Atherosclerosis Overview

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What Is Atherosclerosis?

Atherosclerosis — hardening and narrowing of the arteries — silently and slowly blocks arteries, putting blood flow at risk.

It’s the usual cause of heart attacks, strokes, and peripheral vascular disease — what together are called cardiovascular disease.

How does atherosclerosisdevelop? Who gets it, and why? This deadly process is preventable and treatable. Arteries carry blood from the heart to the rest of the body. They are lined by a thin layer of cells that keeps them smooth and allows blood to flow easily; this is called the endothelium.

Atherosclerosis starts when the endothelium becomes damaged, allowing low-density lipoproteins (LDL – bad) cholesterol to accumulate in the artery wall.

The body sends macrophages – a type of white blood cell – to clean up this cholesterol, but, sometimes, the cells get stuck at the affected site. Over time, a plaque can build up, made of cholesterol, macrophages, calcium, and other substances from the blood.

Sometimes, the plaque grows to a certain size and stops growing, causing the individual no problems. However, sometimes, the plaque clogs up the artery, disrupting the flow of blood around the body. This makes blood clots more likely, which can result in life-threatening conditions.

In some cases, the plaque eventually, breaks open. If this happens, blood cell fragments, called thrombocytes (or platelets), accumulate in the affected area. These fragments may then stick together, forming blood clots. In the brain this can cause strokes, in the heart it can cause a heart attack.

The condition can affect the entire artery tree, but mainly affects the larger high-pressure arteries.

Causes

First, an Anatomy 101 review: Arteries are blood vessels that carry bloodfrom the heart throughout the body. They’re lined by a thin layer of cells called the endothelium. The endothelium works to keep the inside of arteries toned and smooth, which keeps blood flowing.

Atherosclerosis begins with damage to the endothelium. It’s caused by high blood pressuresmoking, or high cholesterol. That damage leads to the formation of plaque.

When bad cholesterol, or LDL, crosses the damaged endothelium, the cholesterol enters the wall of the artery. That causes your white blood cellsto stream in to digest the LDL. Over years, cholesterol and cells become plaque in the wall of the artery.

Plaque creates a bump on the artery wall. As atherosclerosis progresses, that bump gets bigger. When it gets big enough, it can create a blockage. That process goes on throughout your entire body. As a result, not only is your heart at risk, but you are also at risk for stroke and other health problems.

Atherosclerosis usually doesn’t cause symptoms until middle or older age. But as the narrowing becomes severe, it can choke off blood flow and cause pain. Blockages can also rupture suddenly. That’ll cause blood to clot inside an artery at the site of the rupture.

Symptoms of atherosclerosis

The first signs of atherosclerosis can begin to develop during adolescence, with streaks of white blood cells appearing on the artery wall. Most often, there are no symptoms until a plaque ruptures or the blood flow is very restricted, which typically takes many years to occur.

The symptoms depend on which arteries are affected:

Carotid arteries

Carotid arteries provide blood to the brain; when the blood supply is limited, patients can suffer stroke and may experience:

  • weakness
  • difficulty breathing
  • headache
  • facial numbness
  • paralysis

Coronary arteries

Coronary arteries provide blood to the heart; when the blood supply to the heart is limited, it can cause angina and heart attack; symptoms include:

  • vomiting
  • extreme anxiety
  • chest pain
  • coughing
  • feeling faint

Renal arteries

Renal arteries supply blood to the kidneys; if the blood supply becomes limited, there is a serious risk of developing chronic kidney disease, and the patient may experience:

  • loss of appetite
  • swelling of the hands and feet
  • difficulty concentrating

Peripheral arterial disease

In peripheral arterial disease, the arteries to the limbs (most commonly the legs) are blocked. The most common symptom is leg pain, either in one or both legs, usually in the calves, thighs, or hips.

The pain may be described as one of heaviness, cramp, or dullness in the leg muscles. Other symptoms can include:

  • hair losson 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

Arteriosclerosis vs. atherosclerosis

Arteriosclerosis and atherosclerosis are different conditions:

  • Arteriosclerosis is the stiffening or hardening of the artery walls.
  • Atherosclerosis is the narrowing of the artery because of plaque build-up. Atherosclerosis is a specific type of arteriosclerosis.

All patients with atherosclerosis have arteriosclerosis, but those with arteriosclerosis might not necessarily have atherosclerosis. However, the two terms are frequently used with the same meaning.

Diagnosing atherosclerosis

Those who are at risk of developing atherosclerosis should be tested because the symptoms don’t show until cardiovascular disease develops. A diagnosis will be based on the medical history of a patient, test results, and a physical exam.

Blood tests – these measure how much sugar, fat, and protein there is in the blood. If there are high levels of fat and sugar, it could indicate an increased risk of atherosclerosis.

Physical exam

  • The doctor will listen to the arteries using a stethoscope to see if there is an unusual “whooshing” due to uneven blood flow – called a bruit. If a bruit is heard, it can mean there is plaque obstructing blood flow.
  • There may also be a very weak pulse below the area of the artery that has narrowed. Sometimes, there is no detectable pulse.
  • An affected limb may have abnormally low blood pressure.
  • There may be signs of an aneurysm(pulsating bulge) behind the patient’s knee or in their abdomen.
  • Where blood flow is restricted, wounds may not heal properly.

