The first signs of atherosclerosis in women. Monoclonal cause of vascular atherosclerosis. Differences in different localization of atherosclerosis

Atherosclerosis is chronic illness arteries, in particular inner walls. early signs atherosclerosis, deposits of lipids and cholesterol begin to appear in places. At first, only fatty spots appear on the inner shell of the vessel, then connective tissue begins to grow in these places, and atherosclerotic plaques appear. These plaques begin to overgrow with calcium salts, fibrin and platelets adhere to them. As a result, the lumen of the blood vessel can narrow up to complete blockage.

Signs of atherosclerosis of vessels and extremities

Depending on the localization of the disease - the organ of the location of the vessels, there are:

Atherosclerosis of the cerebral vessels, atherosclerosis of the carotid arteries:

• deterioration in concentration, memory;
• decreased mental activity;
• headache;
• promotion blood pressure;
• speech disorder;
• dizziness.

Atherosclerosis lower extremities:

• sharp pain in the toes;
• chilliness in the legs;
• pallor of the skin of the legs;
• lack of pulse on the popliteal and ankle arteries;
• convulsions.

Atherosclerosis of vessels and arteries of the intestine:

• violation of the stool, constipation for several days;
• sharp pain in the abdomen;
• weakness;
• cold sweat;
• lack of bowel function.

Atherosclerosis of the arteries of the heart (coronary arteries):

• sharp compressive pain in the sternum, provoked by stress or physical exertion;
• severe weakness;
• low blood pressure;
• pain in the heart that is not relieved by medicines;
• heart failure.

Atherosclerosis renal arteries:

• pain in the back, lower back;
• dark color urine, the presence of blood in it.

Atherosclerosis of the fundus vessels:

• the presence of spots before the eyes;
• loss of field of vision.

Atherosclerosis of the aortic vessels:

• a sharp drop in blood pressure;
• sharp pain in the upper abdomen;
• cardiopalmus;
• cold sweat;
• The pain cannot be relieved by any medication.

How to determine the stage of atherosclerosis of vessels and extremities?

Currently, the disease is the leader in the world in terms of prevalence. In this disease, the large arteries of the head and the coronary vessels of the heart, abdominal and chest cavity. The insidiousness of the disease lies in the fact that while it develops imperceptibly and almost asymptomatically, the cholesterol plaque is constantly growing, gradually narrowing the lumen in the artery.

Think of a blood vessel as a water pipe through which water flows. Naturally, with age, the pipe becomes covered with rust from the inside, the clearance in it decreases, the flow of water weakens and, accordingly, its amount decreases. The pipe needs to be replaced. But you can't replace an artery! Therefore, it is necessary to strive to reduce the amount of the culprit of the “blockage” - cholesterol and to determine atherosclerosis of the vessels at an early stage.

How to identify signs of atherosclerosis at an early stage?

A person begins to feel the first symptoms of a lack of blood supply to the tissue from the moment when the lumen of the vessel narrows by more than half. Difficult to determine early on atherosclerosis of the aortic vessels. It is usually asymptomatic, it is difficult to recognize it, it is found only during examination of the body. Sometimes there are unpleasant pain in the abdomen or sternum, most often, pressing, squeezing, burning character. There may be shortness of breath and signs of angina pectoris.

At cerebral arteriosclerosis declining mental activity and working capacity, fatigue, excitability increases, sleep worsens at night and drowsiness increases during the day, the ability to concentrate decreases. Sometimes disturbed by headaches, noise in the head, dizziness. Atherosclerosis of cerebral vessels is a very dangerous disease, as it can result in a stroke (bleeding into the brain), paralysis, or death. This disease is especially dangerous in combination with high blood pressure - hypertension.

Pain in the region of the heart of a pressing or squeezing nature, angina attacks, which are aggravated both at rest and during physical activity, will help determine atherosclerosis of the coronary arteries . pain syndrome the heart muscle usually reacts to a lack of nutrition, due to the narrowing of the coronary arteries. This type of atherosclerosis is one of the main causes of coronary heart disease.

