CHEST PHYSIOTHERAPY

CHEST PHYSIOTHERAPY- A HOME HEALTH THERAPY

Chest Physiotherapy is a group of physical exercises in which a physiotherapist helps patient to perform some physical exercises to improve the function of the respiratory organs. Chest physiotherapy is considered one of the best and effective methods to treat many medical conditions related to the respiratory system. It gives strength to the respiratory muscles and lungs thus helps recover from many conditions related to breathing problem. It cures many respiratory diseases like chronic obstructive pulmonary disease, cystic fibrosis, pneumonia, and many more critical conditions. It is the only physical process to overcome many conditions related to respiratory diseases. The cardiac physiotherapy will heal all the pain that you are going through. The process also involves pain management.

There are many categories of Chest Physiotherapy:

Deep breathing exercises: Deep breathing is a type of chest physiotherapy in which a patient who suffers from any respiratory diseases, inhales and exhales deeply to get more oxygen for lungs and to release more Co2 to make the lungs and body fit.

Coughing: It is the part of physiotherapy that helps to break up secretions from the lungs so that the mucous can be removed. In this process, patients are told to sit upright and inhale deeply than the patient exhale coughs and this process is done several times a day.

Percussion: This is the process in which chest wall is struck rhythmically with cupped hands and the process is called cupping or clapping. The purpose of doing this process is to break up the thick secretions so that it can be easily removed to give patients relief from trouble breathing.

Postural drainage: The procedure is used to drain lung secretion.

Some precautions need to be followed by patients in chest physiotherapy.

• It should not be performed by the patient, who suffers from lungs bleeding.
• Patients of asthma should never do such type of exercises because it may make their problem even more worst.

• Damaged chest walls.
• Collapsed lungs
• Tuberculosis

Reference: https://healthcareathomeindia.wordpress.com/2015/08/24/chest-physiotherapy-a-home-health-therapy/

Heart Anatomy

Heart Anatomy: chambers, valves and vessels

The heart has four chambers – two superior atria and two inferior ventricles. The internal partition that divides the heart longitudinally is called the interatrial septum where it separates the atria, and the interventricular septum where is separated the ventricles. The right ventricle forms most of the anterior surface of the heart, while the left ventricle forms the heart apex.

Two grooves on the heart surface indicate the boundaries of its four chambers and carry the blood vessels supplying the myocardium. The coronary sulcus also called the atrioventricular groove, encircles the junction of the atria and ventricles like a crown. The anterior interventricular sulcus cradles the anterior interventricular artery and also marks the anterior position of the septum, where the right and left ventricles separate. It continues as the posterior interventricular sulcus, which marks a similar position on the posteroinferior surface.

Atria: The Receiving Chambers

The only surface feature on each atrium is a small, wrinkled, appendage called an auricle. Auricles increase atria volume slightly. Internally, the right atrium has two basic parts: a smooth posterior and an anterior portion in which bundles of muscle tissue form ridges in the walls. The muscle bundles are called pectinate muscles because they look like the teeth of a comb. The right atrium’s posterior and anterior region are separated by a C-shaped ridge called the crista terminalis.

In contrast, the left atrium is almost entirely smooth and pectinate muscles are only found in the auricle. The interatrial septum contains a shallow depression called the fossa ovalis. The fossa ovalis marks the spot where an opening, the foramen ovale, existed in the fetal heart. The opening closes after birth.

The atria are receiving chambers for blood returning to the heart from circulation. Atria are relatively small, thin-walled chambers because they only need to contract minimally to push blood into the ventricles. In reality, they contribute little to propulsion and pumping action of the heart. Blood enters the right atrium through three veins:

• The superior vena cava returns blood from body regions superior to the diaphragm.
• The inferior vena cava returns blood from body areas below the diaphragm.
• The coronary sinus collects blood draining from the myocardium.

Four pulmonary veins enter the left atrium. These veins, which transport blood from the lungs back to the heart, are best seen in a posterior view.

