Atherosclerosis: Difference between revisions

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{{Atherosclerosis}}
{{Atherosclerosis}}
{{CMG}}
'''For patient information, click [[Atherosclerosis (patient information)|here]]'''


==Pathological Findings==
{{CMG}} {{AOEIC}} [[User:Maheep Sangha|Maheep Singh Sangha, M.B.B.S.]]{{NE}}


[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
{{SK}} Plaque buildup - arteries; hardening of the arteries


<gallery>
==[[Atherosclerosis overview|Overview]]==
Image:Atherosclerosis 1.jpg|Atherosclerosis: Gross, close-up of fatty streak and intimal thickening
==[[Historical Perspective]]==
Image:Atherosclerosis 2.jpg|Atherosclerosis: Gross, very good example of fibrous plaques with ulceration and thrombosis
Image:Atherosclerosis 3.jpg|Atherosclerosis: Gross, proximal left anterior descending artery showing faint fatty streaks and penetrating arteries
Image:Atherosclerosis 4.jpg|Atherosclerosis: Gross, close-up view of aorta. A plaque with ulceration and thrombosis
</gallery>


==[[Atherosclerosis classification|Classification]]==


<gallery>
==[[Atherosclerosis pathophysiology|Pathophysiology]]==
Image:Atherosclerosis 5.jpg|Atherosclerosis: Gross, good example of plaques in aorta
Image:Atherosclerosis 6.jpg|Atherosclerosis: Coronary artery: Gross, close-up view of excellent plaque lesion causing more than 90% occlusion
Image:Atherosclerosis 7.jpg|Atherosclerosis: Gross, good example of advanced calcific atherosclerosis in aorta.
Image:Atherosclerosis 8.jpg|Atherosclerosis: Gross, very good example of calcified and ulcerated atheromatous plaques in aorta
</gallery>


==[[Atherosclerosis causes|Causes]]==


<gallery>
==[[Atherosclerosis differential diagnosis|Differentiating Atherosclerosis from other Diseases]]==
Image:Atherosclerosis with dissecting aneurysm 1.jpg|Atherosclerosis: Dissecting Aortic Aneurysm: Gross, shows dilated aorta with extensive atherosclerosis dissection is seen. A small abdominal aorta, atherosclerotic aneurysm is present. A good picture for association of dilation with dissection
Image:Atherosclerosis 10.jpg|Atherosclerosis: Gross, close-up, an excellent view but appearance much like that of syphilitic aortitis
Image:Atherosclerosis 11.jpg|Atherosclerosis: Gross, an excellent example of ulcerated lesions with many mural thrombi
Image:Atherosclerosis 12.jpg|Atherosclerosis: Gross, very good example of plaque lesion and small mural thrombi
</gallery>


==[[Atherosclerosis epidemiology and demographics|Epidemiology and Demographics]]==


<gallery>
==[[Atherosclerosis risk factors|Risk Factors]]==
Image:Atherosclerosis coronary artery 111.jpg|Atherosclerosis: Coronary artery: Gross, an excellent example of plaque, 80% occlusion, uncomplicated lesion.
Image:Atherosclerosis coronary artery in situ 1.jpg|Atherosclerosis: Coronary artery: Atherosclerosis and thrombotic occlusion: Gross, (an excellent example) in situ on heart
Image:Atherosclerosis 15.jpg|Atherosclerosis: Coarctation: Gross, adult lesion with dramatic demonstration of accelerated atherosclerosis
Image:Atherosclerosis 16.jpg|Atherosclerosis: Coronary artery: Gross, cross section well shown hemorrhage into plaque and thrombosis
</gallery>


==[[Atherosclerosis screening]]==
==Overview==


<gallery>
There is insufficient evidence to recommend routine screening for [disease/malignancy].  
Image:Atherosclerosis 17.jpg|Atherosclerosis: Aorta: Gross, good example of fibrous plaques
Image:Atherosclerosis 18.jpg|Atherosclerosis: Aorta: Gross, an excellent example of fibrous plaques and mural thrombi
Image:Atherosclerosis 19.jpg|Atherosclerosis: Aorta: Gross, thrombi at the origin of celiac axis and superior mesenteric arteries
Image:Atherosclerosis 20.jpg|Atherosclerosis: Aorta: Gross, thrombotic occlusion extending from just below renal arteries into iliac artery
</gallery>


OR


<gallery>
According to the [guideline name], screening for [disease name] is not recommended.
Image:Atherosclerosis 21.jpg|Atherosclerosis: Abdominal Aneurysm Ruptured: Gross, a good example, opened kidneys in marked place. Atherosclerosis in lower thoracic aorta
Image:Atherosclerosis 22.jpg|Atherosclerosis: Adult type coarctation with atherosclerosis in aortic arch
Image:Atherosclerosis 23.jpg|Atherosclerosis: Abdominal Aneurysm Graft Repair: Gross natural color, close-up, an excellent example of Dacron graft that has been in place for years with pseudointima and atherosclerosis
Image:Atherosclerosis 24.jpg|Atherosclerosis: Renal Transplant: Gross, natural color, a close-up view of severe atherosclerosis in abdominal segment of aorta and fatty streaks in descending thoracic much advanced lesions for a 22 years old male with chronic glomerulonephritis
</gallery>


OR


===Saphenous Vein Graft===
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].


