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Plaque definition and everything you need to know – Coronary Artery Disease

Coronary artery disease is a condition in which the heart does not receive enough blood and stops working. The most common cause for this is the plaques. 

Importantly, it is the most prevalent cause of death worldwide, as cardiac diseases have a higher predominance amongst patients. In this article, there will be a thorough explanation of this disease and its causes. Nonetheless, for better comprehension, basic terms and its description will also exist within this article.

You will obtain critical insights about plaques, coronary artery disease, its causes, and how to prevent them by reading this article. Please continue reading to get pearls on this specific topic by the hand of a Doctor.

What is the medical definition of plaque?

Atherosclerosis is the most common form of vascular disease in which the wall of arteries thickens. This narrows the channel within the artery reducing the blood flow. Atherosclerosis is a slow and progressive disease that may start at any age, including childhood. It can begin to progress rapidly in the ’30s. In others, it may become dangerous after the ’60s.

The thickening of the artery wall is due to the appearance of the atherosclerotic plaque. An atherosclerotic plaque accumulates cholesterol, calcium, and degradation products of cells within the walls of the arteries. This accumulation occurs when there is a lesion on the layers of the arterial wall. Therefore, when the layers are open, the fats in the blood deposit within the layers of the artery.

When the plaque builds up and clogs the arteries, the amount of oxygen and nutrients that reach the muscles and organs lowers, leading to a progressive malfunction. The plaque’s location and the type of artery in which it appears tend to vary from person to person. A plaque may appear in the heart, brain, legs, arms, pelvis, or kidneys clogging partially or totally the blood flow in arteries of medium or large size. This plaque buildup leads to various conditions which may endanger life like:

  • Coronary Artery Disease: The plaques buildup in arteries within the heart like the coronary arteries or arteries that leads to it. This condition may progress to the acute coronary syndrome.
  • Carotid Artery Disease: In this condition, plaques buildup in the carotid artery, which supplies blood to the brain.
  • Chronic Kidney Disease
  • Peripheral Artery Disease: Plaques form in arteries of the extremities, especially legs.
  • Angina: Reduction in blood flow to the heart muscle causes chest pain.

What causes plaque in arteries?

The development of plaques in arteries is a slow and progressive process. The mechanism is not known precisely to this day. To fully understand this, it is essential to mention that all the arteries have 3 primary layers which are:

  • Intima (Inner layer): This is the layer in direct contact with the blood, and it is made of endothelial cells.
  • Media (Medium layer): With a composition of smooth muscle cells and elastic fibers, this layer gives the elasticity to the arteries.
  • Adventitia (Outer layer): Is a layer made of collagen fibers that maintain the structure of the artery.

Plaque formation begins in places with alterations of blood flow like bifurcations early in life due to the constant stress of the blood flow. However, several factors may induce damage to arteries like smoking, aging, or high blood pressure. When the intima’s endothelial cells begin to fail and break, lipoproteins like LDL cholesterol enter to deposit within this layer. After this, the immune system recognizes these lipoproteins and ingests those forming “foamy cells,” which replicate and later form the initial atherosclerotic lesion. This process leads to the intimal thickening altering the blood flow, reducing the oxygen and nutrients that reach the muscles and organs. 

The atherosclerotic lesion begins to grow as smooth muscle cells from the media layer migrate to the injury leading to the formation of the fibrous plaque. This plaque forms new small blood vessels within it, which will calcify the plaque and debilitate the intima layer making it very fragile and a vulnerable plaque. Plaque rupture is very likely to happen due to this fragility. Moreover, when lesions occur to this plaque, platelets begin to agglomerate leading to a blood clot and a further clogging of the arteries.

What does plaque look like?

A plaque accumulates fats, lipids, and lipoproteins within the layers of the artery, more specifically, under the intima. It is a condition where the intima thickens slowly and progressive, altering the blood flow due to its narrowing. When the plaque grows, a thin fibrous cap covers it making it an unstable plaque that may break anytime. A plaque may occupy a specific space within the artery, or it may be along the whole artery. It depends on the progression of the disease. The thickening of the wall, or stenosis, and a ruptured plaque leads to conditions like a heart attack due to the clogging of the arteries. 

With this image, the explanation does not stay only in words. The blood flow alteration and the intimal thickening have a visual representation. The red blood cells have a hard time going through the arteries and stacking themselves, which leads to a deficit of oxygen in the muscles. If there is a lesion in the artery while the intima is thick, the platelets will begin to accumulate in the base of the lesion. The platelets, in addition to the red blood cells, ‘ slow traffic, are the perfect scenario for developing a blood clot.

File:Late complications of atherosclerosis.PNG
Source: https://commons.wikimedia.org/wiki/File:Late_complications_of_atherosclerosis.PNG

What habits causes plaque development?

