Multifocal atherosclerosis

Multifocal atherosclerosis is a condition in which atherosclerotic plaques (fatty deposits) form and develop in different arteries or vascular regions of the body at the same time. Atherosclerosis is a chronic disease characterized by impaired vessel structure and function due to the accumulation of cholesterol, cells, and other substances within the arteries. Multifocal atherosclerosis means that the process can affect several arteries or vessels at the same time, rather than just one specific area.

Sites prone to multifocal atherosclerosis may include:

1. The arteries of the heart (coronary arteries), which can lead to angina or myocardial infarction.
2. Arteries in the brain, which can cause a stroke.
3. Lower extremity arteries, which can lead to peripheral arterial disease and limb ischemia.
4. Kidney arteries, which can lead to arterial hypertension and kidney function problems.
5. Other arteries in the body.

Multifocal atherosclerosis is usually the result of common risk factors such as aging, smoking, obesity, hereditary predisposition, high blood pressure, diabetes mellitus, etc. Treatment for multifocal atherosclerosis may include lifestyle changes (e.g., healthy eating, physical activity, quitting smoking), drug therapy to control risk factors, and sometimes surgery if there are serious problems with the blood supply or arteries. Management of multifocal atherosclerosis requires careful medical evaluation and individualized treatment for each patient. [1]

Regardless of pathophysiology, cardiovascular calcification; coronary artery calcification as well as thoracic aortic calcification is associated with a higher risk of cardiovascular mortality in the general population [2] and the occurrence of cardiovascular disease in essentially healthy individuals [3], [4], [5] regardless of common cardiovascular risk factors.

Causes of the multifocal atherosclerosis.

This condition usually has multiple causes and risk factors that may contribute to its development. The following are the main causes and risk factors associated with multifocal atherosclerosis:

1. Age: The risk of atherosclerosis increases with age. Aging blood vessels may contribute to the formation of atherosclerotic plaques.
2. Genetic predisposition: Heredity can play an important role in the development of atherosclerosis. If family members have a history of the disease, your risk may also be increased.
3. Smoking: Smoking is considered a major risk factor for atherosclerosis. Substances in tobacco can damage the vascular wall and promote plaque formation.
4. Diet: Overeating fats, especially saturated and trans fats, can contribute to cholesterol accumulation and the development of atherosclerosis.
5. Physical inactivity: Lack of physical activity can lead to weight gain, increased blood cholesterol levels, and poor overall vascular health.
6. High blood pressure: Hypertension (high blood pressure) increases the strain on blood vessels and may contribute to atherosclerosis.
7. Diabetes mellitus: High blood sugar levels can damage blood vessels and promote the formation of atherosclerotic plaques.
8. Hyperlipidemia: Elevated levels of cholesterol and lipids in the blood can contribute to plaque buildup in the arteries.
9. Obesity: Being overweight may increase the risk of atherosclerosis.
10. Stress: Long-term psychological stress can have a negative effect on blood vessels and contribute to the development of atherosclerosis.

Multifocal atherosclerosis often develops as a result of the interaction of several of the above risk factors.

Symptoms of the multifocal atherosclerosis.

Symptoms of multifocal atherosclerosis may depend on which arteries and vessels are affected and to what extent. Common symptoms may include:

1. Pain in the heart area (angina pectoris): This can be a symptom of atherosclerosis in the coronary arteries that provide blood supply to the heart muscle.
2. Pain in the legs when walking (cervical arterial insufficiency): If atherosclerosis affects the arteries in the legs, the patient may experience pain, numbness, cooling, or weakness in the legs when walking.
3. Ischemic stroke: Atherosclerosis in the blood vessels that feed the brain can lead to an ischemic stroke, which is accompanied by symptoms such as paralysis, speech or vision impairment.
4. Abdominalpain (ischemic bowel disease): Clogged arteries in the abdomen can cause pain and bowel disorders such as intestinal ischemia.
5. Vision problems: Atherosclerosis in the blood vessels that feed the eyes can lead to changes in vision.
6. Lower back or leg pain (peripheral arterial disease): Atherosclerosis in the blood vessels in the lumbar region or legs can cause pain and other symptoms.
7. Kidney pain (renal arterial stenosis): Atherosclerosis in the arteries that feed the kidneys can cause high blood pressure and problems with kidney function.
8. Erection problems: Multifocal atherosclerosis can affect the blood vessels that supply blood to the genitals and cause erectile dysfunction in men.

