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 I monocyte adhesion/migration through Vessel wall into intima to become maccrophages Stage II foam cells (lipid containing macrophages) in intima Stage III appearance of extracellular lipid

Fibrous Cap and Core formation 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)

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

Causes High blood cholesterol High blood pressure Smoking Obesity Lack of physical activity

Risk Factors Uncontrollable Controllable Sex Hereditary Race Age High blood pressure High blood cholesterol Smoking Physical activity Obesity Diabetes Stress and anger

Treatment Lipid lowering drugs Life style modification