Atherosclerosis (AS) is the leading cause of coronary heart disease, cerebral infarction, and peripheral vascular disease. Lipid metabolism disorder is the basis of atherosclerosis, which is characterized by the involvement of the affected arterial lesions from the intima, usually with the accumulation of lipids and complex carbohydrates, hemorrhage and thrombosis, and then fibrous tissue hyperplasia and calcium deposition, and The gradual metamorphosis and calcification of the middle layer of the artery leads to thickening and hardening of the arterial wall and narrowing of the vascular lumen. The lesion often involves the large and medium muscular arteries, and once developed enough to block the arterial lumen, the tissue or organ supplied by the artery will be ischemic or necrotic. Since the appearance of lipids accumulated in the intima of the artery is yellow atheroma, it is called atherosclerosis.
Symptom
The symptoms of atherosclerosis depend mainly on vascular lesions and the degree of ischemia in the affected organs. Aortic atherosclerosis often has no specific symptoms; coronary atherosclerosis, if the diameter of the stenosis is more than 75%, angina pectoris, myocardial infarction, arrhythmia, and even sudden death may occur; cerebral atherosclerosis may cause brain deficiency Blood, brain atrophy, or cerebral vascular rupture; renal atherosclerosis often causes nocturia, refractory hypertension, severe renal insufficiency; mesenteric atherosclerosis can be expressed as postprandial abdominal pain, indigestion, Constipation, etc., severe intestinal wall necrosis can cause blood in the stool, paralytic ileus and other symptoms; lower extremity atherosclerosis caused by severe vascular stenosis can occur intermittent claudication, dorsal artery pulsation disappeared, in severe cases can even occur gangrene.
Diagnosis
The development of atherosclerosis to a certain extent, especially in the presence of organ lesions, is not difficult to diagnose. If dyslipidemia is found in the examination and angiography shows a stenotic lesion in the blood vessel, atherosclerosis should be considered first. It should be noted that atherosclerosis is a systemic disease in which an organ angiogenic atherosclerotic lesion means that the same lesion may already exist in the blood vessels elsewhere; likewise, an organ vascular event means The risk of vascular events increases elsewhere.
1. Patients over the age of 40, if there is a widening of the aorta, can rule out other diseases, suggesting the possibility of aortic atherosclerosis;
2. If there is sudden vertigo or gait instability without signs of increased intracranial pressure, there should be suspected cerebral insufficiency caused by basilar atherosclerosis;
3. After the activity, there is a brief post-sternal and precordial pain or pressure in the anterior region. It is suspected that the myocardial blood supply is insufficient due to coronary atherosclerosis;
4. Nocturia is often one of the early symptoms of renal atherosclerosis.
In addition, patients are often associated with susceptibility to atherosclerosis, such as hypertension, hypercholesterolemia, hypoHDL, diabetes, and smoking. Such as selective electrocardiogram, radionuclide heart, brain, kidney and other organ scans, Doppler ultrasonography, and selective angiography, etc., can help to confirm the diagnosis.
Medical treatement
(1) hypolipidemic drugs 1 statins; 2 fibrates; 3 niacin; 4 cholestyramine; 5 clofibrate; 6 unsaturated fatty acids such as Yishouning, Xuezhiping and Xinmaile; 7 alginic acid diester sodium.
(2) antiplatelet drugs 1 aspirin; 2 dipyridamole; 3 clopidogrel; 4 cilostazol.
(3) dilated vascular drugs 1 benzoquinone (mainly acting on arteries); 2 nitroglycerin and Xiaoxin pain (mainly acting on veins); 3 sodium nitroprusside (acting on arteries and veins); 4α1 receptor blockers such as Prazosin; 5α2 receptor blocker such as phentolamine; 6β2 receptor agonist such as salbutamol; 7 captopril, enalapril; 8 heart pain, thiazolone; Acid, long pressure, prostaglandin, atrial natriuretic peptide, etc.
(4) thrombolytic and anticoagulant drugs 1) thrombolytic drugs such as: 1 urokinase and streptokinase; 2 tissue plasminogen activator; 3 single-chain urokinase-type plasminogen activator; 4TNK- Tissue plasminogen activator. 2) anticoagulant drugs such as: 1 heparin; 2 enoxaparin; 3 nadroparin; 4 bivalirudin.
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