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Reviewed by Dr Neal Uren, consultant cardiologist, Dr Patrick Davey, cardiologist and Dr Stephen Collins, GP
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What is a vascular disease?
Vascular disease is mainly caused by
hardening of the arteries
(atherosclerosis) due to a thickening of the artery lining from fatty deposits or plaques (atheroma).
The arteries are blood vessels that supply blood, oxygen and
nutrients to the body from the heart. Narrow, hardened arteries make it more difficult for blood to flow through and reach the tissue in question.
Those parts of the body most affected by this disease suffer the
consequences of an inadequate blood supply: poor function, tissue damage
and, in worst cases, death.
There are different symptoms, depending on where the
vascular disease is. It most commonly affects the arteries of the heart,
brain and legs.
The heart - cardiovascular disease
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), the part of the heart muscle
that's deprived of blood dies, causing a
heart attack
(myocardial infarction).
If you have risk factors for cardiovascular disease, be aware 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.
The brain - cerebrovascular disease
Narrowed arteries in the brain can become blocked by clots
(cerebral thrombosis). Clots can form in the main
carotid arteries in the neck that supply blood to brain or in smaller cerebral arteries.
Alternatively, smaller diseased arteries may rupture and bleed
into the brain (cerebral haemorrhage).
Both of these events damage the brain and are collectively
referred to as strokes (cerebrovascular accidents or CVAs).
A
stroke normally
produces sudden symptoms. Depending on the artery affected, these
can include numbness or paralysis on one side, speech difficulties, difficulty swallowing and problems with vision, balance and coordination.
The legs - peripheral vascular disease
Atherosclerosis can cause cramping pain in the
leg muscles 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 a result of the leg muscles not getting enough
blood to cater for the physical effort needed.
More advanced atherosclerosis
may cause constant pain at rest, ulceration of the lower leg and even gangrene
in the toes and feet.
What are the risk factors?
Atherosclerosis affects many people. It can start at the age of
20 and increases with advancing age.
The exact cause is unknown, but several
risk factors accelerate the formation of
fatty deposits in the arteries:
-
smoking
-
family history of vascular disease, angina,
heart attacks or
stroke
-
being
overweight
-
an unhealthy diet
-
lack of exercise
-
diabetes
-
being male
-
high blood
pressure
-
high cholesterol levels
-
stress.
How does the doctor diagnose vascular disease?
Diagnosis is made on the basis of your
medical history and symptoms.
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 tests may be
done in the hospital, such as Doppler
ultrasound imaging tests or
angiography, when dye is injected to make the arteries visible on X-rays.
If there are symptoms of atherosclerosis in the brain or
legs, your GP can refer you to a
hospital-based specialist for further investigation.
This may include 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.
First, think about whether you
belong to any of the risk groups. Risk factors are cumulative - the more you have, the
greater the risk of developing a significant problem with cardiovascular
disease.
To minimise your 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 and
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
-
maintain treatment for
diabetes
or
high blood pressure.
In the long term
Vascular disease is the result of atherosclerosis that has
developed over many years. If it's not spotted and progression isn't halted, it can result in significant disability and premature death.
Heart attack and stroke are among the most common causes of premature death in the UK.
Every day in the UK about 60 people under retirement age die
of cardiovascular disease. Across all ages, it is responsible for nearly
150,000 deaths each year.
Taking steps to minimise your risk factors can slow the development of both fatty deposits in your arteries and vascular disease.
When should I see a doctor?
See your GP if you think you have any of the symptoms listed above or if you feel you are at risk of vascular disease.
Your doctor can assess your risk and decide whether further medication or specialist
assessment is necessary.
In many cases early treatment can prevent symptoms from
progressing further.
Aggressive treatment of risk factors may actually
result in the regression of fatty deposits that line the arteries.
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Based on a text by Dr Sabine Gill and Dr Steen Dalby Kristensen, consultant
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Last updated 17.01.2008
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