Plaques in the artery walls are a risk factor for heart attacks and other cardiovascular events. What are problems that could stem from atherosclerosis?
Many patients would have been told by a doctor about their cholesterol levels and blood pressure. Over the years, there has been more general awareness about hypercholesterolemia and hypertension being risks for heart attacks and strokes. Diabetes as another risk factor is becoming common knowledge as well.
Even so, heart disease is still a major cause of death. It will likely stay that way with current obesity rates. This may be a good time to closely examine atherosclerosis, the presence of plaques in the artery walls.
Process of Atherosclerosis
Arteries are pipes with three layers: an innermost layer, a middle muscular layer, and an outer layer for further support. The first step is injury to the inner cell lining. Hypertension, hypercholesterolemia, diabetes, and tobacco smoke can do this. Once that happens, various substances like cholesterol, cellular debris, and calcium seep into the artery wall, forming a plaque. As long as these risk factors go unchecked, the plaque will grow in size until tissue downstream has trouble receiving blood (ischemia). What happens from there depends on which artery is involved.
Coronary Artery Disease
The heart has its own arteries, the coronary arteries, so that it can pump oxygenated blood to itself. If an artery is narrow enough, part of the heart may not get enough blood during increased physical activity. The result is chest pain that goes away with rest. This is called stable angina. When there is more frequent chest pain with less physical activity than before or chest pain even at rest, it becomes unstable angina.
In the worst case scenario, the plaque ruptures and platelets clump at the site, large enough to obstruct blood flow significantly. Cardiac muscle downstream would be deprived of blood and soon die. This is called myocardial infarction, tissue death of heart muscle. A layperson calls it a heart attack. Scar tissue eventually develops and takes the place of muscle. The heart becomes weaker overall, leading to congestive heart failure down the line. Scarring can also affect the heart's electrical system, producing one of many possible abnormal heart rhythms.
Transient Ischemic Attack and Stroke
Atherosclerosis can involve the carotid artery in the neck or in one of the arteries in the brain. Neurological effects like arm and leg weakness, slurred speech, and numbness occur depending on which part of the brain is affected. If the effects are temporary and go away in less than 24 hours, it is called a transient ischemic attack. If the plaque ruptures and forms a clot occluding blood flow, the affected brain tissue may die and the neurological changes may last much longer, sometimes permanently. This is called an ischemic stroke.
Abdominal Aortic Aneurysm
Plaques can form in the aorta, the large artery coming up the heart and down through the chest and abdomen. Atherosclerosis in the abdominal aorta can weaken the artery wall so that pressure from the blood can stretch a wall segment like a balloon. This is called an aneurysm. If it widens enough, there is a risk of rupture and bleeding requiring surgical intervention.
Mesenteric Ischemia
The mesenteric arteries supply the intestines and they, too, can be prone to decreased blood flow from atherosclerosis. The result is either temporary abdominal pain with eating or longer lasting pain when an artery is completely occluded and a segment of intestine dies. While this is rare, the consequences can be serious and life-threatening. With intestinal tissue death, bacteria that normally live in the intestines can make its way into the bloodstream or into the abdominal cavity if the intestine perforates. Intestinal bleeding is another complication.
Peripheral Vascular Disease
Plaques in the arteries going into the legs can produce leg pain from walking (claudication). If it is severe, this pain can occur with just standing. Poor vasculature to tissues can lead to ulcers in the skin or gangrene of the toes and feet requiring amputation.
Final Words
Atherosclerosis is a single process with multiple consequences, but it is also a preventable one. By paying attention to good health, one can increase the chances of living a longer and healthier life.
