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Atherosclerosis

Symptoms and treatment

Atherosclerosis is a narrowing and hardening of the arteries (the blood vessels that carry oxygen-rich blood to the body). This reduces the amount of blood getting through, starving the affected body part.

The process starts with damage to the artery wall. Platelets move in, trying to repair the damage, and settle into the artery wall. LDL cholesterol (the "bad" kind) also moves in and then white blood cells arrive to try to clean up the mess. Eventually, this pile of fatty deposits and cells (called a plaque) can extend far enough into the artery to reduce blood flow, or even cut it off completely. It can also break apart and send clots out into the bloodstream, also blocking blood flow.

While all arteries are susceptible to atherosclerosis, veins do not normally form these plaques. Veins do not receive the same damage as arteries.

Symptoms of Atherosclerosis

Atherosclerosis symptoms depend on the body part affected and usually only occur with advanced disease. Coronary atherosclerosis affects the arteries leading to the heart. You may experience chest pain or pressure (angina) or a heart attack. Intracranial atherosclerosis affects arteries feeding the brain. This can lead to a transient ischemic attack (a temporary blockage that does not cause damage) or a thrombotic stroke (a stroke caused by a clot, also called a thrombus).

Peripheral artery disease involves the arteries in the legs. It causes leg pain when you walk and slow healing from wounds. Atherosclerosis of bowel arteries can cause cramp-like pains shortly after a meal. A complete block causes severe abdominal pain, due to bowel tissue death.

Diagnosis

If you experience any of the above symptoms (or have a family history of circulatory problems) see your doctor. During your visit, the doctor will do a physical exam and get a medical history. Be prepared to discuss your history of smoking, alcohol use and exercise, as well as current medications and any symptoms you might have.

Blood tests can determine blood lipid levels (cholesterol and triglycerides). Other tests depend on the location of symptoms. An electrocardiogram or an echocardiogram, usually with a stress test, can reveal poor circulation to the heart. A Doppler ultrasound measures blood flow through the legs. Comparing blood pressure between the arm and leg can also reveal blood flow problems. Other tests can present an image of plaques and calcium deposits.

Treatment

Atherosclerosis is not curable, and the best treatment is really prevention. So make some healthy lifestyle changes:

  • Exercise
  • Control your blood pressure
  • Control your cholesterol
  • Don't smoke
  • Eat right

If the disease is still mild, these changes can slow its progression and help you avoid or delay more aggressive treatment. Once the disease causes symptoms, other treatments are necessary:

  • A balloon angioplasty involves inserting a thin tube, with a balloon on the end, into the artery. Inflating the balloon crushes the plaque flat against the wall of the artery. Sometimes a stent (a mesh tube) is inserted at the same time to keep the artery open.
  • An endarterectomy involves surgically removing plaques. Thrombolytic medications can break up blood clots and restore blood flow.
  • Anti-platelet and anti-coagulant medications help keep the blood flowing and prevent clot formation.

Atherosclerosis is a lifelong condition, so educate yourself and work with your doctor to craft a plan to fit your unique situation. In addition to your doctor, the National Heart Association and the National Stroke Association are excellent resources for the latest information on vascular health.

By Melissa J. Luther

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