Atherosclerosis

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.
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
 Pathophysiology of Atherosclerosis
[Link] 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.
2. Injury Very low density lipoprotein (VLDL) is produced by the liver and is changed
hypothesis: 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

 This process continues to more accumulation of lipids in the arterial
wall

3. Fatty
streak:
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.
 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
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.
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
 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
 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
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
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.
Thank you