Artery blockage, also known as atherosclerosis or arteriosclerosis, can have fatal consequences such as a sudden death.
The underlying process of artery blockage, actually creates a potential danger zone in each artery, which can have far-reaching consequences for the whole body, not just the brain and heart.
As a whole, every organ depends on arteries for blood and oxygen supply. This means that atherosclerosis can put a strain on the entire body. By making lifestyle changes, whether in combination with medication or not, you can significantly reduce the risk of artery blockage.
Below you will discover all about the harmful effects of an artery blockage. In addition, we also focus on arterial calcification prevention and risk reduction.
Continue reading to learn more about artery blockage, or atherosclerosis, and how to prevent it.
Table of Contents
- 1 Artery blockage: Introduction
- 2 Clot formation on a calcification that occludes the blood vessel
- 3 Cardiovascular disease risk factors
- 4 How to reduce or render harmless existing calcifications?
- 5 What is a heart attack?
- 6 What is a stroke or brain thrombosis?
- 7 What is the link between arterial calcification and sudden death (a heart artery rupture)?
- 8 What role does hereditary burden play in artery blockage?
- 9 What is the role of cholesterol on atherosclerosis?
- 10 Artery blockage: Conclusion
Artery blockage: Introduction
Unfortunately, artery blockage is not revealed in many people until a blood clot suddenly forms on top of the calcification.
That blood clot will wholly or partially occlude the vessel, causing a sudden and complete lack of oxygen in the organ normally irrigated by this artery.
And that causes the tissue, which is no longer supplied with oxygen, to begin to die off quickly, a physical reaction that takes place in a very short time.
Clot formation on a calcification that occludes the blood vessel
The impact of calcification varies depending on the organ affected.
If part of the brain is drained by closing off a cerebral artery, that part dies off after only a few minutes.
The heart muscle, unlike the brain, can hold out a little longer. It takes about 30 minutes here before the occluded tissue begins to succumb to oxygen deprivation.
Infarcts can occur in the heart and brain and less frequently in the kidneys or intestines.
Why does a clot form on a plaque, and what is a plaque?
A plaque is not simply a passive accumulation of cholesterol and fat.
A plaque consists of a core (actually a buildup of cholesterol, calcium, and inflammatory cells) and a capsule that seals that liquid core from the cavity of the blood vessel.
There is no danger as long as such a plaque is well encapsulated. This is called a stable plaque. In other words, a large plaque shielded by a thick capsule is therefore harmless.
A torn capsule creates a blood clot
But if the capsule ruptures for some reason, those liquid contents of the plaque end up in the bloodstream.
And that immediately and very suddenly causes a blood clot that can cause the complete blockage of the bloodstream.
- Does this happen in the brain? Then this causes a stroke.
- Does this happen in the heart? Then this causes an infarction.
The causes why a stable plaque becomes active and begins to rupture are essentially the same as those that give rise to the formation of the plaque itself.
Examples of such causes are as follows:
- Obesity / Being overweight
- High blood pressure
- High cholesterol
On the other hand, inflammatory factors also play a crucial role here.
Inflammatory cells in the blood can indeed attack the capsule around the plaque, causing that capsule to lose its firmness.
The micro inflammatory process within and around the plaque
An ingenious inflammatory process occurs inside and around the plaque at the micro-level.
The body attempts to repair that damaged vessel wall from the constant overload through that inflammatory response.
But unlike inflammation in a joint, where you can quiet the inflammation caused by overuse by resting for a few weeks, the blood vessel, unfortunately, gets no rest at all.
The pounding power of blood pressure with each heartbeat remains anyway, in addition to any other culprits such as nicotine, cholesterol, etc.
Still, the body tries to heal the wound and remove the plaque. But during that clearing process, the capsule is also often gnawed at.
And such a thin and weakened capsule can suddenly tear, causing a clot to form on that plaque.
Cardiovascular disease risk factors
We can do something about some of the risk factors of cardiovascular disease.
Consider, for example, quitting smoking, going on a diet to combat obesity, getting more exercise, combating high blood pressure, and eliminating excessively high cholesterol levels.
In contrast, other risk factors of cardiovascular disease are beyond our control. Examples include your gender, age, and genes.
