ATHEROSCLEROSIS WHAT IS ATHEROSCLEROSIS? Atherosclerosis is a narrowing of the arteries that can significantly reduce the blood supply to vital organs such as the heart, brain and intestines. In atherosclerosis, the arteries are narrowed when fatty deposits called plaques build up inside. These plaques are made up of excess cholesterol, other fats, and inflammatory cells in the artery wall and sometimes calcium deposits. As a plaque grows along the lining of an artery, it produces a rough area in the artery's normally smooth surface. This rough area can cause a blood clot to form inside the artery, which can totally block blood flow. Plaques can lead to narrowing of your arteries and cause symptoms from decreased blood flow such as chest pain (angina) or pain in your legs (claudication). In addition these plaques can sometimes suddenly become unstable and rupture, leading to heart attacks and strokes. Atherosclerosis can be a progressive disease. WHAT CAUSES ATHEROSCLEROSIS? There is no single cause of atherosclerosis. Factors that increase your risk of developing atherosclerosis include: High level of blood cholesterol (hypercholesterolemia) Low level of HDL (the "good cholesterol") High levels of C-reactive protein, a marker for inflammation High blood (hypertension) Diabetes Family history of coronary artery disease at an early age Cigarette smoking Obesity Physical inactivity (too little regular exercise) Older age WHAT ARE THE SYMPTOMS OF ATHEROSCLEROSIS? Atherosclerosis usually doesn't cause any symptoms until blood supply to an organ is reduced. When this happens, symptoms vary, depending on the specific organ involved: Heart Symptoms include the chest pain of angina and shortness of breath, sweating, nausea, dizziness or light-headedness, breathlessness or palpitations. Brain When atherosclerosis narrows brain arteries, it can cause dizziness or confusion; weakness or paralysis on one side of the body; sudden, severe numbness in any part of the body; visual disturbance, including sudden loss of vision; difficulty walking, including staggering or veering; coordination problems in the arms and hands; and slurred speech or inability to speak. If symptoms disappear in less than 24 hours, the episode is called a transient ischemic attack (TIA). When atherosclerosis completely blocks the brain arteries and/or the above symptoms last longer, it's generally called a stroke. Abdomen When atherosclerosis narrows the arteries to the intestines, there may be dull or cramping pain in the middle of the abdomen, usually beginning 15 to 30 minutes after a meal. Complete blockage of an intestinal artery causes severe abdominal pain, sometimes with vomiting, diarrhea or abdominal
swelling. Legs Narrowing of the leg arteries causes cramping pain in the leg muscles, especially during exercise. If narrowing is severe, there may be pain at rest, cold toes and feet, pale or bluish skin and hair loss on the legs. Complications Individuals that have developed atherosclerosis are 5 to 7 times more likely than the general population to have a cardiac or vascular (blood vessel) event. Having atherosclerosis means you are at higher risk for developing a heart attack or stroke. Plaques in your arteries that right now are mild and not causing you a current problem can, without proper treatment, suddenly become unstable leading to a stroke or heart attack. Once you have developed atherosclerosis you remain at increased risk for the rest of your life. Fortunately there are medications you can take and lifestyle changes you can make that can dramatically lower your risk. When to see a doctor? It is possible to have atherosclerosis for many years without having symptoms. See your doctor immediately if you think you are experiencing symptoms of an atherosclerosis-related medical condition (as stated in the above paragraph) or if you have factors increasing your risk for developing atherosclerosis mentioned in the paragraph What causes atherosclerosis? Preparing for your appointment Write down questions to ask your doctor: What's the most likely cause of my symptoms? (Are there other possible causes for my symptoms? What kinds of tests will I need? Do these tests require any special preparation? What treatments are available? Which do you recommend for me? What foods should I eat or avoid? What's an appropriate level of physical activity? How often should I be screened for changes in my condition? I have other health conditions. How can I best manage these conditions together? Don't hesitate to ask questions during your appointment at any time that you don't understand something. Diagnosing atherosclerosis After asking you about your symptoms and examining your you may be diagnosed with atherosclerosis by your doctor in a number of ways: Clinical history: prior angioplasty, cardiac bypass surgery, carotid surgery, Clinical presentation: heart attack, angina, or stroke, Physical examination: bruit (noise heard over artery) or absent pulses, Noninvasive test: ECG, stress test, ultrasound study, Invasive test: angiogram showing narrowings or obstructions Treatments and Drugs Atherosclerosis is a chronic state. The progression of atherosclerosis can be halted and in some cases even reversed. There are four types of medications that have been shown to save your life if you have atherosclerosis if taken appropriately and regularly. It has been estimated that together these medications can reduce