How to treat atherosclerosis of the aorta. Atherosclerosis of the aorta: causes, symptoms, treatment, why it is dangerous. Heart valve damage

Atherosclerosis of the aorta and its branches begins to develop at the end of the first - beginning of the second decade of life; atherosclerotic process in the walls of the aorta occurs earlier and more often than in others arterial vessels. However, clinically, aortic atherosclerosis usually first appears in the fifth or sixth decade of life, and often even its severe forms are asymptomatic. Where clinical symptoms are present, their characteristics depend on the localization of the process.

Atherosclerosis thoracic aorta . With atherosclerosis of the ascending aorta and its arch, aortalgia is often observed - pressing or burning pain behind the sternum, sometimes radiating to both arms, neck, back, top part belly. These pains resemble angina pectoris, but, unlike it, last a long time (hours and even days), then intensify, especially with physical and emotional stress, then weaken, sometimes appear at rest. Apparently, pain occurs due to irritation during atherosclerosis of the sensitive nerve endings of the aortic plexus. At the points of listening to the aorta, a systolic murmur can often be detected, which becomes more pronounced when the patient puts his hands behind his head thrown back (Sirotinin-Kukoverov maneuver) or after several physical exercise. In the second intercostal space on the right, the second tone with atherosclerosis of the aorta becomes more pronounced, often accentuated. With atherosclerosis of the aortic valves, it takes on a metallic tint. Percussion determines the expansion of dullness over top part sternum and to the right of it, especially noticeable during the formation (in rare cases) of an aortic aneurysm. With a significant size of the aneurysm, compression of the trachea and left bronchus may even occur with difficulty in breathing and wheezing; compression of the branches of the vagus nerve by the aneurysm causes bradycardia. As the sclerotic aorta lengthens, a retrosternal pulsation appears. The maximum blood pressure, as the rigidity of the aorta and the large branches extending from it increases, begins to increase, but the minimum pressure does not change noticeably, sometimes decreasing slightly, which leads to a pronounced increase in pulse pressure.

Due to the increase blood pressure and a decrease in the elastic properties of the aorta, the demands on the work of the heart increasingly increase, and it hypertrophies (mainly the left ventricle, which is manifested by an increased apical impulse). Since the coronary arteries of the heart are often affected by atherosclerosis and the blood supply to the myocardium is reduced, left ventricular failure gradually develops with its myogenic dilatation, and shortness of breath appears. In severe atherosclerosis of the aortic arch, which is most pronounced in hypertension, the vessels supplying the head may also become narrowed. shoulder girdle. Circulatory failure that occurs in connection with this leads to numerous manifestations of atherosclerosis of the cerebral arteries (see below). For atherosclerosis of the arteries supplying the shoulder girdle and upper limbs, characterized by paresthesia and weakness in the arms; The pulse in one or both arms is weak or undetectable, and the blood pressure in the arms is lower than in the legs.

Occasionally, a pronounced picture of the so-called aortic arch syndrome is observed: dizziness, short-term loss of consciousness during the transition (especially fast) from horizontal position vertical, transient hemiplegia, hemiparesis. Very often there is an increased reactivity of the sinocarotid zone, manifested by a triad: bradycardia, hypotension, fainting (“carotid sinus syndrome”). Sometimes, when turning the head sharply, epileptiform convulsions occur.

With an aortic arch aneurysm, the left recurrent nerve is compressed; for the resulting paralysis of the left vocal cord indicates, in particular, the hoarseness of the patient's voice. Compression of a bronchial aneurysm can cause atelectasis with left-sided pneumonia or lung abscess. If Horner's triad (anisocoria, enophthalmos, and palpebral fissure narrowing) is observed, it is necessary to investigate whether the patient is suffering from an aortic aneurysm, which puts pressure on the left cervical sympathetic node.

When the heart contracts, the pulsation of the aneurysm can be transmitted to the bronchus, trachea and larynx, and then displacements of the larynx, synchronous with the pulse beats, are visually noted - the Oliver-Cardarelli symptom. Ruptures of aortic aneurysms are very rare, and, as a rule, they are observed in the initial part of the ascending aorta and in the final part of its arch. If the rupture is incomplete, i.e., it has captured only the inner membrane and the part of the middle membrane adjacent to it, then blood entering the site of the rupture dissects the walls of the aorta (see Aortic aneurysm).

Due to the pressure on the esophagus from the significantly dilated, atherosclerotically changed thoracic aorta, the patient experiences difficulty swallowing. Atherosclerotic plaques in the descending aorta, causing narrowing of the mouths of the intercostal arteries, can cause pain in the back and sides, similar to intercostal neuralgia. An aneurysm of the descending thoracic aorta can cause compression of the thoracic vertebrae, sometimes with their destruction, persistent pain in the chest and back, and urination problems.

