Diseases of Blood Vessels

Atherosclerosis

·        Progressive inflammatory disease of the arterial walls that leads to obstruction.  This obstruction leads to inadequate supply of blood/oxygen for the body’s demands.

·        Affects a variety of organ systems

o       Cardio: coronary arteries, aorta

o       Neuro: causes Cerebrovascular Accident/Transient Ischemic Attack

o       Renal: causes renal artery stenosis

o       Peripheral vascular system: causes claudication and limb ischemia (both discussed at the end)

·        Atherosclerosis takes many decades to progress

o       Fatty streaks begin when you’re in your 20’s

o       Intermediate lesions/atheromas start forming in your 30’s

o       Fibrous plaques, complicated lesions, and ultimately rupture of the lesions occurs in your 40’s

Secondary Prevention of Coronary Artery Disease - (stable angina and acute coronary syndrome)

·        So the patient has a history of cardiac problems (e.g., Myocardial Infarction).  Given this information, how can a repeat cardiac event be prevented?

·        Aspirin: cheap; decreases risk of future MI’s by 25%

·        b-blockers: reduce long-term mortality

·        Statins: decrease LDL/triglycerides; leads to decreased risk of death, re-infarction, Cerebral Vascular Accident

·        ACE-inhibitors: decrease risk of heart failure

·        Smoking cessation: 5-year mortality of smokers is double that of non-smokers
 

Peripheral Arterial Disease

·        Risk factors: similar to Coronary Artery Disease (Hypertension, tobacco, Diabetes Mellitus, hyperlipidemia)

·        60% of people with peripheral arterial disease also have Coronary Artery Disease

·        Lower limb ischemia occurs more frequently than upper limb ischemia

·        Like in Coronary Artery Disease, blood/oxygen supply does not meet the body’s demands

• ·        Intermittent claudication

o       Patients will present with cramping in calf/thigh/buttocks that is resolved after resting

o       Symptoms are reproducible (i.e., patient will walk a half block and get cramps; after 5 mins of rest, cramps will resume after another half block of walking)

·        Complications of Peripheral Arterial Disease

o       Critical limb ischemia: experience pain all the time, even at rest; may have tissue necrosis/gangrene

o       Diabetic vascular disease: almost 40% of people with critical limb ischemia have Diabetes Mellitus; typically see microangiopathy (destruction of small blood vessels)

o       Difficult management: debridement, revascularization (via stent), amputation

·        Treatment

o       Walking therapy: when you feel pain, just keep walking

o       Stop smoking

o       Antiplatelet therapy (aspirin or clopidogrel—PlavixÒ)

o       Statins to decrease cholesterol

o       Control Diabetes Mellitus and Hypertension

Aortic Aneurysm

·        Abnormal dilation of aortic wall

·        Etiology: Hypertension, tobacco, genetic, Marfan’s Syndrome

·        Clinical features

o       Often asymptomatic, and an incidental finding during another procedure

o       In non-Marfan’s patients, see aortic aneurysms in the elderly

o       In patients with risk factors, can do prophylactic ultrasound

·        In patients with a chronic aortic dissection, can have a “dance” between dissection and aneurysm, leading to “pushing in” followed by “pushing out” of aorta

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