Atherosclerotic plaques

With atherosclerosis – a chronic disease of the arteries – sooner or later atherosclerotic plaques inevitably form, narrowing the arterial lumen and causing a gradually increasing circulatory deficit in a certain area. Why do they appear? How can their development be prevented? What should you do if the vessels are already affected? We will help you find answers to these and other questions in this material.

ICD 10 code:

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

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The appearance of plaques in atherosclerosis: reasons

Plaques are cholesterol deposits on the vascular arterial wall. They look like small bumps or growths. Currently, a large number of different assumptions are being considered regarding the causes of these growths, but the most reliable of them is considered to be an increased content of cholesterol in the bloodstream.

It should be noted that, in addition to cholesterol, its components (fractional components) also play a major role. Many of them behave quite negatively and provoke the development of atherosclerotic changes in all vascular walls. But there are also such fractions that try to prevent the negative impact 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 (coefficient)," the normal value of which should not exceed 3. It is determined in a laboratory by taking a blood test for a lipid spectrum.

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

Each patient has their own characteristics of atherosclerosis development. Factors that can directly affect the rate of plaque formation have been identified:

• overweight;
• abuse of animal fats;
• nicotine addiction;
• high blood pressure;
• overeating;
• passive lifestyle;
• diabetes or excessive consumption of simple sugars.

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

How plaques arise: pathogenesis

For successful deposition of fats on the walls of arteries, certain favorable conditions must be present in the vessel - for example, a minor defect in the vascular wall, or slow blood flow in a certain area. Most often, this problem occurs in the area of the branching of the artery. In this case, the vessel wall becomes edematous and loose.

The duration of this stage may vary, because in a healthy organism, parietal enzymes prevent the deposition of fats by dissolving them - this process can be observed even in one-year-old children. If the protective mechanisms fail, then the formation of complex compounds begins, which consist of proteins, lipids, cholesterol, and in the complex of such interaction, the deposition of growths on the vascular wall begins.

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

The core consists of some free cholesterol with esters. Around the core are "foamy" cell structures - macrophages containing fats. Over time, fats move into the core, destroying the macrophages.

The outer layer is the part of the growth that protrudes into the lumen of the vessel. It is a fibrous membrane with collagen fibers and elastin, the percentage of which directly affects the tendency of the cap to rupture.

Initially, the growths have a semi-liquid consistency and are still subject to dissolution. However, this does not make them less dangerous. Due to their low density and looseness, the growth elements can break off, which can lead to blockage of the arterial lumen. What this threatens: loss of vascular elasticity, damage to blood vessels, the formation of blood clots - thrombi. All this only aggravates an already problematic situation.

Over time, the atherosclerotic plaque cap becomes denser, and calcium salts are deposited in it. The final stage of its formation begins – atherocalcinosis. The calcified atherosclerotic plaque is already distinguished by its stability and slow growth, which gradually leads to deterioration of blood flow and supply in this area.

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

Plaques in atherosclerosis can be stable and unstable, depending on their structure, volume and composition.

A stable atherosclerotic plaque is characterized by its constancy and slow progression over many years. It contains a large amount of collagen, which makes its walls elastic and resistant to rupture.

Unstable atherosclerotic plaque is rich in lipids. It is prone to rupture and expose the endothelium, which leads to the formation of a thrombus that blocks the affected vessel.

Atherosclerotic plaque rupture may occur without any particular symptoms. The subsequent clinical picture and the patient's condition will depend on the rate of formation and localization of the subsequent thrombus.

"Old" calcified growths do not pose such a danger as semi-liquid ones, since they are not prone to ulceration, but are practically not subject to involution. In most cases, atherosclerotic changes are irreversible and lead to prolonged tissue ischemia, the development of heart failure, coronary heart disease, infarction or arrhythmia.

