Definition:-
Atherosclerosis is a thickening and hardening of large and medium sized muscular arteries, primarily due to involvement of tunica intima and is characterised by fibrofatty plaques or atheromas.
Atherosclerosis is the commonest and the most important of the arterial diseases. Though any large and medium-sized artery may be involved in atherosclerosis, most commonly affected are the aorta, the coronaries and the cerebral arterial systems.
Clinical Features-:
Therefore, the major clinical syndromes resulting from ischaemia due to atherosclerosis are as under:
1. Heart Angina and myocardial infarcts or heart attacks.
2. Brain Transient cerebral ischaemia and cerebral infarcts or strokes.
3. Peripheral arteries Peripheral arterial disease.
4. Other sequelae Aneurysmal dilatation-: due to weakened arterial wall, chronic ischaemic heart disease, ischaemic encephalopathy and mesenteric arterial occlusion.
How hypertension cause Atherosclerosis ?
-: Hypertension is a risk factor for all clinical manifestations of atherosclerosis. Hypertension doubles the risk of all forms of cardiovascular disease. It acts probably by mechanical injury to the arterial wall due to increased blood pressure. Elevation of systolic pressure of over 160 mmHg or a diastolic pressure of over 95 mmHg is associated with five times higher risk of developing IHD than in people with blood pressure within normal range (120/80 mmHg or less). Patients on antihypertensive medication also have increased coronary risk than others.
How smoking cause Atherosclerosis?
-:SMOKING extent and severity of atherosclerosis are much greater in smokers than in non-smokers. Cigarette smoking is associated with higher risk of atherosclerotic Heart disease and sudden cardiac death. Men who smoke a pack of cigarettes a day are 3-5 times more likely to die of IHD than non-smokers. The increased risk and severity of atherosclerosis in smokers is due to reduced level of HDL, deranged coagulation system and accumulation of carbon monoxide in the blood that produces carboxyhaemoglobin and eventually hypoxia in the arterial wall favoring atherosclerosis.
How DIABETES MELLITUS cause Atherosclerosis??
-:DIABETES MELLITUS Clinical manifestations of atherosclerosis are far more common and develop at an early age in people with both type 1 and type 2 diabetes mellitus.
In particular, association of type 2 diabetes mellitus characterized by insulin resistance and abnormal lipid profile termed 'diabetic dyslipidaemia' (high LDL-C, low HDL-C, elevated triglycerides) is common and heightens the risk of cardiovascular disease. The risk of developing IHD is doubled, tendency to develop cerebrovascular disease is high, and frequency to develop gangrene of foot is about 100 times increased. The causes of increased severity of atherosclerosis are complex and numerous which include endothelial dysfunction, increased aggregation of platelets, increased LDL-C and decreased HDL-C. A combination of diabetic dyslipidaemia, hypertension, obesity and insulin resistance is termed 'metabolic syndrome "which poses still greater risk to IHD(Ischemic heart disease).
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Symptoms--:
i) Aorta—Aneurysm formation, thrombosis and embolisation to other organs.
ii) Heart—Myocardial infarction, ischaemic heart disease.
iii) Brain—Chronic ischaemic brain damage, cerebral infarction.
iv) Small intestine—Ischaemic bowel disease, infarction.
v) Lower extremities—Intermittent claudication, gangrene.
Clinical Effects --:
The clinical effects of atherosclerosis depend upon the size and type of arteries affected. In general, the clinical effects
result from the following:-
1. Slow luminal narrowing causing ischaemia and atrophy.
2. Sudden luminal occlusion causing infarction necrosis.
3. Propagation of plaque by formation of thrombi and emboli.
4. Formation of aneurysmal dilatation and eventual rupture.
Atherosclerosis Treatment-:
Once you have a blockage, it's generally there to stay. But with medication and lifestyle changes, you can slow or stop plaques. They may even shrink slightly with aggressive treatment.
Lifestyle changes: You can slow or stop atherosclerosis by taking care of the risk factors. That means a healthy diet, exercise, and no smoking. These changes won't remove blockages, but they’re proven to lower the risk of heart attacks and strokes.
Medication: Drugs for high cholesterol and high blood pressure will slow and may even halt atherosclerosis. They could also lower your risk of hearts attack.
Angiography and stenting: Your doctor puts a thin tube into an artery in your leg or arm to get to diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (using a catheter with a balloon tip) and stenting can often open a blocked artery. Stenting helps ease symptoms, but it does not prevent heart attacks.
Bypass surgery: Your doctor takes a healthy blood vessel, often from your leg or chest, and uses it to go around a blocked segment.
Endarterectomy: Your doctor goes into the arteries in your neck to remove plaque and restore blood flow.
Fibrinolytic therapy: A drug dissolves a blood clot that’s blocking your artery.
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