Vascular disease
Encyclopedia
Vascular disease is a form of cardiovascular disease
primarily affecting the blood vessels.
Some conditions, such as angina
and myocardial ischemia
, can be considered both vascular diseases and heart disease
s .
Cigarette smoking is the major risk factor
.
s and various types of lymphocyte
s. This plaque result in obstructed blood flow leading to diminished amounts of oxygen and nutrients, that reach the target organ. In the final stages, the plaque may also rupture causing the formation of clots, and as a result strokes.
and after a physical examination
performed by a specialist.
The physical exam may be slightly different depending on the type of vascular disease that is suspected. In the case of a peripheral vascular disease the physical exam consists in checking the blood flow
in the legs or flow or the blood pressure
. During the physical examination of a cerebrovascular disease
the doctor listens with the help of a stethoscope
to detect abnormal sounds of blood flow (called bruit
) on the neck.
(carotid angiogram). This test is made by inserting a catheter
into the patient's artery
in the leg with the help of a needle through the vessels
in the abdomen and chest, until it reaches the arteries of the neck. The coronary angiogram is basically the same procedure which is however utilized for detecting cardiovascular
conditions.
The carotid duplex (carotid ultrasound) is another type of noninvasive test which uses ultrasound
waves in order to detect plaque
, blood clots
or any other type of blood flow abnormalities in the carotid arteries
. The specialists may detect hemorrhagic stroke
s with the help of a X-ray computed tomography. They are easily visualized due to the differences in density between the blood, bone and brain tissue. The CT scans are also useful in finding out abnormalities in the heart and in diagnosing cardiovascular conditions.
The Doppler ultrasound is a test used to diagnose both cerebrovascular disease and peripheral vascular disease. It utilizes high frequency sound waves that are being directed to the vein
or artery which presents abnormalities and are then detected on the Doppler.
Electroencephalography
may be required in order to detect electrical impulses in the brain by placing small metal discs called electrodes on the scalp of the patient.
The magnetic resonance imaging
technique is able to obtain 3D images of the body structure. The images are very clear and they are produced by using magnetic fields and recent computer technology. Due to the clarity of the pictures, the MRI can detect any signs of prior strokes. The MRI may also be performed on the heart if a cardiovascular disease is suspected.
A lumbar puncture
may also be performed but this is an invasive test which consists in taking a sample of cerebrospinal fluid
from the space surrounding the spinal cord
. The purpose of this test is finding traces of blood which may be due to cerebral hemorrhage.
Upon suspicion of peripheral vascular disease, the first-line study is the ankle brachial pressure index
(ABPI/ABI) which is a measure of the fall in blood pressure in the arteries supplying the legs. A ABPI value that exceeds 0.9 is the confirmation that a peripheral vascular disease is not present. If the value of the ABPI is lower than 0.8, the peripheral vascular disease exists but it is normally a mild case. On the other hand, a value below 0.5 is the proof of a serious vascular condition.
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
primarily affecting the blood vessels.
Some conditions, such as angina
Angina
Angina pectoris, commonly known as angina, is chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries . Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries...
and myocardial ischemia
Myocardial ischemia
Myocardial ischemia is an imbalance between myocardial oxygen supply and demand. Left untreated, it results in angina pectoris, myocardial stunning, myocardial hibernation, ischemic preconditioning, postconditioning, or under the most severe instances, acute coronary syndrome and myocardial...
, can be considered both vascular diseases and heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
s .
Cigarette smoking is the major risk factor
Risk factor
In epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. Sometimes, determinant is also used, being a variable associated with either increased or decreased risk.-Correlation vs causation:...
.
Background
Vascular disease is a pathological state of large and medium sized muscular arteries and is triggered by endothelial cell dysfunction. Because of factors like pathogens, oxidized LDL particles and other inflammatory stimuli endothelial cells become activated. This leads to change in their characteristics: endothelial cells start to excrete cytokines and chemokines and express adhesion molecules on their surface. This in turn results in recruitment of white blood cells (monocytes and lymphocytes), which can infiltrate the blood vessel wall. Stimulation of smooth muscle cell layer with cytokines produced by endothelial cells and recruited white blood cells causes smooth muscle cells to proliferate and migrate towards the blood vessel lumen. The process causes thickening of the vessel wall, forming a plaque consisting of proliferating smooth muscle cells, macrophageMacrophage
Macrophages are cells produced by the differentiation of monocytes in tissues. Human macrophages are about in diameter. Monocytes and macrophages are phagocytes. Macrophages function in both non-specific defense as well as help initiate specific defense mechanisms of vertebrate animals...
s and various types of lymphocyte
Lymphocyte
A lymphocyte is a type of white blood cell in the vertebrate immune system.Under the microscope, lymphocytes can be divided into large lymphocytes and small lymphocytes. Large granular lymphocytes include natural killer cells...
s. This plaque result in obstructed blood flow leading to diminished amounts of oxygen and nutrients, that reach the target organ. In the final stages, the plaque may also rupture causing the formation of clots, and as a result strokes.