Atherosclerosis abdominal aorta is often particularly significant, but despite this, it does not manifest itself clinically for a long time. It has not yet been studied enough. Impaired blood supply to the digestive tract is associated with disorders of the secretory and motor (and probably excretory) functions of various parts of the digestive tract. Patients complain of heaviness in the stomach, belching, nausea, flatulence, and constipation. If the blood supply to the pancreas is disrupted, symptoms may occur diabetes mellitus, usually mild or moderate in severity.

Atherosclerosis of the mesenteric arteries. The superior mesenteric artery, which is poor in anastomoses, is especially often affected. In such cases, abdominal toad syndrome may occur: 3-6 hours after a heavy meal, the patient suddenly experiences an attack of pain, most often in upper section belly. Other symptoms include bloating, constipation, belching, increased heart rate, palpitations, increased blood pressure, sometimes reflex pain in the heart, and shortness of breath. Sometimes such a terrible symptom as a lack of intestinal motility is observed.

A significant role in the occurrence of attacks of abdominal toad, obviously, is played along with morphological and functional changes from the mesenteric arteries, as indicated by a positive therapeutic effect from the use of nitroglycerin, papaverine and others similar drugs. To differentiate abdominal toad from other diseases of the abdominal organs, it is important first of all to keep in mind the following: pain with it is short-term, paroxysmal and associated with late period digestion, accompanied by flatulence and intestinal paresis; vasodilators and antispastic drugs have a positive effect and at the same time there are no symptoms characteristic of diseases of other organs abdominal cavity. Unlike the pain characteristic of the abdominal form angina pectoris, pain with abdominal angina is not associated with physical stress, cooling, is not accompanied by irradiation into left hand and shoulder and electrocardiographic changes.

When thrombosis of large mesenteric vessels (usually the superior mesenteric artery) or when an embolus from disintegrating atheromatous plaques of the aorta enters them, a picture of intestinal infarction with sharp diffuse, sometimes wandering pains in the abdominal cavity, often in the epigastric region or to the right of it. These pains do not subside due to drugs: the abdomen remains soft and not painful on palpation. Sometimes a picture of collapse develops. Thrombosis of the superior mesenteric artery is accompanied by profuse, repeated fecal vomiting. With thrombosis of the inferior mesenteric artery, the appearance of unchanged blood in the stool is often observed, sometimes in large quantities. Later, a picture of intestinal obstruction with symptoms of peritonitis develops, and the patient dies if vigorous and early anticoagulant therapy or surgical intervention does not save him, which, however, is rare. For diagnosis, the patient’s advanced age and the presence of significant atherosclerosis, especially the abdominal aorta, and thromboembolism in various organs are important.

Atherosclerosis of the renal artery By clinical symptoms polymorphic. When plaques are localized in this vessel or with atherosclerosis of the abdominal aorta in the area of origin of the renal artery, a sharp narrowing of the lumen of the renal artery can occur, up to the closure of individual branches extending from it. IN the latter case Protein, red blood cells, and casts appear in the urine. However, there is no noticeable impairment of renal function and no increase in blood pressure. However, if the mouth or trunk of the main renal artery is significantly narrowed, the maximum and minimum blood pressure increases. With unilateral damage, kidney function may remain normal for a long time, but subsequently arteriolosclerosis and arteriolonecrosis develop in the second kidney. As long as the arteries of one kidney are not stenotic, the disease proceeds as a benign form of hypertension with persistent changes in the urine and a persistent increase in blood pressure. With a sharp narrowing of the main arteries of both kidneys, which can develop simultaneously or sequentially, bilateral arteriolosclerosis eventually occurs, and the disease takes on the character malignant form hypertension (see Hypertension).

When atherosclerosis of the renal artery is complicated by its thrombosis, a severe clinical picture acutely develops, characterized by a triad of symptoms: severe long-term pain in the lower back, sometimes with symptoms of shock, but without the typical kidney stone disease radiating pain to the lower abdomen and groin area; persistent increase in maximum and minimum blood pressure; the appearance of protein, red blood cells and casts in the urine. In addition, increased leukocytosis and accelerated ROE may be observed.

Atherosclerosis of the hepatic and splenic arteries does not give a characteristic clinical picture and is not recognized during life.

In rare cases, a blood clot that forms over an ulcerated plaque can close the lumen of the abdominal aorta itself. When the thrombus is located above the origin renal arteries and the inferior mesenteric artery, phenomena characteristic of the closure of their lumen occur. But more often the thrombus is located at the site of the aortic bifurcation, closing or sharply narrowing the lumen of one or both iliac arteries, which leads to impaired blood supply lower limbs up to the development of gangrene. Features of the clinical picture of thrombosis of the aortic bifurcation are determined by the speed of thrombus formation.

