Atherosclerotic plaques

When atherosclerosis - a chronic lesion of the arteries - sooner or later inevitably formed atherosclerotic plaques, narrowing the arterial lumen and provoking the emergence of a gradually increasing circulatory deficit in a certain area. Why do they appear? How to prevent their development? What if the vessels are already affected? For these and other questions, we will help you find the answer in this material.

Code on the ICD 10:

• atherosclerosis I70;
• aortic atherosclerosis I70.0;
• atherosclerosis of the renal artery I70.1;
• Atherosclerosis of arterial vessels of extremities I70.2;
• atherosclerosis of other arterial vessels I70.8;
• generalized and unspecified form of atherosclerosis I70.9.

[1], [2], [3], [4], [5], [6]

The appearance of plaques in atherosclerosis: the causes

Plaques are cholesterol deposits on the vascular artery wall. By appearance they resemble small tubercles, or outgrowths. At the moment, a large number of different assumptions regarding the causes of the formation of these growths are considered, but the most significant of these is the increased content of cholesterol in the bloodstream.

It should be noted that, in addition to cholesterol, its components (fractional constituents) also play an important role. Many of them behave quite negatively and provoke the development of atherosclerotic changes in all vascular walls. But there are also such factions that try to prevent the negative effects of the first components on the vessels. For a more accurate and visible assessment of the degree of vascular damage, specialists use the so-called "atherogenicity index", the normal index of which should not exceed a number of 3. It is determined in a laboratory way by donating blood to the lipid spectrum.

It is important to note that growths are formed not only in the arteries that are related to the heart, but in any other vessels. The nature of the developing disease and its clinical picture depend on the organ near which the most vascular lesion occurs.

Each patient has its own peculiarities of atherosclerosis development. Factors that can directly affect the rate of plaque formation are identified:

• overweight;
• abuse of animal fats;
• nicotine dependence;
• high blood pressure;
• binge eating;
• passive way of life;
• diabetes mellitus or excessive intake of simple sugars.

If you do not make an effort and do not eliminate the above factors, then sooner or later, atherosclerosis will necessarily make itself felt.

How Plaques Occur: Pathogenesis

For the successful deposition of fats on the walls of the arteries, it is necessary that some favorable conditions are present in the vessel - for example, a slight defect in the vascular wall, or a delayed blood flow at a certain site. Most often this problem arises in the branching of the artery. In this case, the wall of the vessel becomes swollen and friable.

The duration of this stage can be different, because in a healthy body wall enzymes inhibit the deposition of fats, dissolving them - this process can be observed even in one-year-old children. If protective mechanisms fail, the formation of complex compounds begins, which consist of proteins, lipids, cholesterol, and in the complex of such interaction deposits on the vascular wall begin.

Subsequently, where there was a fat deposit, there is an increase in fresh connective tissue, a development of liposclerosis is observed. Over time, the built-up edge becomes more and more formed. The structure of the atherosclerotic plaque is the core and outer layer (the tire), which consist of fats and connective tissue fibers.

The composition of the nucleus is some of the free cholesterol with ethers. Around the nucleus there are "foamy" cellular structures - macrophages containing fats. Over time, fats pass into the nucleus, destroying macrophages.

The outer layer is part of the build-up that protrudes into the lumen of the vessel. It is a fibrous shell with collagen fibers and elastin, the percentage of which directly affects the tendency of the tire to tear.

Initially, the growths have a semi-liquid consistency and are still amenable to dissolution. However, this does not make them less dangerous. Due to their weak density and looseness, the build-up elements can be detached, which can lead to blockage of the arterial lumen. Than it threatens: loss of a vascular elasticity, damage of vessels, formation of clots of a blood - thrombuses. All this only aggravates an already problematic situation.

Over time, the cover of the atherosclerotic plaque is compacted, calcium salts are deposited in it. The final stage of its formation begins - atherocalcinosis. Calcined atherosclerotic plaque already has its stability and slow growth, which gradually leads to deterioration of blood flow and supply in this area.

