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Atherosclerosis … Questions & Answers

Q & A with Dr. Bernd Reisbeck PhD, Senior Consultant and CMO of CardioCare Marbella

How do I know if my arteries have a problem, e.g. narrowed/stenosed?

Generally speaking, any reduced flow will cause malfunctioning of the organ affected and often pain. The exact symptoms depend on the arteries affected.

Narrowing of the arteries of the heart will cause pain in the chest, sometimes radiating to the left arm, mostly with exercise, but also at rest. It can also cause shortness of breath with exertion, or physical fatigue on exertion.

Reduced blood flow to the legs typically causes pain in the leg and foot when walking, tingling in the foot, cold toes and in really severe cases even a blueish discoloration of the toes up to painful black toes, which is called gangrene. It is these symptoms which mostly prompt a visit to the doctor.

What tests will be performed leading to diagnosis?

Beside blood tests screening for the general risk factors for atherosclerosis, cardio-vascular centres will perform several tests, depending on the patient's individual clinical picture.

The heart arteries, also called coronary arteries, are more difficult to examine, primarily because they are hidden around the heart inside the chest, are covered by lung tissue, and are particularly small in size. Whilst a main leg artery can easily measure 1cm, the coronaries are rarely wider than 4mm! As a result doctors use indirect tests to evaluate heart performance, such as the treadmill stress test and the stress echocardiography, and of course a coronary CT scan. Which test is the best for you depends on many factors and should be agreed upon with your cardiologist.

Peripheral arteries, such as neck arteries or leg arteries are situated superficially under the skin and therefore easily spotted by ultrasound. The exact test is called colour-doppler ultrasound examination. Angio-CT scans are also a good tool to detect atherosclerosis.

What is the treatment?

Beside lifestyle changes, we can use medication (e.g. aspirin) to improve blood flow and blood viscosity, and most importantly we use medication to control diabetes and cholesterol levels. In severe cases however, when the symptoms interfere with quality of life, and when acute events like heart attacks are highly likely, we open up these arteries with balloons and stents. These are minimally invasive procedures, which are very well tolerated.

Does it hurt if you open up closed arteries?

Arterial vessels themselves don't have any pain receptors so you don't feel the catheters. Some patients however do feel it when the balloons are opening up the stenosed vessels, but it only lasts for a short moment.

What can I do myself to avoid atherosclerosis?

Early diagnosis and early control of all risk factors reduce the risk and improve the outcome of this disease. Therefore, reducing or eliminating as many factors as possible, optimising your diet and getting regular exercise, controlling or even avoiding chronic conditions, will help reduce the overall risk for atherosclerosis.

What are the risk factors?

Diabetes (high sugar levels), smoking, high blood pressure, elevated cholesterol levels and obesity are all risk factors and unfortunately a genetic predisposition inherited from your parents is unchangeable. A major new risk factor is the existence of a cancer diagnosis and the choice of treatment given.

If you would like to know more about atherosclerosis or any of the services we offer here at CardioCare Marbella, please don’t hesitate to get in contact with us.

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