Internal illnesses. Atherosclerosis (lecture notes)

Lecture notes, cheat sheets
Free library / Directory / Lecture notes, cheat sheets

Internal illnesses. Atherosclerosis (lecture notes)

Lecture notes, cheat sheets

Table of contents (expand)

LECTURE No. 14. Atherosclerosis

Atherosclerosis is a disease of the body, the pathomorphological substrate of which is the accumulation of lipids in the inner and middle membranes of large and medium-sized arteries, followed by the deposition of calcium salts and the development of scar connective tissue. Represents one of the most common diseases among the population of developed countries. There are over 30 risk factors for the disease.

Etiology and pathogenesis. Violation of lipid metabolism leads to a change in the metabolism and permeability of the vascular wall. On the surface of the vascular wall, the formation of atherosclerotic plaques, their ulceration, the formation of thrombotic masses on the ulcerated surfaces occurs. Subsequently, the masses formed on the plaques come off, clogging the vessels of small and medium caliber. In the plaques themselves, secondary deposition of calcium salts occurs.

The main types of dyslipoproteinemia (according to G.F. Fredrikson):

1) type 1: increased chylomicron fraction, no risk of atherosclerosis, very rare (1: 1 people);

2) type 2a: increased LDL fraction, high risk of atherosclerosis; hypercholesterolemia can be familial (heterozygous or homozygous high cholesterol) and non-familial (moderate); occurs very often;

3) type 2b: increased fractions of LDL, VLDL (very low density), the risk of atherosclerosis is very high; occurs very often;

4) type 3: increased fractions of DILI (intermediate density), the risk of atherosclerosis is high, the prevalence is 1: 1000-5000 people;

5) type 4: VLDL fraction is increased, the risk of atherosclerosis is moderate, it occurs very often; combined with hypertension;

6) type 5: increased fractions of VLDL and chylomicrons, the risk of atherosclerosis is moderate, very rare.

Clinic. In type 1, eruptive xanthomas, retinal lipid infiltration, recurrent pancreatitis, and hepatosplenomegaly are noted.

In type 2a, there are: lipoid corneal arch, tuberculate and tendon xanthomas, xanthelasmas.

In type 2b, there are: lipoid corneal arch, xanthelasma, hyperuricemia, impaired glucose tolerance.

Type 3 has palmar xanthomas, tuberculate xanthomas.

Type 4 has recurrent pancreatitis.

Type 5 has xanthomas, dyspnea, and hepatosplenomegaly.

Preclinical period characterized by the appearance of complaints of vague pain from the heart, headaches, decreased performance.

Clinical period characterized by the development of severe atherosclerosis of various localizations.

With atherosclerosis of the aorta, systolic murmur is noted along its course. If the ascending aorta or arch is affected, symptomatic hypertension may occur with an increase in systolic pressure with normal or reduced diastolic pressure.

With atherosclerosis of the coronary vessels, clinical manifestations of coronary heart disease are possible.

With atherosclerosis of the cerebral vessels, memory impairment, dizziness, headache develop, in severe cases - a picture of a stroke, cerebral hemorrhage, psychosis.

With atherosclerosis of the renal arteries, there is more often stable arterial hypertension with high numbers.

With atherosclerosis of the arteries of the abdominal cavity, pain, dysfunction of the gastrointestinal tract are noted.

With atherosclerosis of the arteries of the lower extremities, signs of intermittent claudication are determined.

Additional diagnostic study. To determine the type of dyslipoproteinemia, a biochemical study is carried out on the levels of triglycerides, total cholesterol, HDL.

Protein metabolism is being studied, in which dysproteinemia, a decrease in albumin, and an increase in γ-globulin in the sclerotic stage of the disease are noted.

X-ray examination, Doppler echography, which reveals an increase in the speed of propagation of the pulse wave, and angiography, which establishes the presence of atherosclerotic occlusions, are carried out.

Differential diagnostics. It is necessary to exclude secondary dyslipoproteinemia against the background of taking medications, alcoholism, diabetes mellitus, thyroid diseases, nephrotic syndrome, obstructive jaundice.