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

• accumulation in the vascular wall and formation of fatty “spots”;
• involvement of inflammatory cells in the process - these are monocytes and T-lymphocytes;
• migration of monocytes into the arterial wall, formation of foam cells, deformation of the endothelium;
• attraction of platelets to the damaged area;
• response to damage – release of cellular defense mediators and growth factors;
• increased production of collagen and elastin, their accumulation and the appearance of endothelial tubercles in the vascular lumen;
• compaction and increase in the size of the growth.

What signs may indicate the appearance of plaques?

Symptoms of the formation of atherosclerotic changes in the vessels may not appear for a long time, because the reduction of the lumen due to the growth is a fairly slow and lengthy process.

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

The growths may not disintegrate for a long time and remain in one place, gradually increasing only to a certain size. In this case, there may be no signs of vascular damage.

If the plaque grows steadily, reducing the degree of blood flow in the organs and tissues, then such a sign of the disease as pain may be observed (especially after physical exertion, with accelerated blood circulation).

Another type of symptomatology is observed when the growth decomposes and its elements migrate along the vascular network. A thrombus forms in the area of the destroyed plaque, which increases the likelihood of blockage of the vascular lumen. This condition can provoke a heart attack or stroke (with blockage of the coronary and cerebral vessels).

Absolutely all symptoms of atherosclerosis consist of signs of circulatory disorders and nutrition of certain organs and systems of the body.

Next, we will consider the probable clinical picture of an atherosclerotic lesion, depending on the localization of the vascular lumen disorder.

Atherosclerotic plaques of the carotid artery are often asymptomatic, which, of course, can cause a number of complications. But, by listening more closely to your body, you can notice some signs of atherosclerosis.

For example, ischemic attacks may occur periodically, which manifest themselves as:

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

The listed symptoms are already considered a serious reason to see a doctor.

Atherosclerotic plaques in the aorta can cause different symptoms depending on which part of the aorta they are located in – the thoracic or abdominal part.

With chest localization, severe painful sensations may be observed, which continue for several hours or days. The pain appears behind the breastbone, or in the heart area, sometimes radiating to one of the limbs, the shoulder area, neck, shoulder blade. Such pain, unlike cardiac pain, cannot be eliminated by taking nitroglycerin. Over time, shortness of breath, heart failure, and an increase in upper blood pressure indicators may appear. Signs of cerebral ischemia develop:

• disturbances of consciousness;
• paleness of the face;
• headaches;
• memory impairment;
• increased fatigue;
• muscle cramps when moving the head.

When the abdominal aorta is affected, disorders of the abdominal organs appear:

• causeless pain in the navel area (may be accompanied by flatulence and difficulty defecating);
• loss of appetite and, consequently, weight;
• impotence, infertility;
• intermittent claudication;
• numbness in the lower limbs, feeling of cold in the feet;
• the appearance of ulcers, swelling and redness on the legs.

Atherosclerotic plaques in the vessels of the lower extremities also do not give pronounced symptoms at first. Only with circulatory disorders can pain appear while walking, lameness, which is explained by a deficiency of oxygen and nutrients in the muscles. Subsequently, trophic disorders also develop:

• hair loss on legs;
• paleness of the skin;
• nail problems;
• muscular atrophy;
• trophic ulcers.

At later stages, an additional sign of damage to the blood vessels of the legs is the disappearance of pulsation in areas where arteries are located close to each other (on the thighs, under the knee, behind the inner part of the ankle).

Atherosclerotic plaques in the head (damage to the blood vessels of the brain) manifest themselves, first of all, in mental disorders.

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

• The first signs of cerebral vascular damage are rapid fatigue, memory loss, decreased ability to work, poor concentration, headaches. Over time, depression, loss of interest in everything, capriciousness, irascibility, and a tendency to hysteria appear:
• pronounced symptoms - the appearance of depression, hypochondria, anxiety-delusional syndrome;
• the final development of dementia is the loss of critical perception of one’s own behavior, disorientation in time and space, paresis, visual and speech impairments, strokes.

Atherosclerotic changes in the vascular wall: consequences

Atherosclerotic plaques on the vascular walls are a slow and constant process that affects large areas of the arterial network. The consequences of plaque formation are almost unpredictable. For example, the plaque may remain latent for a fairly long period of time, and then suddenly manifest itself as a coronary attack.