Ventricles: Discharging chambers

The ventricles make up most of the volume of the heart. The right ventricle forms most of the heart’s anterior surface and the left ventricle forms most of the posteroinferior surface. Irregular ridges of muscle called trabeculae carneae mark the internal walls of the ventricular chambers. Another group of muscle bundles called papillary muscles project into the ventricular cavity and play a role in valve function. The ventricles are the discharging chambers, the actual pumps of the heart. Their walls are larger than atrial walls and when they contract, they propel blood out of the heart into circulation. The right ventricle pumps blood into the pulmonary trunk, which sends the blood to the lungs where gas exchange occurs. The left ventricle ejects blood into the aorta, the largest artery in the body.

Heart Valves

Blood flows through the heart in one direction: from the atria to the ventricles and out the great arteries leaving the superior aspect of the heart. Four valves enforce the one-way traffic. They open and close in response to differences in blood pressure.

Atrioventricular (AV) Valves

There are two atrioventricular (AV) valves. One is located at each atrial-ventricular junction and they prevent backflow into the atria when the ventricles contract.

The right AV valve, or tricuspid valve, has three flexible cusps.

The left AV valve has two cusps. It’s called the mitral valve and is sometimes called the bicuspid valve.

Attached to each AV valve flap are collagen chords called chordae tedineae, which anchor the cusps to the papillary muscles. When the heart is completely relaxed, the AV valves flaps hang limp and blood flows into the atria and then through the open AV valve flaps into the ventricles. When the ventricles contract, compressing the blood into their chambers, the pressure rises forcing the blood superiorly against the valve flaps. Because of this, the flap edges meet and successfully close the valve.

Chordae tendineae and papillary muscles serve as wires that anchor the valve flaps in their closed position. If the cups weren’t anchored, they would be blown into the atria the same way an umbrella is blown inside out by the wind. The papillary muscles contract and take up the slack on the chordae tendineae when contractions forcefully hurl blood against the AV valve flaps.

Semilunar (SL) Valves

The aortic and pulmonary (semilunar, SL) valves guard the bases of the largest arteries stemming from the ventricles and prevent backflow into the associated ventricles. Each valve has three cusps, shaped like a crescent moon. The semilunar valves open and close in response to differences in pressure. When the ventricles contract and pressure rises higher than the pressure in the aorta and pulmonary trunk, the valves are forced open and their cusps flatten while blood rushes in. When

the ventricles relax and blood flows back toward the heart, the cusps become full and the valves close. Heart valves – like any mechanical pump, can function with leaks, but if a valve is badly damaged it can greatly reduce cardiac function. A damaged valve forces the heart to re-pump blood over and over because the valve doesn’t close properly and backflow occurs. Because of this, the heart will weaken over time due to overwork.

What Is Vascular Dementia and How Does High Blood Pressure Cause It?

Vascular dementia, the second leading kind of dementia after Alzheimer’s disease, is relatively unknown and unrecognized by the general population compared to Alzheimer’s. Yet it is responsible for at least 20 percent of cases of dementia.

The majority of dementia sufferers actually have both Alzheimer’s disease and vascular dementia; this combination is now the leading cause of age-related cognitive impairment.

What Is Vascular Dementia?
Vascular dementia is a brain disease characterized by problems with reasoning, planning, judgment, memory, and other thought processes. It is caused by brain damage from impaired blood flow to your brain.

Anything that narrows, blocks, or chronically damages your brain’s blood vessels can lead to vascular dementia by reducing circulation and depriving your brain of vital oxygen and nutrients. Without enough oxygen and nutrients, brain cells die and brain function becomes impaired.

Vascular Dementia SymptomsThe symptoms of vascular dementia are highly variable and depend on the cause and location of the blood flow impairment. They can develop suddenly, in distinct steps downward, or very gradually.

Once full-blown vascular dementia has developed, the symptoms can overlap with those of Alzheimer’s disease and can include:

• Problems with memory
• Trouble paying attention and concentrating
• Trouble deciding what to do next
• Confusion
• Reduced ability to organize thoughts or actions
• Difficulty analyzing situations, developing an effective plan and communicating that plan to others
• Restlessness and agitation
• Unsteady gait
• Sudden or frequent urge to urinate or inability to control passing urine
• Depression

High Blood Pressure: Common Cause of Vascular Dementia

High blood pressure is a leading cause of vascular dementia. While not everyone with high blood pressure will develop vascular dementia, hypertension significantly increases the risk.[2] Even if you have just slightly elevated blood pressure (prehypertension), your risk of vascular dementia is three times greater compared to someone with normal blood pressure.[3] And if you have stage 1 or stage 2 hypertension, your risk is even greater—4.5-fold and 5.6-fold, respectively.

