Plaque is a substance that accumulates on the inner walls of blood vessels, primarily composed of fat, cholesterol, calcium, and other substances. The specific cause is unclear, but may be related to factors such as age, smoking, hyperlipidemia, hypertension, and diabetes. Plaque can cause narrowing of the lumen, decreased elasticity, and organ ischemia. Symptoms include dizziness and chest pain. Treatment includes lifestyle interventions, medications, and surgery, and the prognosis varies depending on the degree of ischemia.
symptom
Classification
1. Stable plaque
That is, plaques with thicker fibrous caps and smaller lipid pools are usually more stable and less likely to rupture.
2. Unstable plaque
Also known as vulnerable plaques, these plaques have thinner fibrous caps and larger lipid pools, making them prone to rupture. It is the rupture of unstable plaques that leads to acute cardiovascular events.
Typical manifestations
Plaques themselves are usually asymptomatic, but when related organs become ischemic due to the plaques, symptoms may develop. These symptoms may vary depending on the affected organ.
1. Symptoms related to cardiovascular involvement
When cardiovascular (primarily coronary) arteries become ischemic due to plaque, symptoms such as chest pain, chest tightness, palpitations, and shortness of breath may occur. If plaque detachment causes acute myocardial infarction, symptoms may include persistent severe chest pain, profuse sweating, nausea, vomiting, and even difficulty breathing and fainting.
2. Symptoms related to cerebral vascular involvement
Ischemia caused by cerebral vascular plaques can cause a variety of symptoms, including dizziness, headache, vertigo, blurred vision, slurred speech, and difficulty swallowing. If plaque detachment causes cerebral infarction, more severe symptoms may occur, such as paralysis of one side of the limbs, sensory impairment, loss of consciousness, and facial paralysis. These symptoms may occur suddenly and may be accompanied by nausea, vomiting, nystagmus, and an unsteady gait.
3. Symptoms related to renal vascular involvement
When renal blood vessels (renal arteries) become narrowed or blocked due to plaque, hypertension, especially resistant hypertension, may develop. Other symptoms include renal pain, oliguria, anuria, and edema. If left untreated, prolonged renal vascular ischemia can lead to renal impairment and even renal failure. Symptoms of renal failure may include nausea, vomiting, loss of appetite, fatigue, edema, and itchy skin.
4. Symptoms related to vascular involvement in the limbs
Plaques in the limbs primarily affect the arteries of the lower extremities, leading to lower limb ischemia. Typical symptoms include coldness, numbness, and pain in the lower extremities. As the disease progresses, more severe symptoms may develop, including persistent pain, decreased skin temperature, and weakened or absent dorsalis pedis artery pulses. If left untreated, it can lead to lower limb gangrene. Similar symptoms may also occur if upper extremity arteries are affected.
complication
This symptom generally has no obvious complications.
reason
Overview
The specific cause of vascular plaques is still unclear. It may be related to non-disease factors such as age, smoking, and obesity, or it may be related to disease factors such as hyperlipidemia, hypertension, and diabetes.
Cause of symptoms
1. Non-disease factors
(1) Age factors: As people age, the blood vessel walls gradually age and their elasticity decreases. At the same time, the accumulation of metabolic waste and harmful substances in the blood vessels may also increase. These factors may lead to the formation of vascular plaques.
(2) Smoking: Nicotine and other harmful substances in tobacco can damage vascular endothelial cells, leading to increased inflammatory and oxidative stress responses in the vascular walls, thereby promoting the formation of vascular plaques.
(3) Obesity: Obesity is often accompanied by metabolic abnormalities in the body, such as elevated blood lipid levels and insulin resistance. These metabolic abnormalities increase the levels of lipids and harmful substances in the blood, thereby increasing the risk of vascular plaque formation.
2. Disease factors
(1) Hyperlipidemia: Hyperlipidemia refers to a state in which the lipid content in the blood is too high, especially the increase in low-density lipoprotein cholesterol (LDL-C), which significantly increases the risk of vascular plaque formation. LDL-C will deposit in the blood vessel wall, forming plaques, leading to vascular stenosis and blockage.
(2) Hypertension: Long-term hypertension can damage vascular endothelial cells, leading to increased inflammatory and oxidative stress responses in the vascular walls, and thus promoting the formation of vascular plaques.
(3) Diabetes: Diabetic patients have abnormally high blood sugar levels, which can damage vascular endothelial cells and cause inflammatory reactions. In addition, diabetes can also cause lipid metabolism disorders and increased oxidative stress reactions, all of which promote the formation and development of plaques.
