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Atherosclerosis (Hardening Arteries) in the Elderly

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What is atherosclerosis?

Atherosclerosis (Hardening Arteries) in the Elderly

Atherosclerosis is a common condition affecting the arteries in the body – the blood vessels that carry oxygen rich blood throughout the body. It is a condition where fatty plaques build up inside the artery walls thereby causing hardening and narrowing of the artery. This affects blood flow through the artery and can increase the chances of serious conditions such as a stroke or heart attack developing. It is a slow progressing condition that may start earlier in the life but often leads to the most severe complications in the elderly.

Causes of Atherosclerosis

Arteries are thick and elastic which allows it to withstand the high pressure within it and maintain the pressure through recoil. These characteristics of arteries are important factors in circulation of oxygen-rich blood throughout the body. When the inner lining of the artery wall is damaged, fats in the blood can be deposited within it. Gradually these fatty plaques increase in size thereby narrowing the artery.

The exact cause of atherosclerosis is unclear. There are certain risk factors that have been identified as increasing the chance of developing atherosclerosis. This includes :

  • Obesity
  • Cigarette smoking
  • Hypertension – high blood pressure
  • Hypercholesterolemia – high blood cholesterol
  • Diabetes mellitus (sugar diabetes)
  • Family history

Although some people can have one or more of these risk factors, they will not definitely develop atherosclerosis. The condition can start as early as childhood but is more likely to develop and have serious consequences after the mid-forties.

Signs and Symptoms

Atherosclerosis is largely asymptomatic meaning that there are no symptoms. It is often termed the ‘silent killer’ because when the complications arise, it can often be fatal  yet there is at times no previous warning signs. A significantly narrowed artery can suddenly become blocked almost entirely with even a small blood clot. The flow of oxygen rich blood is then cut off from the part of the body which the artery in question was supplying. Certain parts of the body are more likely to be affected, like the heart, brain and limbs (arms or legs).

Arteries to the Heart

The coronary arteries carry blood to the muscular walls of the heart. There are several coronary arteries and a partial blockage still allows sufficient to blood to flow through. When blocked it may present as angina pectoris. These symptoms include :

  • Crushing chest pain particularly when exercising or with stress
  • Dizziness
  • Sweating
  • Nausea
  • Shortness of breath

When the artery is almost completely blocked, a heart attack will occur.

Arteries to the Brain

The more likely arteries to be affected in atherosclerosis that compromises blood flow to the brain is the neck arteries (carotid arteries). Partially occluded neck arteries will lead to transient ischemic attacks (TIAs). The symptoms of this condition includes :

  • Dizziness and even fainting spells
  • Tingling or numbness of the limbs
  • Muscle weakness in the limbs
  • Confusion
  • Slurred speech
  • Difficulty speaking

When the blockage is complete or almost complete, then part of the brain tissue may die. This is known as a stroke.

Arteries to the Limbs

Reduced blood flow to the limbs due to atherosclerosis is broadly known as peripheral arterial disease (PAD). It causes symptoms such as :

  • Arm or leg pain during activity of the limbs
  • Cramping pain of the leg especially when walking (claudication)
  • Paleness of the affected limb
  • Coldness of the skin on the affected limb

When the artery is blocked suddenly it may cause a condition known as acute limb ischemia.

Treatment of Atherosclerosis

Conservative measures can help prevent atherosclerosis or even reverse the condition to some degree in the early stage. These measures include :

  • Losing weight if overweight or obese.
  • Stopping cigarette smoking.
  • Switching to a low fat and low GI diet which is well balanced.
  • Exercising regularly.
  • Living a healthy lifestyle – alcohol in moderation, having adequate rest, avoiding stress.

Medication may also be of use especially if a predisposing condition is present or severe and in high risk groups like with the elderly. These drugs includes :

  • Anti-clotting drugs to prevent the formation of a blood clot at the narrowed part of the artery.
  • Diabetes medication to control the blood glucose levels.
  • Hypertensives to maintain the blood pressure within the normal range.
  • Cholesterol-lowering drugs to keep the prevent high levels of cholesterol.

Surgical procedures can achieve the following but are reserved for more severe cases :

  • Widen the narrowed artery so that a stent can be inserted to keep it open.
  • Fatty plaques can be physically removed.
  • Clot-dissolving drugs can be injected at the site to break down the clot.
  • Alternative routes can be inserted to bypass the affected artery.

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