Cardiovascular disease occurs due to a combination of risk factors in which underlying heredity also plays an important role.
Tip: Learn more about the fundamentals of cardiovascular disease prevention in our other article How to Prevent Cardiovascular Disease? Prevention Tips & Lifestyle Changes
Atherosclerosis, also known as arteriosclerosis or artery blockage, is called the silent killer (just like cholesterol) because it is an entirely asymptomatic and silent process as long as there is no narrowing in the blood vessel.
Artery blockage can occur in 2 ways:
- A narrowing occurs in the blood vessel because the plaque begins to fill more than 70% of the blood vessel cavity.
- The blood vessel is occluded because a clot suddenly forms on the calcification due to the capsule of the calcification tearing. This is also known as thrombosis or infarction.
Such a clot does not form only with large severe calcifications. Even smaller, completely asymptomatic calcifications can suddenly give rise to a clot and trigger a myocardial infarction or stroke, which is, of course, particularly frightening.
Prevention of artery blockage is crucial
Unfortunately, this is a phenomenon that is impossible to predict by medical science.
No study can currently indicate whether a plaque is on the verge of rupture or is still safely encapsulated. Indeed, the risk of tearing is not only related to the size of such a bulge.
Even relatively small plaques can rupture (even small plaques that give no symptoms and that you can't determine with an exercise test, for example).
This further highlights the need for prevention! In the absence of detection techniques, prevention is really the only effective weapon for slowing artery blockages.
Strokes, myocardial infarctions, and most sudden deaths have arterial calcification as an underlying mechanism, where a clot suddenly forms on a calcification, closing off the blood vessel.
How to reduce or render harmless existing calcifications?
By making lifestyle changes, whether in combination with medication or not, you can significantly reduce the risk of plaque rupture.
In other words, it is possible to reduce overload and thus reduce the inflammatory process:
- If you decide to stop smoking, the aggressiveness of the inflammatory processes decreases throughout your body.
- Lower your blood pressure and thereby reduce that continuous pounding on your blood vessels.
- Sport and exercise adequately.
- Eat plenty of vegetables, fiber, and fruit as these inhibit inflammatory processes.
- Lower your cholesterol because this will make the core of the plaques less fluid.
The more fluid the core of the plaque and the thinner the capsule, the greater the likelihood of capsule rupture.
Until twenty years ago, scientists had to resign themselves to the fact that plaques could not be reduced. However, that understanding has been updated with the advent of statin drugs.
These drugs enabled cholesterol levels to be significantly reduced, effectively reducing existing plaques.
However, we must make it clear that the ultimate goal is not to reduce the size of plaques.
If plaques remain simply stable via lifestyle improvement and/or medication and thus do not start to grow nor tend to rupture, they remain asymptomatic.
And at that point, a person is also at less risk of cardiovascular disease, and quality of life is maintained!
Reduced overload and inflammatory processes will cool down. You then give your repair mechanisms a chance to make a firm capsule and keep the plaque stable and complaint-free.
Decreasing overload is simply a synonym for improving your risk profile.
So stop smoking, start exercising more, lower your blood pressure, eat plenty of fiber, fruits, and vegetables, and lower your cholesterol.
In this way, inflammatory processes decrease, and you lower the risk of artery blockage.
What is a heart attack?
A myocardial infarction is the death of a piece of heart muscle because a plaque has ruptured in the supplying coronary artery on which a clot has formed.
Cardiac muscle cells can only go without oxygen for a limited time. So from the moment a sealing clot forms in one of the crown arteries, the clock starts ticking.
Within about 30 minutes, the first heart muscle cells die.
And after 4 to 12 hours without oxygen, an infarction is complete, and there are usually no cells left to save in the infarct zone...
Thus, a crown artery to the heart occluded by a blood clot must be reopened as soon as possible, preferably within 4 hours.
Complete removal of the clot should not be the main focus. Initially, it is more important that the blood supply is quickly restored.
The treating physician can inject a powerful blood thinner, which dissolves the clot.
Or the doctor may decide to open the blood vessel using a balloon, with or without a stent (using a metal or plastic tube).
This is the so-called Dotter treatment or cardiac catheterization.
That approach where a stent is inserted by the doctor through a catheter (a long thin tube) is applied very frequently today.
