Wed | May 24, 2017

Atherosclerosis – a common disease of the arteries with multiple and severe complications

Published:Wednesday | May 10, 2017 | 5:00 AMDr Mellanie Didier
Arteries
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Atherosclerosis, also known as arteriosclerosis, is a disease of the walls of the arteries. It can affect arteries throughout the body. When the heart arteries are affected, is it known as coronary artery disease/coronary heart disease.

Atherosclerosis in its simplest description refers to hardening of the arteries in the body. It is the result of the accumulation of deposits of fats and cholesterol in the walls of these vessels. The affected portions of the wall thicken and may then accumulate deposits of calcium resulting in hardening of the arteries. The affected areas are called plaques.

The complications of the presence of these plaques include:

- Poor movement of the vessel wall, which slows the forward movement of blood through the vessel.

- Narrowing of the vessel channel/lumen due to:

- Increasing of the size of the plaque over time

- Rupture (bursting) of the plaque.

- Rupture of the plaque can cause clot formation which can block the vessel.

- Fragments of the ruptured plaque can travel and occlude distant smaller vessels, for example, in the brain, eye, toe, and finger, causing death of tissues in these areas or abnormal functioning.

Atherosclerosis may be discovered:

- On investigations done of other purposes

- When specifically evaluated for in patients with the risk factor

 

Risk factors

 

The risk factors for atherosclerotic disease include:

- Genetic

- Age

- Male gender

- Family history of atherosclerosis

- Ethnicity

- Lifestyle

- Smoking

- Excess body weight

- Diabetes

- High blood pressure (hypertension)

- High cholesterol

- Lack of exercise

- High stress levels

- Depression

- Or evaluated in patients who present for the first time with complications of the disease such as:

- Stroke

- Transient (temporary) blindness

- Coldness or pain to the limbs/digits

- Pain walking

- Abdominal pain due to rupture of the aorta which has become dilated due to atherosclerotic disease

Many patients are without symptoms (asymptomatic) prior to these complications. Of the complications of atherosclerotic disease, stroke and coronary heart disease account for the top one and two causes of death in the Jamaican population.

In order to be able to identify atherosclerotic disease in the vessels, your doctor may recommend certain tests. These tests are done by radiologists. These tests serve to document the presence of the disease, its severity and the effect on the blood-flow pattern within the arteries.

These results are necessary to help your doctor formulate the most appropriate treatment plan for you.

These tests used include:

 

Ultrasound

 

- Carotid Doppler

- Arterial Doppler of the Limbs

- Abdominal Ultrasound

- Transcranial Doppler

 

Computed Tomography (CT)

 

- CT Angiograms of the Brain and Aorta

 

Magnetic Resonance Imaging (MRI)

 

- MRI Angiogram of the Brain and the Aorta

 

Nuclear medicine

 

- Perfusion Scan - of muscles of heart

Some patients, as part of their treatment, may benefit from procedures where the vessels are reopened or their channels/lumens widened. These procedures may involve the use of:

- Introduction of medications to dissolve clots formed when the plaques rupture (thrombolytics)

- Or placement of devices known as stents to widen the channel/lumen of the artery at the site of a plaque.

These procedures can be done by radiologists through a very small incision (cut) in the artery with the help of ultrasound and specialised X-rays.

In summary, atherosclerosis is a common disease with multiple severe complications. In the effort to treat and manage it, several tests and procedures done by radiologists are an important components in the process. Let your radiologist help you and your doctor in this challenge.

- Dr Mellanie Didier, MB, BS - DM Radiology, Jamaica Association of Radiologists. Email: yourhealth@gleanerjm.com.