ATHEROSCLEROSIS - Cardiology


ATHEROSCLEROSIS (Vessel Stiffness): "Atherosclerosis", which is colloquially known as vessel stiffness, is a vessel disease characterized with loss of elasticity in arteries resulting with thickening.

Arteries carry the blood which is necessary for the body to survive to organs. Arteries have 3 layers. Sometimes, the innermost layer is damaged under effects of some factors and the substances in blood such as cholesterol, coagulation factors, etc. start to accumulate in this damaged area. While cholesterol accumulates in the vessel wall, the vessel becomes thicker and inner volume of the vessel becomes narrow, so blood flow decreases.


Which organs are affected?

Atherosclerosis (vessel stiffness) concerns not only heart vessels, but also brain and renal arteries as well as other vessels. Death from cardiac and arterial diseases accounts for 34% of all deaths in Turkey. If the blood supply to the myocardium decreases due to atherosclerosis or another reason, myocardium cannot be oxygenated at sufficient level and the ischemia (lack of blood supply to the tissues) develops. İschemia leads to coronary heart disease. Myocardial (muscular) layer of the heart cannot contract sufficiently since it cannot get adequate blood supply and this manifests itself in the patient as angina pectoris (chest pain). The most severe event in the patient with coronary heart disease is that no coronary arteries can provide adequate blood supply (thus, adequate oxygen) to the heart muscle and thus, the heart cannot contract and pump blood to the body. This case is myocardial infarction which is known as heart attack.

Symptoms of the coronary heart disease

• Chest pain (it may spread to left shoulder, left arm and back)

• Limited exercise capacity; getting tired quickly • Difficulty in breathing (dyspnea) during exercise

• Fainting

• Sudden death

Diagnostic methods of the Coronary Heart Disease:The methods used in the diagnosis of CHD include physical examination, blood analysis, ECG (electrocardiography), effort test, echocardiogram, Holter monitoring, SPECT (myocardial perfusion scintigraphy) and the coronary angiography. Coronary angiography is the most accurate diagnosis method.

It is the process of imaging the vessels which supply blood the heart (coronary vessels) and the left chamber of the heart. Coronary arteries are radiologically imaged by administering a contrasting substance given from a thin guide wire which is advanced to heart vessels through arteries located in inguinal region or arms by using local anesthesia. The purpose of this process is to reveal out whether there is a constriction or obstruction in the arteries supplying blood to the heart.

Treatment of the Coronary Heart Disease:

The treatment continues lifetime because coronary heart disease is a chronic and progressive disease. Following the Coronary Angiography, the result may indicate that your vessels are normal or one of the treatment options such as medication, balloon treatment (PTCA) or surgery (coronary bypass) may be suggested.

I -Medication: The medication used in patients with coronary arterial disease targets to prevent episodes of angina pectoris by enlarging coronary arteries or reducing the oxygen need of the heart. In addition, blood diluents and anticoagulant drugs (aspirin and others) also reduce the risk of the heart attack.

2-Balloon Angioplasty (PTCA) and Stent: This method is generally preferred in subjects with the disease in one or two arteries. The process is a continuum of the coronary angiography; guide wire is advanced inside the artery and when it is close to the obstruction site, the little balloon on the catheter is inflated. The inflated balloon opens the obstruction site and then the balloon is deflated and pulled back. This process is referred briefly as balloon angioplasty. In order to prevent recurrence of the obstruction (stenosis) along the same vessel following the balloon angioplasty, a metal device is inserted, which is bio-compatible, is in the form of a mesh tube and has same diameter with the artery and this device is referred as stent. It is reported that there is risk of recurrence within the first 6 months in 20-30% of these cases. The reason is excessive proliferation of the muscle cells on the vessel wall. It is found that drug eluting stents reduce the risk of recurrent obstruction, following insertion of the stent, to 5 percent.

3-Coronary Bypass Surgery: Surgical treatment is employed in the case of pathology in the left main coronary artery or if there is a problem in all 3 main coronary arteries or when the functionality of the heart chamber fails which performs the pumping function. This surgery includes bypassing the blood flow in stenotic region and directing the flow ahead of the obstruction site. In coronary bypass surgery, blood flow to the regions which cannot be supplied blood by the defective coronary vessel is restored using veins referred as saphenous veins or the arteries located on both sides of sternum (the breast bone).

Risk Factors of the Coronary Heart Disease

  • A-Unchangeable (unpreventable) risk factors:
  • B-Changeable (preventable) risk factors:

• Advanced age: Age of 45 years for male and 55 years or the postmenopausal period for female

• Gender: It is more common in men.

• Heredity: Familial history of the disease.

• Smoking

• Hypertension: Blood pressure over (140/90 mmHg).

• Diabetes: Diabetes mellitus

• Stress

• Blood level of "Total Cholesterol" over (200mg/dL)

• Blood level of "HDL Cholesterol" below (35mg/dL)

• Others: Overweight (or obesity), inactive life, gout disease, excessive consumption of alcohol


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