Internal Medicine

arteriosclerosis

introduction

In vascular calcification, which is also called arteriosclerosis is a systematic disease of the arterial blood vessels in the body.

It also becomes colloquial Hardening of the arteries designated. The vascular calcification can increasingly narrow the vascular lumen due to increased fat deposits and thereby weaken the blood supply in the subsequent river area.

Risk factors of arteriosclerosis

Even if there is a constant need to identify new risk factors for arteriosclerosis, there is now consensus about the main reasons for arteriosclerosis (hardening of the arteries) and atherosclerosis.
The main risk factors are:

high blood pressure
increased cholesterol
smoking
Diabtes mellitus
genetic predispositions

A lack of exercise and negative stress are also said to lead to vasoconstriction if this lifestyle is maintained for decades.

The above-mentioned risk factors generally lead to an unfavorable blood composition, a local lack of oxygen and pressure damage and eddy formations at the vascular branches.

Risk factors that cannot be influenced are:

age,
the gender (Statistically, men are more often affected by arteriosclerosis than women)
and menopause. Menopausal women also have a greatly increased risk of developing arteriosclerosis. The reason for this is suspected to be the lack of estrogen.

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Atherosclerosis can be recognized by these symptoms

Atherosclerosis is a vascular disease that can manifest itself in a wide variety of symptoms. The symptoms mainly depend on where the arteriosclerotic plaques have settled. If the arteriosclerosis settles in the coronary vessels, these are severely constricted and blood can hardly be pumped through. This leads to a lack of nutrients and oxygen in the heart muscles, which is initially particularly noticeable during exercise. There is a feeling of pressure and tightness on the chest. Chest pain can also occur, and there is also increased performance loss and fatigue. A lack of oxygen, especially during physical exertion, can also be a sign.

If the arteriosclerosis increasingly settles in the carotid artery, the brain in particular is affected by circulatory disorders. In mild cases there are mild and very unspecific symptoms such as dizziness, headache and fainting spells. If one of the arteriosclerotic plaques suddenly comes off, however, this can have serious consequences in the brain and trigger a stroke, for example.

Atherosclerosis, which tends to affect the peripheral (far from the heart) vessels, mainly leads to circulatory disorders in the hands and feet. These quickly turn blue and cold. In this case too, a lack of oxygen can lead to muscle pain.

Further information is also available here: Symptoms of atherosclerosis

Cold hands and feet

Cold hands and feet are usually due to arteriosclerosis in the supplying vessels. The legs and thus the feet are most frequently affected, but the arteries that supply the arms with blood can also be narrowed by atherosclerosis. Due to the reduced blood flow, not so much heat can be conducted into the hands and feet, which is why they get cold quickly. This is particularly noticeable in winter.

In the cold season the body is often not able to keep hands and feet warm even in healthy people.

thrombosis

Thrombosis most commonly occurs in the deep veins of the leg. There are small valves in the vessels that are supposed to help move the blood back to the heart against gravity. But since they change the flow conditions in the vessel, blood clots can easily form there Thrombi form.

In the disease arteriosclerosis, calcium deposits form in the arteries. Similar to the venous valves, they change the flow behavior of the blood and lead to small eddies. This causes the blood In some places strongly accelerated, in others clearly slowed down. Where the blood flows very slowly, blood cells can get caught on the vessel wall. As a result, more and more parts of the blood get stuck there and a blood clot forms.

dementia

Dementia is a symptom of old age that is mostly due to a degenerative remodeling of the brain. But arteriosclerosis can also play a decisive role in dementia. If arteriosclerotic plaques lead to reduced blood flow to the brain, the tissue there is damaged. Due to the reduced supply of nutrients and oxygen, some of the cells die. Over time, the brain areas can gradually lose size. The less brain mass that remains, the faster the dementia progresses. Other degenerative diseases can also be worsened by arteriosclerosis in arteries feeding the brain.

impotence

Atherosclerosis, when it affects the arteries that supply the genital organs, can also lead to impotence. Especially in men, weak erections and impotence are signs of arteriosclerosis. In the process, the plaques settle in the small vessels that supply the penis with blood. Due to the insufficient blood supply, there is a lack of nutrients. The erection is also usually controlled by a large flow of blood. If this influx does not occur due to arteriosclerosis, weak erections and impotence can be the result.

