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