Your risk is especially high if you develop high blood pressure in mid-life. In that case, even if your late-life blood pressure is reduced to less than 140/90, your risk remains elevated.[3]High blood pressure causes excessive free radical production (oxidative stress) and inflammation directly within the blood vessels that supply the brain.[2] Through these and other mechanisms, hypertension gradually injures the brain’s blood vessels, particularly the small arteries. Over time, the arterial damage caused by high blood pressure leads to what is called “white matter lesions.”

White Matter Lesions
The brain consists of gray matter and white matter. The gray matter contains the nerve cells while the white matter is composed of nerve fibers and myelin, which form the connections between the nerve cells and help to insulate and accelerate impulses.

Alzheimer’s-related dementia is caused primarily by lesions in the grey matter —called amyloid plaques. In contrast, vascular dementia is associated with white-matter lesions that occur when the small arteries that supply the brain are injured.

Many older people who have brain MRIs show white-matter lesions. While there appear to be multiple causes, hypertension is one of the most well-known.[4] Not everyone with white matter lesions develops vascular dementia, but the risk is much greater if white matter lesions are present.

StrokesAnother way high blood pressure leads to vascular dementia is by causing strokes. A stroke occurs when a blood vessel to the brain is either blocked by a clot (ischemic stroke) or bursts (hemorrhagic stroke). High blood pressure causes both types of strokes by damaging blood vessels so they either become blocked or burst more easily.

A single, major stroke can cause immediate dementia. But even mini strokes (transient ischemic attacks) or strokes that don’t cause any noticeable symptoms (silent brain infarctions) increase dementia risk. The more mini or silent strokes you have over time, the more your vascular dementia risk increases.
How to Treat Vascular Dementia Naturally

While the ultimate goal is to prevent vascular dementia before it occurs, treating your hypertension and improving your underlying blood vessel health may also sometimes slow the progression of vascular dementia when it is already present, preventing further decline.

Your best bet for naturally lowering your blood pressure and improving the underlying health of your blood vessels is to follow a comprehensive, multi-faceted treatment program that includes dietary therapy, exercise, nutritional therapy, stress reduction, sleep optimization, and other natural lifestyle interventions.

3 Keys to Maintaining Vascular Heath

A human’s cardiovascular system is one of the most fascinating, complex systems our world has ever seen. By enabling the transportation of necessary oxygen to our cells, filtering CO2 out of the body, transporting nutrients throughout the body, and helping control our body temperature, it is truly amazing.

Just like an irreplaceable antique car or expensive boat, it is necessary to maintain and take care of all the moving parts working hard in your vascular system. Here are three natural habits to focus on to ensure your body is in its most optimal condition to stay healthy!

Sleep 

While this may not come as a surprise, quality sleep is one of the most important factors to staying healthy. Your body is a machine and, as such, it needs time to recharge just as any other piece of technology does. It has been found that not enough sleep, or lack of quality sleep, can disrupt critical functions in the body which puts people at high risk for vascular disease. Quality 6-8 hours of sleep is enough to take some of the load off your system and decrease the chance of any potential problems. 

Physical Fitness

In a world where people can access so many things with the touch of a few buttons, it is essential for folks to remember to spend time fine-tuning themselves. Daily exercise is crucial to maintaining proper vascular health. Exercise is vital to your overall health as it directly affects your heart’s ability to pump blood through your arteries. Physical activity can also significantly decrease vascular problems from occurring in your limbs.

Stress

While this part might not be easy, it may as well be the most crucial aspect to your cumulative health. While it is impossible to eliminate all stress in your life, it is essential to try and manage it as much as possible. It is necessary to plan out mental health days and experiment with new stress-relieving hobbies like yoga or meditation. Try your best to keep your work at work, and don’t let it follow you home. Give your brain a chance to rest and recuperate. To get the most out of yourself, you need to minimize the effects of high-stress levels on your cardiovascular system.

Forming these necessary habits to maintain your cumulative health is one of the most important steps you can take to keep your vascular system in check. 

