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Vascular disease

Vascular disease and trophic sores

Reviewed by Dr Neal Uren, consultant cardiologist, Dr Patrick Davey, cardiologist and Dr Stephen Collins, GP/ © NetDoctor

What is a vascular disease?

Bypass operations: placing blood vessels (A) around the diseased areas can be an effective way of treating atherosclerosis.

Vascular disease is mainly caused by atherosclerosis (hardening of the arteries) due to a thickening of the lining of the arteries (the intima).

The arteries are blood vessels that supply blood, oxygen and nutrients, to the body from the heart. Atherosclerosis is a condition leading to narrow, hardened arteries so that there is insufficient blood flow to satisfy the needs of the tissue in question.

Those parts of the body most affected by this disease suffer the consequences of an inadequate blood supply, namely poor function, tissue damage or death.

There are different symptoms depending on where in the body the vascular disease occurs. It most commonly affects the arteries of the heart, brain and legs.

The heart – cardiovascular disease

When the heart is affected, heavy, tight central chest pain with exertion (angina) or breathing difficulties may be experienced. In the most serious cases, a coronary artery can become blocked by a blood clot (thrombosis) causing severe pain and a serious threat to life.

The brain – cerebrovascular disease

Atherosclerosis in the arteries of the brain can lead to strokes (CVAs) that cause paralysis or loss of other function, such as speech.

The legs – peripheral vascular disease

In the legs, atherosclerosis may cause cramping pain in the muscles on exertion (intermittent claudication).

What are the risk factors?

Atherosclerosis strikes many people. It can start at the age of 20 and increases with advancing age. The exact cause is unknown but several risk factors are understood to accelerate the formation of atherosclerosis:

  • smoking
  • family history of vascular disease, angina, heart attacks or stroke
  • being overweight
  • an unhealthy diet
  • lack of exercise
  • diabetes
  • being male
  • hypertension (high blood pressure)
  • high cholesterol levels in the blood
  • stress.

What are the symptoms of atherosclerosis in the coronary arteries?

A mild degree of atherosclerosis does not cause any symptoms. More severe cases of coronary atherosclerosis may be associated with chest pain on exertion that settles within a few minutes of rest (angina).

If any of the arteries supplying the heart (coronary arteries) get completely blocked (coronary thrombosis), that part of the heart muscle deprived of a supply dies, causing a heart attack (myocardial infarction).

If you have risk factors for cardiovascular disease, beware of heavy or tight chest pain, sometimes also experienced in the throat or left arm. Pain of this nature, not settling within 20 minutes, should be assessed urgently by a doctor or paramedic.

What are the symptoms of atherosclerosis in the arteries of the brain?

Diseased arteries in the brain can become blocked by clots associated with atherosclerosis (cerebral thrombosis) either in the main carotid arteries or in smaller cerebral arteries. Alternatively, smaller diseased arteries may rupture and bleed into the brain (cerebral hemorrhage).

Both of these events damage the brain and are collectively referred to as strokes (cerebrovascular accidents or CVAs).

A stroke normally produces a sudden onset of symptoms. Depending on the artery affected, symptoms can include paralysis, speech difficulties, difficulty swallowing, visual and sensory disturbances.

What are the symptoms of atherosclerosis in the arteries of the legs?

Atherosclerosis in the arteries of the legs can cause cramping leg pain on exertion that settles after a few minutes’ rest (intermittent claudication). In the early stages of the condition, the pain usually occurs in the calves with a particular walking distance or effort, but settles again after 5 to 10 minutes’ rest.

The pain is the effect of muscles not being supplied with enough blood to cater for the physical effort demanded.

More advanced atherosclerosis may cause constant pain at rest, ulceration of the lower leg and even gangrene in the toes and feet.

How does the doctor diagnose atherosclerotic disease?

The diagnosis is, first and foremost, made on the basis of the medical history. If there is diagnostic doubt or difficulty with treatment, then referral to a specialist for further assessment will help in the management of the condition.

Additional non-invasive imaging tests such as Doppler ultrasound or invasive such as angiography may be done in the hospital.

If there are symptoms of atherosclerosis in the brain (CVAs) or in the legs (claudication), the GP can also refer an individual to a hospital-based specialist for further investigation with scans of the brain (CT or MRI scans) and angiograms for a better understanding of blood flow in the limbs.

What can I do to help myself?

The most important thing is to prevent atherosclerosis from developing. In order to prevent vascular disease, consider whether or not you belong to any risk groups. Risk factors are cumulative – the more you have, the greater the risk of developing a significant problem with cardiovascular disease. To minimize the risk:

  • quit smoking. Stopping smoking has been shown to reduce the risk of cardiac problems by 50 per cent after only one year.
  • eat a varied and healthy diet including lots of vegetables, products that are high in fibre and low in fat. Avoid saturated fats (animal fat) in preference to fish and vegetable oils.
  • lose weight if you are overweight.
  • exercise more.

if you suffer from diabetes Type 1 or Type 2 or high blood pressure ensure that treatment for these conditions is maintained and is optimal.

Future prospects

Vascular disease is a manifestation of atherosclerosis that has developed over years. If its presence is not spotted and its progression not checked, it can result in significant disability and premature death.

Heart attack (coronary thrombosis) and stroke (cerebrovascular accident) are among the commonest causes of premature death. Every day in the UK, about 60 people under retirement age die of cardiovascular disease and, across all ages, it is responsible for nearly 150,000 deaths each year.

If the risk factors mentioned above can be minimized, the diseases can be slowed down in their development.

Other advice

If you discover symptoms suggestive of vascular disease, or you if you feel that you are at risk, consult your doctor. By doing so you reduce your risk and will be able to decide whether further medication or specialist assessment is necessary.

Early treatment can, in many cases, prevent these diseases from progressing further and aggressive treatment of risk factors may actually result in regression of plaque.

Based on a text by Dr Sabine Gill and Dr Steen Dalby Kristensen, consultant




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