Limb disease recognized by pain calf muscle. Especially if you walk a long distance, but it disappears immediately when you stop and take a short rest. Also, when receiving small wounds, they heal very slowly. In more advanced forms, wounds generally stop healing and turn into ulcers. With this type of disease, chilly feet, a lame gait, and numbness of the feet occur. The color of the legs becomes pale due to insufficient blood circulation. This disease threatens with amputation of a limb due to possible development trophic ulcer and gangrene.

How to determine the signs of obliterating atherosclerosis of vessels?

Atherosclerosis of this type is the most common vascular disease and occurs mainly in men over 40 years of age. The disease is localized in the arteries of large and medium caliber. The main cause of atherosclerosis is hypercholesterolemia. In the bloodstream, cholesterol circulates in a bound state with proteins and other lipids (triglycerides, phospholipids) in the form of complexes called lipoproteins. Depending on the percentage of the components of these complexes, several groups of lipoproteins are distinguished, two of which (low and very low density lipoproteins) are active carriers of cholesterol from the blood to the tissues and are therefore called atherogenic. Obliterating atherosclerosis often affects people with high levels of these atherogenic fractions of lipoproteins.

To determine the method of treatment of obliterating atherosclerosis of vessels, one should study the pathoanatomical picture. The main changes develop in the intima of the arteries. Pathological changes in the intima, it is customary to distinguish between fatty stripes, fibrous plaques and complicated lesions (plaque ulceration, blood clots). Fat streaks are the earliest manifestation of atherosclerosis, characterized by focal accumulation in the intima of macrophages filled with lipids, smooth muscle cells(foam cells) and fibrous tissue. On the intima, they look like whitish or yellowish spots, clearly visible on preparations stained with fat-soluble dyes. Initial signs lesions may appear in childhood. Then their development stops. Despite the likely association of fatty streaks with fibrous atherosclerotic plaques, the location and distribution of aortic fatty streaks and fibrous plaques do not match. It is widely believed that the fat streaks undergo regression, but the evidence is inconclusive.

The formation of an atherosclerotic plaque in obliterating atherosclerosis of vessels begins with the accumulation of lipids in the intima (the stage of lipoidosis). In the circumference of the foci of lipoidosis, proliferation of the intima and smooth muscle fibers develops, a young connective tissue appears, the maturation of which leads to the formation of a fibrous atherosclerotic plaque (stage of liposclerosis).

Fibrous atherosclerotic plaques, called mother-of-pearl, rise above the surface of the intima, represent its thickening, which can be determined by palpation. In typical cases, the fibrous plaque has a domed shape, a dense texture, protrudes into the lumen of the artery and narrows it. A plaque in vascular atherosclerosis consists of extracellular fat located in the central part, the remains of necrotic cells (detritus), covered with a fibromuscular layer, or a visor containing a large number of smooth muscle cells, macrophages and collagens. The thickness of the plaque in atherosclerosis significantly exceeds the normal thickness of the intima. The extracellular fat of plaques in atherosclerosis is similar in composition to plasma lipoproteins.

What is the danger of obliterating atherosclerosis of vessels?

With abundant accumulation of lipids, blood circulation in the tissue membrane of the plaques is disturbed. The cells that make up the plaque structure undergo necrosis, hemorrhage occurs in the thickness of the plaque, and cavities appear filled with amorphous fat and tissue detritus. Often this is accompanied by the formation of a defect on the surface of the intima, plaques ulcerate, and atheromatous masses and parietal thrombotic deposits are rejected into the lumen of the vessel and, getting into the distal bed with blood flow, can cause microembolism. Calcium salts (atherocalcinosis) are deposited in the tissue elements of the plaque and in the areas of degenerating elastic fibers. These processes proceed in waves and lead to thrombosis and obliteration of the vessel.

Localization of obliterating atherosclerosis of vessels

The favorite localization of the disease is the division of the main arteries:

• brachiocephalic trunk,
• orifices of the vertebral arteries,
• aortic bifurcation,
• common sleepy,
• common iliac, femoral and popliteal arteries.

This phenomenon is explained by the peculiarities of hemodynamics. In the zone of bifurcations of the arteries, the intima experiences a blow from the main blood flow, here there is some slowdown and division of the blood flow along the arterial branches. The main blood flow deviates from a rectilinear trajectory, forms eddies that damage the intima and favor the formation of plaques. This suggests that atherosclerotic lesion of arterial walls is, to a certain extent, a chronic regenerative process in response to chronic trauma to the intima by turbulent and direct blood flow.