Leg pain

Leg pain is a typical symptom of peripheral arterial disease (PAOD). The arteriosclerosis settles in the leg arteries in such a way that hardly any blood reaches the lower legs and feet.

You can also find more information here: Peripheral arterial disease

When walking, the muscles are therefore insufficiently supplied with oxygen and other nutrients. In addition, metabolic waste accumulates that should actually be transported away by the blood. For many sufferers, this means that they can only walk a few meters at a time before severe leg pain sets in. Since affected people often have to stand still, the disease is also known as Intermittent claudication.

Atherosclerosis of the carotid artery

Atherosclerotic plaques can build up in the carotid artery. There they first constrict the vessel and thus reduce the flow of blood to the brain. The result is dizziness, sometimes even fainting. Individual brain regions can also be disturbed. This manifests itself, for example, in impaired vision or forgetfulness.

Small blood clots can also build up on the calcifications in the carotid artery. These can loosen over time and cause a stroke in the brain.

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Atherosclerosis of the abdominal artery

Atherosclerosis can also develop in the abdominal artery. This means that the blood vessels that are supposed to supply the abdominal organs are no longer adequately supplied with blood. This leads to functional disorders of these organs or even to the death of the tissue.

The kidneys are particularly sensitive to a reduced blood supply. she reflexively regulate blood pressure upwards and thus worsen the risk factors for arteriosclerosis.

The abdominal artery itself can also be severely attacked by arteriosclerosis. The wall becomes stiff and brittle, leading to bulging of the abdominal artery, a so-called Aneurysm, can come.

More on this: Calcifications in the abdominal artery

Formation of bypass circuits

If there is constriction of the vessels as a result of arteriosclerosis (hardening of the arteries) and this leads to a lack of oxygen, the body reacts with some countermeasures to compensate for the oxygen debt.

With the reduced vessel volume in arteriosclerosis, there is an increase in blood pressure in front of the narrowed vascular segment. Numerous bypass circuits of the large vessels, which are also known as anastomosis, have already been created anatomically. With increasing blood pressure in the corresponding vascular section, there is an increase in blood flow through these bypass vessels. However, these can only compensate for a certain part of the oxygen debt, because they are usually thinner and cannot transport as much oxygen-rich blood.

In the case of slowly progressing arteriosclerosis and the associated opening of diversion vessels, a certain oxygen requirement can be met, but acute occlusion occurs (Infarct), the immediately required amount of blood can usually not be transported. Even with chronic and slow constrictions, at some point the capacity of the anastomotic vessels is exhausted and the patient then experiences clinical symptoms.

Causes of atherosclerosis

The causes of arteriosclerosis can be found primarily in our modern way of life. The predominantly sedentary work as well as the Abundance of food combined with an almost constantly present stress level promote the formation of arteriosclerotic plaques and thus make arteriosclerosis and its secondary diseases the number one cause of death in industrialized nations.

An imbalance in blood lipid levels is largely responsible for calcium deposits. The most important value is cholesterol, which can be divided into good, protective HDL and bad LDL. The "bad" LDL is deposited from the blood on the vessel walls. There it is taken up by cells and so-called foam cells are formed. These attract further messenger substances, which over time leads to solid calcifications in these areas in the vessel.

The higher the blood lipid levels, the faster and more often these plaques develop. In addition, high blood pressure can put the vessel walls under stress and thus accelerate the formation of calcifications. High blood lipid levels and increased blood pressure are the result of our mostly unhealthy and unbalanced diet. But the chronic lack of exercise also contributes to the fact that more and more people are suffering from high blood pressure, high blood lipids and thus from arteriosclerosis.

