A process of progressivethickening and hardeningof the walls of medium-
sized and large arteries as a result of fat deposits on their inner lining
leading leucocytes and smooth muscles into the intima, a process by which
plague are formed in the walls of arteries and blood vessels.
Risk factors for atherosclerosis include high levels of "bad" cholesterol,
high blood pressure (hypertension), smoking,diabetes and a genetic
family history of atheroscleroticdisease.
Atherosclerosis is responsible for much coronary artery disease
(angina and heart attacks) and many strokes.
Atherosclerosis develops gradually.
Mild atherosclerosisusually doesn'thave any symptomsuntil an artery is
so narrowed or clogged that it can't supply adequate blood to your organs
Sometimes a blood clot completely blocks blood flow, or even breaks apart
and can trigger a heart attack or stroke.
The damage may be caused by:
High blood pressure
High triglycerides,a type of fat (lipid) in your blood
Smoking and other sources of tobacco
Insulin resistance, obesity or diabetes
Inflammationfrom diseases, such as arthritis, lupus or
infections, or inflammationof unknown cause
7. The healthy arterial wall consists of 3 layers: a thin tunica intima
consistingof endothelial cells, a thick tunica media composed of internal
and external elastic lamina and smooth muscle cells, and the tunica
adventitia composed of dense, irregular connective tissue and vasa
vasorum(small blood vesselssupplyingmuscles of the arterial wall).
8. The developmentof atherosclerotic lesions is thought to be a response to
endothelialdamage and dysfunction.Lesions begin as fatty streaks that
result from the accumulation of cells (macrophages, lymphocytes,and
smooth muscle cells) in the tunica intima, and the accumulation of lipid and
cellular debris as these cells undergo necrosis.
10. Most fatty streaks remain benign, but those that progress go on to become
atheroma.As smooth muscle cells continue to proliferate and more foamy
macrophages (full of lipid) accumulate, the atheroma develops a core
consistingof fatty tissue and necrotic cellular debris. Fibroblasts lay down
collagen and other extracellular matrix constituents to form a fibrous
tissue envelope around the atheroma. Cholesterol clefts form in the now
enlargedintima as necrotic cells liberate more and more lipid. Dystrophic
calcification occurs as an attempt to contain the lesion.
11. The sequelae of these patchy, multifocal lesions in the major arteries are
numerousand diverse in consequence.These lesionscan remain silent,
never causing the patient harm. They can also gradually diminishthe flow
of blood through the artery as the lesion grows and slowly beginsto
occlude the lumen. If the fibrous roof of the lesion gives way, the lesion can
thrombus,potentially leadingto an atheroembolism.
12. The presence of vaso vasorum in the adventitia of major arteries
increases the risk of hemorrhage into the lesion, which can lead to an
acute occlusion of the artery lumen as the hemorrhage swells and
raises the roof of the lesion into the lumen.
Atherosclerosis can also cause weakening of the arterial wall,
increasingthe risk of aneurysm (an excessive localized swelling of
artery walls) and arterial rupture.
14. Patient history
H/O: Cramp on right calf 4 days back.
C/O: Fever, SOB (shortness of breath),
constipation, dry cough
Past medical history: Hypertension (HTN),
Diabetics Mellitus (DM)
Past medication history: Metformin 500mg
twice daily, Hydrochlorothiazide 25mg once daily.
Family history: NIL
Social history: Non-alcoholic, smoking 10 per
15. Physical examination
Weight: 80 kg
Pulse: 69 b/m
BP: 130/80 mmhg
Temperature: 99 degrees F
RR: 20 b/m
Heart: normal heart beat, no bruit
Abdomen: Bruit umbilical region
19. Other lab tests;
Electrocardiogram (ECG OR EKG),ChestX-ray, Stress test, Magnetic
ResonanceAngiogram (MRA), Arteriogram, Computed
tomography(CT),Transcutaneous oximetry, Cardiac catherization,
Colour Doppler study of lower limb arterioles and veins;
Impression: Deep facial oedema, severe atheroscleroticarterial
wall in anterior tibial and posteriortibial arteries.
Ultrasonography of abdomen;
Impression: Bilateral pleural effusion with basal consolidation.
21. Surgical procedures
Angioplasty and stent placement: In this procedure, your
doctor inserts a long, thin tube (catheter) into the blocked or narrowed
part of your artery.A second catheter with a deflated balloon on its tip is
then passed through the catheter to the narrowed area. The balloon is
then inflated, compressingthe deposits against your artery walls. A
mesh tube (stent) is usually left in the artery to help keep the artery open.
Fibrinolytic therapy. If you have an artery that's blocked by a
blood clot, your doctor may use a clot-dissolvingdrug to break it apart.
22. Drug chart
Drug Generic name Dose ROA Timing Category ADR’s
Inj.piptaz Piperacillin 4.5g IV TID Anti-biotic Vomiting
Duolin neb salbutamol Bronchus
Inj.pantop Pantoprazole 40mg IV OD Protein pump
15mg O BD Vasopressin,
S/C BD Anti-
25mg O OD Anti-
23. Drug Generic name Dose ROA Timing Category ADR’s
Clopidogrel 75mg O OD Anti-
O BD Sulphonyl
Atorvastatin 40mg O OD Statins Diarrhea,
Tramadol HCl &
10mg O BD Analgesic Anxiety,
Inj.clabid clarithromycin 500
IV BD Macrolide Nausea
24. Drug interactions
Dalteparin – Clopidogrel,
Increase the risk of bleeding. If complications are seen
then discontinue the antiplatelet drug.
Clopidogrel – pantoprazole,
Decrease the activity of Clopidogrel. H2 receptor
antagonist is substituted if an interaction is suspected.
Clarithromycin – tramadol,
Atorvastatin – Clopidogrel,
May have blood clots, chest pain, and swelling.
25. Patient counselling
Tramadol and tolvapton should be taken with
glass full of water.
Clopidogrel and atorvastatin can be taken with
or without food.
Glimipride taken with breakfast.
Antiplatelet drugs taken with plenty of water as
prescribed by physician.
Pantoprazole should be taken after meal.
Stop smoking. Smoking damages your arteries.
Exercise most days of the week. Physical activity can
also improve circulation and promote development of new blood vessels
that form a natural bypass around obstructions.
Eat healthy foods. A heart-healthy diet based on fruits,
vegetablesand whole grains and low in refined carbohydrates,sugars,
saturated fat and sodium can help you control your weight, blood pressure,
cholesterol and blood sugar.
Lose extra pounds and maintain a healthy
weight. If you're overweight, losing as few as 2.3 to 4.5 kilograms an
help reduce your risk of high blood pressureand high cholesterol.
Manage stress. Reduce stress as much as possible.
S A 55yrs old male was admitted in the hospital with H/O cramp on
right calf 4 days back.
O On examination lipid profile , ABI, complete blood count (CBC) are
not in normal range.
A From the above details we can assess him to have atherosclerosis
P Standard treatment.
Medication include antiplatelet, beta blockers, ACE inhibitors.
Surgical procedures like angioplasty and slent placement &