Clinical Picture of Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside the arteries. The latter are mainly composed of fat, cholesterol, calcium and other substances found in the blood. Over time, the plaque narrows the lumen of the artery. This entails restricting the flow of oxygen-rich blood to organs and other parts of the body.

Atherosclerosis can lead to serious conditions, including myocardial infarction (heart attack), stroke, or even death. In this article, we will analyze the clinical picture of this disease in atherosclerotic damage to the arteries of various localizations, and also briefly describe the main risk factors for the disease.

When do symptoms of atherosclerotic changes in the arteries occur?

Atherosclerosis usually does not cause any symptoms until there is a strong narrowing of the lumen of the vessel or its complete blockage. Many people do not realize that they have such a pathology until they need emergency medical care, such as angina pectoris or acute cerebrovascular accident.

Atherosclerotic changes in the arteries can occur over a long period of time (often decades). Since it can affect any organs and tissues, the clinical picture of the disease will depend on the location and degree of narrowing of the artery. Below are the main manifestations of atherosclerosis.

Atherosclerotic damage to the coronary arteries

The coronary arteries carry oxygen-rich blood to the heart to keep it working. They arise from the aorta slightly distal (above) the aortic valve. The following main coronary arteries are distinguished:

  • right coronary artery;
  • left coronary artery and its two branches: anterior descending and left circumflex.

If an atherosclerotic plaque narrows or blocks these arteries, the patient develops a condition called coronary artery disease (CAD). Its common symptom is angina pectoris. The latter is a retrosternal pain or discomfort in the chest, usually aggravated by physical activity, psycho-emotional stress and disappearing at rest.

Pain in CAD is often accompanied by shortness of breath, the patient may also feel discomfort in the shoulders, arms, neck, jaw or back. In some patients, angina pain may even resemble an upset gastrointestinal tract.

Also, in patients with coronary artery disease, arrhythmias are detected in some cases. They are disturbances in the rate or rhythm of the contractile activity of the heart.

Plaques can also form in the smallest arteries of the heart. This disease is called coronary microvascular dysfunction. Symptoms of this pathology include angina pectoris, shortness of breath, sleep problems and fatigue.

Myocardial infarction can be accompanied not only by symptoms of angina pectoris, but also by loss of consciousness, separation of foamy sputum (manifestation of pulmonary edema) and a sense of fear of death. If a myocardial infarction or unstable angina is suspected, the person should be immediately taken to a medical facility.

Atherosclerotic lesions of the arteries supplying the brain

The central nervous system regulates all other structures of the body, maintaining dynamic stability in the internal environment and the stability of basic physiological functions. Therefore, the brain is supplied with blood very intensively: by two vertebral and two carotid arteries. At the expense of the last hemispheres, they feed on 70-85%. The vertebral arteries make up the remaining 15–30%.

In the cranial cavity, these arteries join and divide into the anterior, middle, and posterior cerebral arteries. If the plaque narrows or blocks these vessels, the person may have symptoms of a stroke, which include:

  • sudden weakness;
  • paralysis or numbness of the face, arms or legs, most often on one side of the body;
  • confusion;
  • impaired speech or understanding, as well as problems with vision;
  • breathing problems;
  • dizziness, loss of balance or coordination;
  • problems with walking and falls;
  • loss of consciousness;
  • sudden and severe headache.

Atherosclerotic damage to peripheral arteries

Plaques can also form in the large vessels that supply oxygen-rich blood to the legs, arms, and pelvis (a disease called peripheral arterial disease). If these major arteries are narrowed or blocked, the patient may experience numbness, pain, loss of limb function, and often dangerous infections. However, most patients do not have any symptoms. The first manifestations may occur when the narrowing of the arteries is less than 50%.

Often there is a so-called intermittent claudication syndrome. It affects the arteries of the lower extremities and the patient may have the following symptoms:

  • slight fatigue of the lower extremities;
  • increased sensitivity of the lower extremities to cold;
  • paresthesia (burning sensation, tingling, crawling);
  • intermittent claudication (it is often because of this symptom that patients go to the doctor) and atrophy of the muscles of the lower extremities;
  • pallor of the skin of the lower extremities or their cyanosis (usually observed in more severe stages);
  • hair loss on the lower extremities;
  • weak pulse or its absence below the site of narrowing of the artery;
  • pain at rest, which initially occurs only at night and subsides after a little effort;
  • ulcers and necrosis (death) of the tissue of the lower limb.

Depending on the size of the narrowing of the lumen of the artery and the time of manifestation of the pain syndrome, several degrees of intermittent claudication are distinguished (Fontein-Pokrovsky classification). In the first degree, the patient has no symptoms of the disease, and in the last (fourth) the patient has pain even at rest, ulcers and necrosis of the leg tissues.