Treatment. Effective treatment requires lifestyle changes. It is necessary to follow a diet, exercise, monitor body weight, stop smoking.

Initially, diet 1 is prescribed according to nutritional recommendations for atherosclerosis. In the presence of predisposing factors for the development of atherosclerosis, a more rigid diet is prescribed 2 - with familial hypercholesterolemia, the presence of coronary artery disease (coronary heart disease), with the ineffectiveness of the first stage diet. Antioxidants, fish oil are used.

Medical therapy includes taking anion exchange resins (cholestyramine 4 g 2 times a day, colestipol 5 g 2 times a day, may increase to 30 g per day, 1 hour before or after a meal), HMG-CoA reductase inhibitors (statins)inhibitors of cholesterol biosynthesis at a critical stage of the process (mevacor 10-40 mg/day, lovacor 10-40 mg/day, zocor, symbol 5-40 mg/day, lipostat 10-20 mg/day, lescola 20-40 mg/day , lipobaya 100-300 mcg/day, liprimar 10-40 mg/day), nicotinic acid at an initial dose of 100 mg orally 1-3 times a day with meals with a gradual increase (300 mg weekly) to 2-4 g per day, niacinamide (nicotinic acid preparation), fibric acid group drugsthat enhance the catabolism of VLDL (gemfibrozole 600 mg 2 times a day before meals, clofibrate 1 g 2 times a day), drugs with antioxidant properties (probucol - reduces LDL cholesterol - 500 mg 2 times a day with meals).

In severe hypertriglyceridemia) plasmapheresis is indicated.

Forecast. It is serious, especially with damage to the coronary vessels, cerebral vessels, kidneys.

Prevention. In primary prevention, it is necessary to use dietary regulation, limit alcohol intake, smoking, and expand physical activity.

In secondary prevention, an annual determination of the lipid profile is used: at a triglyceride level of more than 400 mg%, LDL is measured, the study is repeated after 1-8 weeks. If the data differ by 30%, the third study is also carried out after 1-8 weeks, the average results of the three measurements are calculated. With an LDL level of less than 100 mg%, an individual diet and physical activity regimen are selected. At the level of LDL more than 100 mg%, drug therapy is prescribed.

Author: Myshkina A.A.

<< Back: Tricuspid valve insufficiency

>> Forward: Coronary heart disease

We recommend interesting articles Section Lecture notes, cheat sheets:

▪ General sociology. Lecture notes

▪ Social Psychology. Lecture notes

▪ Surgical diseases. Lecture notes

See other articles Section Lecture notes, cheat sheets.

Read and write useful comments on this article.

<< Back

Latest news of science and technology, new electronics:

The existence of an entropy rule for quantum entanglement has been proven 09.05.2024

Quantum mechanics continues to amaze us with its mysterious phenomena and unexpected discoveries. Recently, Bartosz Regula from the RIKEN Center for Quantum Computing and Ludovico Lamy from the University of Amsterdam presented a new discovery that concerns quantum entanglement and its relation to entropy. Quantum entanglement plays an important role in modern quantum information science and technology. However, the complexity of its structure makes understanding and managing it challenging. Regulus and Lamy's discovery shows that quantum entanglement follows an entropy rule similar to that for classical systems. This discovery opens new perspectives in the field of quantum information science and technology, deepening our understanding of quantum entanglement and its connection to thermodynamics. The results of the study indicate the possibility of reversibility of entanglement transformations, which could greatly simplify their use in various quantum technologies. Opening a new rule ... >>

Mini air conditioner Sony Reon Pocket 5 09.05.2024

Summer is a time for relaxation and travel, but often the heat can turn this time into an unbearable torment. Meet a new product from Sony - the Reon Pocket 5 mini-air conditioner, which promises to make summer more comfortable for its users. Sony has introduced a unique device - the Reon Pocket 5 mini-conditioner, which provides body cooling on hot days. With it, users can enjoy coolness anytime, anywhere by simply wearing it around their neck. This mini air conditioner is equipped with automatic adjustment of operating modes, as well as temperature and humidity sensors. Thanks to innovative technologies, Reon Pocket 5 adjusts its operation depending on the user's activity and environmental conditions. Users can easily adjust the temperature using a dedicated mobile app connected via Bluetooth. Additionally, specially designed T-shirts and shorts are available for convenience, to which a mini air conditioner can be attached. The device can oh ... >>

