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9/7/2015

Atherosclerosis|Causes,Symptoms&Treatment

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Atherosclerosis
Overview

ByTinaShahian,PhD

Atherosclerosisisahardeningofthearteriesthatresultsfromabuildupofplaque.Plaqueismadeupofcholesterol,fat,calcium,
clottingagents,celldebris,andothersubstancesnormallyfoundincirculatingblood.Thesesubstancesaccumulateatspecificsites
alongthearteriesand,overtime,restrictorfullyblockbloodflowtodownstreamorgans,suchastheheart,brain,andlimbs.This
processbecomesacceleratedwhenpartoftheplaqueunexpectedlybreaksoff,orformsabloodclot.
Dependingonthelocationoftheplaqueandtheextentofblockage,othercomplicationsmay
result.Plaquebuildupinthecoronaryarteries,whichdeliverbloodtotheheart
(http://www.innerbody.com/image/card01.html),canleadtocoronaryheartdiseasetheprimarycause
ofdeathsintheUntiedStates.Reducedorhaltedbloodflowtotheheartmaycauseaheart
attack(http://www.innerbody.com/diseasesconditions/heartattack).Plaqueinthecarotidarteries(carotid
arterydisease),whichdeliverbloodtothebrain(http://www.innerbody.com/image/nerv02.html),can
causeastroke(http://www.innerbody.com/diseasesconditions/stroke).Ablockageinthemajorarteries
(peripheralarterydisease)causespainandnumbnessinthelimbsandpelvis,whileblockagein
therenalarteries(chronickidneydisease)affectskidneyfunction
(http://www.innerbody.com/image_urinov/dige05new.html).Ananeurysm (http://www.innerbody.com/diseases
conditions/aneurysm)isabulgeinthearterywallthatcanbelethalifitbursts.
Atherosclerosiscanbemanaged(andprevented)withlifestylechangesandmedical
intervention.Everyyearapproximately380,000Americansdiefromcoronaryheartdisease.

CausesandRiskFactors
Atherosclerosiscanbeginduringchildhoodandprogressslowlyintoadulthood.Itisnotclearwhattriggerstheplaqueforming
substancestodepositonthearteries,butdamagedorscarredsitesarethoughttoplayarole.Thefollowingcandamagetheartery
wallsorpromoteplaqueformation:
Highcholesterol.Highlevelsoflowdensitylipoprotein(LDL)cholesterolincreasethechanceofplaqueformation.Unlikehigh
densitylipoprotein(HDL)cholesterol,LDLcholesteroltransportsfatintothearteries,andattractsmacrophagesthatfurther
growtheplaque.
Highfat.Elevatedlevelsoftriglycerides(atypeoffat)inthebloodincreasetheriskofatherosclerosis.
Highbloodpressure(http://www.innerbody.com/diseasesconditions/hypertension).Chronichighbloodpressurecandamagethe
coronaryarteriesandleadtoatherosclerosis.
Smoking.Smokingpromotesplaqueformationbydamagingthearteries.
Inflammation.Inflammationduetoinjuryoranotherunderlyingconditionenhancesthechanceofdevelopingatherosclerosis.
Familyhistory.Theriskofatherosclerosisinhigherforindividualswithafamilyhistoryofheartdisease.

Symptoms
Atherosclerosismaynotproducesymptomsuntilitisatanadvancedstage,atwhichtimemedicalattentionisneeded.Symptoms
varydependingontheaffectedartery.
Coronaryarteries.Atherosclerosisinarteriesthatcarrybloodtotheheartmaycausechestpainandpressurealso
symptomsofaheartattack.
Carotidarteries.Atherosclerosisinarteriesthatcarrybloodtothebraincanleadtonumbnessinthelimbs,droopyfacial
muscles,dizziness,anddifficultyspeaking.
Peripheralarteries.Atherosclerosisinarteriesthatcarrybloodtothearms,legs,andpelviscancausepainwhilewalking,
numbnessand,inmen,erectiledysfunction.
Renalarteries.Atherosclerosisinarteriesthatcarrybloodtothekidneyscancausekidneyfailure.

