Arteriosclerosis

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Arteriosclerosis
Blausen 0227 Cholesterol.png
Blood vessel-plaque and cholesterol
Specialty Pathology
CausesSmoking, High blood pressure [1]
Diagnostic method Blood test, EKG [1]
TreatmentTreatment of underlying condition [2]

Arteriosclerosis is the thickening, hardening, and loss of elasticity of the walls of arteries. [3] This process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by atherosclerosis, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques, cholesterol, and some other substances in and on the artery walls. [4] It can be brought on by smoking, a bad diet, or many genetic factors. Atherosclerosis is the primary cause of coronary artery disease (CAD) and stroke, with multiple genetic and environmental contributions. Genetic-epidemiologic studies have identified a surprisingly long list of genetic and non-genetic risk factors for CAD. However, such studies indicate that family history is the most significant independent risk factor.[ citation needed ]

Atherosclerosis form of arteriosclerosis

Atherosclerosis is a disease in which the inside of an artery narrows due to the build up of plaque. Initially, there are generally no symptoms. When severe, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney problems, depending on which arteries are affected. Symptoms, if they occur, generally do not begin until middle age.

Cholesterol sterol (or modified steroid),[4] a type of lipid molecule, and is biosynthesized by all animal cells, because it is an essential structural component of all animal cell membranes

Cholesterol is an organic molecule. It is a sterol, a type of lipid molecule, and is biosynthesized by all animal cells, because it is an essential structural component of all animal cell membranes.

Coronary artery disease artery disease characterized by plaque building up along the inner walls of the arteries of the heart resulting in a narrowing of the arteries and a reduced blood supply to the cardiac muscles

Coronary artery disease (CAD), also known as ischemic heart disease (IHD), involves the reduction of blood flow to the heart muscle due to build up of plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

Contents

Signs and symptoms

The signs and symptoms of arteriosclerosis may include sudden weakness, facial or lower limb numbness, confusion, difficulty understanding speech, and problems seeing. [1]

Pathophysiology

Monckeberg's arteriosclerosis Moenckeberg.jpg
Monckeberg's arteriosclerosis

The lesions of arteriosclerosis begin as the intima (innermost layer of blood vessel wall) of the arterial wall start to fill up with the deposition of cellular wastes. As these start to mature, they can take different forms of arteriosclerosis. All are linked through common features such as the stiffening of arterial vessels, thickening of arterial walls and degenerative nature of the disease. [5] [6]

A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. Lesion is derived from the Latin laesio "injury". Lesions may occur in plants as well as animals.

Arteriolosclerosis Human disease

Arteriolosclerosis is a form of cardiovascular disease involving hardening and loss of elasticity of arterioles or small arteries and is most often associated with hypertension and diabetes mellitus. Types include hyaline arteriolosclerosis and hyperplastic arteriolosclerosis, both involved with vessel wall thickening and luminal narrowing that may cause downstream ischemic injury. The following two terms whilst similar, are distinct in both spelling and meaning and may easily be confused with arteriolosclerosis.

Monckebergs arteriosclerosis Human pathology

Mönckeberg's arteriosclerosis, or Mönckeberg's sclerosis, also called medial calcific sclerosis or Mönckeberg medial sclerosis, is a form of arteriosclerosis or vessel hardening, where calcium deposits are found in the muscular middle layer of the walls of arteries. It is an example of dystrophic calcification. This condition occurs as an age-related degenerative process. However, it can occur in pseudoxanthoma elasticum and idiopathic arterial calcification of infancy as a pathological condition, as well. Its clinical significance and cause are not well understood and its relationship to atherosclerosis and other forms of vascular calcification are the subject of disagreement. Mönckeberg's arteriosclerosis is named after Johann Georg Mönckeberg, who first described it in 1903.

Hyaline substance with a glassy appearance

A hyaline substance is one with a glassy appearance. The word is derived from Greek: ὑάλινος transparent and Greek: ὕαλος crystal, glass.

Diagnosis

EKG Eletrocardiografo C30+ TEB.png
EKG

Diagnosis of an individual suspected of having arteriosclerosis can be based on a physical exam, blood test, EKG and the results of these tests (among other exams). [1]

Blood test laboratory analysis using a blood sample

A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose test or a cholesterol test, are often grouped together into one test panel called a blood panel or blood work. Blood tests are often used in health care to determine physiological and biochemical states, such as disease, mineral content, pharmaceutical drug effectiveness, and organ function. Typical clinical blood panels include a basic metabolic panel or a complete blood count. Blood tests are also used in drug tests to detect drug abuse. In some of the United States, a blood test is required before marriage.

