PRESENTED BY : FATHIMA SHAIK ROLL# 1431 MD 04

 WHAT IS ATHEROSCLEROSIS?  CAUSES  PATHOGENESIS  SIGNS AND SYMPTOMS  COMPLICATIONS  DIAGNOSIS  TREATMENT

 Chronic inflammatory disorder of intima of large arteries characterized by formation of fibrofatty plaques called atheroma, which protrudes into and obstructs the vascular lumen & weakens the underlying media & may be associated with serious complications.  The Plaques are 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 the organs.  It is a slow, complex disease that may start in childhood and develop faster with increasing age.

 Hypertension  High cholesterol, or saturated fats in diet  High triglycerides in blood, Low HDL, High LDL  Smoking and other sources of tobacco  Diabetes  Family history of Cardiovascular diseases  Obesity  Lack of physical activity

 It is a 6 step process that progresses over several decades before becoming clinically significant.  Begins with an initial lesion in which the damaged artery wall is invaded by LDL. Oxidized LDL are then taken up by macrophages to form foam cells.  Eventually these cells die and form the necrotic core of atheroma. Furthermore, a fibrous cap is formed over the atheroma.

 Fatty streaks are the earliest lesions seen with atherosclerosis in arteries.

 Symptoms of moderate to severe atherosclerosis depend on which arteries are affected.  CORONARY ARTERIES : Angina, Shortness of breath, arrhythmias.  CAROTID ARTERIES: symptoms of Stroke/ Transient Ischemic Attack; paralysis of one side of face, trouble speaking and understanding speech, sudden weakness, severe headache, unexplained falls (loss of balance), vision problems.  PERIPHERAL ARTERIES : pain on walking (Intermittent Claudication), poor wound healing, less sensitivity to heat & cold

1. Myocardial infarction ( heart attack) 2. Cerebral infarction ( stroke) 3. Chronic IHD (Ischemic Heart Disease) 4. ischemic encephalopathy 5. Aortic aneurysms 6. Peripheral vascular disease ( gangrene of the legs) 7. mesenteric occlusion 8. Sudden cardiac death

 PHYSICAL EXAMINATION: may listen to your arteries for an abnormal whooshing sound- BRUIT. A weak or absent pulse can also be a sign of a blocked artery.  ANGIOGRAPHY : is a test that uses dye and special x rays to show the inside of your arteries. This test can show whether plaque is blocking the arteries and how severe the blockage is.

 ANKLE-BRACHIAL INDEX: This test can tell if the arteries in legs and feet are affected with atherosclerosis.  BLOOD TEST –LIPID PROFILE: detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis.  X-Rays, CT-scan and MRI often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.  DOPPLER ULTRASOUND, STRESS TEST, & EKG are also used for diagnosing atherosclerosis.

 Cholesterol Medications (Statins or Fibrates) : lowers LDL and boosts HDL levels.  Anti-platelet drugs (Aspirin): to reduce the likelihood of platelet clumping in narrowed arteries to form a blood clot.  Beta blockers: lowers heart rate and blood pressure, reducing the workload on heart and often relieve symptoms of chest pain.  ACE inhibitors, Calcium channel blockers, Diuretics: help slow the progression of atherosclerosis by lowering blood pressure.

 ANGIOPLASTY AND STENT PLACEMENT: A Catheter with a deflated balloon is inserted into the blocked or narrowed part of artery. The balloon is then inflated, compressing the deposits against the artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.  ENDARTERECTOMY : In this procedure, the fatty deposits are surgically removed.  BYPASS SURGERY: a graft bypass is created using a vessel from another part of body or a tube made of synthetic fabric and inserted. This allows blood to flow around the blocked or narrowed artery.

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