Causes of the manifestation of atherosclerosis of the vessels

Our life is full of various events and upheavals. We are always in a hurry somewhere, we try to be in time everywhere. At the same time, we forget about proper nutrition(we eat almost on the go), we abuse alcohol. Yes, and the environment is not on highest level- emissions of a man-made disaster. And all these factors negatively affect our health. It is especially scary when we do not know why and with what we get sick.

Often, the above factors cause a disease such as atherosclerosis of the vessels. What is the main cause of this disease? Metabolic disorders, clogging of blood vessels with fatty deposits, increased cholesterol levels and causes such a disease. In this case, the blood begins to pass poorly through the vessels. As a result, all this entails more complex diseases. Disease of the heart, kidneys, brain and limbs.

Atherosclerosis begins its development unevenly, as various areas in the human body are affected. Therefore, there are several types.

Metabolic disorders in the body can lead to an increase in cholesterol in the blood and its deposition on the walls blood arteries. This is how atherosclerosis of the vessels gradually develops - a disease of the cardiovascular system, in which the inner walls of the vessels are damaged. cholesterol plaques. Narrowing of the lumen, decreased elasticity and insufficient nutrition of the vessels can lead to serious illness brain, kidneys, heart and lower extremities.

Eastern theory about the origin of atherosclerosis of vessels and limbs

From the point of view of Tibetan medicine, vascular atherosclerosis can develop according to these two scenarios.

Heat scenario. Atherosclerosis of vessels and extremities begins with an imbalance in the liver associated with increased production of cholesterol. The main reasons for this could be:

• fried, spicy, fatty foods;
• anger, irascibility;
• hard liquor.

The above factors may lead to elevated content cholesterol and sticking it to the walls of blood vessels, which is the cause of the development of atherosclerosis of the vessels of the extremities, the brain and other vessels. In addition, the viscosity of the blood increases, which increases the risk of blood clots - blood clots, which can clog blood vessels.

The "cold" scenario associated with an imbalance in the regulatory system of the body and a violation fat metabolism. If a person daily consumes an excessive amount of heavy high-calorie, fatty, sweet, cold food, the body accumulates excess fat, which is deposited in the subcutaneous fatty tissue and internal organs in the form of cholesterol, which also saturates the blood. Thus, vascular atherosclerosis and obesity are closely related.

Causes of obliterating atherosclerosis of vessels

Obliterating atherosclerosis of the main arteries of the lower extremities is the most frequent illness peripheral arteries, often occurring against the background of such adverse factors as

• hypertension,
• diabetes
• , obesity,
• smoking.

Since the appearance of the first clinical signs atherosclerosis progresses rapidly. The process is localized mainly in large vessels(aorta, iliac arteries) or medium-sized arteries (femoral, popliteal). Narrowing and obliteration of these arteries cause severe limb ischemia. Abdominal aorta in vascular atherosclerosis, it is usually affected distally to the renal arteries. Approximately one-third of patients are affected by the aortoiliac (Lerish syndrome), and in 2/3 of patients, the femoral-popliteal segments are affected.

Throughout the world, the prevalence of atherosclerosis of the vessels and limbs is so great that, starting from the age of forty, it is perceived almost as a necessary evil. However, if you adjust your lifestyle, diet and emotional condition, the diagnosis of atherosclerosis will bypass you. Be healthy!

The basis of the vascular wall is muscle fibers, it is covered on the outside by the connective tissue adventitia membrane, on the inside - the endothelium, which, together with the underlying thin layer connective tissue forms the inner shell of the vessel - the intima.

The endothelium has a barrier function and repels cellular elements from itself, therefore, intravascular thrombosis does not normally occur. If the structure of the intima is disturbed, leukocytes migrate to the site of damage, and lipoproteins precipitate from the bloodstream - the process of atherosclerotic plaque formation begins.

Causes and signs of atherosclerosis

There is no unified theory of the development of atherosclerotic lesions, however, most scientists and clinicians consider damage to the vascular endothelium and a decrease in its barrier function to be the starting point for plaque formation. damaged area inner shell arteries becomes a target for atherogenic factors.