your risk of having a heart attack or stroke by 70 to 80%. Aspirin works by inhibiting platelets (tiny parts of cells that play a role in clotting) in the blood and preventing blood clots from forming in the arteries. Beta blockers protect the heart and blood vessels from damage. ACE inhibitors protect the heart and blood vessels from damage. Statins reduce bad cholesterol and inflammation in the arteries thus preventing the build of plaques in the arteries and preventing existing plaques from rupturing. There may be certain conditions that you have or other reasons why you may not be receiving one or more of these medications. You should check with your doctor so you can understand what those reasons are if you are not receiving all four of these medications. There are other medications you may receive to control symptoms or for other purposes. The four types of medications above, however, are the only ones currently proven to save lives. The purpose, action, dose, and major side effects of each medication prescribed should be explained to you. Ask for a written medication sheet and a medication schedule. Lifestyle and prevention Medication alone will not solve your medical condition. Your doctor will probably recommend some changes in your daily activities, exercise, and diet. These changes will depend largely on what your habits were before you were diagnosed with atherosclerosis, on the causes of your atherosclerosis, and on how well your heart is responding to treatment. Making lifestyle changes can often help
relieve signs and symptoms of atherosclerosis. These changes may be among the most important and beneficial you can make: Exercise Once approved by your doctor, you should begin a regular exercise program. In general you should aim for exercising for a minimum of 30 to 60 minutes 3 to 4 times weekly, supplemented by an increase in daily activities. Good ways for you to get exercise include walking, jogging, cycling, swimming or other aerobic activity. You should also try things such as walking during breaks at work or taking the stairs instead of the elevator. Diet You should start a diet that is low in fat, saturated fat, and cholesterol and that helps you maintain a normal weight. The American Heart Association diet is recommended. This diet contains <30% of calories from fat and <7% saturated fat, and < 200 mg a day If you smoke, stop smoking If you smoke, you must stop. Continued smoking once you have atherosclerosis makes you 5 times more likely to have a heart attack, stroke, and die. If you quit, however, your risk goes down dramatically, even in a few days. There are lots of things that your doctor can do to help you quit. Your family should help you by making sure any family members that smoke also quit. Avoid secondhand smoke too. Other Things If you have high blood, you want to make sure your blood is well controlled. If you have diabetes, you want to make sure your blood sugar is well controlled. If you are overweight, you want to loss weight to get to your ideal body weight. Coping and Support Symptoms of chest pain, shortness of breath, dizziness, weakness, trouble speaking, or numbness lasting more that 1 to 2 minutes should prompt you to stop your activities and sit down. If you are having chest pain and have nitroglycerin, place a NTG tablet under the tongue. This may be repeated at five minute intervals. If symptoms persist after 10 minutes you should seek transportation to the nearest hospital Emergency Department either by ambulance or the fastest available transport (i.e. call 112). Take one dose of aspirin 325 mg and chew, unless allergic or previously advised not to take aspirin. Don t delay seeking medical attention if you can not get through to your doctor right away. If your symptoms are severe call 112 first. Don t ignore the warning signs of a heart attack or stroke. Have an immediate plan of action prepared in advance. Prompt medical attention can make the difference between life and death COLLABORATION WITH YOUR DOCTOR These steps can help you work most effectively with your doctor: Keep track of the medications you take. Make a list and share it with any new doctors treating you. Carry the list with you all the time. Keep track of your blood. Consider purchasing a home blood monitor. Keep track of your blood between doctor appointments and bring the record with you to visits. Write down your questions. Before a doctor appointment, prepare a list of any questions or concerns. Ask for clarification. Make sure you understand what your doctor is saying. Managing atherosclerosis requires an open dialogue between you and your doctor. Be honest about whether you're following recommendations concerning your diet, lifestyle and taking medications. Your doctor often can suggest strategies to help you get and stay on track. WHAT TO DO? You should make sure that you have appointments scheduled with your doctors before you leave the hospital. One of the major reasons patients have another heart attack or stroke or need repeat catheterization, angioplasty, or bypass surgery is that they did not continue to take their heart medications. Your LDL, HDL, and BP need to be monitored. There are other blood tests that are also important. Since you have atherosclerosis, members of your family may also be at higher risk. It is important for them to see their doctor to determine what can be done to lower their risk. WHAT YOU SHOULD BEAR IN MIND?