There is also such a thing as a heterogeneous atherosclerotic plaque. This plaque can be attributed to the complicated course of the disease, as it is characterized by the presence of ulcers and hemorrhages, uneven contours and loose depressions.

Plaques in atherosclerosis are stable and unstable, which depends on their structure, volume and structure.

Stable atherosclerotic plaque is characterized by constancy and slow progression over long years. Contains a large amount of collagen, which makes its walls elastic and not rupturable.

Unstable atherosclerotic plaque is rich in lipids. It tends to rupture and denude the endothelium, which leads to the formation of a thrombus overlapping the affected vessel.

The rupture of an atherosclerotic plaque can occur without any special symptoms. The further clinical picture and condition of the patient will depend on the rate of formation and localization of the subsequent thrombus.

"Long-standing" calcified outgrowths do not pose such a danger as semi- liquid ones, since they are not prone to ulceration, but practically do not lend themselves to involution. In most cases, atherosclerotic changes are irreversible and lead to prolonged tissue ischemia, the development of heart failure, IHD, heart attack or arrhythmia.

The most significant stages of atherosclerotic plaque development can be characterized as follows:

• accumulation in the vascular wall and the formation of fatty "spots";
• the involvement of cells of inflammation in the process are monocytes and T-lymphocytes;
• migration of monocytes to the arterial wall, the formation of foam cells, deformation of the endothelium;
• attraction to the damaged area of platelets;
• reaction to damage - isolation of mediators of cellular defense and growth factors;
• enhanced production of collagen and elastin, their accumulation and the appearance of endothelial tubercles in the vascular lumen;
• seal and increase the size of the built-up edge.

What signs can indicate the appearance of plaques?

Symptoms of the formation of atherosclerotic changes in the vessels may not appear for a long time, because a decrease in the lumen due to build-up is a rather slow and prolonged process.

Symptoms of lesions may vary, depending on the location of the problem areas, the size of the deposits and other factors.

The adulthood can not be destroyed for a long time and stay in one place, gradually increasing only to a certain size. In this case, there may not be signs of vascular damage.

If the plaque grows relentlessly, lowering the degree of blood flow in the organs and tissues, then such a sign of the disease as soreness (especially after physical exertion, with the acceleration of blood circulation) can be observed.

Another variant of the symptomatology is observed in the case when the build-up decomposes, and its elements migrate along the vascular network. At the site of the destroyed plaque, a thrombus is formed, which increases the chance of blockage of the vascular lumen. Such a condition can trigger the occurrence of a heart attack or stroke (with blockage of coronary and cerebral vessels).

Absolutely all symptomatology in case of lesion with atherosclerosis consists of signs of circulatory disorders and nutrition of certain organs and systems of the body.

Next, consider the likely clinical picture of atherosclerotic lesion, depending on the localization of vascular lumen disturbance.

Atherosclerotic plaques of the carotid often go asymptomatically, which, of course, can cause a number of complications. But, carefully listening to your body, you can see some signs of atherosclerosis.

For example, periodically there may be ischemic attacks, which are manifested:

• a sharp general weakness;
• numbness;
• sensation of "crawling crawling" in one upper or lower limb, or in the left or right half of the body;
• confusion of speech;
• numbness of one limb;
• impaired vision in one eye.

These signs are already considered a serious reason to call a doctor.

Atherosclerotic plaques in the aorta can give different symptoms depending on in which of the aortic areas they are located - in the thoracic or in the abdominal.

With thoracic localization there may be strong painful sensations that last for several hours or days. The pain appears behind the sternum, or in the region of the heart, sometimes gives in one of the extremities, the shoulder region, neck, scapula. Such pain, unlike cardiac, can not be eliminated by taking nitroglycerin. Over time, dyspnea, heart failure, an increase in upper blood pressure may appear. Developing signs of cerebral ischemia:

• impaired consciousness;
• blushing of the face;
• pain in the head;
• memory impairment;
• increased fatigue;
• muscle cramps when moving head.

With lesions of the abdominal aorta, there are disorders from the abdominal organs:

• unreasonable pain in the navel (may be accompanied by flatulence and obstructed bowel movements);
• loss of appetite and, accordingly, weight;
• impotence, infertility;
• intermittent claudication;
• numbness of the lower extremities, a feeling of cold in the feet;
• the occurrence of sores, swelling and redness on the legs.