Elevated blood levels of atherogenic low-density lipoproteins also contributes to the progression of atherosclerotic lesions. At the initial stage, the damaged intima is impregnated with lipoproteins - an atheromatous spot is formed - the initial stage of plaque formation.

Nonlinear blood flow is normally observed in the places where the arteries branch, and when they spasm and increase blood pressure, it can occur anywhere. In this case, favorable conditions are created both for damage to the endothelium and for the deposition of lipoproteins.

Risk factors for atherosclerosis

Atherosclerosis is a polyetiological process. This means that for the occurrence of a lesion, a combination of several unfavorable factors is necessary, and not just one trigger.

In this case, they often talk not about the causes, but about the risk factors for the disease. These include:

• Smoking- nicotine provokes vasospasm and negatively affects the barrier properties of the endothelium. In addition, chronic nicotine intoxication leads to a change in the ratio of atherogenic and non-atherogenic lipoproteins in the peripheral blood, which is additional reason plaque formation.
• Irrational nutrition, alcohol abuse and a sedentary lifestyle can lead to causes of lipid metabolism disorders and obesity, and also provoke an increase in blood pressure. The combination of increased levels of low-density lipoproteins and high blood pressure gives impetus to the onset of atherogenesis.
• Emotional overload in combination with reduced physical activity: stress response (preparation of the body for intense physical activity). If this mechanism is not implemented, the action stress hormones is too long and causes damage to the endothelium.
• Gender and age: female sex hormones prevent damage to the vascular wall, so atherosclerotic vascular lesions in women often occur after menopause. In general, the likelihood of developing the disease increases with age.
• Heredity: some structural features of the endothelium and fat metabolism, inherited, create favorable conditions for the formation of atherosclerotic plaques.

Classification

Depending on which factor is primary, the hemodynamic and metabolic forms of atherosclerosis are distinguished. In the first case, primary vascular disorders(anomalies of the structure, inferiority of the endothelium,), in the second - metabolic disorders(increased levels of low-density lipoproteins, hyperglycemia).

Depending on the period of the flow, there are three phases:

• The initial phase (preclinical) proceeds without symptoms. Changes in the lining of the vessels are already taking place, but they are not sufficient to disrupt the function of an organ or tissue. At this stage, atherosclerosis can be detected by laboratory parameters, therefore biochemical analysis blood for the content of lipoproteins is included in the list of studies that are mandatory when undergoing a preventive medical examination.
• The phase of extended clinical manifestations, which, in turn, is divided into:
  • ischemic- the formed plaque partially blocks the lumen of the vessel, while the blood supply to the tissues suffers; under increased load ischemic lesion becomes clear; applied to coronary vessels- this is ;
  • thrombonecrotic- an overgrown atheromatous plaque is easily injured, provoking vessel thrombosis, while the blood supply to the tissue is completely stopped, and it can become necrotic; an example of clinical manifestations at this stage is either, dry gangrene or mesenteric thrombosis.
• The sclerotic stage is characterized by persistent narrowing blood vessels and gradual connective tissue degeneration of tissue, for example, cerebro- or cardiosclerosis.

Depending on the activity of the course of the atherosclerotic process, there are:

• progressive atherosclerosis - the formation of new or growth of formed atheromatous plaques continues, gradually aggravated clinical manifestations, the risk of complications is high;
• stabilized atherosclerosis - the development and formation of new plaques stops, clinical manifestations remain unchanged or regress, the risk of complications is low;
• regressive atherosclerosis - clinical symptoms declining, getting better general state and laboratory blood counts.

What are the main symptoms of atherosclerosis?

On the initial stages the formation of an atherosclerotic plaque is asymptomatic, vascular obstruction is not so strong as to cause clinical manifestations.

