What is multifocal atherosclerosis and how to treat it

Etiology and classification

Atherosclerosis rarely occurs due to any one cause. It is quite difficult to determine it: a large number of factors affect the appearance of the disease. The main ones are:

• poor nutrition (a large amount of fatty foods, lack of a full fortified diet);
• bad habits (alcohol abuse and smoking);
• hypodynamia (low physical activity);
• gender (up to 55 years of age, pathology is more common in men, at an older age, approximately the same statistics for both sexes);
• age (usually develops in older people);
• genetic predisposition;
• concomitant diseases (arterial hypertension, endocrinological pathologies, obesity).

Depending on the mechanism of development of the disease, its following forms are distinguished:

• Hemodynamic. Due to the increased pressure, the inner lining of the vessels - the intima - is damaged. As a result, lipoproteins easily penetrate into it and, over time, a plaque forms there.
• Metabolic (alimentary). It occurs due to metabolic disorders, primarily carbohydrates and lipids (fats). At the same time, a lot of cholesterol is detected in the blood, which accumulates in the walls of the arteries.
• Mixed. It develops under the simultaneous influence of the two above-mentioned mechanisms.

Pathogenesis and clinical manifestations

The basis of atherosclerosis is the formation of thickening of the inner lining of the arteries - the so-called plaques. They consist of a clump of cholesterol, proteins, dead immune cells, and overgrown smooth muscle tissue. As a result, the lumen and elasticity of the vessel are significantly reduced. All this leads to a decrease in blood flow in it. Due to a violation of the rheology of the blood and the hemostasis system, blood clots can form on atherosclerotic plaques, which further causes the final blockage of the artery. This happens especially often in the lower extremities, where the blood flow is very slow.

Since the process of atherosclerosis formation is very long, the symptoms may not appear at first. Another reason for such a hidden picture is the development of collaterals, bypass paths of blood supply, with the help of which the body independently tries to cope with the restriction of blood flow.

Unlike classical atherosclerosis, multifocal one gives much more manifestations, because it affects several vessels at once. Against the background of its course, the following can develop:

• ischemic heart disease (narrowing of the lumen of the coronary arteries);
• stroke (both hemorrhagic, due to high blood pressure, and ischemic, due to blockage by a thrombus);
• angiopathy of the legs, which can lead to amputation;
• intestinal ischemia;
• nephropathy;
• visual impairment.

Diagnostics

First of all, the doctor must collect an anamnesis from the patient. At the same time, depending on the localization of the process, patients indicate the corresponding symptoms, be it angina pectoris or visual impairment, intermittent claudication, headache or urinary disorders. Physical examination reveals frequent changes in such patients: heart hypertrophy, the presence of pathological murmurs, pulse surges.

The patient undergoes a general analysis of blood and urine, determines the level of lipoproteins, cholesterol, sugar and many other important parameters. For differential diagnosis, use pharmaceutical tests (nitroglycerin and dobutamine).

For the purpose of instrumental diagnostics, the following methods are used:

• electrocardiography and Holter monitoring;
• ECHO-KG and Doppler sonography;
• radiography of the OGK;
• Ultrasound of the abdominal organs;
• radioisotope study of the kidneys;
• angiography;
• volumetric sphygmography.

All these measures make it possible to establish an accurate diagnosis, determine the localization of the pathology and its immediate cause, which is important for further treatment.

Treatment, prognosis, observation of the patient

The fight against multifocal atherosclerosis is a rather difficult task, since this problem affects many organs at the same time. Therefore, treatment must be comprehensive.

First of all, it is necessary to eliminate provoking factors: adjust nutrition, engage in physical activity and give up bad habits. Otherwise, no amount of treatment will help.

In the early stages, when there are no acute complications yet, drug therapy is used. The following groups of drugs are prescribed:

• anticholesterol (to normalize the lipid spectrum of blood) - statins and fibrates: Rosuvastatin, Atorvastatin, Clofibrate;
• antihypertensive drugs (to lower blood pressure) - beta-blockers, ACE inhibitors, angiotensin receptor blockers, diuretics and others;
• antithrombotic drugs (to prevent thrombus formation): acetylsalicylic acid, "Clopidogrel".

With the development of complications, the doctor prescribes appropriate symptomatic therapy.

Surgical treatment is also often used. For this purpose, the following methods are used:

• stenting of the coronary arteries;
• coronary artery bypass grafting;
• carotid endarterectomy;
• coronary angioplasty.

Since multifocal atherosclerosis affects many arteries at once, the first step is to correct those of them, the state of which is close to the most serious complications. Nevertheless, the risk of developing relapses still remains. Therefore, patients are shown constant drug therapy and periodic examinations by a cardiologist (once every 6 months). With all medical recommendations, the prognosis is relatively favorable. However, it should be remembered that in many unpredictable cases, this pathology is fatal.

Conclusions

Multifocal atherosclerosis is the most severe form of "fatty" vascular lesions due to its systemic nature. In this case, several organs can suffer at once. The disease should be identified and treated as early as possible.

An important feature is the presence of reversible provoking factors that seriously affect the outcome of the pathology. Maintaining a healthy lifestyle significantly reduces the risk of this disease.