Atherosclerosis: Definition, Etiology, Pathogenesis, Clinical effect And MCQs for NEET, GPAT, CSIR NET JRF

” Atherosclerosis is a disease primarily of the elastic arteries (eg. aorta, caratoid and ilaic arteries) and large and medium sized muscular arteries (eg. coronary and popliteal arteries).”

INTRODUCTION :-

1.] Atherosclerosis is a thickening and hardening of large and medium sized muscular arteries, primarily due to involvement of tunica intima and is characterized by fibro fatty plaques or atheromas.

2.] Atherosclerosis is the commonest and the most important of the arterial disease.

ETIOLOGY :-

1.] Atherosclerosis is widely prevalent in industrialized countries.

2.] Major risk factors in atherosclerosis are :

• Major risk factors modified by lifestyle and / or therapy : This includes major risk factors which can be controlled by modifying lifestyle or by pharmacotherapy and includes dyslipidaemia, hypertension, diabetes mellitus and smoking.
• Constitutional risk factor : These are non – modifiable major risk factor that include increasing age, male sex, genetic abnormalities and familial and racial predisposition.

3.] Non – traditional emerging risk factor include a hosts of factor whose role is atherosclerosis is minimal and in some cases it is even uncertain. This risk factor include environmental influences, obesity, hormones, physical inactivity, stressful life etc.

PATHOGENESIS :-

1.] Atherosclerosis is not caused by a single etiologic factor but is a multi functional process whose exact pathogenesis is still unknown.

2.] Since the time of virchow , a number is theories have been proposed as :

• Insudation hypothesis.
• Encrustation hypothesis.

Though, there is no consensus regarding the origin and progression of lesion of atherosclerosis the role of four key factors – arterial smooth muscle cell, endothelial cell, blood monocyte and dyslipidaemia, is accepted by all.

3.] Currently the pathogenesis of atherosclerosis is explained on the basis of the following two theories :

• Reaction – to – injury hypothesis, first described in 1973, and modified in 1986 and 1933 by Ross.
• Monoclonal theory, based on neoplastic proliferation of smooth cells, postulated by Beneditt in 1973.

Above image is taken from Below article:

Nonlinear dynamics of early atherosclerotic plaque formation may determine the efficacy of high density lipoproteins (HDL) in plaque regression

Alexander D. ChalmersChristina A. BursillMary R. Myerscough

CLINICAL FACTOR :-

Major clinical factor of atherosclerosis are in the heart (coronary artery disease), brain (stroke), aorta (aneurysmal dilation), intestine (ischemia) and lower extremities (gangrene).

MULTIPLE CHOICE QUESTIONS :-

1.] Most common site of artery of atherosclerosis ?

a. Right coronary artery

b. Left anterior descending coronary artery

c. Left circumflex artery

d. Diagonal branch of LAD

2.] Most common site of atherosclerosis aneurysm is ?

a. Coronary artery

b. Renal artery

c. Arch of aorta

d. Abdominal aorta

3.] In atherosclerosis, increased LAD in monocyte macrophages is due to ?

a. LDL receptors on macrophages

b. LDL receptor on endothelium

c. Lipids in LDL get auto – oxidized

d. All of the above

4.] Which of the following is the meat common site of atherosclerosis lesions ?

a. Aortic bifurcation

b. Pulmonary arterial trunk

c. Common carotid artery

d. Muddle cerebral artery

5.] Most common cause of abdominal aortic aneurysm is ?

a. Atherosclerosis

b. Syphilis

c. Trauma

d. Congenital

6.] Atheromatous changes of blood vessel affect early in ?

a. Kidney

b. Heart

c. Liver

d. Spleen

7.] Atherosclerosis is seen in which bacteria ?

a. Staph anreus

b. Streptococcus pneumonia

c. Chlamydia pneumoniae

d. Chlamydia trachomatis

8.] Most common cause of aortic aneurysm is ?

a. Syphilis

b. Marfan’s syndrome

c. Atherosclerosis

d. Cogenital

9.] All of the following statements regarding the atherosclerosis are true except ?

a. Omega – 3 fatty acid decrease LDL

b. Atherosclerosis is less important in age more than 45 yrs. age

c. Cigarette smoking is independent risk factor for M.I.

d. C reactive protein is independent risk factor for M.I.

10.] 70 – yrs. old man has abdominal pain with mass in abdomen. Angiography reveals aneurysm of aorta. Most likely cause is ?

a. Trauma

b. Atherosclerosis

c. Syphilis

d. Cogenital

SOLUTION :-

1.] (b) Left anterior descending coronary artery

2.] (d) Abdominal aorta

3.] (c) Lipids in LDL get auto – oxidized

4.] (b) Pulmonary arterial trunk

5.] (a) Atherosclerosis

6.] (b) Heart

7.] (c) Chlamydia pneumoniae

8.] (c) Atherosclerosis

9.] (b) Atherosclerosis is less important in age more than 45 yrs. age

10.] (b) Atherosclerosis

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 373 – 380.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 473 – 484.