NATURAL HISTORY AND MAIN

CONSEQUENCES
 The American Heart Association classification
divides atherosclerotic lesions into six types..
 NATURAL HISTORY
Fatty streaks are the earliest lesion of
atherosclerosis(composed of lipid-filled foam
cells)
They are not significantly raised and thus do not
cause any disturbance in blood flow.
Fatty streaks begin as multiple yellow, flat spots
less than 1 mm in diameter that coalesce into
elongated streaks, 1 cm long or longer.
They contain T lymphocytes and extracellular
lipid in smaller amounts than in plaques.
 Onset
Fatty streaks appear in the aortas of some
children younger than age 1 year and all
children older than age 10 years.
Coronary fatty streaks begin to form in
adolescence and at anatomic sites that may
be prone to develop plaques.
 Experimental evidence
Fatty streaks are related to the known risk
factors of atherosclerosis in adults (especially
serum lipoprotein cholesterol concentrations
and smoking), and some experimental
evidence supports the concept of the
evolution of fatty streaks into plaques.
 Thus, although fatty streaks may be precursors
of plaques, not all fatty streaks are destined to
become fibrous plaques or more advanced
lesions.
 Atherosclerotic plaques develop primarily in
elastic arteries (e.g., aorta, carotid, and iliac
arteries) and large and medium-sized
muscular arteries (e.g., coronary and popliteal
arteries).
 MAIN CONSEQUENCES
Symptomatic atherosclerotic disease most
often involves the arteries supplying the heart,
brain, kidneys, and lower extremities.
Myocardial infarction (heart attack), cerebral
infarction (stroke), aortic aneurysms, and
peripheral vascular disease (gangrene of the
legs) are the major consequences of
atherosclerosis.
Atherosclerosis diminished arterial perfusion

Atherosclerosis also takes a toll through other

consequences of acutely or chronically
diminished arterial perfusion, such as :
Mesenteric occlusion,
Sudden cardiac death,
Chronic ischemic heart disease,
Ischemic encephalopathy.
 Small Arteries
In small arteries, atheromas can lead to :
Occlusion in lumens,
Compromise blood flow to distal organs,
Ischemic injury.
Plaques can undergo disruption and
precipitate thrombi that further obstruct blood
flow.
 Large arteries
In large arteries, plaques encroach on the
subjacent media and weaken the affected
vessel wall, causing aneurysms that may
rupture. Moreover, extensive atheromas can
be friable, and shed emboli into the distal
circulation.