Reference: http://vsafl.com/blog/

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Coronary Arteries

Blockages of the Coronary Arteries

The coronary arteries run along the surface of the heart and supply the heart muscle with blood and oxygen. Coronary artery disease develops when these arteries become blocked and can no longer deliver enough blood and oxygen to the heart muscle. Cholesterol-containing deposits (plaques) are the usual cause of this condition.

When plaques build up, the coronary arteries become narrowed, causing the heart muscle to receive less blood. Diminished blood flow may cause chest pain (angina) or shortness of breath. Complete blockage of a coronary artery can cause a heart attack.

Symptoms

When blockages develop in the coronary arteries, there is inadequate blood flow to the heart muscle. This lack of circulation becomes most obvious to a patient when there is increased physical activity. Typical symptoms of inadequate coronary circulation include the following:

(1) Chest pain (“angina”). A pressure or tightness in the chest, as if someone were standing on your chest. The pain, referred to as angina, is usually triggered by physical or emotional stress. It typically goes away within minutes after stopping the stressful activity.

(2) Shortness of breath. If the heart can't pump enough blood to meet the body's needs, shortness of breath occurs with exertion.

(3) Heart attack. If a coronary artery becomes completely blocked, a heart attack (“myocardial infarction”) may occur. The classic signs and symptoms of a heart attack include “crushing” chest pain, pain in the shoulder or arm, shortness of breath, and sweating.

If such symptoms are experienced, one should seek immediate medical attention.

Causes

Coronary artery disease is caused by damage to the inner layer of a coronary artery. The damage may be caused by various factors, including:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Radiation therapy to the chest

Once the inner wall of an artery is damaged, fatty deposits (mainly cholesterol) accumulate at the site of injury in a process called “atherosclerosis”. If the surface of these plaques breaks or ruptures, blood cells (called “platelets”) accumulate at the site to try to repair the artery. Accumulation of this platelet clump at the site of a plaque can block a coronary artery completely and lead to a heart attack. This is the rationale for recommending antiplatelet medications for patients at high risk for heart attack.

Risk factors

Risk factors for coronary artery disease include:

Male Sex: Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.

Family history: A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age.

Smoking: Nicotine constricts the blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. The incidence of heart attack in smokers is at least 3x higher than for non-smokers.

High blood pressure: Uncontrolled high blood pressure can result in thickening of the artery wall, thus narrowing the channel through which blood can flow.

High blood cholesterol levels: High levels of cholesterol in the blood can increase the risk of formation of plaques and atherosclerosis.

Diabetes: Diabetes is associated with an increased risk of coronary artery disease.

Obesity. 

Lack of exercise.

High stress: Emotional stress may damage the lining of the arteries and increase the risk of plaque formation in the wall of the coronary artery.

As one might expect, a combination of risk factors increases the chance of developing coronary artery disease. “Metabolic syndrome” is an example of this. This “syndrome” consists of high blood pressure, high triglycerides, elevated insulin levels and accumulation of excess body fat at the waist.

Sometimes, patients who are thin, have normal blood pressure, don’t smoke, have no family history of coronary artery disease and have normal levels of blood cholesterol nevertheless develop coronary artery disease. This leads some people to the conclusion that the risk factors that we generally recognize as causing coronary artery disease, may not be the only risk factors after all. Other “possible risk factors” have been proposed to explain such cases. These include the following:

C-reactive protein: a normal protein that appears in higher amounts when there's swelling somewhere in the body. High CRP levels may be a risk factor for heart disease. It is thought that as coronary arteries narrow, there is more CRP in the blood.

Homocysteine: an amino acid that the body uses to make protein and to build and maintain tissue. It is thought by some that excessive levels of homocysteine may increase the risk of coronary artery disease.

Fibrinogen: a protein in the blood that is important for normal clotting of the blood. Excessive fibrinogen, however, may increase clumping of platelets, causing a clot to form in a coronary artery, leading to a heart attack.

Lipoprotein (a): this substance forms when a low-density lipoprotein (LDL) particle attaches to another type of protein in the blood. Lipoprotein (a) may interfere with the body's ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of coronary artery disease and heart attack.