<gallery>
OR
Image:Atherosclerosis 29.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, an excellent demonstration of myofibroblastic type cells in thickened intima
Image:Atherosclerosis 30.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome low mag, advanced plaque with hemorrhage into atheroma and complete lumen occlusion with fresh thrombus
Image:Atherosclerosis 31.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, low mag, early atheromata consisting of subendothelial foam cells, whole graft and fibrous intimal thickening, (102 months after CABG)
Image:Atherosclerosis 32.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, high mag, subendothelial foam cells
</gallery>


According to the [guideline name], screening for [disease name] is not recommended.


<gallery>
OR
Image:Atherosclerosis 32a.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome, low mag, large athero plaque and recanalized thrombus in lumen
Image:Atherosclerosis 32b.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, H&E, low mag, large and ruptured atheromatous plaque with focal hemorrhage and calcification
Image:Atherosclerosis 32c.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome, low mag, very complicated hemorrhagic and necrotic plaque with lumen occlusion. A recanalized thrombus and a large aneurysm at side filled with old blood and atheroma crystals
Image:Atherosclerosis 32d.jpg|Saphenous vein coronary bypass graft: Atherosclerosis: Micro, ald. fusch., complicated occlusive lesion with organized and recanalized thrombus and old hemorrhage into atheroma
</gallery>


===Coronary Arteries===
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with:
*[Condition 1]
*[Condition 2]
*[Condition 3]


[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
==References==
 
{{Reflist|2}}
<gallery>
Image:Atherosclerosis 33.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, good demonstration of organized and recanalized thrombus
Image:Atherosclerosis 34.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, very good example of marked lumen stenosis due to typical fibrous plaque with some calcifications
Image:Atherosclerosis 35.jpg|Coronary artery: Atherosclerosis: Micro, H&E, injected artery, marked large plaque with thin fibrous cap has eroded to adventitia, the start of an aneurysm
Image:Atherosclerosis 36.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, an excellent example of plaque with calcification and marked narrowing of lumen. 90% lumen is occluded by thrombus
</gallery>
 
 
<gallery>
Image:Atherosclerosis 37.jpg|Coronary artery: Atherosclerosis: Micro, low mag, an excellent example of atheromatous plaque causing marked lumen obstruction. An uncomplicated plaque
Image:Atherosclerosis 38.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, an excellent example of athero plaque. the lumen is completely occluded
Image:Atherosclerosis 39.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, a plaque with hemorrhage and organizing mural thrombus in lumen
Image:Atherosclerosis 40.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, a good example of plaque with old hemorrhage and marked lumen compensation 
</gallery>
 
 
 
<gallery>
Image:Atherosclerosis 41.jpg|Coronary artery: Atherosclerosis: Micro, H&E, med mag, plaque rupture with thrombosis
Image:Atherosclerosis 42.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, a good example of atheromatous plaque that appears to owe much of its mass to an organized mural thrombus
Image:Atherosclerosis 43.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, typical uncomplicated fibrous plaque
Image:Atherosclerosis 44.jpg|Coronary artery: Atherosclerosis: Micro, H&E, low mag, a good example of athero plaque with marked lumen narrowing. A small mural thrombus in lumen
</gallery>
 
 
 
<gallery>
Image:Atherosclerosis 44a.jpg|Coronary artery: Atherosclerosis: Micro, low mag, hemorrhage into plaque and thrombosis
Image:Atherosclerosis 44b.jpg|Coronary artery: Atherosclerosis: Recanalized Thrombus: Micro, low mag, H&E, lesion is nearly completely organized, small adventitial dissection probably related to bypass surgery about 24 hours before death (a good example)
Image:Atherosclerosis 44c.jpg|Coronary artery: Atherosclerosis: Plaque Hemorrhage and Thrombosis: Micro, low mag, H&E, quite good photo, large plaque with hemorrhage, organizing thrombus in lumen
Image:Atherosclerosis 44d.jpg|Coronary artery: Atherosclerosis, Severe: Micro, low mag, H&E, more than 90% stenosis, also shown a side branch
</gallery>
 
===Aorta===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Atherosclerosis Aorta 1.jpg|Kidney: Atheromatous Embolus: Gross, natural color, external view of kidney with typical scarring pattern of repeated infarction and aorta with severe atherosclerosis (quite good example)
Image:Atherosclerosis Aorta 2.jpg|Aorta, Atherosclerosis: Gross, natural color, opened thoracic segment showing sessile plaques covering intima with several mural thrombi
Image:Atherosclerosis Aorta 3.jpg|Aorta, Atherosclerosis: Gross natural color view of descending thoracic and abdominal segments with expected distribution of atherosclerotic lesions in subject over 60 years old. Not much in thoracic segment and extensive plaques in abdominal segment, some with ulceration
Image:Atherosclerosis aorta, renal and iliac 1.jpg|Thrombus: Gross natural color aorta with kidneys showing thrombotic occlusion due to atherosclerosis beginning just below renal arteries and extending into common iliac (very good example)
</gallery>
 
