Introduction to: Atherosclerosis

1. Introduction to:Atherosclerosis

2. Atherosclerosis Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. Plaques can also split open and cause blood clots to form inside the artery. These blood clots can suddenly block all blood flow through the artery, or can break off and travel through the bloodstream to block another artery elsewhere.

3. NORMAL ARTERY ATHEROSCLEROTIC PLAQUE ATHEROSCLEROTIC PLAQUE

4. Normal coronary artery Early coronary atherosclerosis Eccentric plaque with a central zone containing yellow lipid

5. • CEREBRAL ARTERIES INJURY• CARDIAC ARTERIES INJURY• RENAL ARTERIES INJURY• AORTA INJURY• INTESTINAL ARTERIES INJURY• EXTREMITY ARTERIES INJURY FORMS OF ATHEROSCLEROSIS

6. CEREBRAL FORM OF ATHEROSCLEROSIS Acute form may be as Hemorrhage within The brain due to rupture Of atherosclerotic aneurism

7. Aortic form of atherosclerosis

8. RENAL FORM OF ATHEROSCLEROSIS Chronic form is called Atherosclerotic Nephrosclerosis or Primary contracted kidney Acute form may be as infarction

9. Intestinal form of atherosclerosis Acute form may be as gangrenous necrosis of the intestine Acute form may be as gangrenous necrosis of the intestine

10. Extremity form of atherosclerosis Acute form may be as gangrenous necrosis.

11. What Causes It? Many researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. These factors are thought to contribute to the damage: • High blood pressure • Elevated LDL ("bad") cholesterol • An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia) • Smoking • Diabetes • Inflammation Once the artery is damaged, blood cells called platelets build up there to try and heal the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The blood flow through the artery is decreased, and the oxygen supply to organs also decreases. Blood clots may form, blocking the artery or entering your bloodstream and cut off blood supply to other organs.

12. Coronary Artery Disease• Chest pain (generally a heavy, squeezing, or crushing sensation with possible burning or • stabbing pains)• Abdominal, neck, back, jaw, or shoulder/arm pain• Weakness• Perspiration• Shortness of breathCerebrovascular Disease• Weakness or paralysis on one side of the body• Trouble speaking or understanding speech• Loss of vision in one eye• Muscle weakness• Sudden trouble walking• Dizziness• Loss of balance or coordination• Sudden severe headache Signs and Symptoms

13. Signs and Symptoms Peripheral Artery Disease • Pain, aching, cramps, numbness or sense of fatigue in the leg muscles (intermittent claudication) • "Bruits" (blowing sounds your doctor can hear with a stethoscope that indicate turbulence in blood flow) • Hair loss • Thickened nails • Smooth, shiny skin surface • Skin that is cold to the touch • Gangrene

14. Expected Duration Atherosclerosis is a long-term condition that continues to worsen over many decades without changes in lifestyle and medication if neccessary.

15. Atherosclerotic plaque It has three principle components: 1. cells –smooth muscle cells, macrophages ,other leukocytes 2 . Extra cellular matrix- collagen, elastic fibers, proteoglycans 3 . Intra cellular and extra cellular lipids

16. Progress stages of atherosclerotic plaques according to infiltrative theory • 1 Prelipidosis • 2 Lipidosis • 3 Sclerosis • 4 Atheromatosis • 5 Ulceration • 6 Calcinosis

17. Lipid strips Artery with atherosclerotic plaque • 2 stage is called lipidosis Aorta • 3 stage is called sclerosis •4 stage is called atheromatosis• 6 stage is called calcinosis calcinosis Atheromatosis or porridge-like substance

18. Stage I monocyte adhesion/migration Stage II foam cells (lipid containing macrophages) in intima Stage III appearance of extracellular lipid

19. Stage IV Core formation (extracellular lipid coalescing into the center of the plaque) Stage VI Thrombosis Stage V Fibrous Cap and Core formation (fully formed lipid core and well developed cap of fibrous tissue seperating the core from the lumen)

20. There are two types of atherosclerotic plaque • 1 vulnerable particularly unstable and prone to produce sudden major problems, such as a heart attack or stroke. • 2 stable THERE ARE A LOT OF LIPIDS

21. Unstable angina with plaque disruption The plaque cap is torn, projects into the lumen, exposing a mass of thrombus filling the lipid core Stable angina. Eccentric coronary stenosis Thick cap

22. Risk Factors • Being male • If female, being past menopause • High blood pressure • High LDL ("bad") cholesterol or triglycerides (fats in the blood) • Diabetes • Being overweight • Smoking • A family history of heart disease • Elevated homocysteine levels • Sedentary lifestyle • Diets high in saturated fat and trans fatty acids (trans fats) • Depression • Obstructive sleep apnea

23. How is the disease diagnosed? • An angiogram is an x-ray study in which dye is used to detect a blockage or other problem in the arteries supplying blood to the heart. It may be used in patients with chest pain or suspected blockage of the arteries feeding the heart. • An exercise electrocardiogram (ECG) or “stress test” measures your heart’s electrical activity, blood pressureandheart rate while you exercise, usually by walking on a treadmill. Imaging techniques used during a stress test (such as an ultrasound) can pinpoint areas where blood flow to the heart may be decreased.Itis usually done to determine the cause of unexplained chest pain, especially if atherosclerosis of the arteries supplying the heart is suspected. • Computed Tomography Scan(CT) scan creates computer-generated pictures of the heart, brain, or other areas of the body. The test can show hardening and narrowing of large arteries. • doctors will also test blood pressure, blood sugar and blood cholesterol levels to look for risk factors that may have contributed to the problem

24. Occlusive atherosclerosis of the internal carotid artery (ICA) CT image shows a low-density atherosclerotic Renal arterial duplex ultrasonography of bilateral renal artery stenosis ‘multi-modal’ vascular MRI

25. Treatment Options • Drug Therapies Cholesterol Lowering Drugs , Blood Pressure Lowering Drugs, Blood Thinning Drugs • Surgical Procedures: Bypass surgery, Minimally invasive bypass surgery, Endarterectomy • Non-surgical techniques: Angioplasty , Atherectomy • Complementary and Alternative Therapies: Nutrition and Supplements, Herbs,Acupuncture, Homeopathy • Lifestyle Changes The changes will focus on weight management, physical activity and a healthy diet

26. Prognosis and Complications • Heart disease • Heart failure • Abnormal heart rhythms • Stroke • Heart attack • Poor blood supply to certain parts of the body (such as the legs or intestines) • Kidney failure • Death

27. Preventive Care • Stop smoking. • Exercise at least 30 minutes a day, 6 days a week. • Eat healthy foods, such as fruits, vegetables, and whole grains that are low in saturated fat and high in fiber. • Maintain a normal weight (or lose weight if you need to). • Reduce stress. • If you have high blood pressure, high cholesterol, diabetes, or another chronic condition, work with your doctor to keep it in check.