Clinical recognition of atherosclerosis of the abdominal aorta and its branches, even advanced ones, is very difficult. Along with the above symptoms, the age of the patient and the presence of atherosclerosis in other localizations are important for the diagnosis. In patients with thin abdominal wall and with underdeveloped muscles, with deep palpation it is sometimes possible to palpate an enlarged, unevenly dense, somewhat curved abdominal aorta, which indicates its atherosclerosis. With an abdominal aortic aneurysm, a pulsating tumor can be detected in the epigastric region, over which a systolic and sometimes diastolic murmur can be heard. No matter how important physical data is in recognizing atherosclerosis of the aorta and its aneurysms, X-ray examination is still crucial.

Atherosclerosis large arteries lower limbs, especially common in diabetes, in expressed cases gives a picture of intermittent claudication (see). Large arteries of the lower extremities during the atherosclerotic process can undergo obliteration.

The aorta is the largest vessel in human body, she carries heaviest loads, which is why it suffers quite often. The aorta passes through the abdomen and thoracic region, therefore it is conventionally divided into the abdominal and thoracic parts. It comes from the left cardiac ventricle and branches into many vessels that supply blood to the organs located in the thoracic and abdominal sections. As a rule, the aorta is not affected entirely, but only a separate section of it. The symptoms that appear depend on the location of the damage. Therefore, the diagnosis of “aortic atherosclerosis” can be made on the basis of different symptoms.

What is atherosclerosis of the aorta?

Atherosclerotic heart disease (atherosclerosis of the aorta) is expressed in the fact that the walls of large and medium-sized arteries are overgrown with connective tissue, their inner surface is covered with lipid deposits. As a result, the vascular walls become thicker and denser, which leads to their loss of elasticity and flexibility, narrowing of the lumens of blood vessels, and a predisposition to the formation of blood clots.

Very often, atherosclerosis of the aorta opens the way serious illnesses blood vessels and heart:

brain stroke;
myocardial infarction.

Causes of development of atherosclerosis of the aorta

Typically, atherosclerosis of the aorta manifests itself in people who have passed the zenith of life (those over forty). This disease mainly affects the male population. This happens because the blood of men contains less anti-atherogenic lipoproteins, moreover, men smoke more often and more intensely and suffer more from stress.

Other risk factors:

high blood pressure;
presence of diabetes mellitus;
impaired glucose response;
lack of physical activity, sedentary image life;
overweight;
characteristics of the mental structure (susceptibility to stress);
gout;
genetic predisposition to atherosclerosis;
high levels of cholesterol and triglycerides in the blood;
use of soft water in cooking.

Factors that actively contribute to the progression of aortic atherosclerosis:

abuse of fatty foods and foods rich in “bad” cholesterol;
foods rich in easily digestible carbohydrates;
psychological stress;
diseases of the endocrine system;
metabolic disorders.

When treating aortic atherosclerosis, these factors must either be eliminated or reduced to a minimum. And this alone can already significantly improve the condition, which coincides with the main task of preventing atherosclerosis of the cardiac aorta and aortic valve.

Symptoms of atherosclerosis of the aorta

Symptoms and signs of atherosclerosis of the aorta of the heart are very diverse, since it does not appear in any specific place, but can begin in any part of it. Therefore, atherosclerosis of the thoracic and abdominal parts of the aorta is distinguished. This is where noticeably different signs of atherosclerosis of the aorta of the heart arise.

There are two periods in the development of the disease:

preclinical, which can only be determined by the results of laboratory tests;
clinical, in which clearly manifested symptoms of aortic atherosclerosis are already observed.

The manifest period can also be divided into the following stages:

ischemia;
trombonecrosis;
sclerosis.

Symptoms of atherosclerosis of the thoracic aorta

Together with atherosclerosis thoracic aorta, similar processes are often observed in the brain and cardiac arteries. This type of disease is insidious and does not manifest itself immediately. It is usually discovered when medical examination regarding other types of atherosclerosis: coronary arteries, cerebral vessels, or when atherosclerosis of the aorta and aortic valve occurs.

With atherosclerosis of the thoracic aorta, patients are concerned about the following symptoms:

from time to time, unpleasant heart pain occurs behind the sternum, having a squeezing or burning effect;
periodically the pain radiates to the neck, spine, arms, under the ribs;
the pain does not come in attacks, but continues for a long time, sometimes for several days, with periodic intensification and remissions;
blood pressure changes - systolic increases, while diastolic remains the same;
if the aortic arch is affected, the patient becomes hoarse voice, and he feels discomfort while swallowing;
fainting;
dizziness and weakness;
after sharp turns of the neck, convulsions may occur;
A pulsation may be felt to the right of the sternum between the ribs.

Symptoms of atherosclerosis of the abdominal aorta

Atherosclerosis of the abdominal aorta has completely different symptoms. It can also remain latent for a long time. Over time, this disease can lead to the abdominal type of coronary artery disease.