===Carotid Artery===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]


<gallery>
{{WH}}
Image:Atherosclerosis carotid artery 2.jpg|Carotid artery: Atherosclerosis: Gross, internal carotid plaque with thrombosis
{{WS}}
Image:Atherosclerosis carotid artery 3.jpg|Carotid artery: Atherosclerosis: Gross, plaque with hemorrhage in carotid bulb
[[Category: (name of the system)]]
Image:Atherosclerosis carotid artery 4.jpg|Carotid artery bifurcation, atherosclerosis
Image:Atherosclerosis carotid artery 5.jpg|Carotid artery, atherosclerosis and thrombosis
Image:Atherosclerosis carotid artery 6.jpg|Carotid artery: Atherosclerosis: Gross, good example of carotid bulb plaque with thrombus
</gallery>


===Lung===
==[[Atherosclerosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
==Diagnosis==
[[Atherosclerosis history and symptoms|History and Symptoms]] | [[Atherosclerosis physical examination|Physical Examination]] | [[Atherosclerosis laboratory findings|Laboratory Findings]] | [[Atherosclerosis other diagnostic studies|Other Diagnostic Studies]]


<gallery>
==Treatment==
Image:Atherosclerosis lung 1.jpg|Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery
[[Atherosclerosis medical therapy|Medical Therapy]] | [[Atherosclerosis primary prevention|Primary Prevention]] | [[Atherosclerosis secondary prevention|Secondary Prevention]] | [[Atherosclerosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Atherosclerosis future or investigational therapies|Future or Investigational Therapies]]
Image:Atherosclerosis lung 2.jpg|Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery
Image:Atherosclerosis lung 3.jpg|Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery
Image:Atherosclerosis lung 4.jpg|Lung: Atherosclerosis: Gross, natural color, arteries show atherosclerotic plaque lesions
</gallery>


===Pulmonary Artery===
==Case Studies==
 
[[Atherosclerosis case study one|Case #1]]
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Atherosclerosis 57.jpg|Pulmonary artery atherosclerosis in patient with pulmonary hypertension
Image:Atherosclerosis 58.jpg|Pulmonary Artery Atherosclerosis: Gross, essentially natural color, artery stained by hemolysis, small plaque lesions 
Image:Atherosclerosis pulmonary artery 1.jpg|Atherosclerosis: Gross, natural color, close-up fatty plaques in large pulmonary artery
Image:Atherosclerosis 60.jpg|Atherosclerosis: Micro, low mag, van Gieson, thickened intima with fatty streak type lesion and preservation of fetal medial structure, a large pulmonary artery, 4yo male with primary pulmonary hypertension
</gallery>
 
===Brain===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Atherosclerosis brain 1.jpg|Brain: Atherosclerosis: Gross, a good example of atherosclerosis in vessels at base of brain. 
Image:Atherosclerosis brain 2.jpg|Brain: Basilar Artery Atherosclerosis: Gross, fixed tissue, an external view of base of brain (typical lesion) 
Image:Atherosclerosis brain 3.jpg|Brain: Old Cystic Encephalomalacia: Gross, fixed tissue, frontal lobe lesion with frontal artery atherosclerosis
Image:Atherosclerosis brain 4.jpg|Brain: Watershed Infarct and Carotid Atherosclerosis
</gallery>
 
===Liver===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Atherosclerosis 65.jpg|
Image:Atherosclerosis 66.jpg|
Image:Atherosclerosis 67.jpg|
Image:Atherosclerosis 68.jpg|
</gallery>
 
===Kidney===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Atherosclerosis renal 1.jpg|Atherosclerosis: Kidney: Atheromatous Embolus: Gross, natural color, kidney with typical scarring pattern of repeated embolism and aorta with severe atherosclerosis (a quite good example)
Image:Atherosclerosis renal 2.jpg|Atherosclerosis: Kidney: Atrophy secondary to renal artery atherosclerosis: Gross, natural color, both kidneys one very atrophic the large left kidney weighed 220 grams and the small left one 90 gram
</gallery>
 
===Spleen===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Atherosclerosis spleen 1.jpg|
Image:Atherosclerosis spleen 2.jpg|
Image:Atherosclerosis spleen 3.jpg|
Image:Atherosclerosis spleen 4.jpg|
</gallery>
 
==References==
{{reflist|2}}


==See also==
==Related Chapters==
<div style="-moz-column-count:2; column-count:2;">
<div style="-moz-column-count:2; column-count:2;">
*[[Monckeberg's arteriosclerosis]]
*[[Monckeberg's arteriosclerosis]]
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Revision as of 15:04, 28 May 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Maheep Singh Sangha, M.B.B.S.Niloofarsadaat Eshaghhosseiny, MD[2]

Synonyms and keywords: Plaque buildup - arteries; hardening of the arteries

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atherosclerosis from other Diseases

Epidemiology and Demographics

Risk Factors

Atherosclerosis screening

Overview

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

Screening

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with:

  • [Condition 1]
  • [Condition 2]
  • [Condition 3]

References

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Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters


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