Atherosclerosis as a multi-systemic pathology affecting people all around the world, it is the main death cause in developed countries, through its acute clinical manifestations. The authors report a clinical case of a 52 year-old man, with a prior medical history of hypertension and dyslipidaemia, with a detected high blood pressure only in the right arm in a medical appointment. We studied the different vascular territories which are more frequently affected by the atherosclerotic disease, it was diagnosed left subclavian artery stenosis (related with the observed subclavian steal phenomenon), bilateral carotid occlusion, bilateral aorto-iliac lesions and left popliteal artery occlusion. The authors would like to emphasize the fact that despite the extension of the atherosclerotic disease, the patient had never had an acute vascular event, until now. They want also to emphasize the relevance of adequate and careful medical history and physical examination. That is why the internal medicine doctors must have a permanent alert attitude and consequently an active role in primary and secondary prevention of cardiovascular diseases.

Patients with an internal carotid artery occlusion have been identifi ed as having an increased risk of an ischemic stroke.Complete bilateral carotid occlusion is a rare condition.Several risk factors are involved in the development of carotid atherosclerosis.The hemodynamic consequences of cerebral blood fl ow obstruction may be reduced through the development of collateral circulatory pathways. To illustrate these points a clinical case is presented and some considerations are drawn about carotid atherosclerotic disease.

Epidemiologic data suggest a link betweenatherosclerosis and chronic infections and inflammatory conditions. During infection andinflammation, a wide range of alterations in metabolism occur. These are part of the body´s reaction known as the acute phase response (APR). Infection and inflammation can also perturb lipoprotein metabolism and produce a widevariety of changes in the plasma concentrations of lipids and lipoproteins.Eicosanoids are a group of oxygenated fattyacids with diverse and potent biological activity, produced from the fatty acids. The varietyof eicosanoids products and their correspondingly diverse physiological effects have been well characterized, and probably represent the best-understood relationship between lipids and biological function. Consequently, attempts tomodulate the production of eicosanoids musttarget either the enzyme activities responsible for synthesizing eicosanoids or the concentration of fatty acids substrate entering biological system through the diet.

The authors briefl.y describe the chronologic process of atherosclerosis and review, trying to integrate the known theories of atherogenesis, the usual evolution of the atherosclerotic plaque. ln the first part of this work only six theories are reviewed, namely the response-to-retention hypothesis, the lipid hypothesis, the monoclonal theory, the encrustation or haemostasis theory, the response-to­ lesion or Ross theory and the oxidative hypothesis.

The authors carry on the discussion about some of the theories concerning atherogenesis, reviewing, in this second part, the scientific evidence of the immunologic theory, the role of calcium in this process, the importance of infections, the fatigue hypothesis of Stehbens, and the role of hemodynamics. Finally the overall conclusion is that all theories contribute to atherogenesis, with more or less relative weight.

Epidemiologial studies show a significant inver­ se correlation between fish consumption and athe­osclerotic disease. lmportant fraction of fish oil polyunsaturated fJ.-3 fatty acids may be the media­ tors ofthis effect, particularly eicosapentanoic acid, mainly through their hypolipidaemic, antiinflam­ matory antiaggregatory, and antithrombotic acti­ on, and by increasing tissue perfusion. Fish oil con­centrates are almost entirely harmless, with the only hypothetical exception of diabetes, as they may worsen glycemic controL

The relation between arterial hypertension and coronary artery disease is analysed. The importance of other concurrent risk factors of atherosclerosis and the less remarkable effi- cacy of antihypertensive treatment in what concerns coronary artery disease are both em­ phasised. Endothelial dysfunction related to several risk factors is mentioned as a key factor to functional and structural alterations of coronary arteries. Coronary pathophysiology in hypertensive heart disease is further discus­sed and several mechanisms responsible for ischemia, mainly subendocardiat in left ven­tricular hypertrophy, are described. Special emphasis is given to the potential importance of prevention and regression of left ventricu­lar hypertrophy and interstitial fibrosis in improving coronary reserve and ventricular function. Finally, the therapeutic measures available to potentially break the causal link between arterial hypertension and coronary artery disease are refereed.