Find out more about the topic here: Causes of atherosclerosis

Diagnosis of atherosclerosis

The diagnosis of arteriosclerosis is usually made relatively late, as the clinical symptoms become noticeable late. An initial suspicion of arteriosclerosis can already be confirmed during the patient survey.

Returns the patient

Chest discomfort when exerted
or increasing memory problems,
Signs of paralysis
or dizziness or syncope,

The doctor will suspect, among other things, a vascular change in the form of vascular calcification (arteriosclerosis).

Information about the distance that can be covered before drawing pains in the legs occurs often indicates arteriosclerotic changes in the vessels.
Furthermore, arteriosclerosis patients with increasing narrowing of the leg arteries report pain when lying down, which only improves when they lie down the leg.

The Ratschow storage sample

In the case of arteriosclerotic changes in the leg or arm arteries, the so-called Ratschow position test can provide certainty.
Ask the patient to raise the affected arm or leg in the air so that the blood flows back from the areas to the center of the body. To accelerate this, the patient is asked to quickly open and close the fist or, with the leg pointing upwards, to spin with the feet.
After a few minutes, the leg or arm is placed on the couch and the time is measured that is required until the area of the body is supplied with blood again (Return of the blood = red coloring of the skin). If the time is more than 7 seconds, an artery occlusion can be concluded. However, this procedure is not used for heart failure or severe PAD.

Imaging methods of examination

In order to confirm the diagnosis of arteriosclerosis, ultrasound examination is the method of choice when it comes to constrictions of the main artery, renal artery or arteries of the legs and arms. With the so-called Doppler examination, the blood flow and turbulence can be made visible and constrictions can be identified. Narrowing of the carotid artery with subsequent undersupply of the brain can also be made visible in this way.

Please also read our article Blocked carotid artery (carotid stenosis)

If the vascular constrictions in the brain are involved, computed tomography (CT) or magnetic resonance tomography (MRI) with simultaneous administration of contrast medium must be performed.
A narrowing of the coronary arteries can be caused by an ECG recording (Signs of ischemia) Above all, an exercise ECG is displayed here.
The most reliable proof of arteriosclerosis can be done by a cardiac catheter examination, in which a catheter is advanced into the heart and contrast agent is given into the coronary arteries.
A simultaneous x-ray examination can then determine constrictions.
In addition to the apparatus-based examinations and patient surveys, the physical examination is also an important part of the diagnosis of arteriosclerosis.

The neurological exam

The neurological examination in atherosclerosis can indicate undersupply of the brain,

eavesdropping on the carotid artery can represent flow noises,
the walk test may indicate a suspected vasoconstriction affecting the legs.
A cold and pale extremity indicates a complete blockage of the arteries. This is an absolute emergency that must be dealt with as quickly as possible in order to save the extremity in question.

The blood test

In general, a blood test and the collection of blood lipids also suggests arteriosclerosis or the risk of arteriosclerosis. The cholesterol levels and the LDL cholesterol levels are particularly important here. If LDL levels are high and HDL levels are low, there is a high risk of arteriosclerosis. Well, it's an LDL decrease and an HDL increase. (HDL is a protein that quickly moves cholesterol from the blood into the cells). In addition, the triglycerides, which are also considered to be risk factors for arteriosclerosis, should be determined in the laboratory.

Which doctor treats arteriosclerosis?

Atherosclerosis is a disease for many different disciplines. First and foremost, it is through one Internists treated. If the heart is affected by the plaques, become Cardiologists consulted. With deposits in the leg vessels or the carotid artery are mostly Vascular surgeons in responsibility. Ideally, atherosclerosis is treated in an interdisciplinary manner, i.e. with cooperation.

Treatment of atherosclerosis

Treatment of atherosclerosis depends heavily on how far it has progressed. Everyone gets slight calcium deposits in their arteries in the course of their life. This usually starts in the early / mid-twenties and continues throughout life. How pronounced these arteriosclerotic plaques are, however, depends heavily on lifestyle.

The treatment of arteriosclerosis begins in the broadest sense with a healthy lifestyle, which includes a balanced diet, plenty of exercise and avoidance of stress. If these measures are not sufficient, a strengthening of the diet and a targeted exercise program may still help.

