Biology: ALBG10

Topic 1: Lifestyle, health and risk CVD & Atherosclerosis

Learning objective
11. Explain the course of events that leads to atherosclerosis (endothelial damage, inflammatory response, plaque formation and raised blood pressure).

Blood vessels Heart structure

Blood clotting

Cardiac cycle

Blood vessels Heart structure

Blood clotting

Cardiac cycle

What happens if things go wrong?

Cardiovascular diseases
Heart diseases were responsible for more deaths (20.2% of deaths) than any other cause (Office for National Statistics in England and Wales 2005)

Followed by cerebrovascular disease (strokes) also a disease of the cardiovascular system Heart diseases and strokes are termed as cardiovascular diseases (CVD)

Cardiovascular diseases

The main causes of death in England and Wales in 2005

Cardiovascular diseases

Cardiovascular diseases

The top 10 diseases that cause the death of Malaysian in 2006 (Malaysian Ministry of Health Department)

Cardiovascular diseases

Cardiovascular diseases

Atherosclerosis

What is atherosclerosis?
Literally means: Hardening of the arteries Build-ups of yellowish fatty deposits (plaques) inside the arteries Begin in late childhood and continues until adulthood

What is atherosclerosis?
Plaque Can build up until it restricts the blood flow in the artery Sometimes can be blocked completely big problem

What is atherosclerosis?

Where do plaques usually formed?

Plaques are likely to form in the

Coronary artery

Carotid artery

can, and does, occur in almost any artery in the body. But in the heart its effects can be crucial. The body depends on a strong pumping heart to circulate life-giving blood, and this includes to the heart muscle itself. If the coronary arteries become blocked, the cardiac muscle begins to fail, and so the blood circulation decreases, which includes the circulation to the heart muscle itself.

How do atherosclerosis forms

1. Endothelial damage

The endothelium inside the artery becomes damaged for some reason
High blood pressure, toxins from cigarette smoke

How do atherosclerosis forms

2. Inflammatory response

White blood cells leave the blood vessels and move into the artery wall These cells accumulate chemicals from the blood (cholesterol) A deposits build up called atheroma

How do atherosclerosis forms

3. Plaque formation

Calcium salts and fibrous tissue also builds up at the site Resulting in plaque (hard swelling) Artery walls loses its elasticity; it hardens

How do atherosclerosis forms

4. Raised blood pressure

The lumen of the artery becomes much smaller This increases the blood pressure harder for the heart to pump blood Can damage lining of endothelium of other vessels more plaques

Course of events in atherosclerosis

1. Endothelial damage - Endothelium becomes damaged - Can be as a result from high blood pressure or toxins from cigarette smoke in the bloodstream 2. Inflammatory response - Damage triggers an inflammatory response - White blood cells leave blood vessels and move into the artery wall - These cells accumulate chemicals (cholesterol) - A deposit builds up (atheroma) 3. Plaque formation 4. Raised blood pressure - Calcium salts - Plaque causes and fibrous the artery to tissue builds up, become results in a hard narrower swelling (plaque) on the inner wall - More difficult for heart to - The build ups of pump blood fibrous tissue around the body causes artery increase in wall to lose blood pressure elasticity i.e. hardens - Dangerous positive feedback

Atherosclerosis timeline

How atherosclerosis forms

Videos

Consequences of atherosclerosis
Aneurysm

Heart disease
Angina Myocardial infraction (heart attack)

Strokes

Problems caused by atherosclerosis

If an area of artery is narrowed by plaque, blood tends to build up behind the blockage

Problems caused by atherosclerosis

If an area of artery is narrowed by plaque, blood tends to build up behind the blockage Artery bulges Wall is under more pressure Wall artery is weakened This is called aneurysm

Problems caused by atherosclerosis

Aneurysm

Problems caused by atherosclerosis

The weakened artery wall may split open and leads to massive internal bleeding

Heart disease
Angina Plaques (from atherosclerosis) that build up slowly in coronary arteries can reduce the blood flow to the heart muscle Normally unnoticed Often symptoms are first noticed during exercise

Heart disease
Angina During exercise, cardiac muscle needs to work harder as it needs more oxygen The narrowed arteries (plaqued arteries) cannot supply enough oxygenated blood and the heart muscle must resort to anaerobic respiration This results in gripping pain in the chest (Angina)

Angina

Angina

Heart disease
Heart attack
Many heart attacks are caused by blood clot as a result of atherosclerosis If a fatty plaque ruptures, cholesterol is released and this leads to rapid blood clot formation (thrombosis) The blood supply to the heart may be blocked completely

Heart disease

Completely blocked arteries

Heart disease
Heart attack
When the blood supply to the heart is completely blocked The heart muscle does not receive any blood and is starved of oxygen and nutrients

This can lead to a heart attack

Heart attack

Heart attack

Videos

Heart disease
Strokes Interruption to the normal blood supply to the area of the brain
Bleeding from damaged capillaries Blockage of blood supply to brain (e.g. by blood clot, atheroma or a combination of the two)

Heart disease
Strokes

Heart disease
Strokes

Heart disease
Strokes If supply of blood is briefly interrupted Mini-stroke Blockage in one of the main arteries could result in a very serious stroke that lead to death

Heart disease
Symptoms of stroke

Videos