Anemia in the pediatric patient
Could Atherosclerosis Already Be Clogging Your Arteries? - WebMD
Ever wish you could see inside your arteries? These blood vessels deliver oxygen-rich blood to every corner of our bodies. Maintaining the flow is essential to life and health.
Atherosclerosis causes narrowing and hardening of the arteries, creating slowdowns in blood flow. Even worse, atherosclerosis can trigger sudden blood clots. Heart attacks and strokes are the often-deadly result.
If we could see what was going on in our arteries, we might think twice about our lifestyle choices. Could atherosclerosis be clogging your arteries? Take a look on this amazing voyage into your body's highway system.
The entire body depends on arteries for blood flow. Atherosclerosis acts throughout the body but is more selective as to where it becomes serious.
"One of the paradoxes of atherosclerosis is that although it acts diffusely, blockages tend to form only in certain places," according to Saul Schaefer, MD, professor of medicine at the University of California-Davis.
The aorta is the main artery of the body. After emerging from the heart, the aorta splits into dozens of branches. Complications from atherosclerosis tend to occur in a few areas:
All our arteries are lined by special tissue called endothelium. Healthy endothelium dilates arteries widely during exercise. It also prevents atherosclerosis or blood clots from developing.
Exposure to certain risk factors can damage the endothelium. Smoking, diabetes, high cholesterol, or high blood pressure are the most well known.
Using tests not widely available, researchers can detect problems in the endothelium before atherosclerosis ever develops. "Most likely, damaged areas of endothelium are where atherosclerosis begins," says Schaefer.
You can't feel problems in your endothelium. But "if you're sedentary, smoke, have diabetes, high blood pressure or cholesterol, you likely have some endothelial dysfunction," according to Schaefer. That can set you up for developing atherosclerosis.
Over years, continued exposure to risk factors tends to cause atherosclerosis. The process works like this:
1. Fatty Streaks
Low-density lipoprotein (LDL or "bad" cholesterol) works its way into the walls of arteries. Once inside, LDL is like toxic waste: hard to detect, hard to dispose of, and potentially disastrous down the road.
If we could see inside arteries, the LDL at this point would be visible in the wall as a fatty streak, like a smear of grease. Autopsies of young people show that fatty streaks develop as early as the teenage years.
2. Plaque Formation
Over time, more cholesterol accumulates in the artery. The body sends leukocytes, a cleanup crew of white blood cells. The cholesterol and the cells responding to it evolve into a "bump" on the artery wall. This is called a plaque.
3. Plaque Growth
Unfortunately, the ongoing "cleanup" doesn't shrink the plaque. In fact, just the opposite: as more cholesterol and cells gather, the plaque grows. What happens next inside your arteries can be a matter of life and death.
As plaques grow, arteries remodel themselves to keep blood flow. They thicken their walls, making room for the enlarging plaque. "The plaque grows but stays out of the way, like a car stranded at the side of the road," explains Schaefer.
Eventually, some plaques grow slowly into the flow of blood. Even so, they rarely cause symptoms until the artery is more than 70% blocked. "Given enough time, arteries can create collateral channels, a natural bypass around the blockage," says Schaefer.
When a plaque does limit blood flow, pain with exertion is the most common symptom. In the coronary arteries, this causes angina (chest pain), and in the legs, claudication (muscle pain).
Surprisingly, these near-complete blockages aren't the most dangerous plaques.
"Another paradox of atherosclerosis is that these severe blockages don't usually cause heart attacks," explains Schaefer.
In general, severe blockages that have occurred over decades are stable. They're the bad neighbor who everyone's gotten used to living with. (Or you just don't know he's there.)
Rather, the plaques to watch out for are the young punks down the block. "Most heart attacks occur because of sudden changes in plaques that only block 20% or 30% of an artery," says Jeff Borer, MD, professor of cardiovascular medicine at Weill Cornell Medical College in New York.
These small but deadly plaques are hard to detect, even with advanced tests for atherosclerosis. "Generally, we just have to infer they're there from the presence of bigger blockages elsewhere," says Borer.
Learning why these smaller plaques rupture is a key focus of ongoing research. Studies over the past decade have demonstrated that inflammation inside the plaque is the key
How does a plaque become inflamed? As plaques grow, leukocytes and muscle cells gather inside. The leukocytes attempt to digest the LDL cholesterol.
That may sound like a good thing. But leukocytes' job description includes releasing chemicals that can be destructive. The local muscle cells also release damaging substances.
The result can be a dissolving of the interior of a stable plaque, rendering it unstable. If the cap of the plaque breaks off, dangerous materials inside are exposed to blood flowing by. A blood clot forms rapidly in the artery, causing a heart attack or stroke.
Severe but stable blockages can often be seen on a stress test or coronary angiogram. However, smaller, dangerous plaques usually go undetected. And with current knowledge, "it's impossible to determine when these plaques are inflamed and therefore more likely to rupture," explains Borer.
