Blood vessel disorder

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Blood vessel disorder generally refers to the narrowing, hardening or enlargement of arteries and veins. It is often due to the build-up of fatty deposits in the lumen of blood vessels or infection of the vessel wall. This can occur in various locations such as coronary blood vessels, peripheral arteries and veins. The narrowed arteries would block the blood supply to different organs and tissues. [1] In severe conditions, it may develop into more critical health problems like myocardial infarction, stroke or heart failure, which are some of the major reasons of death. [2]

Contents

There are many causes contributing to blood vessel disorder including high blood cholesterol and calcium levels, blood clot formation and inflammation of arteries. It is found that age, sedentary lifestyle, diets rich in lipids, smoking, diabetes and family history of cardiovascular diseases are common risk factors. [3] A mild degree of blood vessel disorder may be asymptomatic. [4] Blood tests on cholesterol and calcium level can be performed to monitor the risk of having the disorder. Additionally, techniques such as angiography and ultrasound imaging are useful tools for diagnosis. [5] It can be treated by both medication or surgery, depending on the type of blood vessel disorder.[ citation needed ]

Types of Blood Vessel Disorder

Atherosclerosis: narrowing of the artery Atherosclerosis diagram.png
Atherosclerosis: narrowing of the artery

Atherosclerosis

Atherosclerosis is a developmental disease in the large arteries, defined by the accumulation of lipids, macrophages and fibrous materials in the intima. [1] When the endothelial cell of blood vessel is damaged, it loses the ability to regulate itself. [1] It results in inflammation as the macrophages irrupt the vessel wall. [1] Macrophages take up lipoprotein to form foam cells and release growth factor cytokines to attract more macrophages and smooth muscle cells. [1] A plaque is formed and proliferate to a larger size, gradually occluding the blood flow. [1] More importantly, it causes different complications that affect the whole body. [1]

Aneurysm

An aneurysm is a localized enlargement of arteries, characterized by a balloon-like bulge. [6] It results from the abnormal weakening of blood vessel wall. [7] Common types of aneurysm include abdominal aortic aneurysm, thoracic aortic aneurysm and intracranial aneurysm. [7] Most types of aneurysm, except intracranial aneurysm, are mainly caused by atherosclerosis. [7]

Symptoms of Raynaud's disease Raynauld.jpg
Symptoms of Raynaud's disease

Raynaud’s Disease

Raynaud’s disease is a rare peripheral vascular syndrome that narrows blood vessels, generally in the hands and feet, due to cold or stressful emotion. [8] It is recognized by the reduction of blood flow to fingers and toes with periodic spasm and results in a drastic color change to white or blue. [8] [9] The disease may further develop into ischaemic pain and necrosis of fingers or toes. [9] The pathology of Raynaud's disease starts with the activation of sympathetic nervous system triggered by cold or the feeling of stress. [8]

Symptoms of erythromelalgia Erythromelalgia.jpg
Symptoms of erythromelalgia

Venous thromboembolism

Venous thromboembolism (VTE) is a common peripheral venous disease. It is defined by the occlusion of venous blood vessels by blood clots. There are two major types of VTE: deep-vein thrombosis (DVT) and pulmonary embolism. [10] DVT is often found in the calf, accompanies with the swelling of limbs along the deep vein while pulmonary embolism causes chronic pulmonary hypertension. [11] VTE is the third deadliest cardiovascular disease in the world. [11] Haemostasis is the rapid development of blood clots for the purpose of reducing blood loss. [11] On the contrary, venous clots are formed much slower, in terms of several days or even weeks. Abnormality of coagulation during haemostasis, change in blood flow and endothelial failure may trigger VTE. [11]

Erythromelalgia

Erythromelalgia is a rare clinical disorder causing redness, burning sensation and intense pain in limbs. [12] It is more common to be found in lower limbs than upper limbs. [12] Erythromelalgia initiated from dysfunction of peripheral nerves that thickens the blood vessel walls, resulting in hyperaemic flow in limbs. [13]

Stroke

Stroke is a serious condition of blood vessel disorder caused by the stop of blood supply to the brain. Brain cells with ceased oxygen supply from blood will die in millions per second. [14] Not only is it one of the major causes of death around the world, it is also the cause of permanent disability. Two major types of stroke include ischemic stroke which is caused by atherosclerosis in the brain and hemorrhagic stroke which is the bleeding in the brain due to weakened blood vessel wall inside the brain.[ citation needed ]