Atherosclerotic plaques in the vessels of the lower extremities also initially do not produce significant symptoms. Only with circulatory disorders can pain occur during walking, lameness, which is due to deficiency of oxygen and nutrients in the muscles. Subsequently, trophic disorders also develop:

• loss of hair on the legs;
• blanching of the skin;
• problems with the nails;
• muscular atrophy;
• trophic ulcers.

At later stages, an additional sign of leg vessel damage is the disappearance of pulsations in places of close proximity of the arteries (on the hips, under the knee, behind the inner part of the ankle).

Atherosclerotic plaques in the head (lesions of the cerebral vessels) are manifested, first of all, by mental deviations.

In this case, three stages of pathology development are distinguished:

• the first signs of damage to the cerebral vessels - this is rapid fatigue, memory impairment, disability, poor concentration of attention, pain in the head. Over time, there is depression, loss of interest in everything, capriciousness, quick temper, a tendency to hysterics:
• marked signs - the appearance of depression, hypochondria, anxiety-delusional syndrome;
• the final development of dementia is the loss of critical perception of one's behavior, disorientation in time and space, paresis, visual and speech disorders, strokes.

Atherosclerotic changes in the vascular wall: consequences

Atherosclerotic outgrowths on the vascular walls are a slow and constant process, affecting vast sections of the artery network. The consequences of plaque formation are almost unpredictable. For example, a sufficiently long period of growth may occur secretly, and then suddenly manifest as a coronary attack.

In addition, complications and their nature depend on the location of the atherosclerotic process.

For example, with lesions of the cerebral vessels, the most frequent complications are transient ischemic attack and stroke. Less common, but a severe consequence of the neglected process of atherosclerosis may also be dementia - the development of post-atherosclerotic dementia.

With lesions of the abdominal and thoracic aorta, such unfavorable conditions can arise:

• gangrene of the intestine;
• intestinal obstruction;
• gangrene of the lower extremities;
• aortic aneurysm.

However, the most common complication of atherosclerosis is a stroke. It can happen as a result of blockage of the vessel by a blood clot, due to a deficiency in blood circulation and disruption of brain tissue trophism.

To avoid troubles, it is necessary not only to timely treat, but also not to forget about preventive measures.

[7], [8], [9], [10], [11], [12]

Diagnosis: methods of recognition of the disease

To establish the diagnosis of atherosclerosis, in principle, is not difficult. However, to more accurately characterize the disease, it is necessary to undergo a series of studies that will help assess the complexity of the pathology, the location of the lesion site, the likely consequences.

The general scheme of diagnosis is based on the following stages:

• collection of anamnesis, determination of the symptoms of the disease;
• examination of the patient;
• assessment of the causes of atherosclerosis and possible their elimination;
• collection of analyzes, instrumental diagnostics and other examination procedures.

Analyzes in the laboratory are conducted to establish the original cause of the disease. The organism is examined for infection, since it has long been assumed that infectious diseases can participate in the development of atherosclerosis. Also conduct the following laboratory tests:

• biochemical blood test;
• values of cholesterol metabolism;
• blood lipid levels;
• a blood test for the content of adrenal hormones.

Instrumental diagnosis involves the use of high-precision examination techniques. The first thing is to carry out ultrasound of the vessels, which helps to detect the presence of atherosclerotic changes. In order to determine the degree of arterial damage, the following studies are prescribed:

• method of color duplex scanning of arterial and venous vessels, which is used in conjunction with a two-dimensional study and Doppler. It is carried out in color and spectral mode. The doctor examines the arteries of the brain, spine, arms and legs, kidneys, eye retina, as well as the carotid artery and aorta;
• method of color triplex scanning, or the so-called method of transcranial dopplerography - it is used to examine the vascular network of the base of the brain and extracranial arteries. The method is an ultrasound review, which allows obtaining accurate information on the state of blood circulation in vessels, their structure and degree of blood flow disturbances;
• X-rays are used to detect atherosclerosis of the aorta and some complications. On the roentgenogram you can notice the phenomena of calcification, the widening and elongation of the aortic shade, aneurysm, enlargement of the aortic window;
• Angiography is a method to determine the presence of impaired blood circulation. A special contrast fluid is injected into the bloodstream, which makes it possible to examine the shape of the vessels and assess their condition.

