1. Atherosclerosis

2. Atherosclerosis Most common form of vascular disease Caused by a build up plaque in the tunica intima Narrows the lumen

3. Atherosclerosis ©http://cache.eb.com/eb/image?id=98483&rendTypeId=4

4. Atherosclerosis ©http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18020.jpg

5. Atherosclerosis of the Coronary Artery ©http://www.uphs.upenn.edu/news/News_Releases/jan07/coronary-atherosclerosis.jpg

6. Atherosclerosis with Thrombus (Blood Clot) ©http://www.uwcvb.org/thrombosed%20plaque.jpg

7. Fat enters the area of the endothelial cells Build up of cholesterol and other substances on the tunica intima is called PLAQUE

8. What type of lipid or fat causes this plaque build up? Cholesterol

9. Cholesterol Produced by the liver and is found in saturated fats Some cholesterol is needed for good health –It is the basis for many hormones –Forms cell membranes

10. It becomes a problem when there is too much cholesterol in the bloodstream –Hypercholesterolemia Can lead to coronary heart disease

11. Coronary Heart Disease ©http://www.texasheartinstitute.org/HIC/Anatomy/images/coronill.gif

12. Cholesterol is carried through the bloodstream by lipoproteins There are two types of lipoprotein carriers: –HDL –LDL

13. HDL: high density lipoprotein “Good” type of cholesterol Does not build up on the walls of arteries

14. Thought to protect from heart disease by removing plaque and taking it back to the liver where it can be passed from the body –This is now being questioned in the scientific community

15. LDL: Low density lipoprotein “Bad” cholesterol Accumulates in the arteries causing a build up A clot (THROMBUS) can form near the plaque and block blood flow

16. ©http://www.liponex.ca/images/charts/bad_good.jpg

17. Cholesterol Can be measured with a blood test

18. What Causes Plaque to Build Up on the Walls of Arteries? Inflammation of the tunica intima is a likely contributing factor May be caused by a bacteria or excessive irritation

19. Macrophages are often found near the atherosclerotic area –Attempt to engulf the fat-laden cells

20. As macrophages engulf lipids, they look like foam –Hence the name FOAM CELLS

21. Atherosclerosis ©http://cache.eb.com/eb/image?id=98483&rendTypeId=4

22. Foam Cells and a Cholesterol Cleft Seen in Atheromatous Plaque ©http://www.es.oersted.dtu.dk/~jw/eksamensprojekter/cv010.jpg

23. Foam Cells in the Aorta

24. Macrophages release kinins which stimulate cell mitosis… Normal cells attempt to cover area with healthy cells –ENDOTHELIAL PROLIFERATION Processes continues until lumen is narrowed

25. Narrowing of an Artery ©http://d.yimg.com/origin1.lifestyles.yahoo.com/ls/he/healthwise/h5550977.jpg

26. As plaque increases in size and narrows the lumen it is called an ATHEROMA

27. Atheroma ©http://www.heartzine.com/thumbs/atherosclerosis.jpg

28. Plaque that builds up deeper in the artery, between the intima and the media is called VULNERABLE PLAQUE The film covering the plaque may rupture and cause a clot that could occlude the artery

29. Vulnerable Plaque ©http://www.texasheartinstitute.org/HIC/Topics/images/vplaque.jpg

30. Vulnerable Plaque ©http://www.texasheartinstitute.org/Research/images/prethromb.gif

31. Vulnerable plaque may be even more dangerous than a build up in the intima

32. Coronary Heart Disease ©http://www.lifespan.org/adam/graphics/images/en/18019.jpg

33. Factors that Contribute to the Rate of Atherosclerosis Diet –Fat intake Saturated fats, trans-fats, and dietary cholesterol are all problematic

34. The liver produces enough cholesterol for cellular functions Any additional intake of fat can create problems

35. Saturated Fat ©http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19342.jpg

36. Heredity Genetics are the biggest factor Ex. Your genetic makeup may cause your liver to produce too much cholesterol

37. Hypertension –High blood pressure (the silent killer) Increased pressure on your artery walls damage your arteries, which can speed up the accumulation of fatty deposits

38. Hypertension ©http://www.medmarketplace.com/images/HighBloodPressure.jpg

39. Diabetes High blood sugar contributes to high LDL cholesterol and low HDL cholesterol High blood sugar also damages the lining of your arteries High blood sugar also damages the lining of your arteries