Signs and symptoms

It is often asymptomatic in the early stages of blood vessel disorder. [4] When the disease develops, a variety of signs can be observed in different body parts. For instance, patients may have pale skin, cold hands and feet, and numb fingertips. These are mainly due to the reduction in blood flow to the limbs, resulting in a decrease in heat distribution to these areas. Ulcers and wounds would also take a much longer time to heal because of the impairment in blood clot formation process. Muscle weakness and cramping may occur as well, especially in the legs, because of the insufficient oxygen supply to muscle cells for metabolism.[ citation needed ]

Complications

The vascular system strongly influences the condition of the heart. It is also vital in the rest of the body as the blood vessels are in charge of carrying nutrients and the discard of metabolic wastes. Therefore, blood vessel disorder can cause serious complications in the whole body.[ citation needed ]

Coronary arteries are the blood vessels that supply to the heart for its normal function. Blood vessel disorders occur in coronary arteries would affect cardiac activity. For instance, due to atherosclerosis, the plaque would obstruct and causes ischaemia - the reduction of blood flow through the arteries. Ischaemia would then result in the decrease in oxygen supply to the heart, hence weaken the heart. It causes a vicious cycle as a weakened heart contraction would decrease blood supply to the body, including cardiac muscle (muscle of heart). Moreover, if the plaque suddenly ruptures in the heart, it will cause a heart attack.[ citation needed ]

Risk factors

Various factors may affect one's susceptibility to blood vessel disorders, including behavioural (e.g. smoking), demographic (e.g. age) and genetic (family history) factors. Most of these risk factors first promote the increase in blood pressure, followed by other symptoms and signs.[ citation needed ]

Age

The rise of blood pressure is correlated to ageing. [3] The arterial compliance - the amount of tension produced per stretch of arteries, decreases with age, and the stiffness of arteries increases with age. [3] The structural change in blood vessels causes the elderly to be more susceptible to hypertension, which leads to complications in arteries, the heart and even the brain.[ citation needed ]

Obesity

Having obesity would increase the risk of atherosclerosis. [1] A high-fat and high-cholesterol diet would result in an elevation of lipoprotein level, which is one of the constituents of plaque. Lipoprotein level above > 25–30 mg/dl is considered more susceptible by blood vessel disorders. [1]

Family history

Some of the blood vessel disorders are inherited. For instance, erythromelalgia is caused by the mutation of the SCN9A gene, which alters the neural pathway to blood vessels. [8] Genetic disorders that affect the circulatory, immune or neural system may contribute to hereditary blood vessel disorder. If one’s family history shows records of vascular disorders, it is more likely to inherit the same disease.[ citation needed ]

Smoking

Both active or passive smoking may bring harm to the vascular system. [15] For instance, cigarette smoking, cannabinoids and smokeless tobacco use were all found to raise blood pressure and increase the risk of stroke. [15] Moreover, cigar and cigarette smoking may also cause arterial stiffness. [15]

Medication

Some medications may have the side effect of increasing blood pressure and may even suppress the effect of anti-inflammatory drugs. Pain and anti-inflammatory drugs like Indomethacin, nonsteroidal anti-inflammatory drugs and piroxicam would retain water in the systemic circulation, raising the blood pressure. [16] Other types of medications like antidepressant, hormone and caffeine would also increase blood pressure.[ citation needed ]

Diagnosis

Doctors may look for signs of narrowed, enlarged or hardened arteries by performing a physical examination. [17] If blood vessel disorder is present, there will be a weak or even absent pulse under the narrowed area of the artery. The blood pressure in the affected limb would be lowered and whooshing sounds can be heard over the affected arteries using a stethoscope. [17] After that, the following tests could be adapted to further locate the point of narrowing or enlargement of blood vessels.[ citation needed ]

Angiography showing blockade of coronary artery Angiography coronary stenosis 01.jpg
Angiography showing blockade of coronary artery

Angiography

Angiography is a medical imaging technique used to visualize the lumen of blood vessels. [18] A catheter, which is a long and thin tube, is inserted into a large artery in the arm or groin area. It is then guided along the artery to the targeted blood vessel to be examined. An imaging dye is loaded into the blood vessel through the catheter and the movement of the dye in the blood vessel is recorded as an angiogram. [18] Doctors could determine if there are any abnormalities in the blood vessel using fluoroscopy, computed tomography (CT) angiography or magnetic resonance (MR) angiography. After the catheter is removed, some pressure is applied to the incision site for 10 to 20 minutes to prevent excessive bleeding.[ citation needed ]

