Atherosclerosis complete Topics

1. Atherosclerosis
Dr. Sami

3.  Arteriosclerosis is a general term describing any hardening (and loss of
elasticity) of medium or large arteries
 arteriolosclerosis is any hardening (and loss of elasticity) of arterioles (small
arteries);
 atherosclerosis is a hardening of an artery specifically due to an atheromatous
plaque
 The term atherogenic is used for substances or processes that cause
formation of atheroma.

4. Introduction.
 Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of
the artery develops abnormalities, called lesions.
 These lesions may lead to narrowing due to the buildup of atheromatous
plaque.
 Initially, there are generally no symptoms.
 When severe, it can result in coronary artery disease, stroke, peripheral
artery disease, or kidney problems, depending on which arteries are
affected
 Plaque is made up of fat, cholesterol, calcium, and other substances found in
the blood. The narrowing of arteries limits the flow of oxygen-rich blood to
parts of the body.

5. Stages of Atherosclerosis:
 Endothelial cell injury.
 This is likely the initial factor that begins the process of atherosclerotic
plaque formation. Because the endothelium is constantly exposed to the
circulation, any toxin present can result in damage, as occurs during
tobacco use, diabetes and dyslipidemia.

6.  Lipoprotein deposition.
 When the endothelium is injured or disrupted, lipoprotein molecules can gain
entry .This modified lipoprotein, or LDL, is inflammatory and causing a “fatty
streak” in the arterial wall.
 Inflammatory reaction.
 The modified LDL is antigenic (binding to an antibody ) and attracts
inflammatory cells into the arterial wall.
 Also, after endothelial injury, inflammatory mediators are released further,
increasing leukocyte recruitment.

7.  Smooth muscle cell cap formation.
 Smooth muscle cells migrate to the surface of the plaque, creating a
“fibrous cap.”
 When this cap is thick, the plaque is stable;
 however, thin capped atherosclerotic plaques are thought to be more prone
to rupture or erosion, causing thrombosis.

9. Signs and Symptoms:
 Atherosclerosis is asymptomatic for decades because the arteries enlarge at
all plaque locations, thus there is no effect on blood flow.
 Even most plaque ruptures do not produce symptoms until enough narrowing
or closure of an artery, due to clots, occurs.
 Signs and symptoms only occur after severe narrowing or closure impedes
blood flow to different organs enough to induce symptoms.
 Most of the time, patients realize that they have the disease only when they
experience other cardiovascular disorders such as stroke or heart attack.
 These symptoms, however, still vary depending on which artery or organ is
affected

10.  chest pain or angina
 pain in your leg, arm, and anywhere else that has a blocked artery
 shortness of breath
 fatigue
 confusion, which occurs if the blockage affects circulation to your brain
 muscle weakness in your legs from lack of circulation

11. Risk Factors:
 The atherosclerotic process is not well understood.
 Atherosclerosis is associated with inflammatory processes in the endothelial
cells of the vessel wall associated with retained low-density lipoprotein (LDL)
particles.
 This retention may be a cause, an effect, or both, of the underlying
inflammatory process.

12.  Modifiable
 Bacterial infections
 Diabetes
 Dyslipidemia
 Tobacco smoking
 Trans fat
 Abdominal obesity
 Fatty diet
 Hypertension
 HIV/AIDS
 Nonmodifiable
 Advanced age
 Genetic abnormalities
 Family history

13. Complications:
 Coronary artery disease.
 When atherosclerosis narrows the arteries close to your heart, you may
develop coronary artery disease, which can cause chest pain (angina), a heart
attack or heart failure.
 Carotid artery disease.
 When atherosclerosis narrows the arteries close to your brain, you may
develop carotid artery disease, which can cause a transient ischemic attack
(TIA) or stroke

14.  Peripheral artery disease.
 When atherosclerosis narrows the arteries in your arms or legs, you may
develop circulation problems in your arms and legs called peripheral artery
disease. T
 his can make you less sensitive to heat and cold, increasing your risk of burns
or frostbite. In rare cases, poor circulation in your arms or legs can cause
tissue death (gangrene).

15.  Aneurysms
 excessive localized swelling of the wall of an artery.
 Atherosclerosis can also cause aneurysms, a serious complication that can
occur anywhere in your body. An aneurysm is a bulge in the wall of your
artery.
 Most people with aneurysms have no symptoms. Pain and throbbing in the
area of an aneurysm may occur and is a medical emergency.
 If an aneurysm bursts, you may face life-threatening internal bleeding.
 If a blood clot within an aneurysm dislodges, it may block an artery at some
distant point.

