Atherosclerosis – Part 3

Now that you have your questions and are ready for your appointment, here are some questions that you should expect your doctor to ask. Make sure you have the necessary information.

• Do you have a family history of high cholesterol, high blood pressure, or heart disease?
• What are your diet and exercise habits like?
• Do you or did you smoke or use tobacco in any form?
• Have you had a cholesterol test? If so, when was your last test? What were your cholesterol levels? Some doctors will have the test done before your appointment.
• Do you have discomfort in your chest or pain in your legs with walking or at rest?
• Have you had a stroke or unexplained numbness, tingling or weakness of one side of your body or difficulty speaking?
• What was your last HbA1c? Again your doctor may do the test before your appointment.

During a physical exam, your doctor may find signs of narrowed, enlarged, or hardened arteries, including:

• A weak or absent pulse below the narrowed area of your artery
• Decreased blood pressure in an affected limb
• Whooshing sounds (bruits) over your arteries, heard using a stethoscope
• Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee
• Evidence of poor wound healing in the area where your blood flow is restricted. This is dangerous for those of us with diabetes and can be the cause of amputations.

Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:

• Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit.
• Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
• Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
• Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm and blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.
• Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
• Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan, or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.

Atherosclerosis – Part 2

The buildup of plaque occurs over time. Besides natural aging, factors that can increase the risk of atherosclerosis include:

1. High blood pressure
2. High cholesterol
3. Diabetes
4. Obesity
5. Smoking and other tobacco use
6. A family history of early heart disease
7. Lack of exercise

The complications of atherosclerosis depend on which arteries are blocked. 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), a heart attack or heart failure.
• Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
• 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 artery 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). PAD can also be the cause of amputations.
• 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. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency.

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 block an artery at some distant point.

If you think you may have atherosclerosis or are worried about having atherosclerosis because of a strong family history of heart disease, make an appointment with your doctor to have your cholesterol level checked. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do -

• Be aware of any pre-appointment restrictions. When you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Many blood tests, including cholesterol and triglycerides, require that you fast beforehand.
• Write down any symptoms you're experiencing. Atherosclerosis seldom has symptoms, but it is a risk factor for heart disease. Knowing you have symptoms such as chest pains or shortness of breath can help your doctor decide how aggressively to treat your atherosclerosis. Do not forget to show the doctor any slow healing wounds or foot ulcers, or heal cracks.
• Write down key personal information, including a family history of high cholesterol, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
• Make a list of all medications, vitamins, or supplements you're taking.
• Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
• Be prepared to discuss your diet and exercise habits. If you don't already eat a healthy diet or exercise, you can talk to your doctor about challenges you might face in getting started.
• Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For atherosclerosis, some basic questions to ask your doctor include:

1. What tests will I need?
2. What's the best treatment?
3. What foods should I eat or avoid?
4. What's an appropriate level of physical activity?
5. How often do I need a cholesterol test?
6. What are the alternatives to the primary approach you're suggesting?
7. I have other health conditions. How can I best manage them together?
8. Are there restrictions I need to follow?
9. Should I see a specialist?
   10. Is there a generic alternative to the medicine you're prescribing?
   11. Are there brochures or other printed material that I can take with me?
   12. What websites do you recommend?
   13. How can I best manage my diabetes to prevent heart problems?

Don't hesitate to ask any other questions you may have.

Atherosclerosis – Part 1

If I confused you in the last blog, hopefully I will clear things in this blog. Atherosclerosis is a specific type of arteriosclerosis. It is unfortunate that the terms are sometimes used interchangeably. In my research, I found many articles on atherosclerosis that were specifically about arteriosclerosis.

Arteriosclerosis happens when the blood vessels (arteries) that carry oxygen and nutrients from your heart to the rest of your body become thick and stiff. This in turn can restrict blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries.

Atherosclerosis refers to the buildup of fats, cholesterol, and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis usually is preventable and is treatable. This and the following blogs are on atherosclerosis.

Atherosclerosis develops gradually. Mild atherosclerosis usually doesn't have any symptoms. You usually won't have 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 blocks blood flow, or even breaks apart and can trigger a heart attack or stroke.

Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example: If you have atherosclerosis

1. In your heart arteries, you may have symptoms, such as chest pain or pressure (angina). This is what sent me to the hospital for the ballooning of several arteries and placing a stent in another artery. This is also when diabetes was diagnosed.
2. In the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke.
3. In the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (intermittent claudication).
4. In the arteries leading to your kidneys, you develop high blood pressure or kidney failure.
5. In the arteries leading to your genitals, you may have difficulties having sex. Sometimes, atherosclerosis can cause erectile dysfunction in men. In women, high blood pressure can reduce blood flow to the vagina, making sex less pleasurable.
   

If you think you have atherosclerosis, talk to your doctor. Also, pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain, or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke, or another medical emergency.

Atherosclerosis is a slow, progressive disease that may begin in childhood. The exact cause is yet unknown, but it may start with damage or injury to the inner layer of an artery. The damage may be caused by:

• High blood pressure
• High cholesterol, often from getting too much cholesterol or saturated fats in your diet
• High triglycerides, a type of fat (lipid) in your blood
• Smoking and other sources of tobacco
• Diabetes
• Inflammation from diseases, such as arthritis, lupus, diabetes, infections, or inflammation of unknown cause

Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. Over time, fatty deposits (plaques) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. This causes the organs and tissues connected to the blocked arteries not to receive enough blood to function properly.

Eventually pieces of the fatty deposits may break off and enter your bloodstream. In addition, the smooth lining of a plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ.

Atherosclerosis – The Disease with Many Names

Yes, there are different names for different types of atherosclerosis. All are determined by the amount of plaque that builds up in the various arteries. The image below is very descriptive and shows what happens during plaque buildup.

Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected. Arteriosclerosis does not involve plaque, but the thickening and hardening of the arteries.

Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are the blood vessels that carry oxygen-rich blood to your heart, organs, and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Coronary heart disease (CHD), also called coronary artery disease, is the #1 killer of both men and women in the United States. CHD occurs if plaque builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

When blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain or discomfort) or a heart attack. Plaque also can form in the heart's smallest arteries. This disease is called coronary microvascular disease (MVD). In coronary MVD, plaque doesn't cause blockages in the arteries as it does in CHD.

Carotid artery disease occurs if plaque builds up in the arteries on each side of your neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you may have a stroke.

Peripheral arterial disease (P.A.D.) occurs if plaque builds up in the major arteries that supply oxygen-rich blood to your legs, arms, and pelvis. If blood flow to these parts of your body is reduced or blocked, you may have numbness, pain, and, sometimes, dangerous infections.

Chronic kidney disease can occur if plaque builds up in the renal arteries. These arteries supply oxygen-rich blood to your kidneys. Over time, chronic kidney disease causes a slow loss of kidney function. The main function of the kidneys is to remove waste and extra water from the body.

The cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors. You can control some risk factors, such as lack of physical activity, smoking, and an unhealthy diet. Others you can't control, such as age and a family history of heart disease.

Some people who have atherosclerosis show no signs or symptoms. They may not be diagnosed until after they have a heart attack or stroke. The main treatment for atherosclerosis is lifestyle changes. You also may need medicines and medical procedures. These treatments, along with ongoing medical care, can help you live a healthier life.

Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem. You may be able to prevent or delay atherosclerosis and the diseases it can cause. Making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis and live a long, healthy life.