ARTERIAL DISEASE

Peripheral arterial disease Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to limbs. Causes The most common cause of peripheral arterial disease is atherosclerosis. -And when it occurs in the arteries supplying blood to the limbs, it causes peripheral arterial disease.

Risk factors Factors that increase your risk of developing peripheral arterial disease include: Smoking Being older than age 50 Having diabetes Risk factors Being overweight Having high blood pressure or a family history of it Having high cholesterol or a family history of it or high triglycerides, a blood fat

Signs and symptoms About half of people with peripheral arterial disease have mild or no symptoms. About one-third to one-half develop more severe symptoms, including intermittent claudication. Signs and symptoms Intermittent claudication is characterized by muscle pain or cramping in the legs or arms that is triggered by a certain amount of activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.

Stage of evolution in peripheral ischaemic syndrome: Stage 1: The patient has parenthesias or intense and short pains which appear after prolonged orthostatism Stage 2: Intermitent claudication occurs while walking Stage 3: The pain is continuous Stage 4: the pain is intense, continuous , not influenced by declivity. Signs and symptoms Other signs and symptoms of peripheral arterial disease include: Leg numbness or weakness Cold legs or feet Sores on your toes, feet or legs that won't heal A change in the color of the legs Hair loss on the feet and legs Changes the nails Physical signs of advanced peripheral arterial disease of the legs may appear More severe symptoms may indicate advanced PAD. - Symptoms can be affected by or confused with other health conditions the person also has, such as arthritis. Signs and symptoms Peripheral arterial disease also can be confused with other conditions with similar symptoms.

Tests: Some common tests used to diagnose claudication include: Checking the pulses in feet. Ankle-brachial index. This test compares the blood pressure in the ankle arteries to the blood pressure in the arms. Doppler ultrasound. This test monitors blood flow in the area affected.

Complications Claudication can be worsened by some medications, such as beta blockers. - They can reduce blood flow or cause the blood vessels to constrict, interfering with circulation. In extreme cases, the circulation in the legs can be so limited that the patient feel pain even when you aren't exercising, and the legs might feel cool to the touch.

Though rare, severe cases can lead to poor healing of skin injuries and ulcers. These cuts and ulcers can develop gangrene and require amputation.
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Particular inttermitent claudication LERICHE SYNDROM A syndrome caused by obstruction of the terminal aorta It usually occurs in males and is characterized by fatigue in the hips, thighs, or calves on exercising, absence of pulsation in the femoral arteries, impotence, and often pallor and coldness of the lower limbs. Signs and symptoms:

Impotence Extreme fatigability Wasting of legs Pale legs on standing Pale feet on standing Absent or weak pulse over the aorta or iliac arteries Feeble pulse in femoral arteries Coldness of lower legs

Raynaud's disease
Raynaud's disease is a condition that causes some areas of the body such as fingers, toes, tip of nose and ears to feel numb and cool in response to cold temperatures or stress. In Raynaud's disease, arteries that supply blood to the skin narrow, limiting blood circulation to affected areas. Women are more likely to have Raynaud's disease.

Causes Cold temperatures. When the body is exposed to cold temperatures, the extremities lose heat. -The body slows down blood supply to the fingers and toes to preserve the body core temperature. Stress. Stress causes a similar reaction to cold in the body, and likewise the body's response may be exaggerated in people with Raynaud's. Signs and symptoms

Signs and symptoms of Raynaud's depend on the frequency, duration and severity of the blood vessel spasms that underlie the disorder. Signs and symptoms include: Sequence of color changes in your skin in response to cold or stress Numb, prickly feeling or stinging pain upon warming or relief of stress Screening and diagnosis Clinical examination : Paraclinical :

Antinuclear antibodies (ANA) test..

The semiology of the venous system Thrombophlebitis

Phlebitis is inflammation of a vein. Thrombophlebitis occurs when a blood clot causes inflammation in one or more of the veins, typically in the legs. The affected vein may be near the surface of the skin, causing superficial thrombophlebitis, or deep within a muscle, causing deep vein thrombosis (DVT). Thrombophlebitis often is caused by prolonged inactivity, such as from sitting during a long period of travel in an airplane or automobile or from lengthy bed rest after surgery.

Signs and symptoms Warmth, tenderness and pain in the affected area Redness and swelling Signs and symptoms The pain occurs in orthostatism and disappears in decubitus .

The Homans maneuver ( the dorsal flexion of the foot produces pain in the calf of leg and in popliteal area in case of thrombophlebitis of the shank veins Tachycardia Mahlers sign: in the deep trombophlebitis the pulse increases progressively from one day to another and it called climbing pulse Anxiety ( represent the imminence of pulmonary embolism)

Physical examination: The superficial veins are accessible to the physical examination . The venous stasis edema occurs in case of obstacle of in the venous circulation. In the deep trombophlebitis it is localized under the obstructed area. It can be pale in phlegmatia alba dolens or cyanotic in phlegmatia coerulea dolens. Risk factors Are inactive for a long period of time, such as from sitting in a car or an airplane Are confined to bed for a prolonged time, such as after surgery, a heart attack or a leg fracture Have a type of cancer, such as pancreatic cancer, that may cause an increase of procoagulants substances necessary for blood clotting (coagulation) in the blood Risk factors Stroke that resulted in paralysis of the arms or legs Pregnant or have just given birth, which may mean , have increased pressure in the veins of pelvis and legs Use oral contraceptives or hormone replacement therapy, which may increase the clotting factors in the blood The family history of a blood-clotting disorder or a tendency of blood clots Overweight or obesity Varicose veins clots may develop in dilated superficial veins (varicose veins), causing superficial thrombophlebitis Smoker Superficial thrombophlebitis: Risks for superficial thrombophlebitis Disorders that involve increased blood clotting Infection

Varicose veins Chemical irritation of the area Sitting or being immobilized for a prolonged period The risk is also increased in women who are or were recently pregnant, and by the use of oral contraceptives.

Symptoms Skin redness or inflammation along a superficial vein Warmth of tissue around a superficial vein Tenderness or pain along a superficial vein (worse when pressure is applied) Limb pain Hardening of a superficial vein (induration) -- the vein feels cord-like Paraclinical examination: Ultrasound. A clot may be visible in the image. CT or MRI scans. Both computerized tomography (CT) and magnetic resonance imaging (MRI) can provide visual images of the veins and may show if a clot is present. Complications Pulmonary embolism. -If part of a deep vein clot becomes dislodged, it may travel to the lungs, where it can block an artery and cause a potentially life-threatening situation. Varicose veins. - The pooling of blood can lead to ballooning of the veins, resulting in varicose veins. Swelling. - In some cases, the pooling may become so bad that the leg swells (oedema). Skin discoloration. -With chronic swelling and increased pressure on the skin, discoloration called stasis pigmentation may occur. - In some cases, skin ulcers may develop. Vein obstruction. - Deep vein thrombosis can cause a permanent obstruction to develop in the vein.

If thrombophlebitis is in a superficial vein, serious complications are rare. - However, if the clot occurs in a deep vein, the risk of serious complications is greater.