If blood flow is restored within 4 to 6 hours, there is a real chance that tissue damage can be limited, and the consequences are still minor. And sometimes, timely catheterization can even prevent an infarction.
How to recognize and delay a heart attack?
First and foremost, as a patient, you must recognize that you may be experiencing a heart attack.
The biggest alarm symptom of a heart attack is a constrictive, pressing pain in the chest that does not go away after 20 to 30 minutes.
This pain is often, but not always, accompanied by nausea and sweating, shortness of breath, and/or radiation to the arm.
Don't hesitate for a second and immediately contact your primary care physician and/or call emergency services to initiate an emergency admission.
A blood draw and electrocardiogram will follow once you are in the emergency room.
Suppose the electrocardiogram shows that a blood vessel may have been occluded. In that case, immediate action is taken with medication and usually cardiac catheterization to minimize the infarction.
Time is muscle
In cardiology, this is known by the slogan: "Time is muscle."
Every hospital has protocols to keep the door-to-needle time as short as possible so that you are on the operating table (needle) within 60 minutes of walking in (door).
Those who are good at math know that there is not much time because, within the 4 hours, you have to do the following things:
- Recognize that you may have a heart attack.
- You must sound the alarm and call the emergency services (minimum 20-30 minutes on average).
- Next, you need to reach the emergency room quickly (ideally, you are not too far away from the hospital at that point?).
- In the emergency room, one must recognize the heart attack (which is not always easy).
- One must then start medication, and the team for cardiac catheterization must be convened (with an internal target of fewer than 60 minutes in the hospital).
Hesitating or slowing down is out of the question for symptoms
It is possible to be helped with a heart attack within a 4-hour time frame. Still, there should not be much hesitation or delay between the time of symptoms and treatment at the hospital.
The main delays usually occur outside the hospital. Unfortunately, stories often surface of people who experience chest pains at 3 a.m. but wait until 7 a.m. to call emergency services.
So don't hesitate if you have symptoms of a heart attack. It is better to be sure and play it safe!
There are smaller and larger heart attacks
Surrounding the heart are 3 large crown arteries, each branching off into smaller side branches. This structure is actually best compared to the branches of a tree.
The closer the clot forms to the origin of the coronary arteries, the greater the heart attack.
You can compare this to damage to a twig high up in a tree that will only affect a small part of the crown and damage close to the trunk that will affect a considerable part of the tree.
And the larger the heart attack, the more likely you are to lose a good quality of life afterward.
What is a stroke or brain thrombosis?
A cerebral thrombosis, stroke, cerebral infarction, or CVA (cerebrovascular accident) are all synonyms.
These terms all refer to the situation where a clot forms that obstructs one of the brain arteries causing part of the brain to die.
This manifests itself in typical symptoms where a person loses a specific body function from one moment to the next. Some examples are as follows:
- Suddenly one half of your face has become motionless.
- Suddenly, one arm hangs by your side uncontrollably.
- Or suddenly losing control of your speech.
The underlying mechanism of the loss of a body function is the same...
A plaque forms a clot that suddenly closes a blood vessel to the brain. The type of loss of function depends on the task of the affected part of the brain.
Strokes can have a devastating effect on the lives of the affected patient and those around him.
More so, strokes are the most common cause of disability in the Western world.
Strokes are much more challenging to address than a heart attack and require a different medical approach.
Brain cells are a lot more active, so they succumb after only a few minutes without oxygen...
So the deterioration of these brain cells is much faster than for heart muscle cells.
Doctors who administer medications such as blood thinners to dissolve blood clots should also proceed with great caution because those drugs increase the risk of a brain hemorrhage.
And an additional brain hemorrhage at such a time can have particularly catastrophic consequences for the patient.
Differences between stroke and myocardial infarction
Although a stroke is very similar to a heart attack, there are still a few differences that one should keep in mind.
Some strokes occur because a clot is ejected from the heart to the brain and not because a clot forms on a plaque.
This happens when people have a specific type of cardiac arrhythmia, such as atrial fibrillation.
If someone has to take blood thinners because of an irregular heartbeat, it is often someone with atrial fibrillation.
The blood thinner is very important here because it can significantly reduce the risk of stroke.