Vascular ultrasound

Vascular ultrasound is a non-invasive imaging method to examine the circulation inside blood vessels. Sound waves are transmitted through the tissues of the targeted area and they reflect on the blood cells moving within blood vessels. [19] The waves recorded are displayed as an image of the blood vessel and the speed of waves detected can be used to calculate the speed of blood flow inside the vessel. [20] When the rate of blood flow is too low, there may be a blockage of vessel. By evaluating blood flow in vessels, the severity and specific location of blood vessel disorder can be determined. [20]

Treatments

Different kinds of treatment should be adopted according to the type and severity of blood vessel disorder. Medications are usually prescribed to relieve specific symptoms arisen from the disease while surgery like angioplasty can be performed to provide a more long-lasting effect.[ citation needed ]

Surgery

Angioplasty is a procedure used to widen narrowed blood vessels, especially in coronary arteries. A long and thin tube called catheter is inserted into a large artery through an incision in the wrist, arm or groin area. The catheter is guided to the affected artery using a real-time x-ray video. A thin wire is then introduced into the blood vessel, delivering a small balloon to the affected area. The balloon is inflated to stretch the blood vessel and compress the fatty deposits against the wall of artery. [21] Hence, the vessel is widened and blood can flow through it freely to maintain adequate blood supply to different tissues. Finally, the balloon is deflated and removed. A stent may also be placed to provide support to the vessel wall and prevent it from re-narrowing. [22]

Medications

Beta blockers are medications that inhibit the sympathetic nervous system by blocking the beta adrenergic receptors. They can be used to slow down heart rate and decrease blood pressure by inhibiting beta receptors in the heart. [23] These medications also induce vasodilation by relaxing smooth muscle in blood vessels. Examples of beta blockers include carvedilol, metoprolol, and bisoprolol. [ citation needed ]

Calcium channel blockers are medications that prevent the movement of calcium ions across calcium channels. They can be used to relieve hypertension by causing vascular smooth muscle relaxation. [24] They also reduce the heart rate and contractility to lower the cardiac output, which in turn lower blood pressure. Amlodipine, hydralazine and dihydropyridine are examples of calcium channel blockers.[ citation needed ]

Other medications such as angiotensin-converting enzyme (ACE) inhibitors and diuretics can be used to relieve hypertension. [25] Statins and fibrates can also be prescribed to lower blood cholesterol level and hence reducing the risk of plaque formation in blood vessels. [26] Anti-platelet medications e.g. aspirin help reducing blood clot formation in vessels as well.

Related Research Articles

<span class="mw-page-title-main">Angina</span> Chest discomfort due to not enough blood flow to heart muscle

Angina, also known as angina pectoris, is chest pain or pressure, usually caused by insufficient blood flow to the heart muscle (myocardium). It is most commonly a symptom of coronary artery disease.

<span class="mw-page-title-main">Angioplasty</span> Procedure to widen narrow arteries or veins

Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A deflated balloon attached to a catheter is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn. Angioplasty has come to include all manner of vascular interventions that are typically performed percutaneously.

<span class="mw-page-title-main">Atherosclerosis</span> Form of arteriosclerosis

Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. These lesions may lead to narrowing of the arteries' walls due to buildup of atheromatous plaques. At onset there are usually no symptoms, but if they develop, symptoms generally begin around middle age. In severe cases, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney disorders, depending on which body parts(s) the affected arteries are located in the body.

<span class="mw-page-title-main">Arteriosclerosis</span> Thickening, hardening and loss of elasticity of the walls of arteries

Arteriosclerosis is a vascular disorder characterized by abnormal thickening, hardening, and loss of elasticity of the walls of arteries; this process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by atherosclerosis, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques, cholesterol, and some other substances in and on the artery walls.

Macrovascular disease is a disease of any large (macro) blood vessels in the body. It is a disease of the large blood vessels, including the coronary arteries, the aorta, and the sizable arteries in the brain and in the limbs.

<span class="mw-page-title-main">Angiography</span> Medical imaging technique

Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performed by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.

