ARTHEROSCLEROSIS

DEFINITION:-

It is defined as accumulation of fat in wall of blood vessels (artery or veins) or hardening of blood vessels due to increase level of cholestrol in blood or serum.

CAUSES:-

  • Smoking
  • Genetic
  • Enviromental
  • Elevated serum cholestrol
  • Diabetes
  • Hypertension
  • Stress
  • obesity
  • Physical inactivity.

    PATHOPHYSIOLOGY:-

      There are so many theories of pathogenesis, but here we are discussing about response to injury theory.

      Non-specific injury (due to mechanical, chemical, hormonal, immunologic, hypertension. smoking, cholestrol etc.
      ↓
      Inflammation in intima layer in vessels
      ↓
      Continued exposure to source of intimal injury results in continued deposit and proliferation of smooth muscle cells
      ↓
      Formation of plaque (Artheromas)
      ↓
      Narrowing and obstructing blood flow

    Based on affected area

    1. Brain (Cerebral-arteriosclerosis)
      • Transient ischemic attacks (TIA)
    2. Heart (CAD)
      • Angina Pectoris
      • MI
      • Heart failure.
    3. Kidneys (Renal artery stenosis)
      • Renal insufficiency
      • Hypertension.
    4. Extremities (lower extremities arterial occulsive disease)
      • Pain in muscles
      • Pain at rest
      • Tissue loss (with or without infection or gangerene).

    DIAGNOSTIC EVALUATION:-

    • History collection
    • Arteriography
    • CT (Computed tomography)
    • MRI
    • MRA (Magnetic Resonance Angiography)
    • ECG
    • Echocardiogram.

    COMPLICATIONS:-

    • Stable And Unstable Angina
    • MI
    • Heart failure
    • Aneurysm
    • Renal failure.

    MEDICAL MANAGEMENT:-

    1. Anticoagulant or antiplatelet therapy, e.g., Streptokinase, Aspirin.
    2. Lipid lowering agent
      • Nitcotinic acid (niacin) (It decrease synthesis of LDL, cholestrol, triglycerides)
      • fibric acids.
      • Fenofibrate (reduce synthesis of cholestrol).
      • HMG-Co-Enzyme reductase
        • Lovastatin
        • Atrovastatin
        • Simvastatin: They decrease triglycerides, LDL, level in serum also decrease synthesis of cholestrol.)

SURGICAL MANAGEMENT:-

  • Main surgery is PTCA (Percutaneous Transluminal Coronary Angioplasty)
    • It is a surgical technique in which balloon-tipped catheter is inserted and floated into a blocked coronary artery andthen inflated to mechanically dilate the artery and help to ease blood flow.
  • CABG (Coronary artery bypass grafting).

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