Introduction: Cardiovascular diseases are a high risk of mortality in the population and are inherent to several factors. The main responsible for this disease is atherosclerosis, is due to different risk factors such as dyslipidemia, hypertension, obesity, age, gender, among others. For diagnosis and evaluation of carotid atherosclerosis there are tests such as Triplex Cervical Scan. Methods: The sample consists of 569 individuals, who performed Triplex Cervical Scan in 2019, at the Laboratory of Cardiac and Neurovascular Ultrasound, located at the Hospital do Espírito Santo, in Évora. Results: The sample included 569 individuals, with a mean age of 78 years. The most prevalent cardiovascular risk factors were HTA and dyslipidemia. In the relationship between dyslipidemia and increased severity of the degree of stenosis, statistical significance was proven between the risk factor dyslipidemia with the right carotid axis and the left vertebral artery. Of the individuals with dyslipidemia at the level of the left carotid axis, 25.8% had carotid atherosclerosis without hemodynamic repercussion. Regarding the statistical significance between cardiovascular risk factors and the presence of atherosclerosis with a higher degree of severity, only correlation with the age factor was proven. Discussion: In the study sample, most individuals present several cardiovascular risk factors, and the highest prevalence was recorded in hypertension and dyslipidemia, since they exist in more than half of the sample population. Conclusion: With the present study, it is possible to conclude that in this sample there is a prevalence of several risk factors in individuals with iim values above normal. The age factor that proved to be quite influential in the presence of atherosclerosis. Of the individuals with dyslipidemia more than half have atherosclerosis, at its earliest stage.

Introduction: Aortic dissection (AD) is a disease of the medial layer of the vessel, where a false lumen is created. Among the main risk factors, the following stand out: male gender; atherosclerosis; hypertension; smoking. 1 Abdominal aortic aneurysms (AAA) are defined as having a diameter greater than 30 mm and are located almost exclusively in the infra-renal region.4 They are more common in men over 60 years of age. The main risk factors are also: hypertension; smoking and atherosclerosis.4 The case presented below compiles these two pathologies and explains the difficulty of their diagnosis, in an environment with limited physical resources. Case description: Male, 56 years old, hypertensive and an active smoker. He was admitted to the permanent care service with severe knife-like abdominal pain radiating to the right flank with 2 days evolution, associated with nausea and vomiting. On objective examination, he presented an Arterial Pressor: 140 / 95mmHg; Heart Rate: 101 bpm; the abdomen “in plank” and a pulsating abdominal mass was palpable. In the analytical study: normocytic normochromic anemia with increased inflammatory parameters. He was emergently transported to the referral hospital, where he underwent an abdominal and pelvis CTA that revealed: “ Stanford type B aortic dissection, starting in the arch and up to the iliac bifurcation. The dissection is associated with a large aneurysm (8.7 cm), just below the origin of both main renal arteries “. He was then transported to a hospital in mainland Portugal, where he underwent surgery. Conclusion: When we come across a male patient, over 50 years old; an active smoker with hypertension and dyslipidemia, it is important to sound the vascular disease alert! The patient presented with signs and symptoms for which we must always be aware and suspect an aortic aneurysm: abdomen with signs of peritoneal irritation, pulsatile mass, in a smoker and with uncontrolled hypertension. Despite being a difficult diagnosis, these patients need emergent intervention, being crucial given their suspicion, the transfer to a hospital. Although the AD diagnosis was accidental, the authors emphasize that dyslipidemia, hypertension and smoking are risk factors for AD and that, if not diagnosed and treated in a timely manner, can result in death. The authors would like to emphasize the importance of controlling CVRF and that is recommended AAA screening with echography2 for all men between 65 and 75 years of age, with a history of smoking. Only this way is possible to prevent emergent complications, which in situations of insularity, are even more difficult to manage. Despite the difficulties that doctors have in carrying out urgent care services in a place with few imaging resources it is crucial to have a good cooperation and communication with reference hospitals, so that these patients do not remain in a local health unit with qualified healthcare professionals but with limited physical resources.

Background: Conventional risk factors do not explain completely the atherogenic process. Chronic Helicobacter pylori (HP) infection may cause arterial inflammation and has been epidemiologically linked to the occurrence of atherosclerosis. Studies about the association of HP infection with peripheral arterial disease are limited. Objective: Evaluate the presence of HP using a monoclonal antibody anti-HP in the atherosclerotic plaques of the superficial femoral artery in patients submitted to amputation above-knee. Material and methods: We searched for the presence of HP in 29 non-consecutive patients with Leriche-Fontaine grade IV lower limb ischemia, submitted to amputation above-knee. Femoral artery was isolated and an atherosclerotic plaque specimen immediately distal to the amputation level, was removed, fixed in formalin and evaluated for HP, using a mono clonal antibody, anti-HP. Results: The mean age of the 29 patients was 82 years. 18 were men (62.1 %). Risk factors for cardiovascular disease were present in the majority of patients. Only one patient had known history of HP infection in the past. Morbidity rate was 30%. The mortality rate was 13.8 % (4 cases). In all cases, anti-HP showed no evidence of HP at the atherosclerotic plaque. Discussion/Conclusion: HP infection has been associated both epidemiologically and pathogenetically with atherosclerosis. However, HP was not found in this study at the atherosclerotic plaques of the superficial femoral artery.