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The Heart of the Matter: What is Arteriosclerosis?

Heart disease takes many forms. Chances are, you’re familiar with one of the more common ones: arteriosclerosis.

Simply put, arteriosclerosis is vascular damage that results from a number of causes, such as high cholesterol, high blood pressure, diabetes, and genetic influences, explains Daniel M. Kolansky, MD, director of the cardiac care unit at Penn Medicine, and associate chief of cardiovascular medicine.

How arteriosclerosis can manifest itself

Here’s a look at three different ways arteriosclerosis can manifest itself—and how each is treated.

Coronary artery disease

Coronary artery disease occurs when plaque (a waxy substance) builds up inside a coronary artery. This results in narrowings, or blockages, and the artery can’t supply as much blood to the heart, Dr. Kolansky explains.

“You might not notice symptoms at first,” he says. “But as this process progresses, it may result in chest tightness, arm discomfort, shortness of breath, or other symptoms. And when coronary artery disease is severe, it can lead to a heart attack.”

Coronary artery disease kills almost 370,000 Americans annually and is the most common type of heart disease.

Dr. Kolansky calls heart attacks “the most feared complication of coronary artery disease” because they usually involve a sudden closure of the coronary artery. When a heart attack occurs, restoring blood flow to the closed blood vessel as quickly as possible is critical.

Penn Medicine hospitals have teams in place who treat heart attacks quickly. Physicians commonly use cardiac catheterization, an approach that involves threading thin tubes into the blood vessels to diagnose and treat problems.

Typically, the closed artery is opened with inflation of a tiny balloon (balloon angioplasty). This is usually followed by placement of a coronary stent—a tube that “opens” vessels and restores blood flow.

The procedure often limits the heart muscle damage that could occur and is referred to as Percutaneous Coronary Intervention (PCI). Penn Medicine has a greater than 95% success rate with such angioplasty/stent procedures.

But as Dr. Kolansky notes, preventative measures are still best.Coronary artery disease prevention

For patients who already have coronary artery disease, several treatment options are available. They’re typically divided into two categories: medical therapy and revascularization therapy.

“Medical therapy involves the use of medications, such as aspirin, beta blockers, and cholesterol-lowering drugs,” explains Dr. Kolansky. “But when blockages become too severe, it’s often necessary to treat them with revascularization—these are procedures to restore blood flow to the heart.”

Coronary stenting and coronary bypass surgery are typical examples of revascularization, Dr. Kolansky says, and Penn Medicine is at the forefront of both techniques.

Penn’s interventional cardiologists use the most current versions of coronary stents to open narrowed arteries, and Penn’s cardiac surgeons are skilled at bypassing blocked vessels when that is a more appropriate approach than stenting.

Peripheral artery disease and carotid artery disease

Arteriosclerosis isn’t limited to heart vessels. It also appears as peripheral artery disease (PAD), which is a narrowing in the arteries beyond the heart, Dr. Kolansky explains. PAD can arise in the legs and in the carotid arteries, which supply blood to the head and aorta.

“Patients should be aware of symptoms such as pain in the lower extremities (legs) when walking, as this could be a sign of lower extremity peripheral artery disease,” Dr. Kolansky says.

“And carotid artery disease may present itself as a temporary stroke, referred to as a transient ischemic attack, or TIA,” he adds. “This is a warning sign that patients should be aware of, and if it occurs, they should seek medical attention immediately.”

Symptoms of a transient ischemic attack include:

  • Numbness or tingling in the face
  • Temporary loss of vision, especially in one eye
  • Dizziness or loss of balance
  • A sudden, severe headache

As with coronary artery disease, the first line of treatment for both peripheral and carotid artery disease is prevention, Dr. Kolansky says. And these forms of arteriosclerosis can also be treated with revascularization techniques, including stenting or surgery.

Aortic aneurysm

Many people think of aneurysms as problems that occur in the brain. But aortic aneurysms are a third form of arteriosclerosis to be aware of.

This is an abnormal enlargement in the aorta, your body’s largest blood vessel. This enlargement can weaken the wall of the aorta, and there is a risk of aortic aneurysm rupture, which can be fatal.

Dr. Kolansky warns that aortic aneurysms can be “silent”—meaning there are no outward symptoms—and go undetected until a routine screening.

But there can also be noticeable symptoms, including discomfort in the abdomen or back. In certain patients, such as those who smoke and have high blood pressure, screening might be appropriate.

“Aortic aneurysms are treated by reducing blood pressure and, often, with vascular stenting or surgery,” says Dr. Kolansky. “The goal of surgery is to prevent the aneurysm from expanding or rupturing.”

Aortic aneurysms are typically diagnosed with imaging, such as:

  • An ultrasound
  • A computed tomography (CT) scan
  • A computed tomography angiogram (CTA)—this procedure involves injecting a contrast dye into your veins and creating images of your blood vessels

Penn is currently the largest referral center for complex aortic surgery in the region. Additionally, Penn’s vascular and cardiothoracic surgeons are world leaders in this field, and have a range of treatment options available.

Although arteriosclerosis is a condition that can lead to serious issues, it can be prevented with healthy lifestyle habits. Work with your doctor on creating an action plan for now and the future.

About this Blog

The Penn Heart and Vascular blog provides the latest information on heart disease prevention, nutrition and breakthroughs in cardiovascular care.

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