40. Lack of exercise –Regular cardio is beneficial, but not a huge gain

41. Smoking –Nicotine is a potent vasoconstrictor Increases heart rate Damages the walls of your blood vessels, making them likely to accumulate fatty deposits

42. Gender Estrogen regulates the amount of cholesterol the liver produces Lowers LDL and increases HDL

43. Treatment for Atherosclerosis Coronary by-pass operation Surgery reroutes or bypasses the clogged artery to improve blood flow and oxygen

44. Surgeons take a vessel from somewhere else in the body and make a detour around the occluded vessel Gortex is also used

45. Coronary Artery Bypass ©http://media.allrefer.com/s1/l/c0654300-coronary-bypass-surgery.jpg

46. Coronary Artery Bypass ©http://www.taxus-stent.com/images/coronary_artery_bypass_graf.gif

47. Balloon angioplasty with stent Stent: cage-like wire that holds the lumen open

48. Stent ©http://heart.image-animation.com/ANGIOPLASTY-STENT-1.jpg

49. Stent ©http://heart.image-animation.com/ANGIOPLASTY-STENT-3.jpg

50. Stent ©http://www.taxus-stent.com/images/045g_StentV1_EN_150.jpg

51. Problem? Body tends to scar over the stent: restenosis This is more than just a covering of endothelial cells—actual scaring that narrows the lumen

52. Solution Drug coated stent Same type of stent, but coated with an anti-mitotic drug Lasts 3-31/2 weeks by inhibiting the mitotic ability After 3 weeks, endothelial cells cover stent without the scaring: fibroblast Keeps lumen open

53. What is the problem with this? New study shows that if we prevent the growth of scar tissue over the metal, people have a higher incidence of blood clots How does it cause clots? Platelets hit and tear on bare metal releasing enzymes that create clots

54. Patients are also given an anti-coagulant to prevent blood clots Usually given Plavix

55. Beta-Catheter Once used to clear plaque build up with beta particles Problem? Eradication of normal tissue and formation of scar tissue cutting off the blood supply

56. Now used (sparingly) to clear the overgrowth of normal tissue from a stent after angioplasty

57. Basic fibroblast growth factor AND Percutaneous myocardial revascularization Used together and only done in extreme situations

58. Cardiologist uses a laser catheter to bore channels inside the heart Catheter is sent through the femoral artery and into the left ventricle to the ischemic tissue (“oxygen starved”) The hurt muscle (around the channel) sends out a signal to make new capillaries

59. The fibroblast growth factor is administered to stimulate blood vessel differentiation

60. Percutaneous myocardial Revascularization ©http://images.google.com/imgres?imgurl=http://www.cardiogenesis.com/images/DMR.jpg&imgrefurl=http://www.cardiogenesis.com/medical_fa qs.php&h=185&w=185&sz=44&hl=en&start=19&um=1&tbnid=uQKSEKyGfLP6JM:&tbnh=102&tbnw=102&prev=/images%3Fq%3DPercutaneou s%2Bmyocardial%2Brevascularization%26um%3D1%26hl%3Den%26sa%3DN

61. Atherosclerosis ©http://www.chelationtherapyonline.com/articles/images/a_fibrous_combo.jpg

62. Atherosclerotic Plaque

63. http://images.google.com/imgres?imgurl=http://www.technion.ac.il/~mdcourse/274203/slides/Blood_System/14- Atherosclerotic%2520Plaque.jpg&imgrefurl=http://www.technion.ac.il/~mdcourse/274203/lect8.html&h=600&w=800&sz=90&hl=en&start=3&um =1&usg=__cCVgWzZlhdGPi7IV54ai9b2IsDg=&tbnid=r96- Kp5axf5LUM:&tbnh=107&tbnw=143&prev=/images%3Fq%3Datherosclerotic%2Bplaque%26um%3D1%26hl%3Den%26sa%3DG

64. Atherosclerosis ©http://images.google.com/imgres?imgurl=http://www.opt.indiana.edu/v543/slides/99af.jpg&imgrefurl= http://www.opt.indiana.edu/v543/slides/99af.html&h=263&w=350&sz=53&hl=en&start=4&usg=__lzFd NbEAFztEjiRMA65e4WJXXzI=&tbnid=yrmjDcoMbQHPuM:&tbnh=90&tbnw=120&prev=/images%3Fq %3Dathersclerosis%2Bplaque%2Bslides%26gbv%3D2%26hl%3Den%26sa%3DG