If the arteriosclerosis progresses further, blood pressure and cholesterol lowering drugs are used first. Both high blood pressure and high blood lipid levels promote the formation of plaques and are therefore treated preventively before the actual illness.

Once arteriosclerosis has developed, which actually causes symptoms, blood-thinning medication is usually also prescribed. So you want to make sure that no blood clots settle on the calcium deposits and worsen the situation.

If serious complications arise such as severe circulatory disorders of the legs, the brain or the heart, the calcified and blocked vessel sections must be cleared again.

This can be done using a catheter, i.e. a thin wire that is usually inserted through the inguinal artery. Such a catheter is often used to attach stents, i.e. small wire grids, to the heart. to keep the vessels open, used.
The last therapeutic variant is the so-called bypass, in which a different vessel is used, so to speak Diversion for the blocked vessel section is built.

Find out more about the topic here: Treatment of atherosclerosis

Home remedies for atherosclerosis

A preventive, healthy lifestyle primarily helps against atherosclerosis. This includes all kinds of home remedies that involve a balanced diet. Consuming plenty of vitamins and fiber is also a good way to prevent arteriosclerosis. Endurance sports are suitable for strengthening the cardiovascular system as a whole and thus reducing the risk of arteriosclerosis.

In addition, it helps to be mindful of yourself in everyday life and to reduce your own stress, for example through yoga or meditation. Special home remedies that have a positive effect on arteriosclerosis are many foods that contain vitamins E and C. These include, for example, citrus fruits. These vitamins contain what are known as antioxidants. These substances are able to capture dangerous cell waste products that can damage the vessel walls. This prevents the waste products from reaching the walls of the vessel. Instead, they are excreted along with the unmetabolized portion of the vitamins.

Garlic is also an important home remedy for atherosclerosis. It means that the platelets no longer clump together so easily and thus triggers a natural blood thinning. As a result of this blood thinning, the garlic prevents the formation of blood clots on the calcium deposits in the vessels.

So-called alternating baths are also strengthening the circulation. The lower legs, legs or even the entire body are alternately hot and cold showered. This affects the vessels in a positive way, similar to the hot-cold change in the sauna.

Diet for atherosclerosis

The diet for atherosclerosis is largely based on the types of fat that someone eats. To do this, you have to know that the largest proportion of blood fat consists of cholesterol. This cholesterol can be found in good cholesterol (HDL) and bad cholesterol (LDL) subdivide.

The good cholesterol has a protective effect on the blood vessels, while the bad cholesterol favors the development of arteriosclerosis. In order to lower the LDL level in the blood, one should consume as little saturated fatty acids as possible. These are mainly found in animal fats, i.e. in meat. But deep-frying fat also largely consists of these saturated fatty acids.

In contrast, vegetable fat is particularly valuable for increasing the HDL level in the blood. In addition to herbal margarine and olive oil are also nuts and fish a valuable source of good fat.

It is therefore not important to completely ban fat from the menu when eating, rather attention should be paid to the source of the fat.

In addition, fruits and vegetables with their fiber and vitamins have a very positive effect on the vascular system. As a rule, around 5 servings (50g each) of fruit per day and 250g of vegetables are sufficient for an adult to meet the vitamin requirement.

Another big factor in the development of arteriosclerosis is high blood pressure. This can also be influenced by diet. A high-salt diet has a negative effect on blood pressure. Ready-made products in particular usually have a salt content that is far too high.

Vitamin K2

Vitamin K is usually first associated with blood clotting. This is how blood thinners work like Marcumar as an opponent to vitamin K and thereby prevent blood clotting.

In addition, vitamin K also plays a role in building bones. It leads to the fact that the calcium from the blood is built into the bones. At the same time, vitamin K prevents the calcium from settling on the fat plaques and calcifying them.

How can you prevent arteriosclerosis?

Preventive measures to prevent arteriosclerosis are classically a change in lifestyle.