Differential diagnosis of atherosclerotic plaques is carried out depending on the localization of the process:

• when the cerebral vasculature is affected, atherosclerosis should be distinguished from neurasthenia, neurosis, mild reactive state, consequences of head trauma, syphilis of the brain, senile psychosis;
• when the aorta is affected, the disease must be distinguished from the pathologies of the abdominal cavity, the digestive tract;
• when the limbs are affected, the disease is differentiated from varicose veins, VSD, intermittent claudication syndrome, posttraumatic complications, etc.

[13], [14], [15]

Treatment

Treatment activities usually begin with the appointment of a diet. Medicines prescribed in the case if after 1-2 months the atherogenicity index does not decrease, or when the doctor knows in advance that the patient suffers from ischemic heart disease. It is wrong to believe that there is no need to observe dietary nutrition when taking medicinal therapy.

Successful results of treatment can be obtained only with the use of an integrated approach.

Currently, drugs "number one" for lowering the amount of cholesterol and its fractions are statins. The effect of statins on atherosclerotic plaques is effective and harmless, in addition, these drugs have a specific pleiotropic effect. What does this mean? This means that, thanks to statins, the general condition of the patient improves, as the metabolism in most organs is activated, which has nothing to do with the percentage of cholesterol in the bloodstream.

The category of statins includes medicines based on the following active components:

• Atorvastatin;
• Pravastatin;
• Rosuvastatin;
• Simvastatin;
• Lovastatin and others

These drugs can inhibit cholesterol synthesis in the liver. It is proved that almost half of all cholesterol enters the body with food, and another half is produced by the body itself. From this it is necessary to draw a conclusion that simultaneous observance of certain rules of nutrition can significantly limit the amount of "external" cholesterol, and the use of statins reduces the production of "internal" cholesterol.

In addition to statins, fibrates can also be prescribed - these are medicines that also lower the amount of cholesterol, but are prescribed only in combination with statins, and only when treatment with the first group of drugs does not cope with elevated triglyceride levels. To medicines-fibrates it is possible to carry such means, as Fenofibrate, Ciprofibrate, Clofibrate.

In some cases, doctors prescribe also nicotinic acid, but this drug has a lot of side effects that does not allow using it for a long time.

Also, anion-exchange resins and sorbent materials can be used in the treatment, which reduce the absorption of cholesterol in the intestinal cavity. Such preparations include Cholestyramine, Kolestypol, Neomycin, Enterosgel, Polyphepanum, etc.

Of the vitamin remedies, the most popular are Ascorutin, Aevit, Aneurin, Biovital Vitamin C.

Alternative treatment: application of plants and other natural components

In order to reduce the absorption of cholesterol and reduce its entry into the endothelial tissue of the vascular wall, often prescribe such medicinal charges:

• berries of dogrose 30 g;
• cattle feed 20 g;
• a sheet of birch 20 g;
• a sheet of mint 20 g;
• carrot seed 20 g;
• rhizome eleutherococcus 30 g;
• sheet of cassia holly 20 g;
• kidney tea 20 g;
• rhizome of burdock 20 g.

From this collection, you should prepare the infusion (for 4 tablespoons of collection - 500 ml of boiling water) and drink it 100 ml three times a day after eating.

• raw marine cabbage 20 g;
• berries of hawthorn 30 g;
• berries of black chokeberry 30 g;
• Cowberry leaves 20 g;
• alternating 20 g;
• motherwort 20 g;
• color camomile 20 g;
• corn stigmas 20 g;
• buckthorn bark 10 g.

The infusion is prepared and taken according to the principle of the first recipe.

• flowering hawthorn 30 g;
• raw horsetail field 30 g;
• mistletoe white 30 g;
• leaf vinca 30 g;
• yarrow 60 g.

