Which physical 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

As previously mentioned, the symptoms of noncoronary atherosclerosis are highly variable. Patients with mild atherosclerosis may present with clinically important disease signs and symptoms, while many patients with anatomically advanced disease display no symptoms and have no associated functional impairment.

The physical signs of noncoronary atherosclerosis provide objective evidence of extracellular lipid deposition, stenosis or dilatation of large muscular arteries, or target organ ischemia or infarction. These symptoms include the following:

  • Hyperlipidemia – Xanthelasma and tendon xanthomata

  • Cerebrovascular disease - Diminished carotid pulses, carotid artery bruits, and focal neurologic deficits

  • Peripheral vascular disease - Decreased peripheral pulses, peripheral arterial bruits, pallor, peripheral cyanosis, gangrene, and ulceration

  • Abdominal aortic aneurysm - Pulsatile abdominal mass, peripheral embolism, and circulatory collapse

  • Atheroembolism - Livedo reticularis, gangrene, cyanosis, ulceration, digital necrosis, gastrointestinal bleeding, retinal ischemia, cerebral infarction, and renal failure

The Copenhagen City Heart Study found that xanthelasmata (raised yellow patches around the eyelids) but not arcus corneae (white or grey rings around the cornea) constitutes an independent risk factor for cardiovascular disease. Presence of xanthelasmata indicated increased risk for myocardial infarction, ischemic heart disease, and severe atherosclerosis. [6]

With regard to atheroembolism, the presence of pedal pulses in the setting of peripheral ischemia suggests microvascular disease and includes cholesterol embolization.


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