Using a marker in the blood called C-reactive protein (CRP), doctors can get a general idea of the level of inflammation in the body. This test can't predict heart attacks or strokes with accuracy, though.
Why is atherosclerosis often described as "hardening of the arteries?" As plaques grow and evolve in the artery walls, calcium deposits inside them. The calcium makes the plaque firm and the artery stiffer. In general, stable plaques contain more calcium.
A relatively new test called electron-beam computed tomography (EBCT) can calculate the amount of calcium in the coronary arteries and help predict the risk of heart attack in certain people.
Atherosclerosis is frightening because its complications can be both unpredictable and deadly. However, it's worth remembering that up to 90% of the risk of a first heart attack is preventable. The risk factors are well known, and most can be prevented or treated.
Smoking:Tobacco smoke damages endothelium and accelerates atherosclerosis. Smoking also increases inflammation, the process that makes plaques unstable. On the other hand, "if you quit smoking, after a few years your risk falls nearly to that of a nonsmoker," says Borer.
Sedentary lifestyle:Exercise keeps arteries' endothelium healthy. This helps explain why frequent exercise dramatically reduces the risk of atherosclerosis. Exercise also reduces the risk of diabetes, another cause of atherosclerosis. Thirty minutes a day provides a large benefit, but any exercise is better than none.
High blood pressure and cholesterol: If you're leaving your blood pressure untreated, your arteries are taking the pounding. Lowering cholesterol to healthy levels is proven to reduce the risk of heart attacks. Some people can achieve healthy blood pressure and cholesterol levels with lifestyle changes alone. Many, though, will require medicines to reduce the risk.
What you don't see can hurt you. Until we can see inside our arteries, the best advice is to start lowering your risk for atherosclerosis now.
"Without question, reducing your risk factors will lower your chances of dying from cardiovascular disease," the most common killer of Americans, says Schaefer.
What You Need For Your Atherosclerotic Cardiovascular Disease ... - WebMD
You've made your first appointment with a specialist to talk about atherosclerotic cardiovascular disease (ASCVD). But before your physical exam, your doctor will need to get some basic information about your symptoms, health history, lifestyle, and more. This is the key to your treatment, so a smooth and productive visit depends on having this information ready.
Put a Folder TogetherAny visit to the doctor means that there will be paperwork. This simple tool can make it easier to access it all. You may find that a binder with pockets is helpful, too, since it allows you to separate everything by category. It also gives you a place to keep any information your doctor gives you.
Health Insurance and Payment InformationWhen you make your appointment, make sure that your doctor's office accepts your insurance and find out which insurance cards and forms they'll need. You should also verify copays. To help you complete your forms, you'll need:
You may not have symptoms of ASCVD, especially when it's in the early stages. This is something your doctor needs to know. If you do have symptoms, take some time before your visit to make notes about them. Be as clear and detailed as you can be. You'll want to tell your doctor:
Your doctor will want to know about your own medical history in detail. Be ready to tell them about any illnesses you've had and any conditions that you're currently treating. They'll want to see a list of:
Your doctor will ask you about your family's health history as well as yours. So before your visit, ask a family member or two who know the details about the health of your close relatives, including parents, grandparents, and aunts and uncles. This can include such things as heart disease, diabetes, high blood pressure, and cholesterol levels. If your relatives have been treated for these things, you'll need to know:
Be sure to write down as many details as you can so you can give your doctor as complete a picture as possible.
List of Health Care ProvidersYour specialist will want to see a list of everyone who's treated you, including your dentist and chiropractor, for the last 2 years. They may need to get copies of your medical records. This list may also prompt them to ask you questions.
For example, if they see that you're seeing a natural-healing practitioner, they may ask about treatments, medications, or supplements that they wouldn't ask about without knowing you're also seeing a natural practitioner. You could be taking an herbal supplement for blood pressure that may not interact well with something your specialist plans on prescribing. Or it may not be working and they may recommend a different course of treatments altogether.
This information takes time to pull together and complete. Ask your doctor when you make your appointment if they can send you the medical history form in advance so you can do this at home.
Prescriptions and Supplements ListBring a list of any medications you are currently taking. Don't forget to include vitamins and supplements. You can also ask your pharmacist or primary care provider for a list of what you were prescribed in the last year, even if you are no longer taking them. To be extra thorough, gather medications, vitamins, and supplements in a plastic bag and bring them with you.
A List of QuestionsIt's likely that you'll have at least a few questions for your doctor. You can find suggestions for questions online at websites for ASCVD or health care providers. But if you're concerned about something, ask about it. Your list will be unique to you. Write it down so you'll be sure to ask them all. If you don't understand all the answers, ask the doctor to make them clear to you.