Treatment

Treatment is often in the form of preventive measures of prophylaxis. Medical therapy is often prescribed to help prevent arteriosclerosis for underlying conditions, such as medications for the treatment of high cholesterol, medications to treat high blood pressure (e.g., ACE inhibitors), [2] and antiplatelet medications. Lifestyle changes are also advised, such as increasing exercise, stopping smoking, and moderating alcohol intake. [1]

ACE inhibitor Captopril skeletal.svg
ACE inhibitor

There are a variety of types of surgery:

Epidemiology

In 2008, the US had an estimate of 16 million atherosclerotic heart disease and 5.8 million strokes. Cardiovascular diseases that were caused by arteriosclerosis also caused almost 812,000 deaths in 2008, more than any other cause, including cancer. About 1.2 million Americans are predicted to have a heart attack each year. [16]

History

The diagnostics and clinical implications of this disease were not recognized until the 20th century. Many cases have been observed and recorded, and Jean Lobstein coined the term arteriosclerosis while he was analyzing the composition of calcified arterial lesions. [17] The name comes from the Greek words ἀρτηρία (artēría, artery) and σκληρωτικός (sklērōtikós, hardened). [18]

Related Research Articles

Cardiology branch of medicine dealing with disorders of the heart as well as parts of the circulatory system

Cardiology is a branch of medicine that deals with the disorders of the heart as well as some parts of the circulatory system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.

Macrovascular disease is a disease of any large (macro) blood vessels in the body. It is a disease of the large blood vessels, including the coronary arteries, the aorta, and the sizable arteries in the brain and in the limbs.

Peripheral artery disease artery disease characterized by build up of plaque in the arteries that carry blood to your head, organs, and limbs

Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular disease. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved. The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication. Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg. Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke. Up to 50% of people with PAD do not have symptoms.

Ischemia restriction in blood supply to tissues, causing a shortage of oxygen and glucose

Ischemia or ischaemia is a restriction in blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism. Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue. It also means local anemia in a given part of a body sometimes resulting from constriction. Ischemia comprises not only insufficiency of oxygen, but also reduced availability of nutrients and inadequate removal of metabolic wastes. Ischemia can be partial or total.

Atheroma accumulation of degenerative material in the inner layer of artery walls

An atheroma, or atheromatous plaque ("plaque"), is an abnormal accumulation of material in the inner layer of the wall of an artery; it is present in the arteries of most adults. The material consists of mostly macrophage cells, or debris, containing lipids, calcium and a variable amount of fibrous connective tissue. The accumulated material forms a swelling in the artery wall, which may intrude into the channel of the artery, narrowing it and restricting blood flow. Atheroma is the pathological basis for the disease entity atherosclerosis, a subtype of arteriosclerosis.

Intravascular ultrasound (IVUS) is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the catheter is attached to computerized ultrasound equipment. It allows the application of ultrasound technology, such as piezoelectric transducer or CMUT, to see from inside blood vessels out through the surrounding blood column, visualizing the endothelium of blood vessels in living individuals.

A vulnerable plaque is a kind of atheromatous plaque – a collection of white blood cells and lipids in the wall of an artery – that is particularly unstable and prone to produce sudden major problems such as a heart attack or stroke.

A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. It is commonly performed due to inadequate blood flow (ischemia) caused by atherosclerosis, as a part of organ transplantation, or for vascular access in hemodialysis. In general, someone's own vein (autograft) is the preferred graft material for a vascular bypass, but other types of grafts such as polytetrafluoroethylene (Teflon), polyethylene terephthalate (Dacron), or a different person's vein (allograft) are also commonly used. Arteries can also serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using surgical suture, creating a surgical anastomosis.

Vascular disease cardiovascular system disease that primarily affects the blood vessels

Vascular disease is a class of diseases of the blood vessels – the arteries and veins of the circulatory system of the body. It is a subgroup of cardiovascular disease. Disorders in this vast network of blood vessels, can cause a range of health problems which can be severe or prove fatal.

Foam cell fat-laden M2 macrophages seen in atherosclerosis

Foam cells are the fat-laden M2 macrophages that serve as the hallmark of early stage atherosclerotic lesion formation. As these plaques mature, they become more unstable and inflamed; blood clots triggered when an unstable plaque ruptures are the main driver of heart attack and stroke.

Tangier disease or hypoalphalipoproteinemia is an extremely rare inherited disorder characterized by a severe reduction in the amount of high density lipoprotein (HDL), often referred to as "good cholesterol", in the bloodstream. Worldwide, approximately 100 cases have even been identified.