Ultrasound – an ultrasound scanner can check blood pressure at distinct parts of the body; changes in pressure indicate where arteries may have obstruction of blood flow.

Computed tomography (CT) scan – a CT scan can be used to find arteries that are hardened and narrowed.

Plaque Attacks

Plaques from atherosclerosis can behave in different ways.

They can stay in the artery wall. There, the plaque grows to a certain size and stops. Since this plaque doesn’t block blood flow, it may never cause symptoms.

Plaque can grow in a slow, controlled way into the path of blood flow.Eventually, it causes significant blockages. Pain in the chest or legs when you exert yourself is the usual symptom.

The worst happens when plaques suddenly rupture, allowing blood to clot inside an artery. In the brain, this causes a stroke; in the heart, a heart attack.

The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:

Coronary artery disease : Stable plaques in the heart’s arteries cause angina (chest pain). A sudden plaque rupture and clotting cause heart muscle to die. This is a heart attack.

Cerebrovascular disease:Ruptured plaques in the brain‘s arteries cause strokes with the potential for permanent brain damage. Temporary blockages in an artery can also cause something called transient ischemic attacks (TIAs), which are warning signs of stroke. However, there is no brain injury.

Peripheral artery disease : Narrowing in the arteries of the legs from plaque causes poor circulation. This makes it painful for you to walk. It’ll also cause wounds not to heal as well. Severe disease may lead to amputations.

Who Gets This?

It might be easier to ask: Who doesn’t get atherosclerosis?

It starts early. In autopsies of young soldiers killed in the Korean and Vietnam wars, half to three-quarters had early forms of atherosclerosis.

Even today, a large number of young people without symptoms have evidence of atherosclerosis. A 2001 study of 262 apparently healthy people’s hearts may surprise you:

52% had some atherosclerosis.

It was present in 85% of those older than 50.

17% of teenagers had it.

No one had symptoms, and very few had severe narrowing in any arteries. This was very early disease, detectable only by special tests.

If you are 40 and generally healthy, you have about a 50% chance of developing serious atherosclerosis in your lifetime. The risk goes up as you get older. Most adults older than 60 have some atherosclerosis but often do not have noticeable symptoms.

Still, rates of death from atherosclerosis have fallen by 25% in the past three decades. This is thanks to better lifestyles and improved treatments.

Prevention

Atherosclerosis can get worse over time, but it’s also preventable. Nine risk factors are to blame for more than 90% of all heart attacks:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Abdominal obesity(“spare tire”)
  • Stress
  • Not eating fruits and vegetables
  • Excess alcoholintake (more than one drink for women, one or two drinks for men, per day)
  • Not exercisingregularly

You may notice all of these have something in common: You can do something about them. Experts agree that reducing these lowers your odds of cardiovascular disease.

For people at moderate or higher risk — those who’ve had a heart attackor stroke, or who have angina — a baby aspirin a day can be important. Aspirin helps prevent clots from forming. Ask your doctor before starting that, as it can have side effects.

Treatment

Once you have a blockage, it’s generally there to stay. With medication and lifestyle changes, though, plaques may slow or stop growing. They may even shrink slightly with aggressive treatment.

Lifestyle changes:

Reducing risk factors that lead to atherosclerosis will slow or stop the process. That means a healthy dhttps://www.healthinfi.comiet, exercise, and no smoking. These changes won’t remove blockages, but they’re proven to lower the risk of heart attacks and strokes. The changes will focus on weight management, physical activity, and a healthy diet. A doctor may recommend eating foods high in soluble fiber and limiting intake of saturated fats, sodium (salt), and alcohol.

Medication: 

Taking drugs for high cholesterol and high blood pressurewill slow and may even halt atherosclerosis. They could also lower your risk of heart attack and stroke. some medications can prevent the build up of plaque or help prevent blood clots (antiplatelets). Other medications, such as statins, might be prescribed to lower cholesterol, and Angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure.

Doctors can use invasive techniques to open up blockages from atherosclerosis, or go around them:

Angiographyand stenting: 

Using a thin tube inserted into an artery in the leg or arm, doctors can get to diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (catheters with balloon tips) and stenting can often open up a blocked artery. Stenting helps to reduce symptoms, although it does not prevent future heart attacks.

Bypass surgery: 

Surgeons “harvest” a healthy blood vessel (often from the leg or chest). They use the healthy vessel to go around a blocked segment. Severe cases of atherosclerosis may be treated by surgical procedures, such as angioplasty or coronary artery bypass grafting (CABG).

Angioplasty involves expanding the artery and opening the blockage so that the blood can flow through properly again. CABG is another form of surgery that can improve blood flow to the heart by using arteries from other parts of the body to bypass a narrowed coronary artery

These procedures can have complications. They’re usually saved for people with significant symptoms or limitations caused by atherosclerosis.

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