Arteriosclerosis

DEFINITIONS

Arteriosclerosis is a general term for several diseases, where the artery walls become thicker and less flexible.
The disease is most important and most common is atherosclerosis, where fatty material collects under the inner lining of artery walls.

Atherosclerosis can occur in an artery in the brain, heart, kidneys, other vital organs and arms and legs.
When atherosclerosis occurs in arteries leading to the brain (carotid artery), there can be a stroke. If going on in the arteries leading to the heart (coronary arteries), heart attack can occur.

CAUSE

Atherosclerosis begins when white blood cells called monocytes, to move from the bloodstream into the artery wall and transformed into cells that collect fat ingredients.
In time, fat-filled monocytes will be collected, causing patches of thickening on the inner lining of arteries.

Each area of thickening (also called atherosclerotic plaque or atheroma) is filled with soft materials such as cheese, fat contains a number of substances, especially cholesterol, cells and smooth muscle cells of connective tissue.
Atheroma can be spread in the arteries and the arteries are large, but typically they are formed in the fork, probably because of turbulence in this region causing injury to the artery wall, so here is more easily formed atheroma.

Atherosclerosis affected arteries lose elasticity and because atheroma continues to grow, it will be narrowed arteries. Atheroma long gathering of calcium deposits, which become brittle and may break.
Blood can enter into the atheroma that rupture, so that the atheroma becomes larger and more narrow the artery.
Atheroma that rupture could also shed fat and trigger the formation of a blood clot (thrombus).This clot will further refine even clog the arteries, or the clot is released and flow with the bloodstream and cause blockages elsewhere (embolism).

Increased risk of atherosclerosis in:
- High blood pressure
- High cholesterol
- Smokers
- Diabetes (diabetes)
- Overweight (obesity)
- Lazy exercise
- Old age.
Men have a higher risk than women.

Patients with hereditary disease has homosistinuria widespread atheroma, particularly at a young age. The disease is about a lot of arteries but not always on the coronary arteries (arteries that leads to the heart).
In contrast, the hereditary disease, familial hypercholesterolemia, the cholesterol is very high which causes the formation of more atheroma in coronary arteries other than arteries.

Arterial cross-section - aterosklerosis1.jpg
Plaque & blood clot - Aterosklerosis.jpg

SYMPTOMS

Before the occurrence of arterial narrowing or blockage of a sudden, atherosclerosis usually does not cause symptoms.
Symptoms depend on the location of the formation, so that symptoms can include heart, brain, legs or other places.

If atherosclerotic narrowing of the arteries causing a very heavy, so the body will not get diperdarahinya blood in sufficient numbers, which carry oxygen to the network.
The initial symptoms of the narrowing of arteries can be a pain or cramps that occur when blood flow is not sufficient need for oxygen. For example, during exercise, a person may feel chest pain (angina) because of oxygen to the heart decreases, or when walking, a person to feel cramps in the legs (claudication interminten) because the flow of oxygen to the legs decreased.

Characteristic is that these symptoms occur gradually, in line with the narrowing of the arteries by atheroma that also took place gradually. But if the blockage occurs suddenly (for example, if a clot blocking an artery), the symptoms will occur suddenly.

Diagnosis

Before the occurrence of complications, atherosclerosis may not be diagnosed.
Before the occurrence of complications, terdengarnya bruit (sound blows) on examination with a stethoscope can be an indication of atherosclerosis.
Pulse on the affected area can be reduced.

Inspection can be done to diagnose atherosclerosis:
- ABI (ankle-brachial index), blood pressure measurements were taken at the ankle and arm
- Doppler examination in the affected area
- Duplex ultrasound Skening
- CT scan in the affected area
- Magnetic resonance Arteriografi
- Arteriografi in areas affected by
- IVUS (intravascular ultrasound).

TREATMENT

To a certain extent, the body will protect itself by forming new blood vessels in the affected area. Before the occurrence of complications, atherosclerosis may not be diagnosed.
Before the occurrence of complications, terdengarnya bruit (sound blows) on examination with a stethoscope can be an indication of atherosclerosis.
Pulse on the affected area can be reduced.

Inspection can be done to diagnose atherosclerosis:
- ABI (ankle-brachial index), blood pressure measurements were taken at the ankle and arm
- Doppler examination in the affected area
- Duplex ultrasound Skening
- CT scan in the affected area
- Magnetic resonance Arteriografi
- Arteriografi in areas affected by
- IVUS (intravascular ultrasound).

Can be given drugs to reduce levels of fat and cholesterol in the blood (eg colestyramine, kolestipol, nicotinic acid, gemfibrozil, probukol, lovastatin).
Aspirin, ticlopidine and clopidogrel or anti-coagulant could be given to reduce the risk of blood clots.

Performed balloon angioplasty to flatten plaque and increase blood flow through the deposition of fat.
Enarterektomi is a surgery to remove the sediment.
Bypass surgery is a highly invasive procedure, in which an artery or vein from the patient normally used to create a bridge to avoid a clogged artery.

PREVENTION

To help prevent atherosclerosis, which must be removed are the risk factors.
So depending on the risk factors that have, one should:
- Lower blood cholesterol
- Lower blood pressure
- Stop smoking
- Losing weight
- Exercise regularly.

To people who previously had a high risk for heart disease, smoking is dangerous because:
- Smoking can reduce the levels of good cholesterol (HDL cholesterol) and raise levels of bad cholesterol (LDL cholesterol)
- Smoking causes increased levels of carbon monoxide in the blood, thereby increasing the risk of injury to the artery wall lining
- Smoking will narrow the arteries that had been narrowed because of atherosclerosis, thus reducing the amount of blood to the tissue
- Smoking increases the tendency of blood to form clots, thereby increasing the risk of peripheral arterial disease, coronary artery disease, stroke, and blockage of an artery graft after surgery.

Risk of a smoker to suffer from coronary artery disease is directly related to the number of cigarettes smoked per day. People who quit smoking have half the risk of those who continue to smoke, regardless of how long they had smoked before.
Quitting smoking also reduces the risk of death after coronary artery bypass surgery or after a heart attack. In addition, stopping smoking also reduces the risk of illness and death in someone who has atherosclerosis in the arteries other than arteries to the heart and brain.