Atherosclerosis and arteriosclerosis: Pathology review

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Atherosclerosis and arteriosclerosis: Pathology review

Cardiovascular system

Cardiac tumors

Cardiac tumors




Atherosclerosis and arteriosclerosis: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 75-year-old man is brought to the emergency department due to sudden-onset confusion and headaches accompanied by nausea and vomiting. The patient has a history of poorly controlled hypertension and hyperlipidemia due to noncompliance with medications. The patient has smoked a pack of cigarettes daily for 40 years. The patient’s temperature is 37.0°C (98.6°F), pulse is 100/min, and blood pressure is 205/140 mmHg. On physical examination, the patient is dyspneic. Fundoscopic examination reveals bilateral papilledema. Laboratory results are obtained and shown below:  
Laboratory value  Result 
 Creatinine   1.9 mg/dL 
 Blood urea nitrogen  50 mg/dL 
 Erythrocytes  8/hpf 
 Leukocytes  2/hpf 
 Protein  3+ 
 Sediment   None 
Which of the following histologic findings would likely be seen if this patient’s renal artery was biopsied?  


Mikhail is a 60 year old man with a history of hypertension, diabetes and dyslipidemia who presents to your clinic complaining of sudden-onset retrosternal chest pain associated with shortness of breath. He has a 35-pack-a-year smoking history, and he mentions that he also develops lower limb pain when walking for more than 15 minutes. His father underwent a below the knee amputation of his right lower extremity and died from a stroke. On physical examination, his BMI is 32. On further workup, his ECG and high troponin levels suggest a myocardial infarction. Mikhail goes to the cath lab to undergo per-cutaneous coronary intervention, which showed a clot occluding the left anterior descending coronary artery. After the procedure, his chest pain resolved. However, he started developing a web-like skin rash.

Mikhail suffers from arteriosclerosis, which is a hardening and thickening of the arterial wall, causing it to lose its elasticity. A specific type of arteriosclerosis is atherosclerosis, which is a chronic inflammatory disorder that affects the endothelium of medium and large arteries, and is characterized by the buildup of cholesterol plaques within the arterial lumen. In a descending order, the most common arteries affected by atherosclerosis are the abdominal aorta, coronary artery, popliteal artery and then the carotid artery.

Risk factors for atherosclerosis can be divided into modifiable and nonmodifiable risk factors. Modifiable risk factors include hypertension, diabetes mellitus, smoking and dyslipidemia, particularly an increase in LDL levels or a decrease in HDL levels. Non-modifiable risk factors include age, family history, and being of African-American descent.

The pathogenesis of atherosclerosis is essentially an inflammatory response to endothelial cell injury. The endothelium is injured by stress against the arterial wall, like in hypertension. This is especially more prominent at arterial bifurcations, such as the carotid artery bifurcation. Other causes of endothelial injury include tobacco smoking and homocysteinemia, which is elevated levels of the amino acid, homocysteine.


  1. "Rapid Review Pathology" Elsevier (2018)
  2. "Fundamentals of Pathology" H.A. Sattar (2017)
  3. "Atherosclerotic Vascular Disease Conference: Writing Group III: pathophysiology" Circulation. 2004 (2004)
  4. "Pathophysiology of Heart Disease" Wolters Kluwer Health (2015)
  5. "The pathogenesis of hyaline arteriolosclerosis" Am J Pathol (1986)

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