When the abdominal aorta is affected by atherosclerosis, the following symptoms are observed:

aching pain in the stomach, which disappears on its own after a few hours;
frequent constipation;
bloating;
different hardness and noticeable irregularities when palpating the aorta;
reduction in body weight due to disruption of the digestive system.

In atherosclerosis of the abdominal aorta, one of the most dangerous consequences thrombosis of the mesenteric arteries, the vessels supplying the intestines, may occur. If thrombosis of these arteries occurs, it can cause necrosis of any part of the intestine, and inflammatory processes will occur in the abdominal organs.

Therefore, if stomach pains no longer go away on their own, but become more intense, and at the same time analgesics and antispasmodics can no longer relieve the pain, then in this case urgent health care so that the process does not reach the stage of peritonitis.

Diagnosis of aortic atherosclerosis

When atherosclerosis of the abdominal aorta is suspected, diagnosis is aimed at more accurately determining the degree and scope of the disease and the exact location of the pathologically affected areas of the vessel, because the tactics of its treatment depend on this.

To reveal atherosclerotic lesion aorta or atherosclerosis of the aortic valve, the following instrumental studies are usually performed:

CT angiography;
aortography;
duplex and triplex scanning;
Vascular ultrasound.

Treatment of aortic atherosclerosis

On this moment medicine solves the problem of how to treat aortic atherosclerosis using A complex approach. If the course of the disease is non-progressive, then this usually includes drug therapy, herbal medicine and diet therapy. But if the threat to the patient’s life becomes too high, for example, if significant damage to the aortic walls is observed and severe complications occur, then medical workers may resort to radical methods- surgical intervention.

For lesions blood vessels atherosclerosis, the drug treatment program for aortic atherosclerosis includes the following groups of drugs:

fibrates – these drugs suppress the body’s production of its own fatty substances;
statins combined with essential phospholipids inhibit the process of cholesterol production and its subsequent deposition on the walls of blood vessels;
vitamin PP promotes accelerated metabolism lipids and their rapid removal outside the body;
disaggregants are capable of thinning the blood, thereby reducing its viscosity and inhibiting the process of blood clot formation;
sequestrants also help lower cholesterol and fat levels in the body, and also activate the excretion of bile acids.

In atherosclerosis, the main task of dietary nutrition is the steady implementation of a hypocholesterol diet, which involves minimizing daily diet those products that contain a lot of animal fats.

Atherosclerosis of the abdominal aorta can also be treated with folk remedies, but only if it occurs in mild form, has no complications and pronounced clinical manifestations.

The most effective drugs here are:

infusions of rosehip, viburnum, hawthorn and dill;
decoctions of plantain, parsley, horseradish.

But sometimes this disease does not respond to conservative treatment, and also provokes serious complications that threaten the patient’s life. Then doctors no longer think about how to treat the disease with medications, but resort to surgical intervention. For surgical treatment atherosclerosis can be used:

Lumbar sympathectomy. It is performed when there is progressive atherosclerosis of the lower extremities and abdominal aorta.
Cervical or thoracic sympathectomy. It is performed if there is severe atherosclerotic damage to the coronary arteries or thoracic aorta.
Restorative and various combined surgical interventions: bypass surgery, thromboendarterectomy, resection, prosthetics, lateral vascular plasty.

But doctors pay attention Special attention that surgical methods treatments for atherosclerosis can only eliminate the most dangerous complications this disease, but not the very reason for its development.

Therefore, in order to consolidate the improvements achieved, the patient after surgery must strictly comply with all important recommendations doctors. This applies to both continuation conservative treatment, as well as making certain changes in the patient’s daily lifestyle, which he must adhere to for the rest of his life.

Have you or your loved ones experienced atherosclerosis of the aorta? At what stage was the disease identified and how did you fight it? Tell us about it in the comments.

Atherosclerosis of the aorta: causes, symptoms, treatment, dangers

Atherosclerosis of the aorta is a chronic, continuously progressive pathological process that occurs against the background of impaired metabolism of proteins and lipids and manifests itself as fatty deposits in the vessel wall.

The incidence of atherosclerosis is constantly growing. It is increasingly being found in relatively young people, but the bulk of patients with this pathology are males who have crossed the 50-year mark. In women, the disease manifests itself later, after menopause, which is associated with hormonal characteristics.

Similarly, in parallel with atherosclerosis of the aorta, atherosclerosis develops in other vessels. For example, damage to the arteries of the legs, spreading from the abdominal aorta to iliac arteries, causes intermittent claudication syndrome with pain and impaired trophic tissue of the extremities, and with complete obstruction of the artery, gangrene will occur.

Atherosclerosis of the mesenteric vessels underlies chronic ischemia intestines with abdominal pain, extreme degree diseases - intestinal infarction. Defeat renal vessels contributes to the increase in chronic renal failure.

Atherosclerosis of cerebral vessels causes symptoms of chronic cerebral ischemia, which is clinically referred to as discirculatory encephalopathy. The ischemic stage can eventually lead to dementia, and thromonecrotic changes cause cerebral infarction (stroke). Damage to the aortic arch spreads to the vessels of the neck, threatens thromboembolic syndrome, strokes and is manifested by persistent headaches, attacks of dizziness, decreased memory, and intellectual abilities.

spread of atherosclerosis of the aortic arch to the vessels supplying the brain

Since the aorta is a large vessel with a fairly wide lumen, fatty deposits growing in its wall may not manifest themselves for a long time. Even at an advanced stage of the process, the patient may not make any complaints. The lesion can be detected in the presence of a widespread pathological process in the branches extending from the aorta to the heart, head and other organs.

Abdominal aorta along its length it gives off large arterial trunks to the abdominal organs and kidneys, which also inevitably become “drawn in” into the pathological process. The presence of plaques in the areas of branching of the aorta is caused by turbulence in the blood flow and chronic injury to the inner layer of the artery. Thus, fatty deposits on the wall of the abdominal or thoracic aorta may increase along the vessel and spread to other arterial branches.
Atherosclerosis of the thoracic aorta manifested by ischemic pain - burning in the chest area, radiating to the back, arms, upper abdomen. Such pain can last for a long time, up to several days, then decreasing, then intensifying again, which distinguishes it from angina pectoris. At the same time, combined damage to the thoracic aorta and coronary vessels causes both attacks of angina pectoris and aortalgia in the same patient.

Atherosclerosis of the abdominal aorta causes circulatory problems in the abdominal organs. Patients experience pain of undetermined localization, bloating, and stool disturbances (usually constipation). The pain can migrate from one part of the abdomen to another, intensify after eating, but has no clear connection with digestion.

Involvement in the pathological process of large mesenteric arteries that carry blood to the intestines leads to attacks of abdominal pain in the epigastrium, peri-umbilical area, indigestion, and eating increases the pain. The pain can last for several minutes or even 2-3 hours, while the stomach swells, belching occurs, blood pressure increases, and the pulse quickens. Over time, constipation gives way to diarrhea, and undigested fatty inclusions can be seen in the stool.

Damage to the vessels supplying the legs, as well as the site of division of the abdominal aorta into the iliac arteries, causes ischemic changes in the tissues of the extremities, which is manifested by a feeling of numbness, weakness in the legs, swelling, coldness and pallor of the skin, pain in the calf muscles. In the severe stage of atherosclerosis, necrosis appears, trophic ulcers shins and fingers. When the abdominal aorta is damaged, the sexual sphere suffers, including impotence and urination problems.

Atherosclerosis of the abdominal aorta with involvement of the renal arteries leads to the development of secondary renal hypertension, the urine test changes - protein, blood cells, and desquamated tubular epithelium are found in it. Bilateral damage to the renal arteries is accompanied by malignant, difficult to treat, secondary hypertension.

Very dangerous manifestation atherosclerosis of the aorta can become an aneurysm or which is a protrusion of the vascular wall in the zone of destruction by fatty deposits. Dissecting aneurysm is a direct consequence of the atherosclerotic process, when plaques, having ruptured, cause the penetration of blood, thrombotic masses, and fatty accumulations deep into the vascular wall with stratification and disintegration of its structures.

Carries very high risk aortic rupture, which is accompanied by symptoms of shock with severe hypotension, signs of acute renal and heart failure, severe pain in the stomach, chest. The patient loses consciousness in a matter of minutes, turns pale, his pulse quickens, and his blood pressure drops.

Atherosclerosis of the aorta is fraught with serious complications, including acute or chronic failure arterial blood supply organs. Progressive narrowing of the lumen of the aorta and the vessels extending from it causes ischemic-dystrophic processes ending in atrophy and sclerosis of the parenchyma internal organs. Branches of the aorta with infarctions in the organs are possible.

The diagnosis of aortic atherosclerosis is established after clarifying the symptoms of the pathology, the presence of predisposing factors, general examination, and also based on survey data - lipid spectrum, aortography. Damage to the branches of the aorta is determined using ultrasound, angiography, and rheovasography.

Treatment of aortic atherosclerosis

Treatment of atherosclerosis should be comprehensive, aimed at all parts of the pathogenesis of the disease and risk factors. It includes:

Non-drug effects;

Drug therapy;

Surgical operations.

Non-drug treatment is the first step that a patient with atherosclerosis of any location should take. It includes nutritional correction, normalization of body weight, increased physical activity, refusal bad habits– exclusion of smoking and drinking alcohol. Physical activity and the fight against physical inactivity will be useful for normalization metabolic processes and the patient's body weight.

The most important measure for atherosclerosis is considered to be a reduction in the calorie content of food consumed, minimal amount animal fats, increasing the proportion of fiber and vegetable oils.

To many sick people dietary food this is difficult, because in previous decades there was no need to count calories and deny yourself anything, and many were simply accustomed to frying potatoes and cutlets in fat and putting them on a sandwich thick layer butter and pour three tablespoons of sugar into the tea.

In this regard, the diet often seems unrealistic; patients feel that there is simply nothing to eat - the choice of products is limited, as well as the methods of preparing them. However, this is not at all true when the right approach to nutrition issues.

Studies show that only through normalization of nutrition it is possible to reduce the total concentration of blood cholesterol by approximately 10-15%, and the risk of death from acute cardiac pathology is almost half if you follow a diet and quit smoking. However, statistics also claim that if there are signs of atherosclerosis positive result is possible only with additional drug therapy.

So, the basic principles of nutrition for atherosclerosis:

Minimizing the proportion of products containing animal fats - butter, margarine, fatty cheese, pork, mayonnaise, eggs;

Increasing the amount of vegetable oils, fish, low-fat varieties meat (poultry, rabbit), seafood;

Use large quantity vegetables, fruits, cereals;

Reducing the amount of salt in food;

Exclusion from the diet of baked goods and confectionery products, sweet carbonated drinks, fast food;

Steaming food by stewing, boiling, baking instead of frying, grilling.

Drug therapy includes the appointment of:

Drugs for the treatment of atherosclerosis have been used for just over half a century. During this time, large studies were conducted to determine the safety of drugs, their side effects and effectiveness against atherosclerosis. These studies confirmed that Drug therapy helps reduce cholesterol by about 10%, which is accompanied by lower mortality from coronary heart disease and its complications.

At the same time, negative side effects, poor tolerability by patients, serious risks for patients with liver pathology (especially when taking fibrates) did not allow the widespread use of drugs for atherosclerosis. Everything has changed since the advent of lipostatins, which to this day remain the most commonly prescribed drugs for atherosclerosis. Lovastatin and pravastatin, obtained from fungi, are used, simvastatin is a semi-synthetic drug, and also synthetic fluvastatin, atorvastatin and rosuvastatin.

Statins can reduce atherogenic fractions of lipoproteins by more than half, and also decrease total cholesterol and high-density lipoproteins increase. Drugs last generations help reduce the concentration of triglycerides in the blood serum.

An important property of statins is not only normalization fat metabolism and risk reduction cardiovascular pathology, but also a reduction in mortality among patients receiving them with an established diagnosis of atherosclerosis, ischemic heart disease, and hypercholesterolemia by almost a third, which has a beneficial effect on the prognosis of the disease. Also, drugs in this group are very effective in reducing the risk of death from heart disease in patients with hypertension.
In addition to their effectiveness, statins have been shown in a number of studies to be safe for long-term use by patients with existing vascular changes, cardiac ischemia, diabetes and hypertension. They are usually well tolerated by patients without disturbing their usual lifestyle.
Indication Diagnosed coronary heart disease, vascular atherosclerosis of any location causing clinical manifestations, dyslipidemia with high blood pressure, smoking, old age, which increase the risk of complications of heart and vascular diseases, are considered to be used for lipid-lowering drugs.

The use of statins should be carried out under strict control of the concentration of cholesterol in the blood, while for patients with coronary disease The required dose of statins for heart disease is such that total cholesterol does not exceed 5 mmol/l. In some cases, doctors are forced to prescribe the maximum possible doses of drugs.

Statins are considered safe and have relatively few negative side effects. The most common side effect of drugs in this group is the effect on liver function, which is expressed in an increase in AST and ALT enzymes in the blood. The higher the dose of the drug, the higher its toxicity relative to liver cells. However, such a side effect is often only laboratory symptom, disappearing after discontinuation of the drug and not manifested clinically.

The combination of statins with other antiatherosclerotic drugs can lead to muscle damage, even destruction, as well as kidney failure. To exclude possible side effects, the doctor must strictly select the necessary dosages of drugs, and also refer the patient 1-2 times every six months for a biochemical blood test to determine AST, ALT, CPK (the latter for muscle pain).

A significant disadvantage of statins is their high cost. original drugs, due to which not every patient can afford long-term treatment. The way out of the situation was the so-called generics - identical in composition and chemical formula active substance medicines produced by other pharmaceutical companies. In particular, simvastol costs half the price of the original simvastatin with the same effectiveness.

To combat atherosclerosis the following are prescribed:

Simvastatin (simvastol) from 10 mg daily;

Rosuvastatin - up to 40 mg;

Atorvastatin - initial dose 10 mg, maximum daily dose - 80 mg;

Fluvastatin - from 20 to 40 mg;

Cholestyramine, colestipol - in several doses simultaneously with food or juice;

Probucol - 0.5 g twice a day with meals;

Essentiale forte, essentialcaps - 1 capsule 3 times a day, course 2-3 months.

Aortic atherosclerosis can also be treated surgically. The operation is indicated for advanced stages of pathology with a risk of thromboembolic complications, with developing ischemia in organs that are supplied with blood from the aorta affected by the disease.

Surgical treatment for aortic atherosclerosis is stenting, prosthetics and bypass surgery. The first method is considered minimally invasive and is more often used for young patients.

aortic stenting

In case of severe atherosclerosis, a procedure is carried out in which the affected part of the vessel is removed and a prosthesis made of synthetic materials is sewn in its place. The prosthesis can be in the form of a hollow tube or fork, replacing the affected part of the vessel.

prosthetics of the atherosclerotic-aneurysmal area of the aorta

Bypass surgery - last resort when stenting is no longer indicated due to widespread atherosclerotic lesions, and prosthetics cannot be performed due to technical considerations, access difficulties and lack of prostheses. Bypass surgery is used to create a bypass route for the blood supply to the heart (coronary artery bypass grafting), lower extremities (aortofemoral bypass grafting) directly from the aorta.

Folk remedies are also very popular for the treatment of atherosclerosis. It’s worth noting right away that no herbs or foods will eliminate existing fat and protein deposits, so promises to cleanse blood vessels traditional methods- rather a fantasy.

The most popular among folk remedies for combating atherosclerosis are infusions of clover, hawthorn, pine needles and lemon. Many patients are addicted to garlic mixed with honey, which is designed to cleanse blood vessels of lipid plaques.

Alternative medicine has the right to exist for atherosclerosis, but only in combination with treatment prescribed by a doctor and under his strict supervision. Before using a specific prescription, you need to find out from a specialist whether it will be safe and appropriate for a particular patient.

The disease “atherosclerosis” is associated with impaired fat metabolism, which results in damage to large arteries (the elasticity of their walls decreases, and the lumen of the vessels narrows).

Aortic atherosclerosis is considered to be a symptom of older people. Really, Clinical signs appear after 60 years. It has been established that women get sick later than men; they are protected by estrogens. A study of the development of the disease showed that initial manifestations are present in the vessel wall already at the age of ten. This indicates a long preclinical course of the atherosclerotic process.

Anatomy

The aorta is the most large vessel in the human body. It departs from the left ventricle of the heart, bends through an arc and goes down. The aortic arch has ascending and descending parts. Based on location, blood supply to organs, and passage through the diaphragm, it is divided into thoracic and abdominal. All branches of the aorta, which supply organs, depart from the thoracic region chest. The most vital arteries are those leading to the head and spinal cord, heart, lungs. Branches extend from the abdominal region to digestive tract, kidneys, lower extremities.

The aorta is an elastic type artery. It must continue to eject blood from the heart muscle with sufficient force so that the wave travels in all directions regardless of body position.

This pressure on the walls contributes to the development of atherosclerosis of the aorta and its branches. They primarily retain pathological microorganisms and viruses that damage the inner membrane, deposit low-density lipoproteins and form cholesterol plaques. Due to the large diameter, clinical manifestations are absent for a long time; symptoms of the disease begin to appear only in old age. By this time, the aorta becomes dense with massive areas of calcified plaques and loses its ability to contract and expand. The outgoing vessels become smaller in lumen and do not bring enough blood to the organs. Clinical manifestations of atherosclerosis begin with ischemia of one of the areas of impaired blood supply.

Causes of atherosclerotic lesions of the aorta

In addition to functional and anatomical features, general factors for the development of atherosclerosis cannot be excluded:

hypertonic disease;

diabetes mellitus and other endocrine diseases;

obesity of varying degrees;

lack of sufficient physical activity;

frequent stressful situations, high nervous tension;

genetic predisposition.

Clinical manifestations

Symptoms of aortic atherosclerosis depend on the stage of the disease and its location.

The classification of the development of atherosclerosis involves 3 stages:

ischemic - determined by unstable tissue ischemia in the form of angina attacks (from the heart), intermittent claudication (in the lower extremities), abdominal pain (intestines);

thromonecrotic - manifest severe complications in the form of stroke, myocardial infarction, gangrene of the feet associated with the separation of a blood clot and blocking of smaller vessels;

fibrous - with a chronic long-term course of the disease muscle fibers the myocardium is replaced by fibrous tissue, and areas of cardiosclerosis are formed.

The lumen of the vessel is half closed with atherosclerotic plaques

Symptoms of damage to the thoracic aorta

Deterioration of blood flow through the coronary arteries and brain are the most common manifestations of the disease. Coronet and cerebral vessels They depart immediately from the ascending arc and go to their organs from both sides.

Atherosclerosis ascending department and arc causes severe aortalgia. Unlike angina, they last for several hours or days. They radiate to the left and right arm, shoulder, neck, and interscapular area. They are not relieved by drugs containing nitroglycerin.

