Atherosclerosis (attach PAD conference and see pathlogy)
Annotations:
structure of normal arterial wall:
-intima is closest to lumen and blood and has single layer of endothelial barrier cells
-media is middle andn thickest
-adventitia is outer
normal endothelial layer:
-mostly antithrombotic molecules
-secrete vasodilators (NO/prostacyclin) and vasoconstrictors (endothelin). normally vasodilators predominate.
-immune response
-impermeable to large molecules
-anti inflammatory
-resist leukocyte adhesion
normal smooth muscle cells
-normal contractility
-maintain ECM
-media
inflammation endothelial cells
-increased permeability
-inflammatory cytokines
-increased leukoocyte adhesion molecules
-decreased vasodilation
-decreased antithrombosis
inflammation smooth muscle cells
-increased inflammatory cytokines: IL 1 and TNF alpha
-increased ECM synthesis
-increased migration and proliferation into subintima
What do you look for on pathology?
-identify that it is a coronary artery
by seeing the thick three layers of the artery surrounded by fat with an occluded lumen
-in the lumen, look for narrowing of the white space because of the pink thrombi inside
-look for chronic inflammation (lymphocytes)
-look for white slivers of cholesterol crystals
-look for foam cells that are white engorged spaces with black stuff at the edges
-look for pale areas that are plaques with blue crystals
-look for fibrosis or RBCs that are hemorrhaging