<span class="mw-page-title-main">Interventional radiology</span> Medical subspecialty

Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.

<span class="mw-page-title-main">Peripheral artery disease</span> Medical condition

Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. PAD can happen in any blood vessel, but it is more common in the legs than the arms.

<span class="mw-page-title-main">Ischemia</span> Restriction in blood supply to tissues

Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism. Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue i.e. hypoxia and microvascular dysfunction. It also implies local hypoxia in a part of a body resulting from constriction. Ischemia causes not only insufficiency of oxygen, but also reduced availability of nutrients and inadequate removal of metabolic wastes. Ischemia can be partial or total blockage. The inadequate delivery of oxygenated blood to the organs must be resolved either by treating the cause of the inadequate delivery or reducing the oxygen demand of the system that needs it. For example, patients with myocardial ischemia have a decreased blood flow to the heart and are prescribed with medications that reduce chronotrophy and ionotrophy to meet the new level of blood delivery supplied by the stenosed vasculature so that it is adequate.

<span class="mw-page-title-main">Atheroma</span> Accumulation of degenerative material in the inner layer of artery walls

An atheroma, or atheromatous plaque, is an abnormal accumulation of material in the inner layer of an arterial wall.

<span class="mw-page-title-main">Cardiac catheterization</span> Insertion of a catheter into a chamber or vessel of the heart

Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.

Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia and tissue death (necrosis). Cerebral vasospasm may arise in the context of subarachnoid hemorrhage. Symptomatic vasospasm or delayed cerebral ischemia is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid hemorrhage. Vasospasm typically appears 4 to 10 days after subarachnoid hemorrhage.

<span class="mw-page-title-main">Carotid artery stenosis</span> Medical condition

Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis.

A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. It is commonly performed due to inadequate blood flow (ischemia) caused by atherosclerosis, as a part of organ transplantation, or for vascular access in hemodialysis. In general, someone's own vein (autograft) is the preferred graft material for a vascular bypass, but other types of grafts such as polytetrafluoroethylene (Teflon), polyethylene terephthalate (Dacron), or a different person's vein (allograft) are also commonly used. Arteries can also serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using surgical suture, creating a surgical anastomosis.

<span class="mw-page-title-main">Fibromuscular dysplasia</span> Human arterial disease

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery. FMD has been found in nearly every arterial bed in the body, although the most commonly affected are the renal and carotid arteries.

<span class="mw-page-title-main">Vascular disease</span> Medical condition

Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood and lymph vessels can cause a range of health problems that can sometimes become severe, and fatal. Coronary heart disease for example, is the leading cause of death for men and women in the United States.

<span class="mw-page-title-main">Computed tomography angiography</span> Medical investigation technique

Computed tomography angiography is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, images are created to look for blockages, aneurysms, dissections, and stenosis. CTA can be used to visualize the vessels of the heart, the aorta and other large blood vessels, the lungs, the kidneys, the head and neck, and the arms and legs. CTA can also be used to localise arterial or venous bleed of the gastrointestinal system.

<span class="mw-page-title-main">Coronary artery aneurysm</span> Medical condition

Coronary artery aneurysm is an abnormal dilatation of part of the coronary artery. This rare disorder occurs in about 0.3–4.9% of patients who undergo coronary angiography.

<span class="mw-page-title-main">Acute limb ischaemia</span> Occurs when there is a sudden lack of blood flow to a limb

Acute limb ischaemia (ALI) occurs when there is a sudden lack of blood flow to a limb, within 14 days of symptoms onset. It is different from another condition which is more chronic called critical limb ischemia (CLD). CLD is the end stage of peripheral vascular disease where there is still some collateral circulation (alternate circulation pathways} that bring some blood to the distal parts of the limbs. While limbs in both acute and chronic limb ischemia may be pulseless, a chronically ischemic limb is typically warm and pink due to a well-developed collateral artery network and does not need emergency intervention to avoid limb loss.

<span class="mw-page-title-main">Arterial occlusion</span>

Arterial occlusion is a condition involving partial or complete blockage of blood flow through an artery. Arteries are blood vessels that carry oxygenated blood to body tissues. An occlusion of arteries disrupts oxygen and blood supply to tissues, leading to ischemia. Depending on the extent of ischemia, symptoms of arterial occlusion range from simple soreness and pain that can be relieved with rest, to a lack of sensation or paralysis that could require amputation.

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