Introduction, Causes, symptoms, pathophysiology, diagnosis, treatment

1. Atherosclerosis
Archana.K

2. Atherosclerosis
Introduction:
 The word atherosclerosis is of Greek origin and literally means
focal accumulation of lipid and thickening of arterial intima
(sclerosis [hardening]).
 It is a condition where the arteries become narrowed and
hardened due to an excessive buildup of plaque around the
artery wall.
 Plaque is made up of fat, cholesterol, calcium, and other
substances found in the blood.
 The disease disrupts the flow of blood around the body, posing
serious cardiovascular complications.
 Atherosclerosis can lead to serious problems, including heart
attack, stroke, or even death.
 Atherosclerosis can affect any artery in the body including heart,
brain , legs, arms, pelvis and kidneys.
 Arteriosclerosis is the stiffening or hardening of the artery walls.
 Atherosclerosis is the narrowing of the artery because of plaque
build-up.

3. Causes:
 Can begin in teens, takes decades to cause the symptoms.
 During thirties, fifties, sixties some experience rapid progressing
atherosclerosis.
 Factors:
1. High blood pressure
2. High levels of cholesterol
3. Smoking
4. High levels of sugar in blood
5. High triglycerides- Normal level 400mg/dL-Excessive levels leads to disease.
6. Diabetes- High blood sugar levels
7. Genetics- Parents/siblings
8. Obesity- Excess weight—strain on heart-- risk for atherosclerosis
9. Lack of physical activity
10. Age
11. Sleep apnoea-disorder in which breathing stops or shallows while sleeping
12. Stress-Emotionally upset
13. Alcohol- weakens heart muscles

4. Pathophysiology of Atherosclerosis
1.Endothelial dysfunction:
 Endothelium is a very large organ whose work is to
prevent blood clotting at first.
 Later it is found that endothelium is responsible
for maintain arterial wall health which is very
sensitive to the substances in blood and blood
flow.
 Number of factors cause endothelial dysfunction
the most important being diet, tobacco and
inactivity.
 Modified LDL levels also leads to endothelial
dysfunction and accumulation of plaque.
 This condition is reversible if the factors are
removed.
 Causes of endothelial dysfunction are Modified
LDL, hypertension, diet, tobacco, diabetes,
genetic alterations, Infection by herpes virus.

5. 2. Injury
hypothesis:
Very low density lipoprotein (VLDL) is produced by the liver and is changed into LDL
by means of lipoprotein lipase
This process removes triglycerides from VLDL by hydrolysis, releasing fatty acids and
leaving greater numbers of cholesterol(LDL)
The LDL cross the endothelium and enters in to extracellular matrix where it gets
oxidised and causes inflammation
Oxidised LDL signals monocytes to fix inflammation at arterial wall.
As monocytes enter they transform to macrophages also called foam cells which has
more cholesterol. Macrophage are supposed to remove cholesterol with the use of
HDL. Excess cholesterol causes macrophages to enlarge and fill with lipids
Foam cells die and adds to the plaque

6. This process continues to more accumulation of lipids in the arterial wall
Lipid rich atheromatous lesion called fatty streaks
Smooth muscle cells move from innermost artery wall(tunica media) to
arterial wall (tunica intima)
Smooth muscle cells starts to proliferate by cytokines act of immunity-further
engulfed with lipids due to high cholesterol
Plaque has fibrous cap and sticks out in the artery, locks the blood flow.
3. Fatty
streak:

7. Symptoms
 The first signs of atherosclerosis can begin to develop during adolescence, with streaks of
white blood cells appearing on the artery wall.
 The symptoms of the disease depend on, which arteries are affected.
1. Carotid arteries:
 These arteries provide blood to the brain.
 When the blood supply is limited, patients can suffer stroke and may experience:
 Weakness
 Difficulty in breathing
 Headache
 Facial numbness
 Paralysis
Coronary arteries:
 These arteries provide blood to the heart, when the blood supply to the heart is limited, it
can cause angina (chest pain) and heart attack. Symptoms include:
 Vomiting
 Extreme anxiety
 Chest pain
 Coughing
 Feeling faint

