Atherosclerosis (stenosis and occlusion) of the carotid arteries

Every modern person must know the minimum practical medical actions that can be applied in an emergency situation. It is especially important to understand the location of the main organs, bones, and arteries.

In medical practice, cases are often described when people of any age lose consciousness or simply lie on the ground, without any signs of a normal condition. In this case, the person needs to feel for a pulse in the carotid artery. If it is absent, it is necessary to perform artificial respiration.

What is the carotid artery? It is important to understand the process that it carries out. The carotid arteries direct blood to the brain, and its amount accounts for 70% of the total volume. The name of these vessels is directly related to their ability to put the human body into a state of sleep, when compressed with a certain force for a period of 10 seconds.

What happens if you press on an artery: instructions

When you squeeze it lightly, you feel discomfort and sometimes mild pain. Strong compression easily puts a person to sleep. Receptors perceive pressure as a stimulus to increase pressure, so they do the opposite - they sharply lower it. A person’s heartbeat calms down on the neck, and due to the minimal supply of oxygen, the body experiences drowsiness. Long-term and severe compression of the carotid artery can be fatal.

Typically, a person's pulse is checked on their arm. But in complex traumatic cases this is not enough. Therefore, the pulse is felt in the neck. It should be noted that the pressing force must be controlled. On a thin body, the pulse will be clearly felt even with weak pressure, but if you have developed muscles, you will have to try.

general characteristics

The symptom is caused by jerky contractions of the walls of the carotid arteries or veins of the neck.
Arterial pulsation develops due to increased cardiac output and increased pulse pressure. It remains stable in any position of the body and is well felt when palpated. Sometimes combined with contractions of the temporal and brachial arteries, less often – small peripheral vessels. The patient's head sways in time with the pulse. The pulsation of the veins is provoked by stagnation of blood when the pressure in the SVC system increases. A distinctive feature is the lower force of contractions and the absence of sensation of a pulse wave upon palpation. The veins of the neck are visually dilated, increasing on inspiration, with pressure on the area of ​​the right hypochondrium. Supplemented by pulsation in the epigastric zone.

The following options for pulsation of neck vessels are distinguished:

• caused by physiological factors;
• pathological arterial pulsation: aortic insufficiency, aortic aneurysm, arterial hypertension, hyperthyroidism;
• pathological venous pulsation: diseases of the heart and pericardium, lesions of the pericardium, pulmonary arteries and large veins, diseases of the respiratory system.

Structure of the carotid artery

The common carotid artery and its branches are divided into two halves: on the right side of the body it passes in the neck from the brachiocephalic trunk, and on the left, it comes from the aortic arch in the thoracic region. To understand where the carotid artery is located in a person, you need to feel the pulse in the neck, you need to press the vertical depression in the neck on the right or left side. Everything is clearly shown in the photo.

Medical students often wonder where the carotid artery is located in the neck? To feel the pulse of the carotid artery in the neck, you need to lay the person down or sit on a chair. Place several fingers, usually the middle and index fingers, in the cavity between the Adam's apple and the lateral neck muscle.

Normal heart rate values ​​are about 60-80 beats per minute. Each of the arteries runs diagonally upward; in the lower part they are connected by the trachea.

External carotid artery

The paired organ provides brain tissue with 55 ml of blood per 100 g. tissue, and also saturates with oxygen molecules 3.7 ml per minute. Such provision is considered normal. The external artery in humans is located slightly higher from the larynx, closer to the face, and is part of the front of the head.

In the area of ​​the Adam's apple, the artery diverges to the front and back of the head. The first directs blood flow to the eyeballs, the second to the brain cells. The external artery consists of:

1. front end;
2. medial part;
3. rear end;
4. terminal branches - a system of capillaries directed to the eyes and into the oral cavity.

Proof of the presence of a capillary network is the redness of the face. In stressful situations, excessive physical strain, and hot weather, blood rushes to the skin. For some, this effect is practically unnoticeable, for others it is clearly pronounced. This is influenced by genetic predisposition, skin properties, etc.

The external artery directs blood to the following organs:

• thyroid;
• auricles, tympanic cavity;
• eyes;
• facial muscular system, ligaments;
• skin of the face and head;
• some parts of the meninges, the occipital vessel;
• roots of teeth, soft palate, lingual vessels.

The branches of the external artery do not send blood directly to the brain. However, pathologies in the functioning of blood vessels can lead to negative consequences. All that can be done if the external artery is malfunctioning is to contact a neurosurgeon.

In some cases, plastic surgery is required. What diseases can appear if the artery malfunctions:

1. Benign tumors in the facial and cervical regions.
2. Arteriovenous pathology is the connection between an artery and a vein (blood does not flow into many capillaries).
3. Congenital malformation of blood vessels. Signs are external facial defects, migraines and regular pulsation in the head at night, bleeding from large arteries that cannot be stopped.

As a rule, such diseases arise due to dangerous facial injuries, plastic surgery on the nose, ears, throat, etc. Also, there is a high probability of pathologies occurring due to improper implementation of basic procedures.