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Atherosclerosis|Causes,Symptoms&Treatment

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Diagnosis
Thefirststepindiagnosingatherosclerosisisaphysicalexam.During
theexam,adoctorlistensforabnormalsoundsinthearteriesandlooks
foradecreasedpulseinthelimbs,bothofwhichareevidenceof
restrictedbloodflow.Additionaltestsareperformedtoassessheart
functionandgainacloserviewofthearteries.
Bloodtests.Elevatedlevelsofcholesterol,fat,sugar,andcertain
proteinsaredetectableinthebloodandcanbeassociatedwith
atherosclerosis.
Electrocardiogram.Anelectrocardiogram(EKG)measureselectrical
signalsthatpassthroughtheheart,andcanidentifyanirregular
heartbeatorapastheartattack.
Imaging(http://www.innerbody.com/xraysandradiographyoverview#xraysin
medicalimaging).AchestXray,computedtomography(CT)scan,and
magneticresonanceangiography(MRA)allowcloservisualizationofthe
heartandarteriesforevidenceofplaques.
Bloodpressuretests.Theankle/brachialindextestlooksforblockage
ofthearteriesinthelimbsbycomparingthebloodpressurebetween
theankleandthearmsnormally,bloodpressureintheanklemeasures
thesameorhigherthaninthearm.ADopplerultrasound
(http://www.innerbody.com/ultrasoundandultrasonics)canalsomeasureblood
pressureatvariouspointsinthebody.
Stresstest.Thistestmonitorstheheartsperformancewhileunder
stress,whichisintheformofexercise(treadmillorstationarybicycle),
orinducedwithmedication.Abnormalitiesintheheartrate,rhythm,
andoverallfunctionareeasiertodetectwhentheheartispumping
bloodatafastrate.
Angiography.Duringanangiography,adyeisinjectedintothe
arteriesthroughathincatheter.Xrayimagingallowsforvisualizationof
theflowpathofthedye,whichmimicsthatoftheblood,aswellasany
blockagesalongtheway.

Treatment
Acombinationoflifestylechanges,medication,andsurgerymaybeusedtotreatatherosclerosisorslowitsprogression.
Lifestylechanges.Regularexercisemaintainingahealthyweightandadiethighinfruitsandvegetables,butlowin
cholesterol,fat,andsalthelpslowatherosclerosis.Avoidingsmokinghelpspreventplaquepromotingdamagetothearteries.
Medication.Prescriptionmedicationscanhelpsloworstopdiseaseprogression.Drugsknownasstatinsandfibratesareused
tolowerplaquepromotingLDLcholesterol,whileboostingHDLcholesterollevels.Antiplateletdrugsreduceplatelet
aggregationandclottinginthearteries,whichslowsthegrowthofplaquesandminimizestheriskofacompleteblockage.Beta
blockers,angiotensinconvertingenzyme(ACE)inhibitors,calciumchannelblockers,andwaterpills(diuretics)allhelplower
bloodpressure,reducingburdenontheheart.
Surgery.Whenlifestyleremediesandmedicationfailtocurbdiseaseprogression,surgeryisusedtophysicallyeliminate
plaquefromtheaffectedartery.Duringanangioplasty,adeflatedballoonisdeliveredtothesiteofblockagewhereitisinflated
topushbacktheplaque.Then,ameshtube(stent)maybeinstalledtoactasaphysicalbarrieragainstfutureplaquebuildup.
Acarotidendarterectomyisperformedtodissolveplaquefromthearteriesintheneck.Thrombolytictherapyhelpspreventa
heartattackorstrokebydissolvingbloodclotsandrestoringbloodflowtotheheartandbrain,respectively.Coronaryartery
bypassgraftingimprovesbloodflowtotheheartbyusingveinsfromotherpartsofthebodytoredirectbloodpasttheblocked
site.

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Prevention
Thebestwaytopreventatherosclerosisisbystayingphysicallyactive,maintainingahealthyweight,andmakingsmartfood
choicesthatis,eatingplentyoffruitsandvegetablesandavoidingfoodshighincholesterol,fatandsalt.Itisalsoimportantto
avoidsmokingandstressinducingactivities.Individualswithahighriskofdevelopingheartdiseasemayconsulttheirphysicianto
determinetheidealpreventativeplan.

Sources
Atherosclerosis.AmericanHeartAssociation.Apr2014.RetrievedJun6,2014.
http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/Atherosclerosis_UCM_305564_Article.jsp.
"Atherosclerosis".MayoClinic.MayoFoundationforMedicalEducationandResearch.May2014.RetrievedJun6,2014.
http://www.mayoclinic.org/diseasesconditions/arteriosclerosisatherosclerosis/basics/definition/con20026972.
WhatisAtherosclerosis.NationalHeart,Lung,andBloodInstitute.NIH.Jul2011.RetrievedJun6,2014.
https://www.nhlbi.nih.gov/health/healthtopics/topics/atherosclerosis/.
Thrombolytictherapy.MedlinePlus.Jun2012.RetrievedJun6,2014.
http://www.nlm.nih.gov/medlineplus/ency/article/007089.htm
WhatAreArthritisandRheumaticDiseases?NationalInstituteofArthritisandMusculoskeletalandSkinDiseases(NIAMS).
NIH.Jul2009.RetrievedJun2,2014.http://www.niams.nih.gov/Health_Info/Arthritis/arthritis_rheumatic_ff.asp#a.

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