2. Atherosclerosis
◦ Atherosclerosis is a disease that happens when plaque builds up on the inside walls of your
arteries.
◦ Arteries are blood vessels that deliver blood and oxygen from the heart to the rest of the body.
◦ Plaque is a sticky substance made of fat, cholesterol, calcium, and other substances. As plaque
builds up, your arteries become hard and narrow.
Difference between atherosclerosis and arteriosclerosis
o Atherosclerosis is a type of arteriosclerosis, which is any hardening of the arteries.
o Arteries can become hard or stiff for many different reasons.
o One reason is plaque buildup.
o That’s what atherosclerosis refers to.
o But the two terms are often used to mean the same thing.
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3. Consequences of Atherosclerosis
◦ Hardening of arteries can cause several problems.
◦ Narrow or blocked arteries can’t deliver enough blood, oxygen, and nutrients to the rest of the body.
◦ Blockages can eventually lead to tissue death or infection in your arms, legs, or other body parts.
◦ A piece of plaque can break free and get stuck somewhere in the body, causing damage.
◦ Also, a blood clot can form in a narrow artery. It can eventually loosen and travel through the artery.
◦ Atherosclerosis can lead to serious health problems and medical emergencies, including:
Blood clots
Carotid artery disease
Chronic kidney disease
Coronary artery disease
Heart attack
Peripheral artery disease
Stroke
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4. Stages of Atherosclerosis
◦ Stage 1: Endothelial damage and immune response
◦ Atherosclerosis begins when damage occurs to the inner layer of the artery wall. This layer is called the
intima.
◦ The surface of the intima is lined with endothelial cells. This thin lining, called the endothelium, is the barrier
between blood and the artery wall.
◦ Many things can harm your endothelium. The most common culprits include:
High levels of LDL (“bad”) cholesterol circulating in your blood.
Toxins, like those from cigarette smoke.
High blood pressure that persists for a long time.
◦ Once the endothelium is damaged, several things happen:
1.Cholesterol from the blood starts gathering at the site of injury.
2.These cholesterols become oxidized (a chemical process) and trigger an immune response.
3.This immune response causes many white blood cells (monocytes) to travel to the area. They gather and lead
to inflammation within the artery.
5. Stage 2: Fatty streak
◦ A “fatty streak” is the first visible sign of atherosclerosis.
◦ It’s a yellow streak or patch formed from dead cells at the site of endothelial damage.
◦ Here’s how it forms:
1.The monocytes that move to the artery turn into cells called macrophages. Macrophages
surround and consume the cholesterol.
2.As the macrophages fill up with cholesterol, they appear foamy and are called “foam cells.”
3.After the foam cells consume cholesterol, they die.
4.As the foam cells die, the body sends more and more white blood cells to the area. Those cells
continue consuming cholesterol, get foamy and die. As this process continues, it damages the
endothelium more.
◦ All the dead foam cells form a bulge underneath the endothelium.
◦ This “fatty streak” is the beginning of plaque formation.
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6. Stage 3: Plaque growth
◦ More dead foam cells and other debris continue building up at the site of the fatty streak.
◦ The fatty streak slowly gets bigger and forms a larger piece of plaque.
◦ The artery’s smooth muscle cells form a layer on top of this plaque called a fibrous cap.
◦ The fibrous cap covers the plaque.
◦ It prevents bits of plaque from breaking off into the bloodstream.
◦ Meanwhile, the plaque keeps growing. It gains calcium, which makes it harder.
◦ For a while, the blood still has enough room to pass through.
◦ That’s because the artery wall expands outward to make space for the plaque. But it can only expand
outward so far.
◦ As the plaque gets too big, the opening of the artery becomes narrower and narrower. There’s less room
for the blood to flow through.
◦ The plaque may stay stable for a long time. But eventually, it can rupture.
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7. Stage 4: Plaque rupture
◦ In this final stage, the plaque ruptures and causes major problems in the body.
◦ At this point, the plaque has been in the artery for a long time — perhaps many years.
◦ It has grown in size and taken up more space in the artery.
◦ But the fibrous cap has kept the plaque from breaking open until this point.
◦ When the fibrous cap breaks open, the plaque inside comes into contact with the blood.
◦ This can trigger a blood clot to form.
◦ This blood clot (known as a “thrombus”) blocks the blood flow and leads to a heart attack or stroke.
◦ Researchers are still learning how these ruptures happen and who’s at risk.
◦ A thin fibrous cap may be more likely to rupture than a thicker one.
◦ The size of the plaque itself may not matter as much.
◦ In some cases, smaller plaque bulges lead to a heart attack.
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9. Risk factors for atherosclerosis
• Hyperlipidemia (high cholesterol).
• Hypertension (high blood pressure).
• Hyperglycemia (high blood sugar).
• Immune response and inflammation.
• Smoking is a major cause.
