deposition and intimal thickening of large and medium sized arteries, resulting in fatty streaks and atheromatous plaques.
  • Aorta, coronary arteries, carotid, cerebral, iliac and popliteal arteries
  • Fatty streak- flat, yellow intimal streak. Microscopically, lipid laden macrophages can be seen (also called foam cells).
  • Atheromatous plaque- Raised, yellow-white plaques, Microscopically-Fibrous cap is seen which contains smooth muscles, lymphocytes and foam cells. Necrotic core contains cholesterol clefts, foam cells and necrotic debris.

Major Risk Factors

Minor Risk Factors

Hyperlipidemia

Male gender

Hypertension

Obesity

Smoking

Sedentary life style

Diabetes

Stress (Type A personality)


Elevated homocysteine


Oral Contraceptives


Increasing age


Genetic factors


Clinical complications:
  1. Ischemic heart disease
  2. Cerebrovascular accidents
  3. Atheroemboli (Transient ischemic attacks and renals infarcts)
  4. peripheral vascular disease
  5. Aneurysm formation
  6. Mesenteric artery occlusion

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