Which clinical history findings are characteristic of noncoronary atherosclerosis?

Updated: Dec 23, 2019
  • Author: F Brian Boudi, MD, FACP; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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Answer

Answer

The symptoms of noncoronary atherosclerosis are highly variable. Patients with mild atherosclerosis may present with clinically important symptoms and signs of disease. However, many patients with anatomically advanced disease may have no symptoms and experience no functional impairment.

Although atherosclerosis was initially thought to be a chronic, slowly progressive, degenerative disease, it is now apparent that the disorder has periods of activity and quiescence. Although a systemic disease, atherosclerosis manifests in a focal manner and affects different organ systems in different patients for reasons that remain unclear.

Stroke, reversible ischemic neurologic deficit, and transient ischemic attack are manifestations of the impairment of the patient’s vascular supply to his or her central nervous system and are characterized by the sudden onset of a focal neurologic deficit of variable duration.

Peripheral vascular disease typically manifests as intermittent claudication, impotence, and nonhealing ulceration and infection of the extremities. Intermittent claudication describes calf, thigh, or buttock pain that is exacerbated by exercise and relieved by rest. Intermittent claudication may be accompanied by pallor of the extremity and paresthesias. (A patient with limb claudication can be assumed to have a significant atherosclerotic plaque burden in multiple vascular beds, including the coronary and cerebral vessels. In evaluating preoperative risk in such a patient, pay particular attention to careful risk stratification and medical or interventional efforts to reduce this risk.)

Visceral ischemia may be occult or symptomatic prior to the signs and symptoms of target organ failure.

Mesenteric angina is characterized by epigastric or periumbilical postprandial pain and may be associated with hematemesis, hematochezia, melena, diarrhea, nutritional deficiencies, and weight loss.

Abdominal aortic aneurysm typically is asymptomatic prior to the dramatic, and often fatal, symptoms and signs of rupture, although patients may describe a pulsatile abdominal mass.


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