Arteriosclerotic Heart Disease

BASICS

DESCRIPTION
Arteriosclerosis is a group of diseases characterized by thickening and loss of elasticity of the arterial walls which progressively blocks the coronary arteries and their branches. Arteriosclerosis is the most common form of coronary arteriosclerosis. The process is chronic, occurring over many years, and is the most common cause of cardiovascular disability and death. Other forms of arteriosclerosis include arteriolosclerosis and medialcalcific stenosis, both of which are uncommon in the coronary vasculature.
  • System(s) affected: Cardiovascular
  • Genetics: Tendency is inheritable
  • Incidence/Prevalence in USA: Common. Causes 35% of deaths in men age 35-50. Death rate age 55-64 - 1:100.
  • Predominant age: Men 50-60, women 60-70, for peak clinical manifestations
  • Predominant sex: Male > Female
SIGNS AND SYMPTOMS
  • Variable. May remain clinically asymptomatic even in advanced disease states, eg, silent ischemia.
  • Clinical manifestations
    • Substernal chest pain
    • Exertional dyspnea
    • Orthopnea
    • Paroxysmal nocturnal dyspnea
    • Cardiac arrhythmias
    • Systolic murmur
    • Cardiomegaly
    • Pedal edema
CAUSES
  • Atherosclerosis
  • Narrowing of coronary arteries
  • Embolism compromising coronary arteries at orifices
  • Subintimal atheromas in large and medium vessels
RISK FACTORS
  • Elevated low density lipoprotein (LDL)
  • Decreased high density lipoprotein (HDL)
  • Elevated triglycerides
  • Smoking
  • Family history of premature arteriosclerosis
  • Obesity
  • Hypertension
  • Stress
  • Sedentary life style
  • Increasing age
  • Male sex
  • Postmenopausal female not on estrogen replacement therapy
  • Diabetes mellitus

DIAGNOSIS

LABORATORY
  • Elevated triglycerides
  • Elevated total cholesterol
  • Elevated low density lipoproteins
  • Decreased high density lipoproteins
  • Elevated cholesterol/HDL ratio


Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS
  • Gross - narrowed coronary arteries
  • Micro - cholesterol plaques on intima of coronary vessels
  • Fibrotic subendothelial connective tissue of intima with plaque
SPECIAL TESTS
  • ECG - variable. May be normal or may see ST segment elevation/depression and/or T wave inversion.
  • Exercise stress test - positive
IMAGING
  • Angiography - narrowed coronary arteries
  • Echocardiography - wall motion abnormalities
  • Pharmacologic stress tests (dobutamine, dipyridamole, adenosine) - positive
  • Stress thallium test - positive
DIAGNOSTIC PROCEDURES
N/A

TREATMENT

APPROPRIATE HEALTH CARE
  • Outpatient for management of risk factors
  • Inpatient for acute ischemic syndromes
GENERAL MEASURES
  • Prevention of further progression of the disease
    • Smoking cessation
    • Treatment of hypercholesterolemia (diet, drugs)
    • Increase high density lipoprotein (diet, exercise)
    • Control of blood pressure
    • Diabetes mellitus treated early and adequately
    • Exercise
    • Prophylactic aspirin
    • Stress reduction
    • Diet changes
    • Weight loss
    • Estrogen replacement therapy in postmenopausal women is currently controversial
  • Treatment of complications
    • Covered elsewhere under the individual topics (e.g., angina pectoris, myocardial infarction, heart failure, stroke, peripheral arterial occlusion, etc.)
SURGICAL MEASURES

N/A

ACTIVITY

Exercise may be helpful in preventing clinical coronary disease and useful for therapeutic measures

DIET
  • Low-fat (20-30 grams of fat/day total intake)
  • Weight-loss diet, if obesity a problem
  • Stress reduction
PATIENT EDUCATION

For patient education materials favorably reviewed on this topic, contact: American Heart Association, 7320 Greenville Avenue, Dallas, TX 75231, (214)373-6300

FOLLOW UP

PREVENTION/AVOIDANCE

See General measures

POSSIBLE COMPLICATIONS
  • Myocardial infarction
  • Ventricular fibrillation
  • Congestive heart failure
  • Angina pectoris
  • Sudden cardiac death
EXPECTED COURSE AND PROGNOSIS

Guardedly favorable. Many risk factors can be modified.

MISCELLANEOUS

ASSOCIATED CONDITIONS
  • Obesity
  • Hypertension
  • Diabetes
  • Hypercholesterolemia
AGE-RELATED FACTORS

Pediatric: Preventive measures can begin early (proper nutrition, exercise, weight control, smoking deterrent programs, etc.)
Geriatric: Greatest incidence in this age group
Others: N/A

PREGNANCY

Rare in pregnant women

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations
  • Cardiology
  • Dermatology
  • General Destistry
  • Cardiology
  • Dermatology

ROLE OF HOMOEOPATHY

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