Circulatory disorders in tissues begin at the stage of fibrosis and plaque calcification, and signs of atherosclerosis are determined by the location of the lesion:

• atherosclerosis of the arteries of the brain is manifested by chronic headache, memory impairment, decreased mental performance and concentration; the progression of the process can lead to personality changes and mental disorders; typical complication, which occurs when the lumen of the vessel is completely closed -;
• atherosclerosis of the coronary arteries leads to the development of coronary heart disease; clinically, it manifests itself in the form of seizures severe pain behind the sternum in the region of the heart after physical or emotional stress, as well as a decrease in physical performance; plaque can completely block the lumen coronary artery or provoke its thrombosis - in this case it will develop;
• atherosclerosis of the arteries abdominal cavity leads to partial or complete ischemia of the mesentery and intestines; in the first case, there is pain after eating, bloating and stool disorders, in the second case, acute thrombosis of the mesenteric vessels occurs - a condition requiring emergency surgical care;
• atherosclerosis of the aorta is manifested by chronic arterial hypertension; with a long course, an aortic aneurysm may occur.

Diagnostics

Based on the patient's complaints and changes identified during the clinical examination, the doctor may suspect the presence of atherosclerosis. To clarify and confirm the diagnosis, laboratory and instrumental studies are prescribed:

• Blood chemistry for cholesterol content. This method determines how total cholesterol, and the ratio of the level of high and low density lipoproteins. The latter have a high atherogenic potential, therefore, an increase in their level, especially in combination with a decrease in the level of lipoproteins high density, indicates the active course of the atherosclerotic process.
• X-ray methods of research. Radiography chest is carried out with suspicion of atherosclerosis of the aorta, it can be used to judge the degree of its deformation and the presence of calcifications. To study smaller vessels, angiography (coronary angiography, cerebral angiography) is used - obtaining a series of radiographs after intravascular injection of a radiopaque substance. With this study, you can see the localization and size of plaques, as well as assess the degree of narrowing of the lumen of the vessel.
• ultrasound more often used to study the vessels of the extremities, it can also be used to detect the presence of plaques and assess the degree of narrowing of the vessel.

Treatment of atherosclerosis

Treatment of atherosclerosis without fail includes lifestyle correction and control of the course of concomitant diseases (, diabetes). If this is not enough, medication is prescribed.

With damage to the vessels of the extremities, the heart or the vessels of the mesentery, it is possible to restore their patency surgically.

Non-drug treatment of atherosclerosis

• Diet with low content cholesterol. The best option is the Mediterranean diet. The use of olive oil, fish and seafood, herbs, fresh vegetables and fruits is recommended. Fatty meats are excluded, chicken fillet and lean beef are recommended from meat dishes.
• Rational physical activity contributes to the normalization of vascular tone, is the best prevention obesity and arterial hypertension.
• Stop smoking and drinking alcohol, minimize stressful situations. It is very important to learn how to cope with stress without the use of drugs and psychoactive substances.
• Lifestyle correction is the basis of atherosclerosis therapy, without which no drugs and surgical methods will not be effective. Treatment is with medications that prevent the absorption of cholesterol into the bloodstream. digestive tract or accelerating its breakdown. The selection of the drug and dose should be carried out by a doctor.

Surgery

• Removal of the affected vessel if the blood supply can be restored due to the compensatory development of collaterals. Most often, these are the arteries of the extremities of medium caliber. The affected vessel is removed at a high risk of thrombosis, thrombus separation and related complications.
• Balloon angioplasty or coronary stenting It is used in case of damage to the vessels of the heart to restore the blood supply to the heart muscle during a critical narrowing of the lumen of the supplying artery.

Prevention

The only one reliable way prevention of atherosclerotic vascular disease is healthy lifestyle life. Studies have shown that the first cholesterol spots can appear on the walls of blood vessels already in childhood, so prevention should begin from childhood.

You can prevent complications with already developed atherosclerosis if you take prescribed drugs and follow the recommendations of your doctor. If available accompanying illnesses, their treatment is also a mandatory measure in the prevention of complications.

Prognosis for atherosclerosis

Subject to lifestyle correction, smoking cessation and timely treatment favorable prognosis: stabilization and even regression of the atherosclerotic process is quite possible. Regression of atherosclerosis is possible only at the initial, preclinical stage. If any major symptoms of atherosclerosis have already appeared, supportive treatment will be lifelong.

When treatment is refused and risk factors persist, the likelihood of complications becomes extremely high. In this case, the prognosis, both for the health and for the life of the patient, is unfavorable.

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