A small proportion of strokes are not the result of a clot but instead of a brain hemorrhage (this is a situation that is often even more dangerous for the patient).
What is the link between arterial calcification and sudden death (a heart artery rupture)?
Sudden death is also sometimes called a coronary artery rupture.
Although there are many possible causes of a heart vein rupture, by far the most common form is a deadly heart attack.
At the time of the heart attack, part of your heart muscle is no longer receiving oxygen.
As a result, the heart can no longer perform its function. It can no longer pump, or properly conduct the electrical stimuli necessary for a normal heart rhythm.
The heart is particularly vulnerable during an infarction, and an arrhythmia may occur. This is usually not a cardiac arrest but rather an extremely high heart rate.
However, with such an extremely high heart rate of 250 or more beats per minute, the heart cannot cope, so the heart actually seems to be at a standstill.
You can compare it to a squeeze of your hand. If you do this very quickly, you can easily open and close your fist 2-3 times per second.
However, if you try to do it even faster, say 8 times per second, your fist won't have time to close, and it will look more like your hand is shaking.
In the heart, actually, the same thing happens, and this is then called fibrillation of the ventricles.
However, these extremely fast heartbeats extinguish after a few minutes and then lead to actual cardiac arrest.
The term cardiac arrest is used both for the extremely fast heartbeats where the heart is more likely to be shaking and for an actual arrest because the heart is actually no longer pumping in both cases.
A defibrillator as an intervention
In the minutes after such a cardiac arrest occurs, a defibrillator can be used to stop this arrhythmia as it delivers an electric shock.
Hence the increasing importance of having access to such a defibrillator within the first few minutes of cardiac arrest.
These publicly accessible devices are called AEDs (Automatic External Defibrillators).
In many public places (fitness centers, airports, businesses, sports stadiums, schools, train stations, government buildings, etc.), these devices are hung in clearly marked cabinets.
They are not difficult to use and even give you spoken instructions. So don't hesitate if you witness a cardiac arrest to get the device out and use it.
In fact, you can really save a life with it. Besides, you can't do anything wrong with such a device!
An AED contains a computer that will deliver the electric shock only when such a life-threatening arrhythmia is recognized.
CPR as an intervention
Another life-saving intervention is to give CPR to someone in cardiac arrest. This can be done through chest compression and ventilation.
This will maintain blood flow and bridge the period until medical help (with a defibrillator) arrives.
Thus, most sudden deaths are due to infarctions that often trigger cardiac arrest within the first few minutes.
The sooner you seek medical attention, the sooner a defibrillator can be with you.
This is partly why it is so important to be in the emergency room as soon as possible in the event of an infarction.
What does a coronary artery rupture mean?
What about a coronary artery rupture? What exactly is that, and how does it work?
That commonly used term is actually incorrect because your arteries around the heart don't rupture. Instead, the term simply refers to sudden death, usually from a heart attack.
But why, then, does the term coronary artery rupture persist when referring to sudden death, usually due to infarction? Because in practice, it is reassuring.
At the moment of sudden death, everyone is so upset that a correct explanation of infarcts and arrhythmias is not what people need at that time.
Coronary artery rupture is more than a diagnosis for those people, meaning so much more.
Indeed, it also suggests that the suddenly deceased person did not suffer.
It also implies that no one could have predicted this, that no one is to blame, and that this sudden death was not preventable.
The term coronary artery rupture provides less stress in a very stressful moment.
Remember, however, that other than "he or she did not suffer," the other statements are incorrect. In practice, there is a great deal that can be prevented.
Other causes of sudden death
As stated earlier, most sudden deaths are actually heart attacks. So there are other rarer forms of sudden death.
On the one hand, these are arrhythmias that do not occur at the time of infarction. In people with normal (undamaged hearts), this is often an innate susceptibility to this arrhythmia.
In practice, it is often seen that severely damaged, weakened hearts are more susceptible to life-threatening arrhythmias that can occur spontaneously.
The latter group is often already known to the cardiologist. Here, one can preventively implant a type of pacemaker (this is an internal defibrillator) capable of treating very slow and very fast arrhythmias.
As a final form, you have an aneurysm (a weakness in an artery) or widenings of the aorta (the large body artery) that can effectively rupture.