Bring a Friend or Family MemberIt's a good idea to bring a family member or close friend to your appointment with you if you can. You don't want them to take control of the time or question your treatment. But they can take notes for you so that you can remember everything that you and your doctor talk about. They can also help you remember all the questions that you want to ask. Be sure to fill this person in on the reason for your appointment before you go and let them know how they can best help you.
Polycystic Ovary Syndrome And Cardiovascular Disease
This is the fifth installment of a 6-part series on the lifelong journey of polycystic ovary syndrome (PCOS) and the stops along the way that a female may face. In this installment, I will discuss PCOS and cardiovascular disease.
Continuing the journey with polycystic ovarian syndrome (PCOS), the multitude of health comorbidities that can occur all play a major role in the stress on a patient's cardiovascular system. There is a very high prevalence of obesity and insulin resistance with PCOS. As a result, a female is at risk for type 2 diabetes mellitus (DM), along with dyslipidemia and hypertension, possibly leading to heart disease.1
It has been found that women with PCOS have a heart disease risk factor profile similar to men's. This is due to the possible risk factors of hyperandrogenism, insulin resistance, and anovulation. Chronic anovulation in association with clinical evidence of hyperandrogenism resulting in male pattern characteristics of hypertension, hypercholesteremia, increased body mass index (BMI), and hirsutism, possibly causing thinning of hair or male patterned baldness, increased testosterone levels, and increased androsterone levels. Research shows that a female with PCOS is twice as likely to have a cardiovascular event of a myocardial infarction or cerebral cardiovascular accident than patients without PCOS.1-3
Cardiovascular Complication Go UndetectedCardiovascular complications often go undetected and can be a silent killer in women because symptoms can be non-specific and different than in men. Women don't often experience chest pain or other classic symptoms, or they may experience more subtle symptoms than male patients. When a female patient does seek help, it has been found that health care providers can sometimes downplay their symptoms, or misattribute cardiac symptoms to gastrointestinal reflux or anxiety.1,2
Research suggests that PCOS can accelerate the development of increased risk of atherosclerosis and cardiovascular disease.1 This can occur at any age group, and not just premenopausal or menopausal, as would be the normal time of presentation in a female patient without PCOS. Increased risk of cardiovascular disease has also been found to be more prevalent in premenopausal women with PCOS.1 One gap in research for potential future studies is to identify the risk of cardiovascular events in females with PCOS. There would be a significant benefit from extensive and clear hallmark phenotyping of PCOS abnormalities.
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Research has shown that in female patients with PCOS, both those with and without obesity can develop atherosclerosis.
The many complications of PCOS discussed in this series, including metabolic syndrome, hypertension, and atherosclerosis, are the main contributing factors that put a patient at high risk of cardiovascular disease and complications.1-3
Metabolic syndrome is a complication and a condition distinguished by excess abdominal visceral fat, insulin resistance, hypertension, and abnormal cholesterol levels or atherosclerosis. Metabolic syndrome has a significant negative health impact and is one of the many complications of having PCOS. It is also one of the major contributing factors to an increased risk of cardiovascular disease. Women with PCOS and metabolic syndrome are twice as likely to develop cardiovascular disease or related complications and have increased mortality at younger ages than those without the syndrome.1-3
HypertensionHypertension is considered a silent medical condition because many individuals are not aware they have it. This is when the heart is pumping harder to circulate the blood throughout the body.1-3 Studies show that females with PCOS had increased blood pressure (24%) in comparison to females living without PCOS. Stimulation of the renin-angiotensin system causes hypertension in patients diagnosed with PCOS. Furthermore, an imbalance in the autonomic nervous system increases renal sodium reabsorption, and a reduction in the synthesis of nitric oxide have all been linked to the onset of hypertension in patients with PCOS.2
Abnormal Cholesterol LevelsA patient with PCOS is at risk for unhealthy cholesterol levels: increased triglycerides, increased low-density lipoprotein (LDL) cholesterol, increased total cholesterol, and decreased high-density lipoprotein (HDL) cholesterol, which contributes to atherosclerosis.1-3
AtherosclerosisFemales with PCOS are at higher risk of developing atherosclerosis; however, lifestyle changes may not be enough to reduce their risk because hormonal dysregulation plays a major role in this process of PCOS. Research has shown that in female patients with PCOS, both those with and without obesity, can develop atherosclerosis because insulin resistance is a factor in their hormonal environment. Patients with PCOS are the group of women most likely to develop earlier onset cardiovascular disease when compared to those without the syndrome.1,2
ConclusionWe need to better understand and continue researching the relationship between the effects on the cardiovascular system and cardiovascular disease in women diagnosed with PCOS. For all patients, we should encourage healthy nutrition and regular exercise. In health care, we want to identify anyone at higher risk of developing cardiovascular complications and instill healthy lifestyle practices. However, the approach needs to be more proactive in patients with PCOS, and providers need to work with each individual to continue reaching the goal of health maintenance, blood pressure monitoring, and continued cardiovascular follow-up as she grows older.1-3
Click here to read the full series.
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