3: Atherosclerosis | Pathology USMLE Step 1

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Atherosclerosis | Pathology USMLE Step 1
Definition and Pathophysiology
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Atherosclerosis is a chronic inflammatory disease characterized by the accumulation of lipid-laden plaques within the walls of arteries, leading to progressive narrowing and hardening of the vessels. The process begins with endothelial injury, followed by the infiltration of lipids, inflammatory cells, and smooth muscle cells into the arterial intima. Over time, these components form a fibrous plaque, which may undergo calcification and eventually lead to arterial stenosis or occlusion.
Etiology
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Hyperlipidemia: Elevated levels of LDL cholesterol and decreased levels of HDL cholesterol contribute to lipid deposition within arterial walls.
Hypertension: High blood pressure accelerates endothelial injury and promotes plaque formation.
Smoking: Tobacco smoke damages endothelial cells and promotes inflammation and thrombosis.
Diabetes Mellitus: Hyperglycemia increases oxidative stress and endothelial dysfunction, exacerbating atherosclerosis.
Genetics: Familial hypercholesterolemia and other genetic disorders predispose individuals to accelerated plaque formation.
Clinical Manifestations
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Asymptomatic for many years until significant narrowing or occlusion occurs.
Angina: Chest pain or discomfort due to myocardial ischemia.
Myocardial Infarction: Complete occlusion of a coronary artery leads to myocardial necrosis.
Stroke: Embolization of atherosclerotic plaque material to cerebral vessels causes ischemic stroke.
Peripheral Artery Disease: Claudication, pain, or cramping in the legs during exercise due to impaired blood flow.
Diagnosis
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Lipid Profile: Elevated LDL cholesterol and triglycerides, decreased HDL cholesterol.
Imaging Studies: Coronary angiography, carotid ultrasound, or peripheral angiography to visualize arterial narrowing or occlusion.
Non-invasive Tests: Stress testing (e.g., treadmill exercise test, stress echocardiography) for assessing myocardial ischemia.
Biomarkers: Elevated cardiac enzymes (e.g., troponin) in cases of myocardial infarction.
Treatment
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Lifestyle Modifications: Diet low in saturated fats and cholesterol, regular exercise, smoking cessation, and weight management.
Medications: Statins, antiplatelet agents (e.g., aspirin), beta-blockers, ACE inhibitors, and calcium channel blockers to control risk factors and prevent complications.
Revascularization Procedures: Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for significant coronary artery disease.
Prognosis
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Atherosclerosis is a chronic progressive disease with significant morbidity and mortality.
Early detection and aggressive management of risk factors can slow disease progression and reduce cardiovascular events.
Long-term prognosis depends on the extent of atherosclerotic burden and the effectiveness of treatment interventions.
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[@duamalik9757]

His way of explaining is outstanding ❤

[@James-gh9qm]

Awsm content...wil share ur content 🫡

[@doctorbhanuprakash]

Thanks a ton

[@NunchosNachos-zo2yo]

Awesome sir

[@sarajakeerthi5335]

Sir then please explain what is a calcified plaque ??? ...does it cause decrease of diameter lumen....?

[@jasinthaanbarasu8686]

This is too good sir.tbank you. Please upload physiology

[@doctorbhanuprakash]

Already uploaded

[@Nurse_for_life]

Thank you so much sir your lecture are really helpful ..keep uploading more lecture
​@@doctorbhanuprakash