Aterosklerosis
Aterosklerosis
Pembimbing :
Dr. Bambang Supriadi, Sp. S
Oleh :
Benediktus Bayu Anggoro Putro
Introduction
TERMS/Definitions
Arteriosclerosis is a general term describing
any hardening (and loss of elasticity) of medium
or large arteries
Causes
Atherosclerosis starts with damage or
injury to the inner layer of an artery.
The damage may be caused by:
Epidemiology
Table:1. Estimated
10-year risk of
coronary artery
disease according
to various
combinations of
risk factor levels,
expressed as the
probability of an
event in 10 years.
HDL-C,
Epidemiology
ATHEROSCLEROSIS is less prevalent
in central and south America, Africa,
and Asia. And more prevalent in
united states and Japan.
The mortality in U.S in 5 times higher
than Japan
According to United States data for
the year 2004, for about 65% of men
and 47% of women, the first
symptom of atherosclerotic
cardiovascular disease is heart
attack or sudden cardiac death
Epidemiology
ATHEROSCLEROSIS is less prevalent
in central and south America, Africa,
and Asia. And more prevalent in
united states and Japan.
The mortality in U.S in 5 times higher
than Japan
According to United States data for
the year 2004, for about 65% of men
and 47% of women, the first
symptom of atherosclerotic
cardiovascular disease is heart
attack or sudden cardiac death
Pathophysiology
Atherosclerosis develops as a chronic
inflammatory response of the arterial
wall to endothelial injury.
Lesion progression occurs through
interactions of modified lipoproteins,
monocyte-derived macrophages, Tlymphocytes, and the normal cellular
constituent of the arterial wall.
The contemporary view of
atherosclerosis is expressed by the
response-to-injury hypothesis.
Response-to-injury hypothesis
1.
2.
3.
4.
5.
Response-to-injury
hypothesis
1. Chronic endothelial injury
. with resultant endothelial
dysfunction, causing increased
permeability, leukocyte adhesion,
and thrombosis
Response-to-injury
hypothesis
2. Accumulation of lipoproteins
(mainly LDL and its oxidized forms) in
the vessel wall. Low-density
lipoprotein molecules (LDL) becoming
oxidized (ldl-ox) by free radicals,
particularly oxygen free (ROS). When
oxidized LDL comes in contact with an
artery wall, a series of reactions occur
to repair the damage to the artery wall
caused by oxidized LDL. Cholesterol
can move in the bloodstream only by
Response-to-injury
hypothesis
3. Monocyte
adhesion to the
endothelium
Response-to-injury
4.hypothesis
platelet adhesion
5. factor release
from activated platelet,
macrophages and vascular wall
cells, inducing SMC recruitment,
either from the media or from
the circulating precursors
Response-to-injury
6. SMC
proliferations and ECM
hypothesis
production.
Response-to-injury
7. hypothesis
Lipid accumulation
both extracellularly and within cells
(macrophages and SMCs).
accumulation if lipid-containing
macrophages in the intima gives rise
to fatty streaks, with further
evolution, a fibrofatty atheroma
consisting of proliferated SMC, foam
cells, extracellular lipid, and ECM is
formed.
Symptoms
Atherosclerosis develops gradually,
typically begins in early adolescence,
and is usually found in most major
arteries. There are usually no
atherosclerosis symptoms until an
artery is so narrowed or clogged that
it can't supply adequate blood to your
organs and tissues. Sometimes a
blood clot completely obstructs blood
flow, or even breaks apart and causes
blood clots that can trigger a heart
attack or stroke.
Symptoms
Atherosclerosis symptoms depend on which
arteries are affected. For example:
Atherosclerosis in heart arteries,have
symptoms similar to those of a heart attack,
such as chest pain (angina).
Atherosclerosis in the arteries leading to
brain, have symptoms such as sudden
numbness or weakness in your arms or legs,
difficulty speaking or slurred speech, or
drooping muscles in your face.
Atherosclerosis in the arteries in arms and
legs, produces decreased blood flow is called
peripheral artery occlusive disease (PAOD).have
symptoms such as leg pain when walking
Sometimes atherosclerosis causes erectile
Symptoms
Symptoms
Table 1.Conditions That Accelerate the Progression of Atherosclerosis and the Mechanisms
Responsible.
Condition
Mechanism
Male gender (and females Estrogen increases cholesterol removal by the liver, and the progression of
after menopause)
atherosclerosis is less rapid in premenopausal women that in men
Family history of
ischemic heart disease,
stroke
Primary hyperlipidemia
Inherited disorders causing lipoprotein lipase deficiency (type I), defective LDL
receptors (type IIa), abnormal apoprotein E (type III), deficiency of apoprotein C (type
V), or unknown cause (types IIb and IV).
Secondary
hyperlipidemia
Cigarette smoking
Hypertension
Obesity, particularly
abdominal obesity
Nephrotic syndrome
Hypothyroidism
Elevated plasma
homocysteine
Unsettled. Probably increased homocysteine provides more H2O2 and other reactive
oxygen molecules that foster formation of oxidized LDL.
Complications
The complications of atherosclerosis depend on
the location of the blocked arteries. For
example:
Coronary artery disease.When
atherosclerosis narrows the arteries close to
your heart, you may develop coronary artery
disease, which can cause chest pain (angina)
or a heart attack.
Carotid artery disease.When
atherosclerosis narrows the arteries close to
Stein
Harald
Johnsen,
Signe
Helene
Forsdahl, Kulbir
Singh, artery
Bjarne Koster
your
brain,
you
may
develop
carotid
Jacobsen. Atherosclerosis in Abdominal Aortic Aneurysms: A Causal Event
which
can cause
a transient
ordisease,
a Process Running
in Parallel?
The Troms
Study. AHA : 2016. Available
on : http://atvb.ahajou1rn2a6l3s.org/ by guest on February 13, 2016
ischemic attack (TIA) or stroke.
Complications
Peripheral artery disease.When atherosclerosis
narrows the arteries in your arms or legs, you may
develop circulation problems in your arms and legs
called peripheral arterial disease. This can make you
less sensitive to heat and cold, increasing your risk of
burns or frostbite. In rare cases, poor circulation in your
arms or legs can cause tissue death (gangrene).
Aneurysms.Atherosclerosis can also cause
aneurysms, a serious complication that can occur
anywhere in your body. An aneurysm is a bulge in the
wall of your artery. Pain and throbbing in the area of an
aneurysm is a common symptom. If an aneurysm
bursts, you may face life-threatening internal bleeding.
Although this is usually a sudden, catastrophic event, a
slow leak is possible. If a blood clot within an aneurysm
dislodges, it may obstruct an artery at some distant
Prevention
The same healthy lifestyle changes
recommended to treat atherosclerosis
also help prevent it. You've heard it
before stop smoking, eat healthy
foods, exercise regularly, maintain a
healthy weight, drink less alcohol. Just
remember to make changes one step at
a time, and keep in mind what lifestyle
changes are manageable for you in the
long run.
References: