A report on Atherosclerosis

The progression of atherosclerosis (narrowing exaggerated)
Atherosclerosis and lipoproteins
Micrograph of an artery that supplies the heart showing significant atherosclerosis and marked luminal narrowing. Tissue has been stained using Masson's trichrome.
Severe atherosclerosis of the aorta. Autopsy specimen.
Progression of atherosclerosis to late complications.
CT image of atherosclerosis of the abdominal aorta. Woman of 70 years old with hypertension and dyslipidemia.
Microphotography of arterial wall with calcified (violet color) atherosclerotic plaque (hematoxylin and eosin stain)
Doppler ultrasound of right internal carotid artery with calcified and non-calcified plaques showing less than 70% stenosis

Pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions.

- Atherosclerosis
The progression of atherosclerosis (narrowing exaggerated)

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Overall
A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.

Myocardial infarction

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A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle.

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle.

A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.
Cross section showing anterior left ventricle wall infarction
Diagram showing the blood supply to the heart by the two major blood vessels, the left and right coronary arteries (labelled LCA and RCA). A myocardial infarction (2) has occurred with blockage of a branch of the left coronary artery (1).
A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the right coronary artery. Elevation of the ST segment can be seen in leads II, III and aVF.
ECG : AMI with ST elevation in V2-4
Inserting a stent to widen the artery.

The complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI. MIs are less commonly caused by coronary artery spasms, which may be due to cocaine, significant emotional stress (commonly known as Takotsubo syndrome or broken heart syndrome) and extreme cold, among others.

Atherosclerotic plaque from a carotid endarterectomy specimen. This shows the division of the common into the internal and external carotid arteries.

Atheroma

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Abnormal and reversible accumulation of material in the inner layer of an arterial wall.

Abnormal and reversible accumulation of material in the inner layer of an arterial wall.

Atherosclerotic plaque from a carotid endarterectomy specimen. This shows the division of the common into the internal and external carotid arteries.
Narrowed arterial blood vessel blocked with an atheroma.
Illustration comparing a normal blood vessel and partially blocked vessel due to atherosclerotic plaque. Notice the enlargement & absence of much luminal narrowing.

Atheroma is the pathological basis for the disease entity atherosclerosis, a subtype of arteriosclerosis.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.

Stroke

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Medical condition in which poor blood flow to the brain causes cell death.

Medical condition in which poor blood flow to the brain causes cell death.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.
There are two main categories of strokes. Ischemic (top), typically caused by a blood clot in an artery (1a) resulting in brain death to the affected area (2a). Hemorrhagic (bottom), caused by blood leaking into or around the brain from a ruptured blood vessel (1b) allowing blood to pool in the affected area (2b) thus increasing the pressure on the brain.
A slice of brain from the autopsy of a person who had an acute middle cerebral artery (MCA) stroke
CT scan of an intraparenchymal bleed (bottom arrow) with surrounding edema (top arrow)
Illustration of an embolic stroke, showing a blockage lodged in a blood vessel.
Histopathology at high magnification of a normal neuron, and an ischemic stroke at approximately 24 hours on H&E stain: The neurons become hypereosinophilic and there is an infiltrate of neutrophils. There is slight edema and loss of normal architecture in the surrounding neuropil.
A CT showing early signs of a middle cerebral artery stroke with loss of definition of the gyri and grey white boundary
Dens media sign in a patient with middle cerebral artery infarction shown on the left. Right image after 7 hours.
12-lead ECG of a patient with a stroke, showing large deeply inverted T-waves. Various ECG changes may occur in people with strokes and other brain disorders.
Walking with an orthosis after a stroke
Stroke deaths per million persons in 2012
Hippocrates first described the sudden paralysis that is often associated with stroke.

The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical symptoms as well as results of further investigations; on this basis, a stroke is classified as being due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) an embolism originating in the heart, (3) complete blockage of a small blood vessel, (4) other determined cause, (5) undetermined cause (two possible causes, no cause identified, or incomplete investigation).

Illustration depicting atherosclerosis in a coronary artery

Coronary artery disease

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Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart.

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart.

Illustration depicting atherosclerosis in a coronary artery
Clogged artery
Micrograph of a coronary artery with the most common form of coronary artery disease (atherosclerosis) and marked luminal narrowing. Masson's trichrome.
Illustration depicting coronary artery disease
Coronary angiogram of a man
Coronary angiogram of a woman
Deaths due to ischaemic heart disease per million persons in 2012
Disability-adjusted life year for ischaemic heart disease per 100,000 inhabitants in 2004. no data <350 350–700 700–1,050 1,050–1,400 1,400–1,750 1,750–2,100 2,100–2,450 2,450–2,800 2,800–3,150 3,150–3,500 3,500–4,000 >4,000

Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a coronary artery (the arteries that supply blood to the heart muscle) develops atherosclerosis.

Illustration depicting angina

Angina

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Chest pain or pressure, a symptom of coronary heart disease, usually due to insufficient blood flow to the heart muscle .

Chest pain or pressure, a symptom of coronary heart disease, usually due to insufficient blood flow to the heart muscle .

Illustration depicting angina
Illustration depicting angina
Diagram of discomfort caused by coronary artery disease. Pressure, fullness, squeezing or pain in the center of the chest. Can also feel discomfort in the neck, jaw, shoulders, back or arms.

The main mechanism of coronary artery obstruction is atherosclerosis as part of coronary artery disease.

Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.