Stages

Multifocal atherosclerosis does not have standardized stages like cancer, for example. Rather, it is a systemic disease that can affect different arteries and vessels at different times, making it more difficult to categorize by stage. However, it is possible to identify common features and changes that can be observed in different arteries in multifocal atherosclerosis:

1. Early changes (preclinical stage):

   • The beginning of the formation of atherosclerotic plaques within the arteries.
   • Deposition of cholesterol, cells and other substances on the inner wall of the arteries.
   • Absence of pronounced clinical symptoms.

2. Midline changes (clinical manifestations):

   • Increased size of atherosclerotic plaques and thickening of arterial walls.
   • Appearance of clinical symptoms such as angina pectoris, leg pain when walking, dizziness, etc., depending on which arteries are affected.
   • The formation of blood clots (blood clots) or thromboembolism may occur.

3. Recent changes (complications):

   • Prolonged disruption of blood supply to organs or tissues, which can lead to complications such as heart attacks (cardiac, cerebral), limb ischemia, thromboses and embolisms, aneurysms, and others.

It is important to realize that multifocal atherosclerosis can develop in different arteries at the same time, and the process can be heterogeneous in different parts of the body. Patients with this condition may present with different symptoms and may require an individualized approach to treatment and risk factor management.

Complications and consequences

Multifocal atherosclerosis can lead to various complications and consequences, depending on the arteries and vessels that are affected and the severity of the disease. Here are some of the possible complications and consequences of multifocal atherosclerosis:

1. Myocardial infarction (heart attack): If atherosclerosis affects the coronary arteries that supply blood to the heart, it can lead to an impaired blood supply to the heart and the development of a myocardial infarction.
2. Stroke: Atherosclerosis of the arteries of the brain can cause a stroke, resulting in impaired brain function due to inadequate blood supply.
3. Peripheral arterial disease (PAD): Multifocal atherosclerosis in the arteries of the lower extremities puts you at risk for PAB, which can lead to limb ischemia, walking pain, ulcers, and even amputation.
4. Angina and angina: Atherosclerosis of the coronary arteries can causeangina, which leads to pain and pressure in the chest area.
5. Arterial Aneurysms: Atherosclerosis can weaken the walls of arteries and contribute to the formation of aneurysms, which can be dangerous because of the possibility of rupture.
6. Arterial hypertension: Multifocal atherosclerosis may increase the risk of arterial hypertension (high blood pressure), which is itself a risk factor for cardiovascular complications.
7. Thrombosis and embolism: Atherosclerotic plaques can be a source of thrombosis (blood clots) or emboli, which can block arteries and lead to acute organ ischemia.
8. Renalcomplications: Atherosclerosis of the renal arteries can cause arterial hypertension and problems with kidney function.
9. Death: In the most serious cases, multifocal atherosclerosis can be fatal, especially if important arteries are affected or if complications are not controlled.

Diagnostics of the multifocal atherosclerosis.

Diagnosis of multifocal atherosclerosis involves several steps and methods:

