ATHEROSCLEROSIS

 

Atherosclerosis 

 

 Atherosclerosis is a thickening and hardening of large and medium-sized muscular arteries, primarily due to involvement of tunica intimae and is characterized by fibrous fatty plaques or atheromas.

The term atherosclerosis derived from athero-(meaning porridge) referring to the soft lipid rich material in the center of atheroma and sclerosis (scarring) referring to connective tissues in the plaques.

Etiology 

Cardiovascular disease, mostly related to atherosclerotic coronary heart disease or ischemic heart disease (IHD) is the most common cause of the premature death in the developed countries of the world.

#Major risk factors

(a)           Modifiable

-         Dyslipidemia

-         Hypertension

-         Diabetes mellitus

-         Smoking

(b)           Constitutional

-         age

-         gender

-         genetic factors

-         familial and racial factors

 

# Emergency risk factors

-          obesity

-         Hormones –estrogen deficiency

-         Physical inactivity

-         Prothrombotic factors

 

Pathogenesis

 

The pathogenesis of atherosclerosis consists of 4 stages :

1.   Firstly endothelial injury is the initial triggering event in the development of lesions of atherosclerosis.

2.    Endothelial injury causes adherence, aggregation and platelet release reaction at the site of exposed sub endothelial connective tissue and infiltration by inflammatory cells, and as a result causing proliferation of smooth muscle cells.

3.   Aggregation of the platelet causes formation of small thrombus.

4.   This causes mild inflammatory reaction which together with foam cells is incorporated into the atheromatous plaque.

 

Clinical effects on various organs

 

 

Clinical effect depends on the artery type, size.

Large arteries that get affected most often are the aorta, renal, mesenteric and carotids whereas medium arteries involve cerebral arteries and coronary arteries.

According to the symptoms atherosclerotic disease involves most often the following.

a)   Heart- Myocardial infarction, ischemic heart disease

b)   Brain- chronic ischemic brain damage, cerebral damage, cerebral infarction and stroke.

c)    Aorta- aneurysm, thrombosis and embolisation to other organs.

d)   Small intestine- ischemic bowel disease, infarction

e)   Lower extremities - intermittent claudication, gangrene. 

Diagnosis

 Atherosclerosis can be diagnosed by

MRI, CT scans and ultrasounds. 

Through blood tests we can also diagnose hdl levels(high density lipoprotein) which increases due to deposition of fats in blood vessels.

 

 

TREATMENT

 

1.  FIRSTLY, lifestyle changes should be done in order to prevent the conditions to appearance of atherosclerotic plaques in the vessels. Changes like food eating habits simultaneously with the habit of exercising regularly.

2.   SECONDLY, medication treatments like fibrinolytic drugs, anti atherosclerotic drugs and also symptomatic treatment of the risk factors happened to the patient like medication for the hypertension and other.

3.  THIRDLY AND LASTLY, surgical treatment is done if it is a severe case atherosclerotic plaque in the vessel which is blocking the way of blood cells and leading to embolisation in the organs.

 

                                               -  by Dr. Ravi Ranjan