8. Heart attack:
 If the plaque ruptures in coronary artery it creates blood clot and
blocks supply to heart leads to heart attack.
 Chest pain- pressure, pain and tightness at the center of the
chest.
 Pain in other parts of the body(left arm, leg, right arm, shoulder,
jaw, neck)
 Sense of anxiety, breathlessness, nausea, vomiting, wheezing.
Aneurysm:
 If atherosclerosis weakens the walls of blood vessels, it can lead
to the formation of an aneurysm (a bulge in a blood vessel).
 If it increases and ruptures leads to a severe problem like internal
bleeding and organ damage.
 An aneurysm can develop anywhere in the body
 Brain aneurysm : Which develops inside the brain, person
experience severe pain middle and side abdomen, In men it can
spread up to scrotum.
 Aortic aneurysm: Which develops inside the aorta (large blood
vessel that run from abdomen to heart), person experience
sudden severe headache.

9. Renal arteries:
 These supply blood to the kidneys
 If the blood supply becomes limited, there is a serious risk of developing chronic
renal failure.
 The patient may experience:
 Loss of appetite.
 Swelling of the hands and feet.
 Difficulty in concentrating
Peripheral arterial disease:
 The arteries to the limbs, usually the legs, are blocked.
 The most common symptom is leg pain, either in one or both legs, usually in the
calves, thighs or hips.
 Hair loss on legs or feet
 Male impotence (erectile dysfunction)
 Numbness in the legs
 The color of the skin on the legs change
 The toenails get thicker
 Weakness in the legs

10. Diagnosis
 A physical exam by means of a stethoscope and gentle probing of the arteries with the
hand (palpation).
 A weak or absent pulse below the narrowed area of artery.
 Whooshing sounds (bruits) over arteries
 Signs of a pulsating bulge (aneurysm) in abdomen or behind knee
 Blood tests: To detect increased levels of cholesterol and blood sugar
 Doppler ultrasound: measures blood pressure at various points to detect blockages.
 Ankle-brachial index: Atherosclerosis in arteries of legs and feet. Comparison of blood
pressure in ankle with arm by doctor.
 ECG: Electrocardiogram measures activity of heart.
 Stress test: Exercise stress test
 Angiogram: shows narrow and blocked arteries. Liquid dye injected into the arteries of
heart through a long, thin tube (catheter) that is fed through an artery, usually in leg,
to the arteries in heart.
 As the dye fills arteries, the arteries become visible on X-ray, revealing areas of
blockage.
 Ultrasound: measure blood pressure at different points in body. Useful for large
arteries.
 Computerized tomography scan: Takes a series of X-ray images and uses a computer to
assemble them into a more detailed three-dimensional image.
 detect narrowing or hardening in the larger arteries

11. Treatment
Life style changes:
 Weight management, healthy diet, physical activity.
 Limited intake of fats, sodium, alcohol.
Medication:
 To prevent the deposition of plaque ,using antiplatelet agents or Thrombolytic
agents.
 To lower cholesterol such as statins.
 To lower blood pressure such as Angiotensin-converting enzyme (ACE)
inhibitors, Diuretics (Water pills).
Surgery:
 Severe cases of atherosclerosis may be treated by surgical procedures, such
as angioplasty or coronary artery bypass grafting (CABG).
Angioplasty:
 Angioplasty is a procedure in which a tiny device is inserted into narrowed
blood vessels that supply blood to the heart.
 This device widens the arteries and increases blood flow

12. Balloon Angioplasty:
 percutaneous transluminal coronary angioplasty
(PTCA)
 uses a small, thin tube (called a catheter) with a tiny
balloon at its tip.
 cardiologist guides the tube into the heart, where it is
inserted into a narrowed coronary artery
 The tiny balloon is then inflated to widen the
narrowed area.
 cardiologists also insert a metal wire frame that
serves as a scaffolding to help keep the artery open.
 This device is called a stent.
 There are two types of stents:
 Bare metal stents
 Drug coated stents

13. Endarterectomy:
 Fatty deposits must be
surgically removed from
the walls of a narrowed
artery
 When this procedure is
done on neck it is called
carotid endarterectomy.
Bypass surgery:
 A graft bypass may be
created using a vessel
from another part of body
or a tube made of
synthetic fabric.
 This allows blood to flow
around the blocked or
narrowed artery.

15. Thank you