Coronary arteries

Arteriosclerosis. It is the loss of the elasticity and thickness of the arteries, making blood circulation more difficult. It is a general term used in both human and veterinary medicine.

Summary

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  • 1 Terminology
  • 2 History
  • 3 Atheroma Plates
  • 4 Morphology
  • 5 risk factors
    • 1 Not modifiable
    • 2 Modifiable
    • 3 Other factors with effect
  • 6 main symptoms
    • 1 Signs of atherosclerosis
  • 7 Main causes
  • 8 Types of Arteriosclerosis
  • 9 To prevent arteriosclerosis
  • 10 Treatment
  • 11 Some useful tips
  • 12 Sources

Terminology

The terms arteriosclerosis, arteriolosclerosis and atherosclerosis are similar both in writing and in meaning, although they are undoubtedly different. Arteriosclerosis is a generalized term for any hardening with loss of elasticity of the arteries, the word comes from the Greek artery, which means “artery” and sclerosis which means “scar, stiffness”. Arteriolosclerosis is used exclusively for the hardening of arterioles or small-caliber arteries. Atherosclerosis is a hardening caused specifically by atheroma plaques.

History

It is called the degenerative and proliferative processes of the arterial wall combined with induration, loss of elasticity and reduction of lumen. The primary degenerative processes appear in the intima and in the media . These injuries are more frequent in old animals. There is a predilection for the abdominal aorta, although other sites may be affected. The consequences are: Thrombosis , Aneurysms and Rupture with hemorrhage .

MACRO, plaques of various sizes appear, with slight thickening and folding of the intima, or whitish oval or linear elevations. The consistency is firm, but brittle. MICRO, the intimate elastic membrane shows the most characteristic changes with irregular contours, partial duplications and fragmentations, there is proliferation of smooth muscle cells in the middle layer and collagen transformation and presence of elastic tissue. The vascular endothelium is not affected. Cartilage metaplasia may occur .

Atheroma Plates

Arteriosclerotic disease begins in all individuals, regardless of the place of origin, in the first 20 years of life and in the same way. Initially, a very benign small plaque develops, the so-called fatty stria, which can be found in the first years of life in large and medium arteries such as the aorta and the coronary arteries. These stretch marks can disappear or evolve very slowly and cause the formation of atheroma plaques.

Morphology

They present a soft, lumpy and yellowish central nucleus, formed by lipids (cholesterol and its esters), covered by a fibrous layer. They usually only appear occupying a part of the circumference of the arterial wall, in the form of patches, variable throughout the vessel. Initially scattered, but increase in number as the disease progresses.
In advanced cases, a calcification process of the plaques is observed that increases the risk of acute plaque change:

  • Rupture of the plaque, ulceration or erosion can occur, causing the exposure of thrombogenic agents and can cause the appearance of a thrombus and block a vessel located in front of the plaque area, which would cause a lack of supply blood in the area supplied by the corresponding artery (ischemia), which can be fatal if the blockage takes place in a coronary artery or in a cerebral artery;
  • Hemorrhage can occur inside the plate, due to rupture of the capillaries inside it, which can lead to a bruise and favor the rupture of the plate.
  • Vasoconstriction of the affected area can also favor the rupture of the plaque.
    The key processes of atherosclerosis are thickening of the intima and accumulation of lipids.
    Location

Atheroma plaques have a characteristic distribution, since they appear mainly in the great arteries, in areas of turbulent blood flow, especially:

  • The abdominal aorta, more frequently than the thoracic aorta;
  • Especially in the orifice of origin (ostium) of the major arterial branches.
  • In descending order (after the abdominal aorta), the most commonly affected vessels are: either the coronary arteries, or the internal carotids, or the Willis polygon vessels, a set of arteries that supply blood to the brain.
  • Normally, the vessels of the upper extremities are not affected, as well as the mesenteric arteries (superior and inferior) and the renal arteries (with the exception of their respective ostia).
  • In the same individual, several lesions usually coexist at different stages of evolution.

Risk factor’s

This disease is the main cause of death in western, developed or first world countries, that is, North America , Europe and Australia , associated with an unhealthy lifestyle. Risk factors for the development of atherosclerosis can be grouped into two categories, depending on the possibility of acting on them.

Not modifiable

  • Age has a dominant influence. Death rates from ischemic heart disease (for example, myocardial infarction) increase throughout life, even in old age. Atherosclerosis is not normally evident until mid-life or later, when arterial injuries cause organ damage. Between 40 and 60 years of age, the incidence of myocardial infarction multiplies by five.
  • Sex hormones. Male hormones are atherogenic, while estrogens protect against atherosclerosis, which is why in women the rate of atherosclerosis-related diseases increases after menopause.
  • Family history and genetic alterations. The family predisposition to atherosclerosis and ischemic heart disease is well defined and probably polygenic (that is, several genes are involved). Genetic propensity is normally associated with other risk factors, such as hypertension or diabetes, and less frequently with alterations in lipoprotein metabolism, which produce high blood lipid levels, as occurs in familial hypercholesterolemia.

