Atherosclerosis
Normal coronary artery
Early coronary atherosclerosis
Atherosclerosis
• Chronic, progressive, multifocal disease of the vessel wall intima within large /medium sized arteries
• Atheroma or plaque formation– İntimal thickening (smooth muscle cell proliferation)– Lipid accumulation
Arteriosclerosis
• Diffuse process that involves distal vessels well
Basic processes in atherosclerosis
Stage Imonocyte adhesion/migration throughVessel wall into intima to become maccrophages Stage IIfoam cells (lipid containing macrophages) in intima
Stage IIIappearance of extracellular lipid
Stage IVCore formation (extracellular lipid coalescing into the center of the plaque)
Stage VFibrous Cap and Core formation (fully formed lipid core and well developed cap of fibrous tissue seperating the core from the lumen)
Stage VIThrombosis
Stable angina. Eccentric coronary stenosis
Stable angina. Eccentric coronary stenosis
thick cap
Unstable angina with plaque disruption
The plaque cap is torn,projects into the lumen, exposing a mass of thrombus filling the lipid core
Unstable angina with plaque disruption
• High blood cholesterol• High blood pressure• Smoking• Obesity• Lack of physical activity
Risk FactorsUncontrollableUncontrollable
•Sex
•Hereditary
•Race
•Age
ControllableControllable
•High blood pressure
•High blood cholesterol
•Smoking
•Physical activity
•Obesity
•Diabetes
•Stress and anger
Treatment • Lipid lowering
drugs • Life style
modification