Common diseases
Hyperlipidemia, hypertension, diabetes
Seeking medical treatment
Emergency (120) indications
1. Sudden severe chest pain accompanied by profuse sweating that cannot be relieved indicates the possibility of acute myocardial infarction.
2. Sudden onset of hemiplegia on one side, inability to speak, crooked mouth, etc., may indicate a stroke.
3. Sudden lower back or upper abdominal pain, which may be accompanied by hematuria, hypertension, nausea, vomiting and other symptoms, may indicate renal artery embolism.
4. Sudden limb pain, numbness, paleness, abnormal sensation, etc., indicate possible extremity arterial embolism.
5. Other critical situations occur.
In all of the above cases, you must call the emergency number or go to the emergency room immediately.
Outpatient indications
1. Accompanied by symptoms such as chest pain, chest tightness, palpitations, and difficulty breathing.
2. Accompanied by symptoms such as dizziness, headache, hemiplegia, aphasia, and staring.
3. Accompanied by symptoms such as refractory hypertension, renal pain, oliguria and fever.
4. Accompanied by symptoms such as coldness and numbness of the lower limbs, intermittent claudication, pain and even cramps, and weakened or absent dorsalis pedis artery pulse.
5. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
1. If the condition is critical or the symptoms are severe, please go to the emergency department immediately.
2. For patients with stable conditions, refer to the appropriate department for treatment based on the symptoms of organ ischemia. Symptoms of cerebral ischemia, such as dizziness and headache, should be addressed by the neurology department; precordial discomfort, chest tightness, and chest pain should be addressed by the cardiology department; renal pain should be addressed by the nephrology department; and lower limb discomfort should be addressed by the vascular surgery department.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. Routine stethoscope auscultation and electrocardiogram examination are generally required during the consultation, and patients are advised to wear relatively loose clothing.
3. Patients may need to undergo tests for cholesterol, triglycerides, lipoproteins, etc. Patients are required to fast after 10 pm the night before the test and have blood drawn on an empty stomach the next morning.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
5. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
6. It is recommended to arrange for family members to accompany the patient to the hospital.
7. Patients and their families can prepare a list of questions they want to ask in advance.
What questions might a doctor ask a patient?
1. What discomfort do you have? When did these symptoms begin?
2. Has this situation ever happened to you before?
3. Under what circumstances do you feel your symptoms get worse? Under what circumstances do your symptoms get better?
4. Have you ever had ultrasound, CT, or other examinations to check your vascular condition?
5. What other medical conditions do you have? Do you have hypertension or diabetes? What treatments have you received? How are your blood pressure, blood lipids, and blood sugar levels controlled?
6. Do you have a habit of smoking or drinking? How much do you drink per day?
7. What is your diet like? Do you often eat foods high in fat, sugar, or salt?
8. Are you stressed in your daily life or work? Do you have time to exercise?
9. Has your family ever encountered a similar situation?
What questions can patients ask their doctor?
1. What is the cause of my situation?
2. Is my condition serious? Is my life in danger?
3. What tests do I need to do?
4. What treatment do I need? Do I need surgery?
5. How long will I need treatment? Can it be cured?
6. What should I pay attention to in my daily life?
7. I have other diseases. Will they conflict with the treatment?
8. Do I need follow-up examinations? How often?
examine
Scheduled inspection
The doctor will first perform a physical examination on the patient to get a preliminary understanding of the condition, and may then recommend that the patient undergo blood routine examinations, blood biochemistry, ultrasound examinations, CT examinations, MRI examinations, angiography, electrocardiograms, and other examinations.
Physical examination
Your doctor will perform a thorough physical examination, which includes measuring your blood pressure, listening to your heart and blood vessels, checking your pulses and blood flow in your extremities, and assessing your general health.
Laboratory tests
1. Blood routine test
Check the white blood cell count, neutrophil count, red blood cell count, platelet count, hemoglobin concentration, etc. This test can rule out other diseases.
2. Blood biochemistry
Blood biochemical examinations include the detection of indicators such as blood lipids, blood sugar, liver and kidney function. These indicators can reflect whether the patient has factors such as high blood lipids and high blood sugar that may lead to the formation of vascular plaques.
Imaging examinations
1. Ultrasound examination
Ultrasound is a commonly used noninvasive method for vascular plaque examination. Through the reflection and scattering of ultrasound waves, doctors can clearly visualize the intravascular structure, including the size, location, and morphology of plaques. Ultrasound can also assess the degree of vascular stenosis and changes in hemodynamics.
