ATHEROSCLEROSIS

ATHEROSCLEROSIS
Atherosclerosis is a disease of large and medium-
sized muscular arteries caused by deposition of
lipid plaques in the walls of arteries called
atheromas. It is characterized by :
Endothelial dysfunction,
Vascular inflammation, and
The buildup of lipids, cholesterol, calcium, and
cellular debris within the intima of the vessel wall.
• The formation of atherosclerotic lesions can
affect any artery. The most commonly affected
arteries are the coronary arteries of the heart.
CORONARY ATHEROMA
Coronary atheroma :lipid deposit within intimal
coat of coronary artery
↓
Narrowing of lumen
↓
Diminished blood supply to myocardium
↓
Formation of thrombus in coronary arteries
↓
Complete occlusion
↓
Infarction /necrosis
Steps in the Development of Atherosclerosis
1.Formation of lipid plaques may be
precipitated by endothelial injury (examples:
hypertension, immune response, toxins in
cigarette smoke, etc.).
2.Infiltration of cholesterol molecules into
blood vessel walls.
3.Monocytes enter area of injury and release
growth factors that stimulate smooth
muscle and endothelial cell proliferation
4.Monocytes phagocytose lipoproteins and
become lipid-filled “foam cells.”
5.Platelets adhere to the endothelial lesion;
fibroblasts infiltrate area and cause
Progressive sclerosis or hardening of tissue.
5.Calcification of plaques may occur over
time.
6.Significant narrowing of the blood vessel
lumen can occur over time.
Manifestations of
atherosclerosis
• Tissue ischemia due to
reduced blood flow.
• Aneurysm or
hemorrhage due to
weakening of blood
vessel walls.
• Breaking-off of
atherosclerotic
plaques to form
travelling emboli.
Risk Factors for Atherosclerosis
Elevated serum levels of LDL
Low serum levels of HDL
Familial history of hyperlipidemia or
atherosclerotic disease
Obesity
Smoking
Hypertension
Diet high content of saturated fat & cholesterol
Age > 45 years in males; > 55 years in females
Drugs —β-blockers, oral contraceptives, etc.
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
 MI is defined as a diseased
condition which is caused by
reduced blood flow in a
coronary artery due to
atherosclerosis & occlusion
of an artery by an embolus
or thrombus.
 MI or heart attack is the
irreversible damage of
myocardial tissue caused by
prolonged ischaemia &
hypoxia.
MYOCARDIAL INFARCTION
 Referred to as “Heart attack” due to death of
cardiac muscle due to prolonged severe
ischemia.
 Can occur at any age- 10% of MI occur in people
younger than 40 years and 45% in younger than
65 years.
 Risk increases with age as there is increased
incidence of risk factors.
 Males are more affected than females in middle
age.
 In elderly age – both are equally affected. 
ETIOPATHOGENESIS OF MYOCARDIAL INFARCTION
 PATHOPHYSIOLOGY

Myocardial ischemia leads to decrease in oxygen supply

causing cessation of aerobic metabolism. This further
causes decrease in ATP, creatinine phosphate  and
increase in lactic acid which reduces the contractility of
myocardium.
Biochemical Basis of Myocardial Infarction
 Myocardial infarction ("heart attack") most
commonly occurs when a coronary artery
becomes occluded following the rupture of an
atherosclerotic plaque, which then leads to the
formation of a blood clot (coronary
thrombosis).
 This event can also trigger coronary vasospasm.
If a vessel becomes completely occluded, the
myocardium normally supplied by that vessel
will become ischemic and hypoxic.
 Without sufficient oxygen, the tissue dies. The
damaged tissue is initially comprised of a
necrotic core surrounded by a marginal (or
border) zone that can either recover normal
function or become irreversibly damaged.
 After several weeks, the infarcted tissue forms a
fibrotic scar. Long-term consequences include
ventricular remodeling of the remaining
myocardium (e.g., development of
compensatory hypertrophy or
dilation), ventricular failure, arrhythmias and
sudden death.
Sign And Symptoms
 Chest pain most common symptom described as a
sensation of tightness, pressure, or squeezing.
 Not relieved by rest, position change or nitrate
administration.
 Pain radiates most often to the left arm, but may also
radiate to the lower jaw, neck, right arm, back, and
upper abdomen, where it may mimic heartburn.
 Levine's sign, in which a person localizes the chest
pain by clenching their fists over their sternum.
 SILENT AMI - 20-30% subjects don’t have chest pain,
common in patients with diabetes mellitus,
hypertension, & in elderly patients.
Risk Factors For Ischemic Heart Disease
A number of factors increase the risk of
developing ischemic heart disease. Risk factors
for ischemic heart disease include:
Diabetes
Family history of heart disease
High blood cholesterol
High blood pressure
High blood triglycerides
Obesity
Physical inactivity
Reducing Risk of Ischemic Heart Disease
We may be able to lower your risk of ischemic
heart disease by:
Carefully managing  diabetes
Getting regular physical activity
Keeping cholesterol at a healthy level
Maintaining normal blood pressure
Quitting smoking and other tobacco use
Reducing the amount of cholesterol and
fat in diet.
MEDICATIONS
Drug therapy is commonly used for treatment of ischemic
heart disease and includes:
 Angiotensin-converting enzyme (ACE) inhibitors, which
relax the blood vessels and lower blood pressure
 Angiotensin receptor blockers (ARBs), which lower
blood pressure
 Anti-ischemic agents such as ranolazine (Ranexa)
 Antiplatelet drugs to prevent  blood clots
 Beta-blockers, which lower the heart rate
 Calcium channel blockers to reduce workload heart
 Nitrates, which dilate the blood vessels
 Statins, which lower cholesterol
Surgical Procedures Used To Treat Ischemic Heart
Disease
Severe symptoms that are not relieved by
medication alone are treated with surgical
procedures including:
 Angioplasty and stent placement (procedure to
remove plaque and restore blood flow in
clogged arteries)
 Coronary artery bypass graft (procedure that
helps restore blood flow to the heart by routing
the flow through transplanted arteries)
Diagnosis of Acute Myocardial Infraction

Clinical Features: History of severe, prolonged

chest pain, dyspnoea, pulmonary congestion, and
oedema
Laboratory tests: Cardiac Troponin T and I, CK-MB,
Myoglobin.
Electrocardiogram (ECG)
Imaging tests: X-Ray
Ecocardiography: determines ventricular functions
Radiologic (Angiography)
THANK YOU SO MUCH FOR
YOUR ATTENTION