Prepare the infusion (2 tablespoons collection for 400 ml of boiling water) and use in small sips throughout the day. It is recommended to conduct such treatment courses, for one and a half to two months, with intervals for rest in 1 month.

To adjust the level of cholesterol, you can prepare and a mixture of herbs:

• color arnica 10 g;
• raw yarrow 40 g;
• St. John's wort 50 g.

A mixture of herbs pour boiling water (400 ml of water - 2-4 tablespoons of the mixture) and eat throughout the day in small sips.

To stabilize vascular permeability, it is possible to prepare such a collection:

• cumin 20 g;
• leaves periwinkle 20 g;
• rhizome of hawthorn 40 g;
• mistletoe white 60 g.

Four tablespoons of the mixture pour 500 ml of boiling water, insist, filter and use 2 glasses a day, regardless of food intake.

Also a good effect is expected from the addition of beverages and dishes to such drinks as strawberries, field horsetail, St. John's wort, mother-stepmother leaf, fennel, marsh swine, motherwort.

Successfully used in the treatment of plaques tincture of garlic, 20 drops to 3 times a day, as well as alcohol tincture on onions, 25 drops three times a day. Duration of treatment - about one month.

Treatment with herbs should be supplemented by proper nutrition, which provides for a lower intake of cholesterol and animal fats.

[16], [17], [18], [19], [20],

Dietary nutrition in atherosclerotic plaques

Treatment of atherosclerotic changes in the vessels will not be so successful if you do not pay proper attention to the principles of nutrition. The therapeutic diet provides for limiting the use of foods that contain cholesterol - animal fats, meat and offal, eggs, canned food (both meat and fish), as well as chocolate, cocoa, fatty dairy products.

Preference is given to foods rich in iodine, ascorbic acid and group B vitamins. For example, it is considered useful products to be cabbage, beans, zucchini and eggplant, broccoli and cauliflower, berries, nuts, dried fruits, citrus fruits.

It is extremely useful to use watermelon on the walls of vessels to use watermelon, which, in addition to diuretic action, actively removes excess cholesterol from the bloodstream.

Instead of butter and margarine it is necessary to use vegetable oils that contain a large amount of unsaturated fatty acids.

Of drinks it is preferable to drink green tea - it is rich in antioxidants, perfectly tones blood vessels and strengthens their walls.

Important: at the first signs of the formation of atherosclerosis, it is necessary to sharply limit the consumption of sugar and sweets, as well as table salt.

[21], [22]

Homeopathy and its use in atherosclerosis

Homeopathic remedies are often used to treat vascular diseases, in particular, atherosclerosis. Such drugs can be purchased at the pharmacy, both on a prescription for a doctor and on a free sale. There are also specialized homeopathic pharmacies, where you will be provided with qualified help in selecting the most suitable drug.

Which homeopathic remedies are most often recommended for atherosclerotic build-ups in the vessels?

• Escolus compositum is an iodine-containing homeopathic preparation used for peripheral circulation disorders (edema, varicose veins, endarteritis, arteriosclerosis, and also to relieve the condition after strokes and heart attacks). The duration of the course of treatment is one month. The drug is taken 10 drops per 100 ml of clean water, three times a day, half an hour before a meal.
• Angio inel - a multi-component herbal homeopathic remedy, is applied to 1.1 ml once a day for the first three days. Then the treatment scheme is determined by the doctor individually.
• Arteria-heel is a drug that improves blood circulation in the brain with lesions of atherosclerosis. It is prescribed 10 drops three times a day. With caution should take the drug to patients with thyroid disease.
• Bariyodel is a homeopathic sublingual tablet containing a large number of plant components. They are prescribed for senile sclerosis, dementia, atherosclerosis, and post-stroke states. Contains iodine in its composition. Standard drug take 1 tablet under the tongue three times a day.
• Cerebrum compositum is a polycomponent homeopathic remedy containing plant, animal and mineral components. The effect of the drug is directed to the regulation of metabolic processes in the central nervous system. Usually appoint 1 ampoule sc, to / m or / to three times a week.
• The placenta compositum is a vasodilator and venotonic homeopathic remedy, which improves blood circulation and tissue trophism. As a rule, the drug is prescribed for 1 ampoule 1-2 times a week.