16.  Chronic kidney disease.
 Atherosclerosis can cause the arteries leading to your kidneys to narrow,
preventing oxygenated blood from reaching them.
 Over time, this can affect your kidney function, keeping waste from exiting
your body.

17. Diagnose:
 A cardiologist may listen to your heart to see if you have any abnormal
sounds. They’ll be listening for a whooshing noise, which indicates that an
artery is blocked.
 weakened pulse
 slow wound healing, which indicates a restricted blood flow

18. Tests can include:
 a blood test to check your cholesterol levels
 a Doppler ultrasound, which uses sound waves to create a picture of the
artery that shows if there’s a blockage
 an ankle-brachial index (ABI), which looks for a blockage in your arms or legs
by comparing the blood pressure in each limb
 a magnetic resonance angiography (MRA) or a computed tomography
angiography (CTA) to create pictures of the large arteries in your body

19.  a cardiac angiogram, which is a type of chest X-ray that’s taken after your
heart arteries are injected with radioactive dye
 an electrocardiogram (ECG or EKG), which measures the electrical activity in
your heart to look for any areas of decreased blood flow
 a stress test, or exercise tolerance test, which monitors your heart rate and
blood pressure while you exercise on a treadmill or stationary bicycle

20. Prevention:
 Lifestyle changes can help to prevent as well as treat atherosclerosis,
especially for people with type 2 diabetes.
 Helpful lifestyle changes include:
 eating a healthy diet that’s low in saturated fat and cholesterol
 avoiding fatty foods
 getting at least 75 minutes of vigorous exercise or 150 minutes of moderate
exercise each week
 quitting smoking if you’re a smoker
 losing weight if you’re overweight or obese
 managing stress
 treating conditions associated with atherosclerosis, such as hypertension, high
cholesterol, and diabetes

21. Treatment:
 Lifestyle changes
 You can change some risk factors for atherosclerosis such as smoking, high
cholesterol levels, high blood sugar (glucose) levels, lack of exercise, poor
dietary habits, and high blood pressure.

22.  Medicines
 Medicines that may be used to treat atherosclerosis include:
 Antiplatelet medicines.
 These are medicines used to decrease the ability of platelets in the blood to
stick together and cause clots. Aspirin, clopidogrel, ticlopidine, and
dipyridamole are examples of antiplatelet medicines.
 Anticoagulants.
 Also called blood thinners, these medicines work differently from
antiplatelet medicines to decrease the ability of the blood to clot. Warfarin
and heparin are examples of anticoagulants.

23.  Cholesterol-lowering medicines.
 These are medicines used to lower fats (lipids) in the blood, particularly low
density lipid (LDL) cholesterol. Statins are a group of cholesterol-lowering
medicines. They include simvastatin, atorvastatin, and pravastatin among
others.
 Blood pressure medicines.
 Several different groups of medicines act in different ways to lower blood
pressure

24.  Coronary angioplasty:
 With this procedure, a long thin tube (catheter) is thread through a blood
vessel to the heart.
 There, a balloon is inflated to create a bigger opening in the vessel to
increase blood flow. Although angioplasty is done in other blood vessels
elsewhere in the body, percutaneous coronary intervention (PCI) refers to
angioplasty in the coronary arteries to permit more blood flow into the heart.
There are several types of PCI procedures, including:

26.  Balloon angioplasty. A small balloon is inflated inside the blocked artery to
open the blocked area

28.  therectomy. The blocked area inside the artery is shaved away by a tiny
device on the end of a catheter.

30.  Laser angioplasty. A laser used to vaporize the blockage in the artery.

32.  Coronary artery stent. A tiny mesh coil is expanded inside the blocked artery
to open the blocked area and is left in place to keep the artery open

34.  Coronary artery bypass
 Most commonly referred to as bypass surgery, this surgery is often done in
people who have angina (chest pain) due to coronary artery disease (where
plaque has built up in the arteries). During the surgery, a bypass is created by
grafting a piece of a healthy vein from elsewhere in the body and attaching it
above and below the blocked area of a coronary artery. This lets blood flow
around the blockage. Veins are usually taken from the leg or from the chest
wall. Sometimes more than one artery needs to be bypassed during the same
surgery.