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

For example, when the blood vessels of the brain are affected, the most common complications are considered to be transient ischemic attack and stroke. A less common but serious consequence of the advanced process of atherosclerosis can also be dementia - the development of postatherosclerotic dementia.

When the abdominal and thoracic aorta is affected, the following adverse conditions may occur:

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

However, the most common complication of atherosclerosis is stroke. It can occur as a result of a blood vessel being blocked by a thrombus, due to a lack of blood circulation and a disruption of the trophism of brain tissue.

To avoid troubles, it is necessary not only to carry out treatment in a timely manner, but also not to forget about preventive measures.

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Diagnostics: methods of disease recognition

Diagnosing atherosclerosis is not difficult in principle. However, for a more accurate characterization of the disease, it is necessary to undergo a series of studies that will help assess the complexity of the pathology, the location of the affected area, and the probable consequences.

The general diagnostic scheme is based on the following stages:

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

Laboratory tests are performed to establish the underlying cause of the disease. The body is examined for infection, as it has long been assumed that infectious diseases can contribute to the development of atherosclerosis. The following laboratory tests are also performed:

• biochemical blood test;
• cholesterol metabolism values;
• blood lipid levels;
• Blood test for adrenal hormone levels.

Instrumental diagnostics involves the use of high-precision examination methods. First, an ultrasound of the vessels is performed, which helps to detect the presence of atherosclerotic changes. In order to determine the degree of damage to the arteries, the following studies are prescribed:

• a method of color duplex scanning of arterial and venous vessels, which is used together with a two-dimensional study and Dopplerography. It is carried out in color and spectral mode. The doctor examines the arteries of the brain, spine, arms and legs, kidneys, retina, as well as the carotid artery and aorta;
• color triplex scanning method, or the so-called transcranial Doppler method - it is used to examine the vascular network of the base of the brain and extracranial arteries. The method is an ultrasound scan that allows you to get accurate information about the state of blood circulation in the vessels, their structure and the degree of blood flow disorders;
• X-ray examination is used to detect aortic atherosclerosis and some complications. On the X-ray one can see calcification, widening and elongation of the aortic shadow, aneurysm, widening of the aortic window;
• Angiography is a method that allows you to determine the presence of impaired blood circulation. A special contrast fluid is injected into the bloodstream, which makes it possible to examine the outlines of the vessels and assess their condition.

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

• in case of damage to the vascular network of the brain, atherosclerosis should be distinguished from neurasthenia, neurosis, mild reactive state, consequences of head injuries, syphilis of the brain, senile psychosis;
• in case of aortic damage, the disease must be distinguished from pathologies of the abdominal cavity and digestive tract;
• When the limbs are affected, the disease is differentiated from varicose veins, VSD, intermittent claudication syndrome, post-traumatic complications, etc.

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Treatment

Treatment usually begins with a diet. Medicines are prescribed if the atherogenic index does not decrease after 1-2 months, or when the doctor knows in advance that the patient suffers from ischemic heart disease. It is wrong to assume that there is no need to follow a diet when conducting drug therapy.

Successful treatment results can only be achieved by using an integrated approach.

Currently, statins are considered the "number one" drugs for lowering the amount of cholesterol and its fractions. 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, since there is an activation of metabolism in most organs, which is in no way related to the percentage of cholesterol in the bloodstream.

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

• Atorvastatin;
• Pravastatin;
• Rosuvastatin;
• Simvastatin;
• Lovastatin, etc.

The listed drugs are capable of inhibiting cholesterol synthesis in the liver. It has been proven that almost half of all cholesterol enters the body with food products, and another half is produced by the body itself. From this it follows that the simultaneous observance of certain nutritional rules can significantly limit the amount of "external" cholesterol, and the use of statins reduces the production of "internal" cholesterol.