Although atherosclerosis is a disease that may start in childhood, several risk factors may accelerate disease progression. An unhealthy lifestyle and unhealthy habits induce the rigidity of the arteries, making them vulnerable to lesions. Other habits may alter the blood’s components like more accumulation of fats in the blood or add more stress to the artery itself. Among these risk factors, there are habits like:

  • Smoking: Cigarettes are among the primary risk factors that alter the arteries making them more rigid and vulnerable to lesions. It is a habit that causes about 1 in every 5 deaths in the United States affecting nearly every organ within the body like heart, lungs, eyes, bones, amongst others.
  • Eating unhealthy food: Fast food or foods with high fats and sugar content promote a rise in the levels of fats in the blood that may accumulate in the lesions. This habit can also lead to a surge in the blood sugar levels, leading to conditions like Insulin Resistance or Diabetes
  • Sedentarism: Lack of physical activity promotes the accumulation of fats in the blood and elevates the risk of developing high blood pressure.

How can you prevent plaque buildup?

Plaques in atherosclerosis are something that will always happen due to an essential factor, aging, and there is nothing to do about it. However, a person can take preventive measures to avoid developing plaques that may imply a risk to their lives. Preventing plaque buildup is an easy task as it only takes promoting a healthy lifestyle. There are several actions that individuals can take to avoid plaque buildup like:

  • Physical Activity: Doing at least 30 minutes of exercise a day on five days of the week will improve the patient’s health. Doing exercise helps in maintaining a healthy weight and reducing levels of fats in the blood. It can also improve heart function, strengthening the muscle, and improving the heart’s ability to pump blood through the body allowing the oxygen levels in muscles to rise.
  • Weight Control: Regular physical activity and a good nutritional plan may help decrease the risk of developing obesity and other conditions that may affect the patient life.
  • Quit smoking.
  • Heart-Healthy Eating: Making changes in the food may help ensure a longer life and reduce the risk of cardiovascular disease.

However, the patient should inform the physician if there is any family history of heart disease or high blood pressure. If these conditions exist, the physician should do a complete screening of the patient and indicate the use of pharmacological treatment.

What foods dissolve plaque in arteries?

There are no foods that can dissolve plaque in arteries, mostly because this is only possible through pharmacotherapy. However, dietary changes may stabilize these plaques and prevent them from growing. Eating heart-friendly foods may reduce the amount of cholesterol and fats in the bloodstream, reducing the risk of developing heart diseases. Several foods must be in a diet to promote healthy arteries and stabilizing the plaques like:

  • Vegetables: Rich in antioxidants that may reduce the inflammation like cabbage, spinach, broccoli, and carrots.
  • Fruits: They add up the necessary amount of sweets to the diet, such as bananas, oranges, apples, grapes, and pears.
  • Whole grains: Oatmeal, brown rice, and whole-grain bread promote the reduction of cholesterol and add up fibers to diet.
  • Protein-rich foods: The inclusion of foods rich in protein and low in fats reduce appetite and hunger levels leading to weight loss. This also contributes to strengthening muscles and lowering blood pressure as these foods help the heart and arteries. The foods are the following:
    • Fish like salmon or tuna are rich in Omega-3 that helps reduce cholesterol levels.
    • Lean meats like chicken, turkey, or 95% lean ground beef.
    • Eggs
    • Avocados
    • Nuts and seeds
    • Legumes as beans, lentils, chickpeas, amongst others.

Is high blood pressure a sign of clogged arteries?

Not exactly, although high blood pressure has a direct correlation to atherosclerosis and arteries clogging, atherosclerosis is a product of high blood pressure. Hypertension is a significant risk factor in the development of atherosclerosis. In fact, atherosclerosis tends to occur in those parts of the vascular system that are subject to high pressure. Moreover, these two diseases are distinct entities. People with hypertension may not manifest extensive atherosclerosis, and atherosclerosis is not always in the company of hypertension.

High blood pressure levels or hypertension induce changes in the conformation of the arteries as well as atherosclerosis. In hypertension, there is a thickening in the media layer due to the artery’s constant stress. This also induces constant damage in the intimal layer due to the high pressure allowing the cholesterol to deposit within the intimal layer. Therefore, in people with hypertension, atherosclerosis should always be in mind as it is a complication of high blood pressure. High blood pressure may affect coronary arteries and induce coronary atherosclerosis, leading to myocardial infarction.

What are the warning signs of clogged arteries?

Atherosclerosis is a disease that usually does not cause signs or symptoms until it reaches a stage that severely narrows or totally blocks an artery. This is why many people find out about this disease too late when they have a medical emergency. However, some people may present signs and symptoms, although it depends on the artery in which the plaque develops. These are the most common warning signs in the different arteries through the body.

Coronary Arteries

These are the arteries that supply the heart muscle, yes, the heart also needs its very own arteries. The plaque burden within these arteries directly correlates to diseases like Myocardial infarction or Ischemic heart disease. The occlusion of these arteries has cardinal signs like:

  • Angina: It is the name that receives the oppressive chest pain that occurs when the heart does not receive enough blood rich in oxygen. People can also feel this pain in the jaw, neck, shoulders, arms, or back. It is a pain that usually gets worse with physical activity or emotional stress, and it goes away with rest.
  • Shortness of breath.
  • Arrhythmias or palpitations (feeling that your heart is pumping out).

