Author Ольга Кияница
Atherosclerosis (AS) is a chronic disease of the blood vessels, on the inside of which deposited atherosclerotic plaques. Endothelium arteries under the influence of layers lose their elasticity. Vessels acquire pathological fragility, in addition, the risk of thromboembolism increases because the plaques can partly or completely break away and clog the lumen of the vessel.
In Wikipedia it is noted: "It is important to distinguish atherosclerosis from arteriosclerosis of Menkeberg, another form of sclerotic arterial lesions."
Cardiac arteriosclerosis promotes the onset of coronary heart disease, which often increases the risk of sudden cardiac arrest. Despite the fact that atherosclerosis is more often defined in older people, in the last decades it is substantially "younger", so the signs of the disease are often manifested in 40 years and younger people.
Video: Elena Malysheva. Atherosclerosis
Atherosclerosis develops for many reasons, some of which are associated with predisposing factors, and others - with risk factors. The more etiopathological factors are determined in a particular patient, the higher the likelihood of developing an AS as a coronary heart disease with all its consequences. At the same time, not only the circulatory system of the heart, but also the brain, hands and feet can suffer. It is quite complicated to carry out the AU on the background of diabetes.
Among all the predisposing factors contributing to the onset of atherosclerosis, smoking is considered to be the most dangerous. Also, the development of the AU passes more actively in the presence of hypertension, diabetes, obesity in the patient. In men, in comparison with women, atherosclerosis is more often defined, which may be due to the appearance of the first symptoms in 45 years, whereas in the opposite sex - at age 55, mainly during menopause.
Hyperlipidemia is one of the main risk factors that today plays a major role in the development of the AS. Care should be taken when determining indicators with the following values:
- Total cholesterol is greater than 5 mmol / L.
- LDL (low density lipoprotein) is greater than 3 mmol / L.
- LP (a) (lipoprotein) greater than 50 mg / dl.
The probability of vascular arteriosclerosis is increased with decreased activity, malnutrition, frequent emotional conflicts, and the presence of relatives of such a disease. Some women during the postmenopausal period increase the process of formation of atherosclerotic plaques.
Video Atherosclerosis Formation of an atherosclerotic plaque
The key cause of atherosclerosis is lipid metabolism disorder, which involves changing the ratio of low density lipids and very low density to high density lipids. Normally, the latter must prevail over the previous ones.
There are several stages of atherosclerosis development:
- Stage 1 - the formation of lipid spots. It is asymptomatic and characterized by the formation of yellow-brown strips in the places of defeat.
- Stage 2 is the formation of lipid formation. In the area of lipid spots, inflammation develops, which is accompanied by the destruction of cholesterol formations, followed by encapsulation of fatty deposits and their appearance in the lumen of the vessel.
- Stage 3 - the occurrence of complications. A similar stage is the last in the development of atherosclerosis. Clinical signs begin to be clearly expressed, clots form in various organs and tissues, resulting in complications in the form of stroke or necrosis of tissues.
The development of atherosclerosis is an irreversible process that can extend for both months and years. Much depends on the way of life of the patient, the accompanying diseases, the quality of the therapy.
Atherosclerosis can develop in various parts of the vascular bed.
Atherosclerotic plaques are often diagnosed in the aorta, coronary arteries of the heart, arteries of the brain, arteries of the kidneys, intestines and lower extremities.
Atherosclerosis aorta . It is diagnosed in most cases, since in the abdominal aorta often formed atheromatosis, calving and petrification. May be complicated by thromboembolism, which causes intestinal necrosis, lower limbs or kidney infarction.
Atherosclerosis of the coronary arteries . I can develop various forms of coronary heart disease, but most often myocardium affects myocardial infarction.
Atherosclerosis of the arteries of the brain . It is able to induce the development of acute and chronic cerebrovascular disorders. In the first case, a stroke is formed, and in the second case - an atherosclerotic dementia.
Atherosclerosis of the lower extremities . The femoral artery is mainly affected, which causes the patient to experience pain during walking or develops a severe complication in the form of gangrene of the lower limb.
Atherosclerosis of the renal arteries . In the organ there are wedge-like portions of atrophy of the parenchyma with stromal collapse. Infarctions of the kidney may also develop, which in some cases end with scarring of the affected area.
Intestinal atherosclerosis . It is difficult to flow, as well as other forms of pathology. In the absence of treatment leads to thrombosis of vessels and subsequent gangrene (necrosis) of the organ.
At an early stage, atherosclerosis is not easy to diagnose, so the disease is most often determined in the unopposed form. Important is the correct determination of the affected area, using various methods, including anamnesis and primary screening.
History collection . At the reception of the doctor, a patient is interviewed, during which complaints, the appearance of the first symptoms, the nature of their progress, are clarified. The hereditary factor, which in some cases plays an important role in the development of the disease, is determined. Also, signs of diseases of satellites of atherosclerosis: arterial hypertension, angina pectoris, or a previously infarcted myocardial infarction may be detected. Anamnesis helps to select the direction in which further diagnostics is necessary.
