CHAPTER 5

Plaque Attack

PART 1 Atherosclerosis: Hardened Artery Disease

Atherosclerosis is the leading cause of death in the US and in most of the developed world. By 2020, atherosclerosis is expected to be the leading cause of death worldwide. It doesn’t have to be. Atherosclerosis, also know as hardening of the arteries, is largely caused by having an unhealthy lifestyle. It develops when we eat too many unhealthy foods, when we smoke, when we’re overweight and don't get enough exercise, or when we don't control diabetes and high blood pressure. It’s both preventable and treatable. READ MORE

Atherosclerosis can occur in any of the arteries of your body. When the two carotid arteries, which run up along either side of the front of your neck, become clogged, it’s termed carotid artery disease. When the arteries that supply blood to your heart, the coronary arteries, develop atherosclerosis by becoming narrowed and stiffened, the condition is called coronary artery disease (CAD) or coronary heart disease (CHD).

Symptoms of Atherosclerosis
Because atherosclerosis develops slowly, there may be no symptoms until an artery is so clogged that it can’t deliver adequate blood to your organs or tissues. They become starved of oxygen in a condition called ischemia. Plaques can form in any of the arteries of your body. If atherosclerosis reduces blood flow to your

coronary arteries, symptoms can include chest pain (angina), shortness of breath, and fatigue

brain, stroke-like symptoms may occur, such as sudden numbness or weakness in the arms and legs, difficulty speaking, or drooping facial muscles

arms and legs, walking may become painful

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PART 2 What Happens When Plaques Rupture?

Sometimes plaques rupture: the interior of the plaque breaks through the fibrous cap. This causes the immune system to form a blood clot over the rupture, just as it would for a wound on the surface of the skin. If the clot forms in the coronary arteries that feed the heart muscle, the result can be a heart attack. If a carotid artery leading to the brain is blocked, it can cause a stroke. If the clot forms in a more distant vessel, but breaks off and travels through the bloodstream, either a stroke or a heart attack may result. READ MORE

According to Dr. Ira Tabas of Columbia University Medical Center, in our society most people have some degree of atherosclerosis by the age of 20 or even younger. Fortunately, the vast majority of arterial plaques are stable. But about 2% of arterial plaques are unstable and likely to rupture. What, exactly, prompts them to rupture is “the billion-dollar question,” says Dr. Tabas. LESS

PART 3 Atherosclerosis Complications: Dangerous, and Perhaps Fatal

Atherosclerosis can result in many complications, ranging from the painful to the fatal.

Angina
Partially clogged coronary arteries make it difficult for oxygenated blood to reach your heart muscle tissue, resulting in chest pain, fatigue, or shortness of breath.

Heart Attack
Eventually a plaque may rupture. Platelets in the bloodstream sense the plaque rupture and attempt to heal the injury by forming a blood clot, or thrombus. If the thrombus remains in place and completely blocks the artery, the tissue that artery supplies blood to will be deprived of oxygen and will die. If a coronary artery is blocked, the result will be myocardial infarction—a heart attack. One third of all heart attacks are fatal. Even if the heart attack victim survives, the heart is permanently damaged because the heart's dead tissue is replaced by scar tissue, which can't pulsate the way healthy heart tissue does. The heart can no longer beat efficiently. It must work harder to pump blood throughout the body, stressing the weakened heart even more.

Stroke
If the thrombus breaks away and travels to the brain, it can cause a stroke. A thrombus that breaks off and travels through the bloodstream is called an embolus. If the embolus becomes lodged in an artery in your brain, an ischemic stroke, in which blood supply is cut off to portions of your brain, can be the result.

Symptoms of stroke vary according to the location of the blockage or bleeding in your brain. For instance, if there is a blockage in the area of the brain that controls movement in the left arm, there will be weakness or complete loss of movement in the left arm. Strokes generally affect only one side of the body because they usually occur on only one side of the brain. Because nerves from the brain cross over to the other side of the body, damage to the left side of the brain, for instance, will create symptoms on the right side of the body.

Arrhythmias
Irregular heart beats, termed arrhythmias, occur when the electrical impulses that coordinate your heartbeat don’t function properly. Heart disease is a major cause of arrhythmia, due to lack of blood flow and consequent heart tissue damage.

Carotid Artery Disease
The carotid arteries on either side of your neck, which carry blood to the brain, can become clogged, causing stroke or transient ischemic attack (temporary clotting of a blood vessel in the brain).

Peripheral Artery Disease
The arteries in the arms and legs become narrowed and circulatory problems develop. People with peripheral artery disease may be less sensitive to heat and cold, increasing the risk of burns or frostbite. In extreme cases, lack of circulation can cause tissue death.

Aneurysm
Blood vessels weakened by atherosclerosis may develop aneurysms, bulges in the arterial wall. There are usually no symptoms. If the aneurysm ruptures and creates internal bleeding, the results can be life threatening.

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