Do I understand and have a way of getting my prescribed medications? Do I understand my prescribed diet? Do I have a follow-up appointment with my physician? Do I know the warning signs that I may be getting in trouble? Do Every Day! Follow your doctor s advice Take your medications the way you should Exercise, eat a healthy diet, keep a healthy body weight Keep your doctor s appointments Keep a record of your LDL, HDL, and blood readings Life Saving Medications Medication Dose If not, why not/comments Aspirin Beta blocker ACE inhibitor Statin Monday Tuesday Wednesday Thursday Friday Saturday Sunday EXERCISE / Blood Pressure HOW CAN I LEARN MORE? Talk to your doctor, nurse, or health care professional. The American Heart Association also has a web site you can visit at www.americanheart.org. There is a program called One Of a Kind a personalized health management program. This program was developed by the American Heart Association to help you live a healthier life. It works by giving you information that s tailored to your own health and lifestyle needs. You can use this information to develop new healthier habits and lower your risk.
1. For your visit to your doctor please prepare answers to the following questions that may interest him (Be prepared to answer the following questions your doctor can ask you) Questions you may be asked by your healthcare specialist: Do you have a family history of atherosclerosis? Was or is someone in your family obese (overweight)? Do you have a family history of cerebral (brain) stroke? Do you have a family history of vascular diseases? Do you have a family history of high blood? Do you have a family history of coronary artery (heart) disease? What is your lifestyle? Are you on a diet? What are your eating habits? Are you physically active? Do you use any regular medication? Do you have a family history of high cholesterol? Have you had a cholesterol test before? If so, what were your cholesterol levels? Do you have any discomfort in your chest or pain in your legs with walking or at rest? Did you ever have a stroke? 2. For your visit to your doctor please take with you the following list of questions to discuss with him during your consultation (Be prepared to ask and discuss with your doctor the following questions) Doing this will improve your chance to beter manage your health condition! What can/should you ask during consultations with the healthcare professional? What is hardening of the arteries (atherosclerosis)? What are the first warning signs of atherosclerosis? What causes atherosclerosis? Is atherosclerosis treatable? Is atherosclerosis dangerous? How can atherosclerosis be prevented? How does atherosclerosis develop? How is atherosclerosis diagnosed? What is the difference between atherosclerosis and arteriosclerosis? What are the major risk factors for atherosclerosis? Is atherosclerosis the same as coronary artery disease? How quickly does atherosclerosis occur? Will I develop atherosclerosis even when my blood cholesterol is low? How will atherosclerosis affect my mental or psychological outlook? Why is the heart more vulnerable to atherosclerosis? Can a regular echocardiogram find atherosclerosis? How does atherosclerosis affect the function and structure of the cardiovascular system? What tests are there to check for atherosclerosis or placque buildup in the arteries? What is a good herbal remedy for atherosclerosis? Should I be concerned about atherosclerosis throughout my body? To what degree does smoking precipitate atherosclerosis and heart attack? How is atherosclerosis related to heart attacks and strokes?
Is cholesterol good or bad? Is atherosclerosis genetic in origin? What is coronary disease? What causes coronary artery disease? What are the symptoms? How is coronary artery disease diagnosed? What can I change in order to prevent atherosclerosis? What is the difference between atherosclerosis and arteriosclerosis? Does everyone suffer from atherosclerosis as they age? Does ultrasound diagnose atherosclerosis? Which arteries are most at risk for atherosclerosis? What is the difference between an atheroma, atherosclerosis and ischaemic heart disease? Is there any connection between atherosclerosis and multiple sclerosis? What is the immune response in atherosclerosis? References 1. http://www.med.ucla.edu/champ/athero.pdf (accessed 17.09.2013) 2. http://umm.edu/health/medical/altmed/condition/atherosclerosis (accessed 17.09.2013)