2. CT examination
CT is a high-resolution imaging method that can show the three-dimensional structure of blood vessels and the details of plaques. Through CT examinations, doctors can understand information such as plaque density, degree of calcification, and vessel wall thickness, which helps to assess plaque stability and predict disease progression.
3. MRI examination
MRI is a non-invasive imaging method that can provide more information about blood vessels and plaques. MRI can show the composition and structure of plaques and their relationship with surrounding tissues, helping to assess plaque risk and predict disease progression.
Other tests
1. Angiography
Angiography is an invasive examination method that injects contrast agents into blood vessels, allowing doctors to clearly visualize the vessel’s contours and blood flow. Angiography can visually demonstrate the degree of vascular stenosis and the location of plaques, which is crucial for assessing disease severity and developing treatment plans.
2. Electrocardiogram
An electrocardiogram (ECG) is primarily used to assess the heart’s electrical activity, helping to detect abnormal heart rhythms and myocardial ischemia. While an ECG itself is not directly used to diagnose vascular plaques, it can indirectly reflect how the heart is affected by vascular plaques.
diagnosis
Diagnostic principles
Doctors can generally make a diagnosis based on the patient’s medical history, clinical manifestations (such as dizziness, headache, chest pain, palpitations, etc.), and the results of relevant auxiliary examinations (such as ultrasound, CT, MRI, angiography, etc.).
Differential diagnosis
Vascular plaques can usually be diagnosed through imaging examinations and generally no differentiation is required.
treat
Expected treatment
Treatment of vascular plaques primarily aims to control their progression and alleviate related symptoms. Because the development of vascular plaques is often associated with hyperlipidemia, hypertension, and diabetes, treatment should focus on lowering lipids, blood pressure, and blood sugar. Treatment options include general therapy, medication, and surgery.
General treatment
1. Eat a healthy diet
Control total dietary calories to maintain a normal weight. Overweight or obese individuals should reduce their total daily calorie intake, lower their cholesterol intake, and limit alcohol and sugary foods. Those with hypertension or heart failure should also limit their salt intake.
2. Maintain moderate physical activity
Participating in a certain amount of physical labor and sports activities is beneficial for preventing obesity, strengthening the circulatory system, and regulating blood lipid metabolism. It is an active measure for preventing this disease. The amount of physical activity should be determined based on physical condition, physical activity habits, and cardiac function, aiming to avoid excessive cardiac strain and discomfort. Physical activity should be gradually introduced; avoid forced strenuous activity.
3. Reasonable arrangement of work and life
Maintain a regular lifestyle and maintain an optimistic and cheerful mood. Avoid overwork and emotional agitation. Balance work and rest, and ensure adequate sleep.
4. Quit smoking and limit alcohol consumption
It is recommended not to smoke, avoid secondhand smoke, and drink a small amount of alcohol.
5. Control risk factors
Diabetic patients should control their blood sugar in a timely manner, including diet control; hypertensive patients should be given antihypertensive drugs to lower their blood pressure to an appropriate level; those with increased blood cholesterol should control their cholesterol and be given lipid-lowering drugs as appropriate.
Drug treatment
1. Blood pressure medication
Patients with hypertension can choose nifedipine, captopril, etc. to lower their blood pressure to near normal range.
2. Lipid-regulating drugs
Patients with dyslipidemia can choose simvastatin, clofibrate, etc. to lower cholesterol and regulate blood lipid concentration.
3. Blood sugar control drugs
People with diabetes can choose metformin, insulin, etc. to control blood sugar at normal levels.
4. Antiplatelet aggregation drugs
To prevent thrombosis and reduce the occurrence and development of vascular occlusive diseases, patients can choose drugs such as aspirin and clopidogrel.
5. Thrombolytic drugs
For patients with ruptured plaques in the arteries and subsequent acute thrombosis leading to stenosis or obstruction of the lumen, thrombolytic drugs including streptokinase and alteplase can be used.
6. Appropriate treatment for ischemic symptoms
For example, vasodilators (such as nitroglycerin) and beta-receptor antagonists (such as metoprolol and propranolol) are used in cases of angina pectoris.
Related drugs
Nifedipine, captopril, simvastatin, clofibrate, metformin, insulin, aspirin, clopidogrel, streptokinase, alteplase, nitroglycerin, metoprolol, propranolol
Surgical treatment
If vascular plaques cause moderate to severe vascular stenosis and ischemia of organs and tissues in the blood supply area occurs, intravascular or surgical intervention such as stent implantation, endarterectomy or bypass grafting can be considered.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, and personal constitution, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.