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March 1957

A Hemodynamic Concept of Atherosclerosis, with Particular Reference to Coronary Occlusion

Author Affiliations

New York

Lecturer, Department of Forensic Medicine, New York University Post-Graduate Medical School; Milton Helpern, M.D., Professor and Chairman of the Department.

AMA Arch Intern Med. 1957;99(3):418-427. doi:10.1001/archinte.1957.00260030100010

The primary relation of hemodynamics to the inherent pathology of atherosclerosis is the subject of the present communication. Hemodynamic factors can account for the characteristically patchy distribution of atherosclerotic lesions and the relative freedom from atherosclerosis in apparently identical adjacent areas of intima. Local factors, based upon the laws of hydrodynamics, can account for the varied pathologic appearance of arterial occlusive disease in the aorta and coronary arteries, as well as in arteries of the viscera and extremities.

The distribution of atherosclerotic lesions indicates strongly that there are certain points of predilection. Such points of predilection are determined by the nature of the motion of fluids, in this case the blood. The incidence and degree of atherosclerosis at typical areas of predilection have been recorded in 100 consecutive autopsied cases (Table). Hemodynamic atherosclerotic lesions occurred in more than one location in 90% of cases examined. The incidence, location, and degree