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10. Symptoms of atherosclerosis
◦ Some early warning signs include:
Chest pain (angina) while exercising. This pain stops when you rest.
Leg cramps when walking (intermittent claudication).
Transient ischemic attack (TIA). This " mini-stroke " has the same symptoms as a stroke. But it goes away within a day and doesn’t
damage the brain. If you have a TIA, you’re at risk of having a stroke within days or weeks.
◦ If you have a blood clot or sudden blockage, you may have a heart attack or stroke.
◦ Symptoms of a heart attack include:
Chest pain. It may be mild discomfort or severe, crushing pain.
Pain in one or both arms or shoulders.
Discomfort in your neck or jaw.
Nausea or vomiting.
Heart palpitations.
Anxiety or a feeling of “impending doom.”
Sweating.
Dizziness or fainting. 2/16/2023
11. Contd….
◦ The blood clot or blockage can also lead to a stroke.
◦ Symptoms of a stroke include:
• Sudden numbness or weakness in your face, arms, or legs, especially on one side of the body.
• Sudden trouble speaking or understanding others.
• Slurred or confused speech.
• Trouble seeing in one or both eyes.
• Severe dizziness or loss of balance.
• Trouble walking.
• Sudden and severe headache.
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12. Diagnosis and tests
• Family medical history.
• Personal medical history.
• Physical exam, listening with a stethoscope for weak or absent pulse or an abnormal sound in the
arteries, is called bruit.
• Blood tests can measure the amount of fat, cholesterol, sugar, and protein in the blood.
◦ Angiography- This test uses special X-rays to locate and measure blockages. The healthcare
provider will inject a contrast dye into the arteries to help the blockages show up on the X-rays. The
healthcare provider will insert a catheter (thin tube) into one of the arteries, usually in the groin or arm.
◦ Ankle/brachial index- This test compares the blood pressure in the ankle to the pressure in the arm
to measure blood flow in the limbs.
◦ Chest X-ray- A chest X-ray takes pictures inside the chest.
◦ CT scan- This scan takes pictures inside of the body and can show any hardening and narrowing of
the large arteries.
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13. Contd….
• Echocardiogram (echo)- An echo takes pictures of the heart’s valves and chambers and
measures how well the heart is pumping.
• Electrocardiogram (EKG)- An EKG measures the heart’s electrical activity, rate, and rhythm.
• Exercise stress test- This test measures heart function while physically active.
• Carotid ultrasound- This test takes ultrasound pictures of the arteries in the neck (carotid
arteries). It can detect the hardening or narrowing of these arteries as blood flows to the brain.
• Abdominal ultrasound- This ultrasound takes pictures of the abdominal aorta. It checks for
ballooning (abdominal aortic aneurysm) or plaque buildup in your aorta.
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14. Treatment for atherosclerosis
◦ Treatment for atherosclerosis may involve lifestyle changes, medications and surgical procedures.
◦ Common treatment goals include:
• Lowering the risk of blood clots.
• Opt for healthier food choices.
• Preventing complications like heart attack or stroke.
• Slowing or stopping plaque buildup in the arteries.
• Helping the blood flow better by widening the arteries or bypassing blockages.
◦ Prescribe medications to:
• Manage the blood pressure.
• Lower the cholesterol.
• Manage the blood glucose levels.
• Prevent blood clots.
◦ Surgical procedures, such as:
• Coronary angioplasty
• Coronary artery bypass surgery
• Carotid endarterectomy 2/16/2023
15. Risk factors for atherosclerosis
◦ Non-modifiable risk factors include:
• Family history of premature cardiovascular disease.
• Older age (age 45 for men and people designated male at birth [DMAB]; age 55 for women and people designated female at birth
[DFAB]).
◦ Some medical conditions raise the risk for atherosclerosis, including:
• Diabetes mellitus. Diabetes makes a person 2 to 6 times more likely to develop atherosclerosis. This condition puts younger
women (pre-menopausal) at risk.
• High blood pressure (hypertension). High blood pressure that persists for a long time can damage the artery wall. If the blood
pressure is higher than 110/75 mm Hg, you face a greater risk. And that risk goes up the more the blood pressure goes up.
• High cholesterol. High levels of LDL, or “bad cholesterol,” can be especially dangerous.
• Obesity. Obesity raises the blood pressure, blood sugar and cholesterol levels. It also causes inflammation throughout the body.
◦ Lifestyle factors also play a role. These factors include:
• Smoking.
• Lack of physical activity.
• A diet high in saturated fat, and trans fat, cholesterol, sodium (salt) and sugar.
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16. Prevention of atherosclerosis
• Eat a healthy diet low in saturated and trans fats, cholesterol, sodium (salt) and sugar.
• Exercise regularly. Start with short walks and build up to 30 minutes a day most days of the
week.
• Keep a healthy weight.
• Manage any health conditions, especially diabetes, high blood pressure and high cholesterol.
• Quit smoking.
• Have an annual checkup with the primary care provider.
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