For example, aesthetic punctures, rinsing the sinuses, tooth extraction, cosmetic injections in the eye area. Rare cases of the disease can cause hypertensive complications.

Diagnostics

Diagnostic measures are carried out by a cardiologist. If the respiratory system is involved, a pulmonologist is involved in the examination. Patients with thyrotoxicosis are referred for consultation to an endocrinologist. When collecting anamnesis, attention is paid to the presence of heart and lung diseases, which can provoke secondary pathologies accompanied by pulsation of the cervical vessels.

The survey identifies complaints of shortness of breath, increased fatigue, rhythm disturbances and other changes indicating the nature of the disease. During the examination, the type of vascular pulsation is determined (arterial or venous), neck swelling, dilatation of superficial veins, increased blood pressure, peripheral edema and other manifestations are identified. Percussion and auscultation of the heart and lungs are performed. The additional examination program includes the following procedures:

• ECG.
  Basic research for suspected diseases of the cardiovascular system. Helps determine the type of arrhythmia, confirm myocardial ischemia or hypertrophy. To assess the reserve capacity of the heart muscle, load tests (treadmill test, bicycle ergometry) are used.
• Echocardiography.
  An imaging method that allows you to evaluate the morphological and functional features of the heart. It is used in the diagnosis of aortic and tricuspid insufficiency, aneurysm and coarctation of the aorta, endocarditis, and other cardiac pathologies. Makes it possible to determine the presence and amount of effusion during cardiac tamponade.
• Radiation techniques.
  X-ray of the OGK confirms cardiomegaly and pulmonary congestion in diseases accompanied by heart failure. Used to determine the nature and severity of pulmonary pathology. In case of pulmonary embolism, pulmonary angiography is recommended, in case of SVPV, venocavagraphy is recommended. In some cases, chest CT and cardiac MRI are indicated.
• Other hardware research.
  If kidney disease is suspected, causing arterial hypertension, a kidney ultrasound is prescribed. In patients with severe heart failure, an abdominal ultrasound is performed to evaluate the condition of the internal organs. For diseases of the respiratory system, spirography is performed. To clarify the causes of SVPV, an ultrasound scan of the neck vessels is performed.
• Lab tests.
  In patients with heart failure, protein-carbohydrate metabolism is examined, creatinine, urea, COS, gas and electrolyte composition of the blood are determined. In case of renal pathology, the indicators of the nephrological complex are assessed. In case of lung diseases, sputum analysis is carried out; according to indications, a morphological examination of a biopsy specimen or a cytological analysis of rinsing water is carried out.

Ultrasound of neck vessels

Internal carotid artery

The branch of the internal artery is directed through the temporal bone. The strength of blood flow increases due to external and internal factors. The number of oxygen molecules entering the brain with the blood exceeds the norm and a person feels a surge of strength, energy for work and other vigorous activities.

But a long process can lead to the opposite - a person feels a loss of strength, drowsiness and fatigue. Oxygen must be supplied normally - excess or deficiency harms the body. Components of the internal artery:

• cavernous - in the dura mater;
• cervical - located deep under the muscle layer;
• part in a torn hole;
• brain;
• stony - laid in the bone canal.

The artery runs laterally, along the edge of the pharynx, parallel to the ear gland. It is divided into small vessels. The complex system supplies brain cells well with oxygen. In the cranium, the branch of the clivus and the pituitary vessel depart from the internal artery. Small arteries are directed to:

• gray matter;
• nuclei of the medulla oblongata;
• white matter;
• cortical parts.

Pathological deformations of the carotid artery Lack of treatment for diseases such as atherosclerosis, syphilis, tuberculosis can lead to deformation of the artery. Against the background of inflammatory processes, internal tissues begin to grow, and the lining of the artery ruptures, letting blood into the area between the walls.

As a result, medical intervention can lead to narrowing of the artery, as a result, a lack of oxygen molecules provokes an ischemic stroke. The narrowing can also cause other health problems - an internal artery that twists incorrectly, or splits into three, a blood clot, or an aneurysm.

Causes of the pathological condition

There are many reasons for the development of arterial occlusion. The most common is atherosclerosis. This disease is characterized by the formation of a plaque-growth on the inner side of the vascular wall. The object consists of a cholesterol substrate, fat cells, blood cells - platelets. Plaque growth occurs at a slow pace. As it grows, the internal vascular lumen decreases. The growth itself becomes the basis for the formation of a blood clot. With the blood flow, the thrombus can move into narrower sections of the canal and block the arterial lumen. If the plaque has resulted in only a partial occlusion of the bloodstream, the flow may cause the plaque itself to rupture. This also results in overlapping of narrower areas.

Other diseases of the vascular system and heart that contribute to thrombosis of the bloodstream also lead to narrowing or blocking of the ducts. The root cause of the abnormal condition can be a bacterial infection that develops in the heart muscle, internal parts, and valves. Often, congenital disorders, acquired defects, and tumor formations of various nature play a decisive role. Anatomical tortuosity and confused configuration of the vascular network become the basis for the risk of formation of wall closure. External injuries to intracranial structures, such as traumatic brain injuries of varying severity, can also lead to abnormal degeneration of the CC network.