Primary inspection . Conducted after collecting anamnesis. The doctor can conduct functional tests, but his attention may be attracted by the following symptoms of impaired circulation:
- There is no hair on the arms and legs;
- the patient may have insufficient body weight;
- nails are often deformed;
- sebaceous and sweat glands work intensely;
- the presence of edema, even in the absence of kidney disease.
Auscultation of the heart is imperative, during which noise, irregular rhythm can be detected. Blood pressure measurement may indicate an increase in blood pressure.
Appears at the stage of progression of the disease, when vascular changes are so severe that metabolic processes in various organs and tissues are violated. It is worth noting the features of the clinical picture in the heart, brain and upper / lower extremities.
Atherosclerosis of the coronary arteries of the heart manifests pain in 75%. It can be nauseating, pressing or stupid.It is often observed irradiation of painful sensations in the shoulder blade, back, in the left hand. In some cases, pressure in the chest can be felt, maybe difficult breathing (on breath and exhale). The most characteristic symptom is the occurrence of seizures of angina pectoris. Depending on the severity of the course, other symptoms may appear: nausea with vomiting, heart failure, feeling cold, weakness in the extremities.
The cerebral vascular arteriosclerosis has no characteristic symptoms, as blood circulation can be disturbed in other diseases (insufficiency of the vertebrobasilar basin, osteochondrosis, etc.). With a violation of cerebral blood supply, it is observed:
- ringing in the ears;
- high excitability;
- disorder of ability to coordinate movements;
- increased fatigue, lethargy.
The atherosclerosis of the upper / lower extremities is mainly manifested by chilliness in these parts of the body, with the appearance of a feeling of "running ants" on the arms and legs. The skin in these parts of the body is often pale and the vascular pattern appears.
In severe cases, the upper / lower extremity A / C is manifested by the following symptoms:
- The skin is thinning, the hair on it falls, which is due to the degeneration of tissues.
- There are pain in the limbs, which can reach the "intermittent lameness".
- On the skin of the hands and feet there are wounds, resembling trophic ulcers.
- The fungus becomes resistant, because of which the skin acquires a reddish tinge.
- The fabrics can begin to die, which will indicate the development of gangrene.
The severity of the clinic largely depends on the severity of the pathological process. The more active it is and the more serious the defeat, the brighter the clinical picture becomes.
Instrumental survey methods
In case of suspicion of atherosclerosis, the patient gives blood from the vein, in which different parameters are examined (total cholesterol, coefficient of atherogeny, etc.).
The assessment of the circulatory system is carried out by means of radiography and angiography. X-ray images show well-marked atherosclerotic plaques. An angiography uses an contrast agent that makes the blood vessels more visible.
The ultrasound with dopplerometry is carried out, due to which the process of blood flow is measured on a certain vessel. This method makes it possible to detect small deviations, further evaluating the contractile function of the ventricles.
Treatment and prevention
A combined approach to improving the condition of a patient with atherosclerosis is used. Of great importance are non-medicated methods of treatment, pharmacological preparations are obligatory, and if necessary, surgical intervention is used.
Included in the main tactics of exposure to progressive atherosclerosis, also used for preventive purposes. The presented treatment should be carried out for at least six months, and even better its principles to accept as a new, healthier lifestyle. In particular, the following is recommended:
- refuse to smoke;
- to refuse alcohol;
- to refuse from fried and greasy food;
- restrict the use of red meat;
- to lead an active lifestyle;
- if necessary, reduce body mass;
- to maintain psychological and physical comfort.
An anti-atherosclerotic diet plays an important role in non-medicated treatment. It can be represented by the "Mediterranean" diet, which consists of vegetable oils rich in omega-3, as well as raw vegetables and fruits. It is also good to use black bread instead of white, instead of red meat, poultry without fish or fish.
Both symptomatic and etiopathological treatment is carried out. The correction of accompanying atherosclerosis diseases (hypertension, diabetes mellitus, metabolic disorders) is obligatory.
Anti-lipid drugs are divided into four groups:
- Drugs that disrupt cholesterol absorption. These include anion resins (cholestyramine), plant sorbents (guar), blocker Aβ-CoA-transferase. The last resort is on approbation.
- It is divided into several subgroups. IIA - inhibitors of 3-OH-3-methylgluratyl CoA reductase, which are more commonly known as statins. IIB - fibrates (fenofibrate, clofibrate). IIC is nicotinic acid.
- Unsaturated fatty acids. Promote increased high density lipoprotein. This includes Eikonol, Linetol.
- Endothelotropic drugs. Improve the trophy of the endothelium. This includes polyczalan, aevit, and others.
Interventions are conducted in two ways:
- An open way when endarterectomy is carried out.
- Endovascular, that is, for participating in the introduction of balloon catheters, expanding narrowed artery. After expansion, stents are installed.
The method of treatment is selected strictly according to indications, in which considerable importance is attached to the degree of obliteracy, the place of injury.
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