A thickened aorta increases the load on the heart. Hypertrophy (thickening of the muscle) occurs. Heart failure gradually develops with attacks of suffocation.

Atherosclerosis of the aorta with damage to the heart is indicated by a significant increase in arterial blood pressure. systolic pressure(upper) with normal lower numbers.

An increase in the arc causes difficulty swallowing and hoarseness.

The placement of plaques at the mouth of the coronary arteries or simultaneous sclerosis of the heart vessels themselves give rise to typical retrosternal attacks of angina, radiating to the left arm and left half chest, with shortness of breath, palpitations. They are related to physical activity or transferred stressful situations. In the event of a complication, a blood clot blocks one of the branches and occurs acute heart attack myocardium.

Manifested by dizziness short-term loss consciousness, pallor of the face, headaches with high blood pressure, decreased memory, increased fatigue, convulsions when turning the head.

Symptoms of atherosclerosis of the abdominal region

Atherosclerosis of the abdominal aorta is manifested by symptoms from the abdominal organs. First of all, the blood supply to the mesenteric vessels feeding the intestines is disrupted.

Pain around the navel is of an intermittent “wandering” nature, accompanied by bloating and constipation.

Weight loss is associated with disruption of the digestive system.

One of the favorite locations is the bifurcation of the abdominal aorta (divergence into 2 channels). Signs of this localization of atherosclerosis are associated with dysfunction of the pelvic organs and blood supply to the legs.

Absence of pulsation at the level of the navel, under the knees and on the back of the feet.

Problems with sexual life in men, infertility.

Soreness of the calf muscles when walking, disappearing when stopping.

Intermittently limping gait.

Numbness and coldness of the feet.

The appearance of necrotic ulcers on the skin of the legs.

Swelling and redness of the legs and feet.

Ulcer on the heel resulting from complete obliteration of the artery

Severe complications associated with thrombosis of leading arteries are:

Signs of intestinal gangrene caused by cessation of blood flow through the mesenteric artery. They manifest themselves in severe abdominal pain, tension in the abdominal muscles, and increased intoxication. Urgent surgical care is required.

With thrombosis of the superior mesenteric artery, symptoms are localized in the upper abdomen and right hypochondrium, accompanied by profuse vomiting feces. Thrombosis of the inferior mesenteric artery appears intestinal obstruction and bleeding.

Gangrene of the legs due to thrombosis of the femoral artery. Treatment consists of removing necrotic tissue up to amputation of the limb for life-saving reasons.

A serious complication is the formation of an aneurysm of the thoracic or abdominal sections. In the wall of the vessel, most often due to thinning, a saccular protrusion outward is formed. It grows and is palpable when examining the patient. Aneurysm dissection leads to acute bleeding. The rupture causes death.

Diagnostics

Considering the predominant development of the disease in older people, doctors need to carefully examine and medically examine patients. The combination of a variety of symptoms with a characteristic blood pressure indicates damage to the aorta. Enlargement of the heart and expansion of the aortic arch are visible on the fluorogram. Impaired blood supply to the heart, brain, and lower extremities is confirmed using electrocardiography, rheoencephalography, and angiography.

Treatment

Treatment of aortic atherosclerosis requires:

symptomatic agents acting on auxiliary vessels and maintaining blood flow at a sufficient level;

reducing the concentration of cholesterol in the blood through diet and special medications;

helping organs at risk of ischemia perform functions and support metabolism.

Symptomatic medications are prescribed by doctors of various specialties during medical examination. Distributed antihypertensive drugs, reducing upper pressure, diuretics, strengthening drugs vascular wall, dilating additional vessels.

Most popular in Russia known remedies statins that block cholesterol synthesis. Pick up the right drug V therapeutic dosage the doctor will help.

The essence of surgical treatment is the replacement of part of the aorta with an artificial prosthesis. The indications are determined by the vascular surgeon.

A diet to lower cholesterol involves limiting fatty meat products, canned food, butter, lard, mayonnaise, sausages, confectionery and sweets, strong coffee and tea, sweet carbonated drinks, alcohol, white bread.

Daily intake herbal tea delays atherosclerosis

horseradish decoction - grate 250 g of horseradish, add 3 liters of water and cook for 20 minutes, cool and take ½ cup three times a day before meals;

rosehip tincture - to prepare, put the washed berries in a half-liter jar to the 1/3 level, add vodka, leave for 2 weeks in a dark place, shaking daily, take the finished tincture 20 drops three times a day;

lemon balm is recommended to be taken and brewed as tea, it is especially indicated for brain symptoms.

Any medicinal and folk remedies may cause individual intolerance in the form of allergic rash, skin itching, swelling of the face. The attending physician should be informed about this. If atherosclerosis of the aorta is detected, patients should regularly (quarterly) undergo blood tests for sugar and cholesterol. Dose adjustment or timely replacement of medications may be required.