The latter is a dramatic moment where the victim usually bleeds to death quickly, but it is fortunately quite rare.
What role does hereditary burden play in artery blockage?
Hereditary predisposition certainly plays a crucial role in the development of cardiovascular disease.
Except for some rarer diseases where only one particular gene is abnormal and causes the disease, for most of us, hundreds of genes have small abnormalities (variants) that contribute to our risk profile.
However, it is only rarely written in your genetic material, or DNA, that you will get cardiovascular disease.
Usually, from your DNA can be concluded only: "You are more predisposed to cardiovascular disease." And that, of course, is a vital difference.
In other words, most of us do not inherit cardiovascular disease from our parents. What we do inherit, for example, is the following:
- Tendency to develop diabetes more quickly when overweight.
- Somewhat higher cholesterol (which is strongly hereditary).
- Tendency to develop obesity more quickly.
- Tendency to develop higher blood pressure.
In other words, you inherit a risk picture from your parents but with it, not the disease itself.
If you are burdened with some genes that can give you higher blood pressure, you can keep a closer eye on your blood pressure.
And if the blood pressure is too high, you can have it treated.
You then no longer have high blood pressure, and those particular genes do not contribute to your risk profile anymore.
You can inherit high cholesterol, but through dietary efforts and/or medication, you can still lower your cholesterol and thereby reduce the impact of that inherited burden.
The same goes for being overweight.
You may have to watch your diet more than an average person and put in a little more effort. But with a bit of extra effort, you can still maintain a healthy weight.
Genetics load the gun, but your lifestyle pulls the trigger!
In other words, you can often avoid your hereditary load with a little extra effort and attention to your weak spot!
What is the role of cholesterol on atherosclerosis?
Cholesterol is one of the main factors driving the process of artery blockage. In fact, high cholesterol levels accelerate and worsen this body process.
Related: Lowering cholesterol levels refers to the so-called "bad" cholesterol. Not all cholesterol is bad though, learn all about it in our other post What Is the Difference Between Good and Bad Cholesterol Exactly?
But cholesterol is not the only culprit. If anything, high blood pressure, smoking, and diabetes have an even greater impact on an individual.
But cholesterol does require extra attention because elevated cholesterol levels are much more frequent in the population.
An estimated 65% in the US today struggle with excessively high cholesterol. By comparison, the percentages of diabetics and smokers are much lower than that.
In other words, by focusing prevention on cholesterol, we immediately reach a much larger portion of the population that can make health gains.
Which does not change the fact that treating high blood pressure, quitting smoking, exercising and exercising more, eating more healthy food, and diabetes prevention are equally important.
Thus, prevention of atherosclerosis or artery blockage is definitely not an either-or story but rather a both-and story.
Artery blockage: Conclusion
A plaque is not simply a passive accumulation of cholesterol and fat.
A plaque consists of a core or a buildup of cholesterol, calcium, and inflammatory cells and a capsule that seals that liquid core from the cavity of the blood vessel.
This inflammatory process, which is the body's attempt to heal the wound and remove the plaque, can cause the capsule to be eaten away.
And when that capsule suddenly ruptures, those liquid contents of the plaque enter the bloodstream.
This immediately and very suddenly causes a blood clot that seals the blood vessel and drains the tissue that depends on that blood vessel.
If this happens in the brain, it causes a stroke. If this occurs in the heart, it's an infarction.
Thus, heart attacks, strokes, and most sudden deaths have a similar underlying mechanism: arterial calcification, where a clot suddenly forms on such a calcification, closing off this blood vessel.
Reduce the overload, and the inflammatory processes will cool down. You then give your repair mechanisms the chance to make a firm capsule and keep the plaque stable and complaint-free.
Reducing the overload means, for example, exercising and moving more, quitting smoking, lowering your blood pressure, eating enough fiber, fruits and vegetables, lowering your cholesterol, etc.
The vast majority of sudden deaths are actually heart attacks. The heart is particularly vulnerable to arrhythmias during an infarction, and cardiac arrest may occur.
Heredity definitely plays a role, but except for some more exceptional conditions, in most cases, you inherit only a risk profile and not the disease itself.
In other words, you are not doomed from birth! Because between having a predisposition and actually developing cardiovascular disease, there are many intermediate steps.