This includes:

sufficient exercise
a balanced diet
a consequent stress reduction

Preventive sports include endurance sports, as they strengthen the cardiovascular system and can thus prevent vascular diseases. A healthy and balanced diet is usually most easily achieved with a Mediterranean diet. This dispenses with many "bad" animal fats and instead works with more vegetable fats. Only fatty acids from fish are also good for the body.

The composition of the fats that we eat determines whether we have more bad LDL or more good HDL in us. The bad LDL is caused by animal fats and promotes the development of arteriosclerosis.

In today's world, stress also plays an increasingly important role in the development of vascular diseases such as arteriosclerosis. Therefore, meditation, yoga, and other relaxation techniques are valuable options in atherosclerosis prevention.

In addition, harmful stimulants such as too many sugary foods and drinks as well as alcohol and cigarette consumption should be reduced to a minimum or avoided completely. They favor the imbalance of our blood lipids, trigger high blood pressure and put the cells of the body under stress. All of these factors have a negative effect on the risk of atherosclerosis.

Learn more about this under: How can you prevent arteriosclerosis?

Can you cure arteriosclerosis?

It is not possible to cure arteriosclerosis. These limescale deposits affect every adult and settle in the vessels from their early twenties. However, the severity of arteriosclerosis depends to a large extent on how active someone is and how balanced their diet is.

In addition, drugs such as blood pressure and fat lowering drugs can greatly reduce the body's arteriosclerotic potential. Basically, however, atherosclerosis affects everyone.

Much more important, however, is that Ask about the disease value of arteriosclerosis. Those who behave in a healthy manner may never feel that they are carrying such vascular calcifications. Others develop arteriosclerotic plaques at the age of thirty. This disease-related arteriosclerosis can be halted for several years (sometimes even decades) precisely through a lifestyle change and medication. However, it is not entirely curable.

Serious secondary diseases such as PAD, which usually lead to blockages of the leg vessels, or coronary artery disease, in which the coronary arteries become blocked, can be treated but not cured. In this way, diseased vessel sections can be bridged with a bypass. Stents, i.e. small wire grids, can hold the vessels open. However, arteriosclerosis remains as a disease.

Here you will find more information: Can you cure arteriosclerosis?

Life expectancy with arteriosclerosis

Life expectancy is severely limited due to arteriosclerosis compared to healthy people. Above all, the secondary diseases in the heart and brain limit life expectancy. Life expectancy can also decrease when other organs in the abdomen are affected. The quality of life is also severely restricted. In addition, the PAOD, i.e. the circulatory disorder of the legs, is usually noticeable in the quality of life.

Can arteriosclerosis regress?

In contrast to curing arteriosclerosis, regression of the disease is quite possible. By changing certain unhealthy habits, at least the progression of arteriosclerosis can usually be stopped.

Anyone who suddenly changes their eating habits from unhealthy food to a balanced diet can have a very positive effect on their arteriosclerosis. Even those who quit smoking can greatly improve their blood vessels in addition to their lungs, and arteriosclerosis can even partially regress. Atherosclerosis can also be suppressed with the help of drugs such as fat-lowering drugs and blood pressure medication.

What are the consequences of arteriosclerosis?

Atherosclerosis has numerous very different consequences, depending on where the calcifications are deposited.

Particularly in connection with smoking and diabetes mellitus, vascular constrictions occur in the legs, less often in the arms, which are also known as peripheral arterial occlusive disease (PAOD) referred to as. Atherosclerosis is that most common arterial disease and is associated with generalized atherosclerosis.

Peripheral arterial disease affects the lower extremity in 90% and the upper extremity in 10%. It can be a one-day disease (a section of the vessel becomes diseased) or as a two-day illness (several vessel sections are affected) occurrence. In the lower extremities, both legs are often affected at the same time, but mostly to different degrees. The legs are no longer adequately supplied with oxygen and other important nutrients. So it comes to pain in the legs, especially during physical exertion. If the PAD is more advanced, walking distances of only a few meters are possible.

