CARDIOLOGY TO IMPRESS - The Ultimate Guide for Students and Junior Doctors©
Imperial College Press
Five steps to understanding the pathogenesisof atherosclerosis:1.Damage to the arterial endothelium
— caused by repeatedinjury to the endothelial cells. This makes the endothelium morepermeable to lipids and low density lipoprotein (LDL) allowingthem to migrate into the tunica intima.
2.Formation of a fatty streak
— macrophages are also ‘attracted’ tothe injured endothelium and migrate into the intima. They then takeup the oxidised LDL to form foam cells. The foam cells together with activated platelets trigger the movement of smooth muscle cellsfrom the tunica media into the intima.
— the build up of smooth muscle cells, foam cellsand free lipids creates the lipid plaque.
— as the plaque grows, the smooth muscle cellsare replaced by collagen. The collagen layer forms a fibrous plaque.
— when the plaque fissures, this results infurther platelet aggregation and the formation of a thrombus,causing further narrowing of the luminal diameter of the vessel.
Layers of the endothelium
Let’s begin by examining a ‘normal’ blood vessel — composed of endothelial cells. The endothelium has three layers: tunica intima,tunica media, and tunica adventia.