In addition to statins, fibrates may also be prescribed - these are drugs that also lower cholesterol levels, 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. Fibrate drugs include such drugs as Fenofibrate, Ciprofibrate, Clofibrate.

In some cases, doctors also prescribe nicotinic acid, but this drug has a large number of side effects, which does not allow its long-term use.

Anion exchange resins and sorbent substances that reduce the absorption of cholesterol in the intestinal cavity can also be used in treatment. Such drugs include Cholestyramine, Colestipol, Neomycin, Enterosgel, Polyphepan, etc.

The most popular vitamin products are Ascorutin, Aevit, Anevrin, Biovital vitamin C.

Traditional medicine: the use 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, the following herbal mixtures are often prescribed:

• rose hips 30 g;
• raw material of dried grass 20 g;
• birch leaf 20 g;
• mint leaf 20 g;
• carrot seeds 20 g;
• Eleutherococcus rhizome 30 g;
• cassia leaf 20 g;
• kidney tea 20 g;
• burdock rhizome 20 g.

An infusion should be prepared from this collection (4 tablespoons of the collection – 500 ml of boiling water) and drunk 100 ml three times a day after meals.

• raw seaweed 20 g;
• hawthorn berries 30 g;
• chokeberries 30 g;
• lingonberry leaf 20 g;
• succession 20 g;
• motherwort 20 g;
• chamomile flower 20 g;
• corn silk 20 g;
• buckthorn bark 10 g.

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

• hawthorn blossom 30 g;
• horsetail raw material 30 g;
• mistletoe 30 g;
• periwinkle leaf 30 g;
• yarrow 60 g.

Prepare an infusion (2 tbsp. of the mixture per 400 ml of boiling water) and drink it in small sips throughout the day. It is recommended to carry out such treatment in courses of one and a half to two months, with a rest period of 1 month.

To regulate cholesterol levels, you can also prepare this herbal mixture:

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

The herbal mixture is poured with boiling water (2-4 tablespoons of the mixture per 400 ml of water) and consumed throughout the day in small sips.

To stabilize vascular permeability, you can prepare the following collection:

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

Four tablespoons of the mixture are poured with 500 ml of boiling water, infused, filtered and consumed 2 glasses per day, regardless of food intake.

A good effect is also expected from adding medicinal plants such as strawberries, horsetail, St. John's wort, coltsfoot leaves, fennel, marsh cudweed, and motherwort to drinks and dishes.

Garlic tincture is successfully used to treat plaques, 20 drops up to 3 times a day, as well as alcohol tincture on onions, 25 drops three times a day. The duration of treatment is about one month.

Herbal treatment must be supplemented with proper nutrition, which includes reduced intake of cholesterol and animal fats.

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Dietary nutrition for atherosclerotic plaques

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

Preference is given to food rich in iodine, ascorbic acid and B vitamins. For example, seaweed, legumes, zucchini and eggplant, broccoli and cauliflower, berries, nuts, dried fruits, citrus fruits are considered healthy products.

It is extremely useful to eat watermelon when growths appear on the walls of blood vessels, which, in addition to its diuretic effect, actively removes excess cholesterol from the bloodstream.

Instead of butter and margarine, you should use vegetable oils, which contain a large amount of unsaturated fatty acids.

Of the 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 atherosclerosis, it is necessary to sharply limit the consumption of sugar and sweets, as well as table salt.

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Homeopathy and its use in atherosclerosis

Homeopathic remedies are often used to treat vascular diseases, in particular, atherosclerosis. Such drugs can be purchased at a pharmacy, both with a prescription from a doctor and over the counter. There are also specialized homeopathic pharmacies where you will receive qualified assistance in choosing the most suitable drug.

What homeopathic remedies are most often recommended for atherosclerotic growths in blood vessels?

