Atherosclerosis

General Information

Classification: Cardiovascular

What is it?

Figure 1 Development of fatty, atherosclerotic plaque within blood vessels.

Inflammation derived from lipid deposits (principally low-density lipoproteins/LDLs) in tunica media of blood vessels, which lead to plaque formation

Extremely high incidence within older individuals, and is considered the major cause of other cardiovascular diseases/CVD (which is the leading cause of death)


Risk Factors: hypercholesterolemia, older age, male, obesity, sedentary lifestyle, hypertension (HT), genetic predisposition, diabetes mellitus/Type 1

Signs and symptoms across the body:

  • In heart: causes chest pain/angina
  • In brain: weakness in limbs, drooping muscles, transient ischemic attack/TIA
  • In extremities: peripheral artery disease/PAD
  • In kidneys: increased blood pressure/BP, renal failure

Arteriosclerosis vs Atherosclerosis

Arteriosclerosis: hardening and/or calcification of arteries

Atherosclerosis: subtype of arteriosclerosis, where the closing of arteries is due to fatty plaque formation

Evaluation: catheterization, angiogram, CT


Pathophysiology:

  1. Fatty streak deposition in tunica intima
    • LDLs are trapped by proteoglycans and modified, disrupting the endothelial barrier
  2. Fibrous cap formation (migration of smooth muscle cells) mediated by IGF, angiotensin II as plaque continues to grow
  3. Plaque rupture occurs when fibrous cap weakens
    • The thrombus (blood clot) can be released and lead to complications depending on location of the artery

Treatment

Protective treatment/lifestyle changes: increased aerobic exercise, diet of low red meats and trans fats, diminish smoking frequency

To control BP: ACE inhibitors, Angiotensin II blockers (ARBs)

To lower cholesterol levels: statins

Aspirin for pain

Surgical procedures (revascularization)

  • Balloon coronary angioplasty or percutaneous coronary intervention (PCI):
    • Insert catheter (thin tube) into accessible vessel up to the coronary artery → balloon is inflated to increase blood flow and push plaque away → can insert stent to keep the artery open after balloon is removed
  • Coronary artery bypass: graft a healthy vein to the area of the blockage, bypassing the plaque/occluded area

Complications

In heart

  • Ischemic heart disease or coronary artery disease/CAD
  • Arrythmias

In extremities:

  • Peripheral artery disease/PAD
  • Deep vein thrombosis in lower extremities

Others: muscle pain or other paresthesias, stroke

Comments!

2 responses to “Atherosclerosis”

  1. Peripheral Arterial Disease (PAD) – Amytomically Avatar
    Peripheral Arterial Disease (PAD) – Amytomically

    […] formation (for pathophysiology, see Atherosclerosis) most commonly in abdominal aorta, iliac, femoropopliteal, and tibiofibular […]

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  2. Abdominal Aortic Aneurysm (AAA) – Amytomically Avatar
    Abdominal Aortic Aneurysm (AAA) – Amytomically

    […] Factors: atherosclerosis*, white male, smoking, older age (>60), high BP/cholesterol/obesity, history of aortic […]

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