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ATHEROSCLEROSIS

Ida Kusuma - ida-kusuma@hotmail.com


Indri Kartika Sari indri.sari@student.sgu.ac.id
Norita Tjhin - noritatjhin@gmail.com
Monica Julius Lie monica.julius@hotmail.com
Swiss German University - Pharmaceutical Engineering
batch 2010

Atherosclerosis is the build up of a waxy


plaque on the inside of blood vessels. In
Greek,atheremeansgruel,
andsklerosmeanshard. Atherosclerosis is
often called arteriosclerosis. Arteriosclerosis
(from the Greekarteria, meaningartery) is a
general term for hardening of the arteries.
Arteriosclerosis can occur in several forms,
including atherosclerosis.

Atherosclerosis can occur in almost any


artery in the body. But in the heart its
effects can be crucial. The body depends
on a strong pumping heart to circulate
life-giving blood, and this includes to the
heart muscle itself. If the coronary arteries
become blocked, the cardiac muscle
begins to fail, and so the blood circulation
decreases, which includes the circulation
to the heart muscle itself. (Thibodeau,
494)

Risk Factors
Uncontrollable
Sex
Hereditary
Race
Age

Controllable
High blood
pressure
High blood
cholesterol
Smoking
Physical activity
Obesity
Diabetes
Stress and anger

Mechanism of Action
Atherosclerosis is associated with deposits of cholesterol which

appear to originate from LDL particles that circulate in the blood.


LDL contains fatty acid that have more than one double bond.,
which can be attacked by reactive forms of oxygen (free
radicals).
LDL becomes oxidized and may give rise to products that are
toxic to the cells of artery wall.
Macrophages attempt to remove the oxidized LDL but are unable
to degrade the cholesterol, which accumulates as droplets in the
cells and giving them foamy appearance.
The toxic products can ill the foam cells leaving cholesterol
deposits, and the accumulated cholesterol, cells and debris
constitute an antheroma which can narrow the channel of artery.

Stage I
Monocyte adhesion/migration
Stage II
Foam cells (lipid containing
macrophages) in intima
Stage III
Appearance of extracellular lipid

Stage IV
Core formation
(extracellular lipid coalescing into the center
of the plaque)

Stage VI
Thrombosis

Stage V
Fibrous Cap and Core formation
(fully formed lipid core and well developed cap of
fibrous tissue seperating the core from the
lumen)

Screening and Diagnosis

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Coronary
Angiography

Narrow in

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coronaries

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Stress
Test

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Electrocardiogram

show s

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Sit

electrical

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Hemodynamics within arterial lesions: A longstanding bioengineering


problem
Flow pattern

Arteriogram of a stroke patient

Velocity map of flow

Malek AM et al (1999)

Normal coronary artery


Lumen has been distended at a
pressure of 100mmHg with 10% formal
saline

Early coronary atherosclerosis


Eccentric plaque with a central
zone containing yellow lipid

Stable angina. Eccentric coronary stenosis

Other Test
Blood tests: used to evaluate kidney and thyroid

function as well as to check cholesterol levels and


the presence of anemia.
Chest X-ray: shows the size of your heart and

whether there is fluid build up around the heart


and lungs.
Echocardiogram: shows a graphic outline of the

hearts movement
Ejection fraction (EF): determines how well your

heart pumps with each beat.

Drug Therapies
Statins
Inhibit

enzyme HMG-

CoA reductase.
Side

effects

can

include myositis
inflammation

of

or
the

muscles,

joint

pain,

stomach

upset,

and

liver damage.

Drug Therapies
Niacin (Nicotinic Acid)
Increase HDL, lower fatty acid released in blood
Side effects may include redness or flushing of the skin , stomach

upset, headache, dizziness, blurred vision, and liver damage.


Bile acid sequestrants
Sequestrant bind bile acid to intestine, prevent it from reabsorbed

into blood.
Liver produces more bile to replace it so liver use LDL cholesterol

in the blood.

Drug Therapies
Cholesterol absorption inhibitors
The medication ezetimibe (Zetia) limits how much dietary

cholesterol can be absorbed in the small intestine.


Therefore it deceases the amount of intestinal cholesterol

that is delivered to the liver.


Reduced levels of cholesterol delivered to the liver results

in increased hepatic LDL receptor activity, which leads to


increased clearance of LDL cholesterol.
Side effects include headaches, nausea, muscle weakness.

Drug Therapies
Fibric acid derivatives (fibrates)
Effective at lowering triglyceride levels, and moderately

effective at lowering LDL, treat high triglycerides and low HDL


in people who cannot take niacin.
Fibrates appear to activate a protein called peroxisome

proliferator-activated receptor alpha (PPAR-alpha).


PPAR-alpha activates the enzyme lipoprotein lipase and

ultimately results in decreased formation of very low-density


lipoprotein (VLDL) cholesterol (which is converted into LDL
cholesterol) and triglycerides and an increase in HDL
cholesterol.

Treatment
Many people are able to manage coronary artery

disease with lifestyle changes and medications.


Other people with severe coronary artery disease

may need angioplasty or surgery.

Treatment (continued)
1. Stenting
a stent is introduced into a blood vessel on a balloon

catheter and advanced into the blocked area of the


artery
the balloon is then inflated and causes the stent to

expand until it fits the inner wall of the vessel,


conforming to contours as needed
the balloon is then deflated and drawn back
The stent stays in place permanently, holding the vessel

open and improving the flow of blood

Treatment (continued)
2. Angioplasty

a balloon catheter is passed through the guiding catheter to


the area near the narrowing. A guide wire inside the balloon
catheter is then advanced through the artery until the tip is
beyond the narrowing.

the angioplasty catheter is moved over the guide wire until

the balloon is within the narrowed segment.


balloon is inflated, compressing the plaque against the

artery wall
once plaque has been compressed and the artery has been

sufficiently opened, the balloon catheter will be deflated and


removed.

Treatment (continued)
3. Bypass surgery
healthy blood vessel is removed from leg, arm or chest
blood vessel is used to create new blood flow path in your heart
the bypass graft enables blood to reach your heart by flowing

around
(bypassing) the
blocked portion
of the diseased
artery. The
increased blood
flow reduces
angina and the
risk of heart
attack.

Prevention
Get regular medical checkups.
Control your blood pressure.
Check your cholesterol.
Dont smoke.
Exercise regularly.
Maintain a healthy weight.
Eat a heart-healthy diet.
Manage stress

Citations
1.

Insel, Paul Core Concepts in Health McGraw-Hill Companies,


2002

2.

Clark, John A Visual Guide to the Human Body Barnes & Noble
Books, 2001

3.

Thibodeau, Gary, Ph.D. Anatomy & Physiology Mosby Books,


2000

4.

Marieb, Elaine R.N., Ph.D. Essentials of Human Anatomy &


Physiology Pearson Education, 2003

5.

American Heart Association, Heart Disease and Stroke


Statistics, 2003 Update

6.

www.Guidant.com

7.

www.Webmd.com

8.

www.Spotlighthealth.com

9.

Mayoclinic.com

10. Americanheart.org