• Aesculus compositum is an iodine-containing homeopathic preparation used for peripheral circulatory disorders (edema, varicose veins, endarteritis, arteriosclerosis, and to alleviate the condition after strokes and heart attacks). The course of treatment lasts one month. The preparation is taken 10 drops per 100 ml of clean water, three times a day, half an hour before meals.
• Angio injel is a multi-component herbal homeopathic remedy, used 1.1 ml once a day for the first three days. Then the treatment regimen is determined by the doctor on an individual basis.
• Arteria-heel is a drug that improves blood circulation in the brain when affected by atherosclerosis. Prescribed 10 drops three times a day. Patients with thyroid disease should take the drug with caution.
• Bariodel is a homeopathic sublingual tablet containing a large number of herbal components. It is prescribed for senile sclerosis, dementia, atherosclerosis, and post-stroke conditions. It contains iodine. The standard dosage of the drug is 1 tablet under the tongue three times a day.
• Cerebrum compositum is a multicomponent homeopathic remedy containing plant, animal and mineral components. The drug's action is aimed at regulating metabolic processes in the central nervous system. Usually prescribed 1 ampoule subcutaneously, intramuscularly or intravenously up to three times a week.
• Placenta compositum is a vasodilator and venotonic homeopathic remedy that improves blood circulation and tissue trophism. As a rule, the drug is prescribed 1 ampoule 1-2 times a week.

Homeopathic treatment is not recommended to be carried out independently, without consulting a doctor. These drugs do not cause harm and have virtually no side effects, but the decision on the advisability of taking them should be made by a specialist.

Resorption of atherosclerotic plaques

Unfortunately, it is almost impossible to completely clear the vessels from growths. Any methods that involve removing the atherosclerotic plaque can lead to complications such as the formation of blood clots and blockage of the vascular lumen.

As for calcified growths, such plaques cannot be dissolved or destroyed. Therefore, the treatment of vascular deposits usually comes down to alleviating the patient's condition and preventing further plaque formation.

But what should be done in severe and advanced cases, for example, when the narrowing of the arterial lumen threatens the patient’s life?

There are special procedures for such cases.

• Stenting of coronary arteries is a surgical method that restores the lumen in a "clogged" artery. The procedure is performed using balloon vascular plasty: a metal stent with a special balloon is inserted into the affected arterial vessel using a catheter. At the required site, the balloon is inflated, opening the stent, which remains in the vessel as a supporting structure, which ensures the necessary and constant lumen.
• Aortocoronary bypass surgery is a method aimed at preventing irreversible changes in the heart muscle, improving cardiac activity, and increasing the quality of life. This operation involves laying bypasses (bypasses) 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 deposits in the vessels. Perhaps, new effective ways to combat this disease will appear soon.

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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?

• Fight against excess weight and obesity.

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

• Stabilization of the nervous system.

Try to avoid stressful situations in every possible way, do not get nervous, be friendly and cheerful. If you do get nervous, drink some calming tea based on valerian, mint, or use pharmaceutical preparations (Novo-Passit, Fitosed, valerian extract, etc.).

• A good night's sleep.

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

• Blood pressure control.

If possible, check your blood pressure regularly. Remember: an increase in these indicators also increases the risk of developing atherosclerosis.

• Healthy lifestyle.

Such seemingly banal advice as giving up bad habits, an active lifestyle, and physical exercise will help preserve your health for many, many years.

• Proper nutrition.

Avoid unhealthy food, alcohol. Give preference to plant products, fermented milk products, nuts - such healthy products help to lower the level of cholesterol in the blood.

In addition, try to visit a doctor periodically, and also conduct a blood test for glucose and cholesterol levels. This is the only way you can 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, aortic atherosclerosis is most favorable, while a more negative course is observed with damage to the coronary vessels, especially if the patient already has attacks of angina. Slow 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 features of the patient's profession. In most cases, cerebral vascular damage requires termination of professional activity if such work is associated with mental and physical stress, frequent stress and nervous tension.

General working capacity is impaired, as a rule, at later stages of the disease, as well as with the development of complications.

Atherosclerotic plaques are dangerous due to the development of stroke and heart attack. At the first suspicion of the disease, it is necessary to immediately contact a cardiologist or vascular surgeon.

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