Coronary stent

A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention (PCI). Coronary stents are now used in more than 90% of PCI procedures. Stents reduce angina and have been shown to improve survivability and decrease adverse events in an acute myocardial infarction.

The following outline is provided as an overview of and topical guide to cardiology:

Lipohyalinosis is a cerebral small vessel disease affecting the small arteries, arterioles or capillaries in the brain. Originally defined by C. Miller Fisher as 'segmental arteriolar wall disorganisation', it is characterized by vessel wall thickening and a resultant reduction in luminal diameter. Fisher considered this small vessel disease to be the result of hypertension, induced in the acute stage by fibrinoid necrosis that would lead to occlusion and hence lacunar stroke. However, recent evidence suggests that endothelial dysfunction as a result of inflammation is a more likely cause for it. This may occur subsequent to blood–brain barrier failure, and lead to extravasation of serum components into the brain that are potentially toxic. Lacunar infarction could thus occur in this way, and the narrowing – the hallmark feature of lipohyalinosis – may merely be a feature of the swelling occurring around it that squeezes on the structure.

Atherectomy

Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine if it is superior to angioplasty. It has also been used to treat coronary artery disease, albeit ineffectively.

Arterial embolism Interruption of blood flow to an organ

Arterial embolism is a sudden interruption of blood flow to an organ or body part due to an embolus adhering to the wall of an artery blocking the flow of blood, the major type of embolus being a blood clot (thromboembolism). Sometimes, pulmonary embolism is classified as arterial embolism as well, in the sense that the clot follows the pulmonary artery carrying deoxygenated blood away from the heart. However, pulmonary embolism is generally classified as a form of venous embolism, because the embolus forms in veins. Arterial embolism is the major cause of infarction.

Tracheobronchomalacia congenital disorder of respiratory system

Tracheobronchomalacia or TBM is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse. This condition can also affect the bronchi. There are two forms of this rare condition: primary TBM and secondary TBM. Primary TBM is congenital and starts as early as two years old. It is mainly linked to genetic causes. Secondary TBM is acquired and starts in adulthood. It is mainly developed after an accident or chronic inflammation.

References

  1. 1 2 3 4 5 "How Is Atherosclerosis Diagnosed? - NHLBI, NIH". www.nhlbi.nih.gov. Retrieved 2015-06-19.
  2. 1 2 "ACE inhibitors: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-19.
  3. " arteriosclerosis " at Dorland's Medical Dictionary
  4. "Atherosclerosis". PubMed Health Glossary.
  5. Rubin, Raphael; Strayer, David S.; Rubin, Emanuel (2011-02-01). Rubin's Pathology: Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. ISBN   9781605479682.
  6. Insull, William (2009). "The Pathology of Atherosclerosis: Plaque Development and Plaque Responses to Medical Treatment". The American Journal of Medicine. 122 (1 Suppl): S3–S14. doi:10.1016/j.amjmed.2008.10.013. PMID   19110086.
  7. Diehm, C.; Allenberg, J.-R.; Nimura-Eckert, K.; Veith, F. J. (2013-11-11). Color Atlas of Vascular Diseases. Springer Science & Business Media. ISBN   9783662062876.
  8. "Atherosclerosis: MedlinePlus". www.nlm.nih.gov. Retrieved 2015-06-19.
  9. Mohan, Harsh (2012-11-30). Pathology Practical Book. JP Medical Ltd. ISBN   9789350902660.
  10. "hyperplastic arteriosclerosis" . Retrieved 2015-06-19.
  11. "hyaline arteriolosclerosis" . Retrieved 2015-06-19.
  12. "Angioplasty: MedlinePlus". www.nlm.nih.gov. Retrieved 2015-06-19.
  13. "Coronary artery bypass surgery". MedlinePlus.
  14. "Atherosclerosis -Treatment". UK NHS. Retrieved 21 November 2013.
  15. "Thrombolytic therapy: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-19.
  16. "Atherosclerosis". Merck Manuals. Retrieved 13 February 2015.
  17. Mayerl, Christina; Lukasser, Melanie; Sedivy, Roland; Niederegger, Harald; Seiler, Ruediger; Wick, Georg (2006). "Atherosclerosis research from past to present—on the track of two pathologists with opposing views, Carl von Rokitansky and Rudolf Virchow". Virchows Archiv. 449 (1): 96–103. doi:10.1007/s00428-006-0176-7. PMID   16612625.
  18. Copstead-Kirkhorn, Lee-Ellen C.; Banasik, Jacquelyn L. (2014-06-25). Pathophysiology. Elsevier Health Sciences. p. 322. ISBN   9780323293174 . Retrieved 25 July 2016.

Further reading

Classification
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