Diagnosis
It can be very difficult to make a vascular disease diagnosis as there are a wide variety of symptoms that a person can carry. Vascular diagnosis is primarily made upon the symptoms, family historyFamily history (medicine)
In medicine, a family history consists of information about disorders from which the direct blood relatives of the patient have suffered. Genealogy typically includes very little of the medical history of the family, but the medical history could be considered a specific subset of the total history...
and after a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
performed by a specialist.
The physical exam may be slightly different depending on the type of vascular disease that is suspected. In the case of a peripheral vascular disease the physical exam consists in checking the blood flow
Blood flow
Blood flow is the continuous running of blood in the cardiovascular system.The human body is made up of several processes all carrying out various functions. We have the gastrointestinal system which aids the digestion and the absorption of food...
in the legs or flow or the blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
. During the physical examination of a cerebrovascular disease
Cerebrovascular disease
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process...
the doctor listens with the help of a stethoscope
Stethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...
to detect abnormal sounds of blood flow (called bruit
Bruit
Bruit is the term for the unusual sound that blood makes when it rushes past an obstruction in an artery when the sound is auscultated with the bell portion of a stethoscope.The term "bruit" simply refers to the sound...
) on the neck.
Tests and exams
In order to confirm a cerebrovascular disease, few additional tests may be required whenever there are doubts in what the diagnosis concerns. These may include tests such as the cerebral angiographyCerebral angiography
Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms....
(carotid angiogram). This test is made by inserting a catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
into the patient's artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
in the leg with the help of a needle through the vessels
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
in the abdomen and chest, until it reaches the arteries of the neck. The coronary angiogram is basically the same procedure which is however utilized for detecting cardiovascular
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
conditions.
The carotid duplex (carotid ultrasound) is another type of noninvasive test which uses ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
waves in order to detect plaque
Atheroma
In pathology, an atheroma is an accumulation and swelling in artery walls that is made up of macrophage cells, or debris, that contain lipids , calcium and a variable amount of fibrous connective tissue...
, blood clots
Thrombus
A thrombus , or blood clot, is the final product of the blood coagulation step in hemostasis. It is achieved via the aggregation of platelets that form a platelet plug, and the activation of the humoral coagulation system...
or any other type of blood flow abnormalities in the carotid arteries
Carotid artery
Carotid artery can refer to:* Common carotid artery* External carotid artery* Internal carotid artery...
. The specialists may detect hemorrhagic stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
s with the help of a X-ray computed tomography. They are easily visualized due to the differences in density between the blood, bone and brain tissue. The CT scans are also useful in finding out abnormalities in the heart and in diagnosing cardiovascular conditions.
The Doppler ultrasound is a test used to diagnose both cerebrovascular disease and peripheral vascular disease. It utilizes high frequency sound waves that are being directed to the vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
or artery which presents abnormalities and are then detected on the Doppler.
Electroencephalography
Electroencephalography
Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...
may be required in order to detect electrical impulses in the brain by placing small metal discs called electrodes on the scalp of the patient.
The magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
technique is able to obtain 3D images of the body structure. The images are very clear and they are produced by using magnetic fields and recent computer technology. Due to the clarity of the pictures, the MRI can detect any signs of prior strokes. The MRI may also be performed on the heart if a cardiovascular disease is suspected.
A lumbar puncture
Lumbar puncture
A lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid for biochemical, microbiological, and cytological analysis, or very rarely as a treatment to relieve increased intracranial pressure.-Indications:The...
may also be performed but this is an invasive test which consists in taking a sample of cerebrospinal fluid
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
from the space surrounding the spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
. The purpose of this test is finding traces of blood which may be due to cerebral hemorrhage.
Upon suspicion of peripheral vascular disease, the first-line study is the ankle brachial pressure index
Ankle brachial pressure index
The Ankle Brachial Pressure Index , known more commonly as an ABI, is the ratio of the blood pressure in the lower legs to the blood pressure in the arms. Compared to the arm, lower blood pressure in the leg is an indication of blocked arteries...
(ABPI/ABI) which is a measure of the fall in blood pressure in the arteries supplying the legs. A ABPI value that exceeds 0.9 is the confirmation that a peripheral vascular disease is not present. If the value of the ABPI is lower than 0.8, the peripheral vascular disease exists but it is normally a mild case. On the other hand, a value below 0.5 is the proof of a serious vascular condition.