1. Physical examination and history: The physician interviews the patient, obtains his medical and family history, and identifies the presence of risk factors for atherosclerosis, such as smoking, diabetes mellitus, arterial hypertension, hyperlipidemia, and others.
2. Physical Exam: The physician may perform a physical exam, including assessing pulses, blood pressure, and listening to the arteries with a stethoscope.
3. Laboratory tests: Blood tests may be performed to assess the patient's cholesterol and other lipid levels. Sugar levels may also be measured for diabetes mellitus.
4. Instrumental methods:
   • Duplex scanning (ultrasound) of the arteries: This method allows visualization of the structure and blood flow in the arteries. It can be used to detect atherosclerotic plaques, stenosis (narrowing) and overall assessment of the arteries.
   • Angiography: This is an X-ray examination that involves injecting a contrast agent into the arteries and creating X-rays to visualize the arteries in detail and identify stenoses and atherosclerotic changes.
   • Magnetic resonance angiography (MRA) and computed tomography angiography (CTA): These techniques can be used to create highly detailed three-dimensional images of the arteries.
5. Electrocardiogram (ECG) and other cardiac studies: Patients with multifocal atherosclerosis may require electrocardiography and other cardiac studies to evaluate the heart and identify comorbidities.

Diagnosis of multifocal atherosclerosis is important to determine the location and extent of arterial damage in the body and to develop the best treatment plan and risk factor management.

Treatment of the multifocal atherosclerosis.

The treatment of multifocal atherosclerosis can be complex and requires a comprehensive approach. Here are the common treatments, steps and principles for managing this condition:

Stage 1: Diagnosis and Assessment.

• Detection of atherosclerotic changes in various arteries and vessels by medical examinations such as ultrasound, angiography, CT or MRI.
• Evaluate the extent of the lesion and identify major risk factors such as cholesterol levels, blood pressure, diabetes mellitus, and others.

Stage 2: Lifestyle changes.

• Developing a healthy lifestyle, including healthy eating, moderate physical activity, quitting smoking, and stress management.
• Following dietary recommendations, including reducing saturated fat, salt and sugar intake.

Stage 3: Medication treatment.

• Prescribing medications to control major risk factors, such as statins to lower cholesterol, antihypertensive drugs to manage blood pressure, and antithrombotic drugs to reduce the risk of thrombosis.
• Anticoagulants may be prescribed to prevent blood clots.

Stage 4: Procedures and surgical intervention.

• In cases of severe vascular stenoses or occlusions that threaten the blood supply to organs or extremities, an angioplasty procedure with stenting or surgical removal of atherosclerotic plaques may be required.
• These procedures are performed in order to restore normal blood flow.

Step 5: Regular monitoring and supervision.

• Patients are advised to have regular check-ups with their doctor to monitor their condition, evaluate the effectiveness of treatment, and adjust their treatment plan if necessary.

List of authoritative books and studies related to the study of multifocal atherosclerosis

Books:

1. "Atherosclerosis: Diet and Drugs" (by Arnold von Eckardstein, 2005) - This book provides an overview of atherosclerosis, including multifocal atherosclerosis, and risk factors, and discusses treatment and prevention approaches.
2. "Atherosclerosis: Cellular and Molecular Interactions in the Artery Wall" (authors: Edouard L. Schneider and Franco Bernini, 1995) - A book on the biological and molecular mechanisms of atherosclerosis, including its multifocal forms.
3. "Multifocal Atherosclerosis" (Author: Yuri N. Vishnevsky, 2019) - A book that discusses aspects of diagnosis and treatment of multifocal atherosclerosis.

Research and articles:

1. "Multifocal Atherosclerosis in Patients With Acute Coronary Syndrome: Prevalence, Clinical Features, and Outcomes" (Authors: Authors' Collective, 2017) - A study evaluating multifocal atherosclerosis in patients with acute coronary syndrome.
2. "Multifocal Atherosclerosis in the Coronary, Carotid, and Peripheral Arteries: Comparison of Prevalence and Outcomes" (Authors: Authors' Collective, 2018) - A comparative study of the prevalence and outcomes of multifocal atherosclerosis in different arteries.
3. "Multifocal Atherosclerosis and Cardiovascular Risk in Patients With Coronary Artery Disease" (Authors: Authors' Collective, 2020) - A study investigating the association of multifocal atherosclerosis with cardiovascular risk in patients with coronary artery disease.

Literature

Shlyakhto, E. V. Cardiology: national guide / ed. By E. V. Shlyakhto. - 2nd ed., revision and supplement. - Moscow: GEOTAR-Media, 2021