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Atherosclerosis: symptoms and diagnosis
Last reviewed: 23.04.2024
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Symptoms of atherosclerosis
Atherosclerosis first develops asymptomatically, often for many decades. Signs of atherosclerosis appear when there are obstructions to the blood flow. Transient ischemic symptoms (eg, stable exertional angina, transient ischemic attacks, intermittent claudication) can develop when stable plaques grow and decrease the arterial lumen by more than 70%. Symptoms of unstable angina, myocardial infarction, ischemic stroke, or leg pain at rest can occur when unstable plaques burst and suddenly close a large artery, with the addition of thrombosis or embolism. Atherosclerosis can also cause sudden death without previous stable or unstable angina.
Atherosclerotic lesion of the arterial wall can lead to aneurysms and stratification of the arteries, which is manifested by pain, pulsating sensations, lack of pulse or sudden death.
Diagnosis of atherosclerosis
The approach depends on the presence or absence of signs of the disease.
[The course of atherosclerosis, accompanied by symptoms
Patients with signs of ischemia are assessed for the vastness and localization of occlusion of vessels using various invasive and non-invasive studies depending on the affected organ (see other sections of the manual). To determine the risk factors for atherosclerosis, anamnesis is collected, a physical examination, lipid profile and blood glucose concentrations are performed, the content of HbA1 and homocysteine is determined.
Since atherosclerosis is a systemic disease, it is necessary to investigate other areas (for example, coronary and carotid arteries) in the detection of lesions in one area (for example, the peripheral artery).
Since not all atherosclerotic plaques create the same risk, visualization methods are used to identify plaques, especially those threatening with a rupture. Most studies require a catheterization of blood vessels; they include intravascular ultrasound (using an ultrasound sensor located at the end of the catheter and capable of giving an image of the arterial lumen), angioscopy, plaque thermography (for detecting an elevated temperature in plaques with active inflammation), optical layered tomography (using an infrared imaging laser), and elastography (to identify soft, lipid-rich plaques). Immunoscintigraphy is a non-invasive alternative, involving the use of radioactive substances that accumulate in an unstable plaque.
Some clinicians examine whey markers of inflammation. CRP content> 0.03 g / l is an important prognostic sign of cardiovascular lesions. High activity of lipoprotein-associated phospholipase A2 is believed to predict cardiovascular pathology in patients with normal or low LDL.
Asymptomatic course of atherosclerosis
In patients with risk factors for atherosclerosis without signs of ischemia, the significance of additional studies is unclear. Despite the fact that imaging studies such as polypositional CT, MRI and ultrasound can detect atherosclerotic plaque, they do not improve the accuracy of the prognosis of ischemic development in comparison with the risk factor assessment (eg, the Framingham risk index) or the analysis of findings found in instrumental studies, and are usually not recommended.
Microalbuminuria (> 30 mg albumin in 24 hours) is a marker of kidney damage and its progression, as well as a powerful predictor of cardiovascular and vascular morbidity and mortality; however, a direct relationship between microalbuminuria and atherosclerosis has not been established.