Homeopathic treatment is not recommended to be done independently, without consulting a doctor. These drugs do not cause harm and almost no side effects, but the decision on the appropriateness of their administration should be made by a specialist.

Atroosclerotic plaque dissolution

Unfortunately, it is almost impossible to completely clean the vessels from the growths. Any methods that involve the removal of an atherosclerotic plaque can lead to complications such as the formation of thrombi and clogging of the vascular lumen.

As for calcined outgrowths, such plaques can not be dissolved or destroyed. Therefore, treatment of vascular deposits reduces, as a rule, to alleviating the patient's condition and preventing the further appearance of plaques.

But, what to do in severe and neglected cases, for example, when the narrowing of the lumen arteries threatens the life of the patient?

For such cases, there are special procedures.

• Stenting of the coronary arteries is a surgical method that restores the lumen in a "blocked" artery. The procedure is carried out with balloon vasodoplasty: a stent with a special balloon is inserted into the affected arterial vessel by means of a catheter. At the required site, the balloon is inflated, reveals the stent, which remains in the vessel as a supporting structure, which provides the necessary and constant clearance.
• Aortocoronary shunting is a method whose purpose is to prevent irreversible changes in the heart muscle, improve cardiac activity, improve the quality of life. This operation involves laying out bypasses (shunts) between the "clogged" coronary vessel and the aorta, which helps restore full blood circulation.

Of course, scientists around the world continue to work on the problem of the formation of deposits in the vessels. Perhaps, soon there will be new effective ways to fight this disease.

[23], [24]

Prevention

According to statistics, every fifth person on the planet has atherosclerotic changes in the vessels. Indeed, atherosclerosis is a very common disease. Therefore, great importance is given to the prevention of this pathology.

What are the preventive measures?

• Fighting overweight and obesity.

If you have extra pounds, then it is recommended to follow a low-calorie diet (with standard motor activity - about 1800 calories per day), and also to limit the consumption of salt, simple carbohydrates, animal fats.

• Stabilization of the nervous system.

In every way try to avoid stressful situations, do not be nervous, be friendly and cheerful. If you are still nervous, drink calming tea based on valerian, peppermint, or use pharmaceuticals (novopassit, fitosed, valerian extract, etc.).

• A good night's sleep.

Try to get enough sleep, rest, and not once a week, but daily. It is best to go to bed and wake up at the same time every day, so that the body has time to recover overnight.

• Control of blood pressure.

If possible, periodically check blood pressure. Remember: increasing these indicators at the same time increases the risk of atherosclerosis.

• Healthy lifestyle.

Such seemingly trivial advice as a rejection of bad habits, an active lifestyle, exercise will help to save your health for many, many years.

• Proper nutrition.

Avoid harmful food, alcohol. Give preference to plant products, sour-milk food, nuts - such healthy foods contribute to lowering the level of cholesterol in the blood.

In addition, try to periodically visit a doctor, as well as conduct a blood test for glucose and cholesterol. Only in this way you will be able to suspect the disease in time and prevent its further development.

Forecast

Prognostic conclusions are determined by the stage of the process and its localization.

For example, atherosclerosis of the aorta is most favorable, and a more negative course is observed when coronary vessels are affected, especially if the patient already has angina attacks. Sluggish coronary sclerosis of small vessels can lead to severe circulatory failure.

The possibility of employment is determined by the degree of vascular damage and the nature of the process, as well as the specific characteristics of the patient's profession. The defeat of cerebral vessels in most cases requires the termination of professional activity, if such work is associated with mental and physical stress, frequent stress and nervous tension.

General ability to work is disrupted, as a rule, at later stages of the disease, as well as in the development of complications.

Atherosclerotic plaques are dangerous for the development of stroke and heart attack. At the first suspicions on disease it is necessary to address urgently to the doctor-cardiologist or the vascular surgeon.

[25], [26],