Speaking of chronic circulatory disorders in the lower extremities, it is important to mention Leriche’s syndrome. It also occurs as a result of atherosclerotic damage to the wall of the artery, however, the peculiarity is that the narrowing occurs either in the final segment of the abdominal aorta, or in both limbs. Leriche’s syndrome includes the following symptoms:

  • intermittent claudication of both legs and a weak or undetectable pulse on them;
  • atrophy of the muscles of the lower extremities;
  • impotence;
  • pain at rest in both lower extremities.

Damage to the renal arteries

The renal arteries supply the kidneys with oxygen-rich blood. When these vessels are damaged by atherosclerosis, chronic kidney disease (CKD) develops. This pathology eventually causes kidney failure.

In the early stages of CKD, there are no signs or symptoms. As the disease progresses, it can cause fatigue, change in urination patterns (more or less), loss of appetite, nausea, swelling of the face, arms or legs, itching or numbness, headaches, problems concentrating, memory, and thinking. In the terminal stage, patients need a kidney transplant.

Kidney dialysis

Atherosclerosis of the arteries of the intestine

This pathology is manifested primarily by severe, acute, incessant pain in the abdomen. Associated symptoms may include nausea and vomiting, transient diarrhoea, anorexia, and bloody stools. In this case, there may be no changes in blood tests and deviations in other standard diagnostic methods (ultrasound, ECG, etc.).

What are the risk factors for the disease?

Factors that increase the likelihood of developing the disease and its symptoms include:

  • tobacco smoking;
  • diabetes mellitus;
  • hypertension;
  • increased levels of cholesterol and fats in the blood (hypercholesterolemia and hyperlipidemia);
  • obesity.

Also, the symptoms of atherosclerosis are most often detected in males.

What other symptoms may disturb a patient with atherosclerosis?

In most cases, these patients are comorbid, that is, they have another disease. Therefore, there will also be symptoms of comorbidities, such as thirst in metabolic syndrome or diabetes mellitus, or headache in hypertension.

Thus, atherosclerosis is a pathology that develops over the years and often has symptoms already with severe damage to the arteries. Atherosclerotic lesions can affect the vessels of any organs and systems and lead to serious health problems. The symptoms of the disease and the clinical picture depend on the localization of the narrowing and its degree.


References:

  1. Marinescu, M. A., Löffler, A. I., Ouellette, M., Smith, L., Kramer, C. M., & Bourque, J. M. (2015). Coronary microvascular dysfunction, microvascular angina, and treatment strategies. JACC. Cardiovascular imaging, 8(2), 210–220. https://doi.org/10.1016/j.jcmg.2014.12.008
  2. Harrison`s Principles of Internal Medicine 19/E (Vol.1). Dennis Kasper, Anthony Fauci, Stephen Hauseret all. McGraw-HillEducation 2015 ISBN: 0071802134 ISBN-13(EAN): 9780071802130.
  3. Naylor, A. R., Ricco, J. B., de Borst, G. J., Debus, S., de Haro, J., Halliday, A., Hamilton, G., Kakisis, J., Kakkos, S., Lepidi, S., Markus, H. S., McCabe, D. J., Roy, J., Sillesen, H., van den Berg, J. C., Vermassen, F., Esvs Guidelines Committee, Kolh, P., Chakfe, N., Hinchliffe, R. J., … Venermo, M. (2018). Editor’s Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery55(1), 3–81. https://doi.org/10.1016/j.ejvs.2017.06.021

Thanks to modern methods of treatment, it is possible to stop the growth of atherosclerotic plaques and somewhat reduce their size.

Yes maybe. Atherosclerosis is the leading cause of ischemic stroke, which is often the first manifestation of atherosclerotic vascular changes.

Atherosclerotic changes in the arteries can occur over a long period of time (often decades). Life expectancy depends on many factors, including lifestyle, adherence to treatment, the presence of risk factors, etc.

Atherosclerosis usually does not cause any symptoms until there is a strong narrowing of the lumen of the vessel or its complete blockage. Many people do not realize that they have such a pathology. Therefore, a doctor can accurately determine the risk of atherosclerotic damage to the arteries after conducting an examination and obtaining the results of laboratory and instrumental diagnostic methods.

Factors that increase the likelihood of developing atherosclerosis and its symptoms include:

  • smoking;
  • diabetes;
  • hypertonic disease;
  • increase in the level of cholesterol in the blood (hypercholesterolemia);
  • overweight.

Also, the symptoms of atherosclerosis are most often detected in males.

Leave a Reply

Your email address will not be published.