FMAM_ateroscleroza
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Transcript of FMAM_ateroscleroza
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ATEROSCLEROZA
Conf. Dr. Adriana Iliesiu
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- Arterioscleroza (rigiditate )
- Arterioloscleroza
– Ateroscleroza (ATS) = aterom• oala focala a intimei!
• "eneralizata
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Aterom sau Placa ateroscleroticaAterom sau Placa aterosclerotica
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StriuriLipidice
Tip II
Leziuniintermediare Aterom
Tip III
PlaciFibroaseTip IV , V
Leziuni complicate/rupturaTip VI
Din prima decada Din a treia decada Din a patra decadaSmooth muscle
and collagen
AtherosclerosisATS - Stadiile evolutiveATS - Stadiile evolutive
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#. $umatul#. $umatul
%. &TA (diastolica si'sau sistolica)%. &TA (diastolica si'sau sistolica)
. Diaetul zaarat. Diaetul zaarat
*.*. CColesterol totalolesterol total crescutcrescut ((++ LDL)LDL)
,,,, HDL-colesterol HDL-colesterol scazut scazut
--VârstaVârsta , sex , sex
--Obezitatea*Obezitatea*
-Factori inflamatori (fibrinogen, proteina C reactia-Factori inflamatori (fibrinogen, proteina C reactia
! ! "sC#$%"sC#$%
Factori de risc ai ATSFactori de risc ai ATS
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Dezvoltarea Ateromului
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Evolutia ATS
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Ti-uri de -laci aterosclerotice
Stable Plaque Unstable Plaque Disrupted Plaque
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Localizarile ATS
• coronare
• carotide
• arterele eri!erice
•art" renale
• aorta
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Evolutia clinica a ATS
ATS nemani!esta clinic (silentioasa)
ATS mani!esta
#ronica - rogresia lenta
Acut - rutura lacii - Aterotrom$oza
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Aterotrom$oza
Aterom % trom$us & o$structie vasculara
Consecinte clinice
• coronare – sindroame coronariene acute• carotide – A'# ischemice
• artere eri!erice - ocluzie arteriala eri!erica
acuta
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Aterotrom$oza
• leziuni aterosclerotice - -laci ulneraile ( in!lamatie si trom$oza)
• laci neo$structive (usor stenotice – nu se deisteaza la angiogra!ie)
iez liidic crescut
#aison su$tire#elularitate crescuta
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ani!estarile clinice ale ATS
Cronica
• #arotidian - su!luri
• iocardic
– Angina ectorala
sta$ila
• Arterial eri!eric
– #laudicatia
intermitenta
• enal – *TA secundata
Aterotromoza
• #ere$ral• iocardic
• Arterial eri!eric
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Diagnosticul aterosclerozei
• Diagnosticul leziunilor aterosclerotice#oronarogra!ia + arteriogra!ia
Ecogra!ia vasculara
#omuter tomogra!ia (%angiogra!ia)
ezonanta magnetica (% angiogra!ia)
• Diagnosticul ischemiei ( consecinta) – Teste de rovocare a ischemiei
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Preventia ATS
• /rimara – Pacientii asimtomatici la risc inalt
• Factori de risc multili
• ,n singur !actor de risc cu nivel crescut (#h ./0+LDL #* /10+ TA 2304220)
• D5
• Secundara
– Pacientii cu $oala coronariana+ arteriala eri!erica+
aterosclerotica cere$rovasculara
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Stratificarea riscului &TA -entru -ro"nostic
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6$iectivele reventiei
• enuntarea la !umat
• Alimentatie sanatoasa+ e!ort !izic
• 7nde8 masa cororeala 9 /:;g4m
• TA 9 2104
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6$iectivele reventiei
• Alte medicamente ro!ilactice
– Asirina
– >$
– 7E#a
– anticoagulante
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Evolutia omului – viziune moderna
Aterosleroza & cauza cea mai !recventa de mortalitate si
mor$iditate in tarile dezvoltate