Carotid Arteries

The carotid arteries are the ones that supply the brain with blood. When a plaque narrows the bloodstream within these arteries, carotid artery disease is onset. The narrowing of these arteries may lead to conditions like a stroke. It has signs and symptoms like:

  • Loss of consciousness
  • Sudden and severe headache
  • Paralysis or numbness of the face, arms or legs on one side of the body.
  • Sudden weakness.
  • Trouble speaking
  • Dizziness.
  • Confusion

Peripheral Arteries

Peripheral Artery Disease is a condition in which the extremities and pelvis blood supply is deficient due to a plaque narrowing the artery. This condition may present signs like:

  • Numbness
  • Pain
  • Inability to realize movements
  • Infections and necrosis of the limbs

Renal Arteries

These arteries are in charge of supplying the kidneys with oxygen-rich blood. When the plaque buildup reduces blood flow, chronic kidney disease may start to develop. This condition causes a slow loss of kidney function over time. However, in the early stages, this condition does not produce any symptoms. When it gets worse, it may produce the following:

  • Tiredness
  • Loss of appetite
  • Nausea
  • Swelling
  • Numbness
  • Changes in the voiding habit

How is coronary artery disease diagnosed?

The diagnosis of coronary artery disease includes several tests. The physician asides from a complete history, which consists of a full interrogation of symptoms and a family history of cardiac disease, must consist of a comprehensive physical examination. The following tests will allow the physician to make an assertive diagnosis and have critical insight into the patient’s condition.

Electrocardiogram (ECG) 

This is the most basic test as it records the electrical activity of the heart through its nodes. It is a quick and economical test available in almost any medical center as it can detect previous heart attacks or ongoing heart attacks.

Echocardiogram

This test allows the physician to assess heart functionality. Besides, all the parts of the heart that contribute to the heart-pumping activity. If there are parts of the heart that do not work correctly, this may be due to a previous heart attack, coronary artery disease, or other conditions.

Exercise Stress Test 

This test consists of performing an electrocardiogram while doing exercise on a treadmill or a stationary bike. This to see what happens in the heart while on stress events.

Cardiac catheterization and angiogram

The physician inserts a catheter into an artery or a vein that goes directly to the heart. The doctor uses X-rays to guide the catheter through the blood vessels into the correct position. To see better if there is any blockage, the physician uses dyes through the catheter to have a clearer image of the blockage. This test may be therapeutic (or aid to treat the plaque).

When the catheter reaches the artery blockage, it can use a balloon for the artery dilatation and put a “Stent” that will finally keep a continuous dilatation. There are other therapeutic measures like carotid endarterectomy, which removes the plaques of the arteries after making a diagnosis.  

Cardiac Computed Tomography Scan 

With this test, the physician can see if there are any calcium deposits in the arteries that narrow them. If there is a substantial amount, it is most likely that there is a coronary artery disease. The Computed Tomography Angiography is a variant of this test. The patient receives a contrast dye through its veins. With this test, the physician will be able to get a full image of the heart arteries and its functionality.

Can ECG detect a blocked artery?

It depends; the electrocardiogram is a non-invasive test that is on every emergency of the world. It is a quick and cheap test that evaluates the heart’s electrical activity and if there is a disruption of it. A physician can make several cardiac diagnoses with this tool. However, the electrocardiogram can only diagnose a symptomatic artery blockage; in other words, it can make a quick diagnosis of a heart attack. The electrocardiogram cannot make a diagnosis of asymptomatic arteries blockages or predict a heart attack. In order to detect the asymptomatic blockage of an artery, the best option is an echocardiogram, a non-invasive quick test.

What is cardiac rehabilitation and recovery?

It is a program under the supervision of a doctor looking forward to improving the patient’s cardiovascular health. People who have undergone cardiovascular diseases like heart attack, heart failure, angioplasty, or heart surgery are eligible for this program. It is a team effort as it is the patient and the doctor, as it includes a team of specialists like nutritionists, psychologists, pharmacists, and nurses. This program has three essential parts that are equally important, and they consist of:

  • Exercise counseling and training: Acquiring the habit of regularly doing physical activity has benefits on the heart. It strengthens the muscle, allowing it to pump blood effectively.
  • Education for heart-healthy living: The rehabilitation also looks to improve the patient’s life by eliminating risk factors like smoking. It also seeks to educate the patient giving nutritional plans and tips for healthy eating that can benefit the heart.
  • Counseling to reduce stress: Chronic psychological stress can harm the whole body. It can especially affect the heart, and the arteries inducing an immune response that may aggravate the atherosclerotic lesions. Therefore, this part of the program looks to identify and help the patient to nullify the daily sources of stress.

What can somebody do if it has risk factors or symptoms of it?

This tool is a coronary artery disease symptoms checker. It would help anybody to determine the likelihood of having an underlying plaque formation. It gathers the most important risk factors, signs, and symptoms to do so. And, the most important thing, it is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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