Cardiovascular disease

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Class of diseases that involve the heart or blood vessels.

Class of diseases that involve the heart or blood vessels.

Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.
Calcified heart of an older woman with cardiomegaly
Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of cardiovascular calcification, showing in orange calcium phosphate spherical particles (denser material) and, in green, the extracellular matrix (less dense material)
Cardiovascular diseases deaths per million persons in 2012
Disability-adjusted life year for inflammatory heart diseases per 100,000 inhabitants in 2004 No data Less than 70 70–140 140–210 210–280 280–350 350–420 420–490 490–560 560–630 630–700 700–770 More than 770
Disability-adjusted life year for cardiovascular diseases per 100,000 inhabitants in 2004 no data <900 900–1650 1650–2300 2300–3000 3000–3700 3700–4400 4400–5100 5100–5800 5800–6500 6500–7200 7200–7900 >7900

Coronary artery disease, stroke, and peripheral artery disease involve atherosclerosis.

Automated arm blood pressure meter showing arterial hypertension (shown by a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)

Hypertension

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Long-term medical condition in which the blood pressure in the arteries is persistently elevated.

Long-term medical condition in which the blood pressure in the arteries is persistently elevated.

Automated arm blood pressure meter showing arterial hypertension (shown by a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)
Determinants of mean arterial pressure
Illustration depicting the effects of high blood pressure
Rates of hypertension in adult men in 2014.
Diagram illustrating the main complications of persistent high blood pressure
Image of veins from Harvey's Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus
Graph showing, prevalence of awareness, treatment and control of hypertension compared between the four studies of NHANES

Hypertension can also be caused by endocrine conditions, such as Cushing's syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn's syndrome or hyperaldosteronism, renal artery stenosis (from atherosclerosis or fibromuscular dysplasia), hyperparathyroidism, and pheochromocytoma.

Early in a coronary artery bypass operation, during vein harvesting from the legs (left of image) and the establishment of cardiopulmonary bypass by placement of an aortic cannula (bottom of image). The perfusionist and heart-lung machine are on the upper right. The patient's head (not seen) is at the bottom.

Coronary artery bypass surgery

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Surgical procedure to restore normal blood flow to an obstructed coronary artery.

Surgical procedure to restore normal blood flow to an obstructed coronary artery.

Early in a coronary artery bypass operation, during vein harvesting from the legs (left of image) and the establishment of cardiopulmonary bypass by placement of an aortic cannula (bottom of image). The perfusionist and heart-lung machine are on the upper right. The patient's head (not seen) is at the bottom.
René Gerónimo Favaloro was an Argentine cardiac surgeon and educator best known for his pioneering work on coronary artery bypass surgery using the great saphenous vein.
Three coronary artery bypass grafts, a LIMA to LAD and two saphenous vein grafts – one to the right coronary artery system and one to the obtuse marginal system.
Illustration depicting single, double, triple, and quadruple bypass
Illustration of a typical coronary artery bypass surgery. A vein from the leg is removed and grafted to the coronary artery to bypass a blockage.
Coronary artery bypass surgery during mobilization (freeing) of the right coronary artery from its surrounding tissue, adipose tissue (yellow). The tube visible at the bottom is the aortic cannula (returns blood from the HLM). The tube above it (obscured by the surgeon on the right) is the venous cannula (receives blood from the body). The patient's heart is stopped and the aorta is cross-clamped. The patient's head (not seen) is at the bottom.
Heart bypass patient showing almost invisible residual scarring. Left: days after operation. Middle: chest scar, two years later. Right: leg scar from harvested vein, two years later.
Illustration depicting coronary artery bypass surgery (double bypass)
Illustration of Single bypass
Illustration of Double bypass
Illustration of Triple bypass
Illustration of Quadruple bypass

The obstruction being bypassed is typically due to arteriosclerosis, atherosclerosis, or both.

Lovastatin, a compound isolated from Aspergillus terreus, was the first statin to be marketed.

Statin

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Statins, also known as HMG-CoA reductase inhibitors, are a class of lipid-lowering medications that reduce illness and mortality in those who are at high risk of cardiovascular disease.

Statins, also known as HMG-CoA reductase inhibitors, are a class of lipid-lowering medications that reduce illness and mortality in those who are at high risk of cardiovascular disease.

Lovastatin, a compound isolated from Aspergillus terreus, was the first statin to be marketed.
Atorvastatin bound to HMG-CoA reductase: PDB entry
The HMG-CoA reductase pathway, which is blocked by statins via inhibiting the rate limiting enzyme HMG-CoA reductase.
The oyster mushroom, a culinary mushroom, naturally contains lovastatin.

Low-density lipoprotein (LDL) carriers of cholesterol play a key role in the development of atherosclerosis and coronary heart disease via the mechanisms described by the lipid hypothesis.

Vascular ischemia of the toes with characteristic cyanosis

Ischemia

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Restriction in blood supply to any tissues, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism .

Restriction in blood supply to any tissues, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism .

Vascular ischemia of the toes with characteristic cyanosis
Native records of contractile activity of the left ventricle of isolated rat heart perfused under Langendorff technique. Curve A - contractile function of the heart is greatly depressed after ischemia-reperfusion. Curve B - a set of short ischemic episodes (ischemic preconditioning) before prolonged ischemia provides functional recovery of contractile activity of the heart at reperfusion.

This most frequently results from atherosclerosis, which is the long-term accumulation of cholesterol-rich plaques in the coronary arteries.