Atheroma Complication

• Atheroma Complications pt1:

  • complications don’t arise only when a plaque ruptures and a thrombus forms
  • The insidious slow growth of an atheroma (sometimes over quite long time frames) will cause an insidious clinically silent narrowing of an artery
  • Blood flow is progressively compromised until it becomes inadequate to meet the metabolic demands of the myocardium and myocardial ischaemia results
  • The point at which blood flow and demand become uncoupled in this way is known as the ischaemic threshold
• Atheroma Complications pt2:

  • It may not normally be obvious that they have an ischaemic threshold – especially where the individual is sedentary and resting
• Atheroma Complications pt3:

  • However, they may become symptomatic either when:
  • The atheroma grows large enough to seriously occlude a vessel lumen resulting in a supply to demand mismatch at low levels of work intensity, which will impact on an individual’s activities of daily living
  • Or when the individual steps up their activity levels and the tissues supplied by the affected artery increase their demand for blood flow (O2), which the compromised vessels cannot meet. You might expect the atheroma to be smaller than in the above scenario
• Atheroma Presentation:

  • the impact on the patient depends on the size and anatomical location of the atheroma
  • But basically, the same process of atheroma formation underpins peripheral arterial disease, which may result in leg pain or amputation and atheroma +/- the development of a thrombus underlies ischaemic stroke and some types of dementia (e.g. ischaemic dementia / multi-infarct dementia)