Modifiable

  • Hyperlipidemia or increased level of lipids in the blood. It is the highest risk factor for atherosclerosis. Most of the evidence refers to hypercholesterolemia, that is, cholesterol levels in the blood. The main component of serum cholesterol associated with an increased risk are low-density lipoproteins, or LDL, which have a fundamental physiological role in the transport of cholesterol to peripheral tissues. However, high-density lipoproteins, or HDLs, protect against atherosclerosis by removing cholesterol from tissues and atheromas to carry it to the liver, where it is excreted with bile.

That is why HDL is called “good cholesterol”: the higher the HDL level, the lower the risk, and vice versa for LDL. Exercise and moderate alcohol consumption increase the HDL level, while obesity and smoking decrease it. A diet rich in cholesterol and saturated fatty acids (present in egg yolk, animal fats, and butter) increases LDL levels. Conversely, a diet low in cholesterol and low in the ratio of saturated and unsaturated fatty acids causes a reduction in LDL levels. What’s more, omega-3 fatty acids, abundant in fish oils, are probably beneficial, while transaturated fats produced by artificial hydrogenation of vegetable oils (used in baked goods and margarines) can adversely affect cholesterol levels. Drugs called statins decrease circulating cholesterol levels by inhibiting a key enzyme of cholesterol biosynthesis in theliver , HMG-CoA reductase.

  • High blood pressure (HT), one of the main risk factors at any age, alone responsible for a 60% increased risk of cardiovascular disease. HT is the main cause of ventricular hypertrophy, related to heart failure. Men between 45 and 62 years of age whose blood pressure (Pa) is above 169/95 mmHg have a five times greater risk of cardiovascular accident than those with a Pa of 140/90 mmHg or less. Both an increase in systolic and diastolic pressure are important in increasing risk. An increase in Pa causes shear forces that break the fragile endothelium that lines the inner surface of the arteries. Antihypertensive treatments reduce the incidence of diseases related to atherosclerosis,
  • Toxic substances in tobacco such as nicotine have a direct toxic effect on the wall of the arteries, causing an inflammatory response. Smoking a pack of cigarettes or more a day doubles the death rate from cardiovascular disease. Quitting smoking lowers the risk significantly.
  • Mellitus diabetes. Diabetes induces hypercholesterolemia, and an increased predisposition to atherosclerosis. The incidence of myocardial infarction is double in diabetics, and a 100-fold increase in the frequency of lower limb gangrene induced by atherosclerosis is observed.

Other factors with effect

  • Sedentary life, with little physical exercise, since it modifies many risk factors, and ultimately reduces the inflammatory response in the wall of the arteries.
  • Stress, associated with a competitive lifestyle (“type A” personality).
  • Obesity, often associated with hypertension, diabetes, hypertriglyceridemia, and low HDL levels.
  • Chlamydia pneumoniae infections.

Main symptoms

The symptoms of arteriosclerosis vary according to the arteries involved. Signs of inadequate blood supply usually appear first on the legs. There may be numbness and cold in the feet, and leg cramps and pain even after a little exercise, numbness and tingling of the hands, feet and face, weakness, heaviness of the legs, pain when walking, speech disorders, vision disturbances, difficulty swallowing, pain in the left arm, shortness of breath when exercising, difficulty urinating.

If the coronary arteries are involved, the patient may have sharp pains, characteristic of angina. When the arteries leading to the brain are involved, the vessels can burst, causing bleeding in the brain tissues. A cerebrovascular attack, with partial or complete paralysis on one side of the body, can result if there is a blockage with a blood clot. It can also lead to memory loss and a confused state of mind in the elderly. If the arteries leading to the kidneys are involved, the patient may suffer from high blood pressure and liver disorders.

Signs of atherosclerosis

  • High blood pressure.
  • LDL and total cholesterol raised above 200-250 mg / dl.
  • Triglyceride values ​​above 150mg / dl.

Main causes

  • Old age. It generally begins to manifest itself from the age of 50.
  • Inadequate diet with excess fats, sugars and foods rich in cholesterol.
  • Alcoholism and smoking
  • Stress .
  • Lack of exercise.
  • Genetic predisposition.

