FSM template

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Think positively and masterfully, with
confidence and faith, and life becomes more
secure, more fraught with action, richer in
achievement and experience fun!
Eddie Rickenbacker 1890-1973,
Decorated Aviator and Businessman
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Pathology of Atherosclerosis
Dr. Venkatesh M. Shashidhar Senior Lecturer in
Pathology Fiji School of Medicine
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Introduction

• Modern life style disease
• Major cause of IHD, MI, Stroke Aortic disease
  - Major cause of
• Incidence is decreasing since 1995 - West
• Better understanding Change in life style.

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Definition

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

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Risk Factors

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

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

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(No Transcript)
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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.

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Development of Coronary Atherosclerosis
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Structure of Atheroma
Fibrous Cap Necrotic center Cholesterol
Cry. Macrophages
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Morphologic 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.

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Morphologic types
Fatty dots F.Atheroma Plaques Complicated
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Stages of Atheroma - Aorta
Stage VI III II
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Coronary Atherosclerosis
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Atheroma Aorta
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Atheroma Coronary Artery
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Atheroma Coronary Artery
Calcification
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Atheroma with Thrombosis
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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.

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Common Sites

• Aorta, Carotid Iliac. (large vessels)
• Major Vessels - Heart, Brain Kidney.
• Coronary
• Renal
• Limbs

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Coronary Atheorsclerosis
LCx LAD

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

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Coronary Thrombosis With Infarction
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Coronary Narrowing in Atherosclerosis
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AG41 Atherosclerosis Aorta, Ruptured aneurism.
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Aorta Dissecting Aneurisms AG-9
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Thrombo-embolism
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Lipoprotiens - LDL HDL

• Good and Bad Fats?
• Low LDL, High HDL
• Mono/Poly unsaturated
• Omega-3 fatty acids (Fish)
• LDL ?Positive balance
• HDL ?Negative.
• No Chol. in vegetable oil
• Saturated fats form chol in vivo.

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Summary

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

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