The narrowing of the coronary vessels supplying the heart leads to coronary heart disease. First of all, the oxygen-rich blood still flowing in through the narrowed vascular lumen is still sufficient to supply the heart muscles. For this reason, the resting patient usually does not notice any vessel constriction.

However, the oxygen demand of the heart muscle increases with exercise. The blood can no longer cover the increased oxygen demand via the constricted vessels. There is severe pain behind the breastbone. One also speaks of the unstable angina pectoris.

If the blood vessel of the heart muscle narrows further, pain occurs even at rest because the oxygen demand of the slowly beating heart can no longer be met either. The patient with arteriosclerosis then has pain at rest (unstable angina pectoris). This is an absolute emergency that needs urgent attention. If the vessel becomes completely blocked, a heart attack occurs, in which the heart muscle cells die due to a lack of oxygen.

Atherosclerosis can also establish itself in the two carotid arteries. Atherosclerosis can also endanger the supply of the brain. For this reason, in the case of a long-term greatly increased fat value, in addition to a reduction in mental abilities, the blood vessels supplying the brain can also become blocked. The under-supplied brain area dies or is severely impaired by an acute edema, which in turn can lead to partly regressive, partly permanent paralysis and failures.

The pathological arteriosclerosis can have far-reaching and dangerous consequences.Mostly it is the organs to be supplied that are affected. The arteriosclerosis leads to a reduction in blood flow and thus to a reduction in the oxygen supply to the organ connected to the respective vessel.

The vessels that supply the intestines can also narrow and lead to pain, especially after eating. The total occlusion of those supplying the intestines is dangerous Mesenteric artery. Characteristically, the patient initially feels severe pain, which then regresses without further treatment and makes the patient feel safe. A short time later, however, there is a further increase in pain and the death of the intestinal section.

Most often, a mesenteric infarction is caused by arterial thrombi, mostly caused by atrial fibrillation. Atherosclerotic changes in the inner wall of the blood vessels can promote and accelerate infarcts of the intestine.

What is a plaque?

Plaques arise after the bad blood lipids, i.e. LDL, have deposited on the vessel wall. The LDL leads to the fact that inflammatory cells are increasingly brought to the vessel wall. These attack the LDL and only really build it into the vessel wall. So-called foam cells are created.

Over time, several foam cells form real fat stains in the vessel walls. In addition to the formation of foam cells, the cells of the vessel wall are also stimulated to grow. So they form connective tissue, which is deposited on the foam cells.

This mixture of connective tissue and fat deposits forms a plaque. As a result, the composition of the plaques is changed by further remodeling processes, so that blood clots can form on them and hard calcifications develop.

Stages of arteriosclerosis

The arteriosclerosis is noticeable in the vessels in the later stages through their calcium deposits. Even before this, however, there are changes in the structure of the vessel wall. These remodeling processes are also involved in the stages of arteriosclerosis, as they represent the preliminary stages of the disease.

Whoever has healthy blood vessels does elastic are and no restrictions show, one speaks of stage 0.
The first damage to the vascular wall is usually caused by fat deposits. This is known as stage I.
In stage II, this wall damage is already advanced. The vessel reacted to the fat deposits and enclosed them with connective tissue. Conversion processes are now taking place in this enclosed area.
Stage III is the end stage of the disease. The vascular walls are severely damaged, the arteries are narrowed and secondary diseases such as PAD or coronary artery disease already exist.

These secondary diseases can also be divided into stages. The CHD is classified according to the number of vessels affected and the degree of narrowing of the vessels. The stages of PAD are based on the walking distance, which is still possible despite the arteriosclerosis in the legs.

Blood values in atherosclerosis

In arteriosclerosis, the blood lipid values are primarily of interest. A distinction is made between total cholesterol, good (HDL) cholesterol, bad (LDL) cholesterol and other fats such as triglycerides. In arteriosclerosis, these blood lipids are usually all too high. In particular, the relationship between HDL and LDL is decisive for the development of the disease. Usually there is too much of the LDL and too little of the HDL.