Types of Arteriosclerosis

  • Atherosclerosis, is the most frequent form of arteriosclerosis, characterized by a thickening of the intimate tunic with plates containing macrophages full of lipids, fats, mainly cholesterol.
  • Arteriosclerosis obliterans, a specific form of arteriosclerosis of the arteries of the lower extremities, common in adults over 55 years of age, characterized by fibrosis of the layers of the arteries with obliteration and considerable narrowing of the lumen of the vessel.
  • Monckeberg sclerosis, rare, seen especially in the elderly, and which generally affects the arteries of the thyroid gland and uterus and rarely narrows the arterial lumen.
  • Hyaline arteriosclerosis or nephrosclerosis, refers to the thickening of the walls of the arteries due to the deposit of hyaline material (The word hyaline is derived from the Greek hyalos, which means glass), generally seen in patients with kidney and diabetic pathologies.
  • Sclerosis of old age, in which a remodeling of the great arteries is naturally observed as age increases, characterized by arterial stiffness and associated with systolic hypertension.

To prevent arteriosclerosis

Aerobic exercises, a way to avoid arteriosclerosis

We can not do anything to avoid the passage of time, change the genetic load or sex, but we can influence the development of arteriosclerosis by acting on risk factors. Healthy habits to prevent atherosclerosis:

  • Physical activity. Physical exercise practiced regularly, three weekly sessions of 50-60 minutes, preferably of the aerobic type such as walking, brisk walking, cycling, running, swimming … It does not need to be strenuous or fatigued, moderate exercise offers magnificent results.
  • Heart-healthy diet. Correct caloric intake. Vegetable foods such as legumes, fruits, vegetables, rich in antioxidant substances (vitamins A, E, C,) are highly recommended. Folic acid, present in green leafy vegetables, nuts or vegetable oils, has an important role in prevention, as do omega-3 fatty acids, which is found in blue fish. Tea and wine (consumed moderately) also contain antioxidants as powerful as vegetables and fruits. Olive oil is preferable to other types of oil. We must reduce the consumption of foods rich in cholesterol and saturated fats: eggs, whole milk, fatty meats, sausages, organ meats.
  • Controlling stress. Stress has a detrimental effect on arteriosclerosis. It is not easy in today’s society to avoid stressful situations, so it is necessary to combat emotional tension through relaxation techniques. They are easy to carry out and very effective.
  • Combat excess weight. Obesity is usually accompanied by hypertension, increased cholesterol and uric acid, diabetes … In many cases, by reducing weight, these abnormalities are totally or partially corrected. This is why maintaining a correct body weight is so important.
  • Control high blood pressure. In most cases hypertension is slight and can be controlled with healthy hygiene habits: exercise, diet, relaxation … Only when the numbers are very high permanently can pharmacological treatment be required.
  • Give up smoking. Tobacco which has a very harmful effect not only on arteriosclerosis, but also on other diseases.

Treatment

There is no proven medical treatment for arteriosclerosis despite being the drug most probably sought after by the pharmaceutical industry.

Pharmacological treatment (antihyperlipidemic, antiplatelet or anticoagulant) serves to reduce its causes or consequences.

Surgical treatment is very decisive in ischemic heart disease and also in other locations.

Prophylactic treatment consists of avoiding the predisposing factors of the disease and its complications: obesity, hypertension, sedentary lifestyle, hyperglycemia, hypercholesterolemia, smoking, etc.

For this, the ideal is to practice gentle exercise, a balanced diet such as the Mediterranean, low in fat, relaxation techniques to avoid stress, stop smoking, etc.

Some useful tips

One of the most effective home remedies for arteriosclerosis is lemon peel. Strengthens the entire arterial system. The grated lemon peel can be added to soups and stews, or drizzled over salads. To make a medicine, the peel of one or two lemons must be thinly cut, covered with warm water and left to subtract for about twelve hours. A teaspoon of tea can be taken every three hours, or immediately before or after a meal.

Parsley is another effective remedy for arteriosclerosis. It contains elements that help keep blood vessels, particularly capillaries, and the arterial system in a healthy condition. It can be ingested as a tea: a teaspoon of dried parsley should be simmered in a full cup of water for a few minutes. This can be ingested two to three times per day.

Beet juice, ingested daily, has been found valuable in arteriosclerosis. It is an excellent solvent for inorganic calcium deposits. Carrot and spinach juices are also beneficial if ingested once a day. These juices can be ingested individually -500ml, or as a combination. When ingested as a combination, they should be in the following proportion: carrots -300ml and spinach -200ml to prepare 500ml of juice.
The honey is considered beneficial in the treatment of atherosclerosis. It is easily digested and assimilated. The patient should drink a glass of water with a teaspoon of honey tea and another of lemon juice in it, before going to sleep. You can also ingest it if you wake up at night.

The herb psyllium husk, botanically known as Plantagoovata, has been found valuable in arteriosclerosis. The oil from the seeds of this silver must be used. It contains 50% linoleic acid, an unsaturated harrow, and is, therefore, useful in the prevention and treatment of this disease.

Smoking, if habitual, should be stopped as it constricts the arteries and aggravates the condition.

The patient should exercise abundantly outdoors and learn to calmly take mental stress and worries.

 

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