Energy from space for Starship 08.05.2024

Producing solar energy in space is becoming more feasible with the advent of new technologies and the development of space programs. The head of the startup Virtus Solis shared his vision of using SpaceX's Starship to create orbital power plants capable of powering the Earth. Startup Virtus Solis has unveiled an ambitious project to create orbital power plants using SpaceX's Starship. This idea could significantly change the field of solar energy production, making it more accessible and cheaper. The core of the startup's plan is to reduce the cost of launching satellites into space using Starship. This technological breakthrough is expected to make solar energy production in space more competitive with traditional energy sources. Virtual Solis plans to build large photovoltaic panels in orbit, using Starship to deliver the necessary equipment. However, one of the key challenges ... >>

Random news from the Archive

Omnicomm monitoring system for school buses 21.01.2014

The Omnicomm company ("Omnikomm") announced that 500 buses transporting schoolchildren in 26 districts of the Kurgan region were equipped with the Omnicomm transport monitoring system. The project was implemented by the official dealer of Omnicomm in the city of Kurgan - the Tachograph-Service company, whose customer was the Main Department of Education of the Kurgan Region.

As part of the project, all school transport in the Kurgan region was equipped with Omnicomm Optim on-board terminals and connected to the Omnicomm Online cloud service. With its help, each educational institution of the region will be able to monitor the location of its transport in real time and, if necessary, respond to emergency messages. The Omnicomm monitoring system automatically detects and reports emergency situations, such as delays in the traffic schedule or unauthorized departure from the route.

The main requirements of the customer for the equipment were reliability and vandal resistance, which is especially important when drivers of passenger transport work in a large region with a high load on the transport infrastructure.

The use of intelligent monitoring systems in passenger transport allows not only to take control of its operation, but also to reduce the number of accidents. Improving road safety is essential for passenger transport, and especially for children. In addition, the Omnicomm vehicle monitoring system monitors fuel consumption and prevents fuel theft, which means a significant reduction in operating costs for a fleet of several hundred vehicles.

“As the population grows, traffic intensity and tension on the roads increase, there comes a time when a qualitative leap is needed in the work of passenger transport, based on the latest achievements in the field of information technology,” says Pavel Ustyuzhanin, deputy head of the Main Department of Education of the Kurgan Region. the department organizes safety when transporting children by school buses.We purchase new vehicles that meet modern safety requirements, equip existing buses with the necessary control devices, including satellite navigation systems.In 2013, within the framework of the GLONASS Target Program, all school buses in the Kurgan region were equipped with the Omnicomm satellite transport monitoring system.We are satisfied with the reliability and functional characteristics of the Omnicomm system, as well as the professionalism of the Tachograph-Service company.A very necessary solution has been created that allows not only only better to manage school transport, but also positively affects the social life of the entire area. We are not going to rest on our laurels, and our immediate plans include the creation of a regional dispatch service."

Other interesting news:

▪ Piezoelectric MEMS Microphones for Smartphones

▪ Laboratory in a vest pocket

▪ LEDs emit ultraviolet light

▪ Weather does not affect mood

▪ New life for polyurethane waste

News feed of science and technology, new electronics

Interesting materials of the Free Technical Library:

▪ section of the site Big encyclopedia for children and adults. Selection of articles

▪ article Traumatology and orthopedics. Crib

▪ Why don't women have beards? Detailed answer

▪ article Kerguelen cabbage. Legends, cultivation, methods of application

▪ article Cement for gluing products from celluloid. Simple recipes and tips

▪ article Battery charge limiter indicator. Encyclopedia of radio electronics and electrical engineering

Leave your comment on this article:

All languages of this page

Home page | Library | Articles | Website map | Site Reviews