Atherosclerosis according to harshmohan text
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Atherosclerosis (as given in standard pathology text content equivalent to Harsh Mohan) can be summarized like this:
Definition
Atherosclerosis is an intimal lesion of large and medium arteries characterized by formation of an atheromatous plaque with:
- Fibrous cap
- Lipid-rich necrotic core (cholesterol, cholesterol esters, debris)
- Inflammatory cells, smooth muscle cells, extracellular matrix, and often calcification.
Book source used: Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 466-475
Important risk factors
Non-modifiable
- Increasing age
- Male sex
- Family history/genetic predisposition
Modifiable
- Hyperlipidemia (especially high LDL, low HDL)
- Hypertension
- Cigarette smoking
- Diabetes mellitus
- Inflammation-related/metabolic contributors
Book source: Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 467-468
Pathogenesis (response-to-injury hypothesis)
- Endothelial injury/dysfunction (from HTN, hyperlipidemia, smoking, turbulent flow, etc.)
- Increased permeability and LDL entry into intima
- Oxidation/modification of LDL
- Monocyte adhesion and migration, macrophage formation
- Foam cell formation (macrophages + SMC uptake lipid)
- Cytokine-mediated inflammation and smooth muscle migration/proliferation
- ECM deposition (collagen) forming fibrous cap
- Lipid necrotic core enlarges, calcification may occur
- Progression to stable or vulnerable plaque
Book source: Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 468-470
Morphology
- Fatty streak: early flat yellow lesion composed of foam cells
- Fibrofatty atheromatous plaque: raised intimal lesion with cap + necrotic core
- Complicated plaque: rupture/erosion, hemorrhage, thrombosis, calcification
Book source: Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 471-474
Clinical effects/complications
- Chronic stenosis causing ischemia (classically significant at ~70-75% cross-sectional narrowing in coronaries)
- Acute plaque rupture/erosion causing thrombosis and infarction (MI/stroke)
- Atheroembolism
- Aneurysm formation due to medial weakening
Major outcomes:
- Myocardial infarction
- Cerebral infarction (stroke)
- Aortic aneurysm
- Peripheral vascular disease
Book source: Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 472-475
If you want, I can also give this in exact exam format used in MBBS (definition, etiopathogenesis, morphology, complications) in 2-page answer style.
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