Associated unfavorable factors are:

• bad habits (smoking, alcoholism);
• diabetic syndrome;
• constant consumption of “heavy” foods with a high concentration of animal fats;
• excess weight gain.

Concept of carotid artery aneurysm

An aneurysm is an increase in the size of a small area of ​​an artery with an accompanying thinning of its lining. This is a very dangerous disease that can be fatal if the walls of the vessel rupture. Aneurysm can be congenital or acquired, due to muscle atrophy, prolonged inflammatory processes, etc.

What can cause a wall rupture:

• stress, prolonged nervous and physical tension;
• sudden surges in pressure;
• injury to the cervical spine or head.

Blood gradually builds up after the rupture, putting pressure on the surrounding brain tissue. Very often death occurs, but in the case of a small hematoma, the situation can be corrected with surgery.

Treatment

Conservative therapy

Treatment tactics are chosen taking into account the cause of vascular pulsation:

• Arterial pulsation of cardiac etiology.
  For aortic insufficiency, angiotensin receptor blockers, ACE inhibitors, calcium channel blockers, and diuretics are indicated. In case of aortic aneurysm, complications are prevented by prescribing lipid-lowering and antihypertensive drugs, anticoagulants.
• Arrhythmias.
  If there is a causative pathology, its etiopathogenetic therapy is recommended. Antiarrhythmic drugs from the groups of sodium, calcium and potassium channel blockers, and beta-blockers are recommended.
• Arterial hypertension.
  Diet, normalization of weight, and regular physical activity are necessary. The drug treatment regimen includes antihypertensive, hypoglycemic and lipid-lowering drugs, antiplatelet agents, and beta-blockers.
• TELA.
  Therapy is carried out in an intensive care unit. Oxygen inhalations, fluid infusions, and thrombolytics are indicated. Subsequently, heparin is used prophylactically. When pneumonia develops, antibiotics are used.
• Pericarditis.
  For bacterial infections, antimicrobial agents selected based on culture results are indicated. For hemopericardium, fibrinolytics are injected into the heart cavity, and for tumors, cytostatics are administered. For secondary pericarditis, glucocorticoids are effective.
• Pulmonary heart.
  The underlying pathology is treated. Symptomatic drugs include respiratory analeptics, mucolytics, bronchodilators. Oxygen therapy is helpful. Decompensation requires glucocorticoids. According to indications, antihypertensive drugs, diuretics, cardiac glycosides, and potassium preparations are used.
• Hyperthyroidism.
  The list of non-drug methods includes diet therapy, hydrotherapy, and sanatorium-resort treatment. Patients are prescribed thyreostatics. Sometimes radioiodine therapy is performed.

Artery disease - thrombosis: concept and characteristics

Thrombosis is a disruption of normal blood circulation in the brain. As a rule, a thrombus forms at the site where the artery branches into external and internal. In this area, blood does not move as intensely, which allows platelets to form deposits on the walls of blood vessels. What can affect platelet formation:

• congenital or acquired heart disease;
• brain damage;
• increased blood clotting;
• an autoimmune hypercoagulable state associated with the production of antiphospholipid antibodies;
• a disease associated with heart rhythm disturbances - sudden excitation and slowdown.

How does thrombosis manifest itself, symptoms:

• without any symptoms;
• sharp pain;
• subacute;
• chronic.

The patient experiences tinnitus, migraines in the head, constant pain in the cervical spine, blurred vision, the inability to chew normally due to muscle problems, and possible loss of consciousness.

Thrombosis of the internal carotid artery is characterized by a lack of sensation in the limbs, nervousness, hallucinations, inability to speak normally, and skin pain on the head. If a section of the intracranial artery is damaged, vomiting, lack of sensation in the limbs, and sleep disturbances are possible.

How to identify problems with the carotid artery When visiting a clinic, an accurate diagnosis can only be made based on research:

1. Magnetic resonance angiography.
2. Rheoencephalography.
3. Electroencephalography.
4. Computer tomography.
5. Ultrasound examination of blood vessels.

Course of the disease

Once atherosclerotic plaques appear, they will no longer be able to resolve, but only gradually progress. The rate of growth of an athersclerotic plaque depends on many risk factors, including cholesterol levels. All people over 50 years of age are recommended to undergo an annual ultrasound of the carotid arteries in order to exclude the development of atherosclerotic plaques and the risk of ischemic stroke.

With the development of complications of atherosclerosis of the carotid arteries, discirculatory encephalopathy quickly progresses. Frequent TIAs, and even more so ischemic stroke, contribute to the death of part of the brain tissue and disruption of brain function. Patients with atherosclerosis of the carotid arteries often develop vascular dementia (dementia).

After restoration of the patency of the carotid artery, the phenomena of cerebrovascular insufficiency are stopped, and the likelihood of repeated cerebrovascular accidents is significantly reduced.