Sleep apnea: a condition characterized by repeated stopping and starting of breathing while a person is sleeping. This results in a dropping of oxygen levels in the blood, an elevation of blood pressure, and a strain on the heart which may lead to coronary artery disease.

Treatment of Coronary Artery Disease

Treatment consists of modifying the risk factors that cause coronary artery disease. Weight reduction, management of hypertension and diabetes, stopping cigarette smoking, increasing physical activity, and lowering cholesterol levels through diet and medications are all very important treatment recommendations for patients with, or at risk for, coronary artery disease. Interventions such as coronary angioplasty and stenting or coronary artery bypass surgery are treatment options available for patients who are not adequately treated with less invasive options

Link: https://vascular.cmesociety.com/  

CEREBROVASCULAR DISEASES

Cerebrovascular disease is any disease or condition where the blood vessels (vascular) in or connected to the brain (cerebro) have difficulty supplying blood to the brain. Arteries may become blocked by fatty deposits or by a blood clot. The results of cerebrovascular disease can result in a cerebrovascular event such as a stroke or a cerebral aneurysm.

How Does Cerebrovascular Disease Affect Blood Flow to the Brain?
Cerebrovascular diseases can limit the flow of blood through the arteries to the brain. The carotid arteries bring oxygen-rich blood to the front part of the brain. The blood vessels which carry oxygenated blood to the back portion of the brain are called the vertebral arteries.
This lack of blood flow to the brain may be caused by:
Thrombosis: A cerebral thrombosis is a blood clot that develops in an artery that delivers blood to a portion of the brain.
Embolism: An embolism is when the blood flow of the vessel is impeded by an object in such as a blood clot, piece of plaque or air bubble that has floated in the bloodstream until it lodges in the brain. A thrombus can travel and become an embolus.
Hemorrhage: Bleeding in the brain caused by leaking or burst vessels.
Stenosis: The carotid blood vessels can narrow, thereby reducing the flow of blood.
Ischemia: When there is a loss of blood flow to brain tissue, which can be caused by thrombosis and lead to an embolism.

The specific cause of vascular disease in the brain depends on the type of condition, but the majority of cerebrovascular events are caused by atherosclerotic disease, which is the accumulation of plaque that can slow blood flow to the brain and lead to a stroke.
Complex Cerebrovascular Conditions Treated at NSPC in New York

The leading cerebrovascular neurosurgeons at NSPC have extensive experience in treating an array of complex cerebrovascular diseases including:

• Aneurysms of the brain
• Cerebral arteriovenous malformations (AVMs)
• Carotid and intracranial stenosis
• Moyamoya disease
• Stroke including hemorrhagic and ischemic stroke
  

Our award-winning physicians are highly trained in traditional open surgery, microsurgical treatments, and minimally invasive endovascular procedures.

Cerebrovascular Disease Treatments
Brains aneurysms
Cerebral aneurysms occur when an artery wall in the brain becomes weak and pouches out. Larger aneurysms are more likely to burst. Both ruptured and unruptured aneurysms can be treated by either open surgical clipping or less invasive endovascular techniques.

Surgical clipping of aneurysms involves attaching a thin, metal clip on the base of the aneurysm to prevent additional blood from filling the space. With endovascular therapy , a small incision is made to allow a very small balloon catheter to enter an artery and travel to the site of the aneurysm. Once there, a coil is put inside to block blood to the aneurysm. A stent may also be employed to strengthen the artery wall.

Brain arteriovenous malformations (AVMs)
An arteriovenous malformation is an abnormal entanglement of veins and arteries. The normal function of arteries is to bring oxygenated blood to the brain or spine and of veins to carry the blood away. But with arteriovenous malformations, an abnormal network of arteries and veins means the oxygen-rich blood in the arteries is not going to the necessary tissue but is redirected to the veins. These weakened blood vessels are more likely to thin and leak blood into the brain than healthy vessels. Minimally invasive embolization employs neuroendovascular therapy to transports medical glue through a catheter to the AVM site to seal off blood flow to the vascular malformation.

Microsurgical techniques may be recommended for certain cerebral AVMs. This open surgery utilizes a computer-assisted craniotomy to remove a small portion of the skull allowing the neurosurgeon access to the brain. A surgical resection to remove the AVM may also be coordinated with stereotactic radiosurgery to destroy any remaining portion of the AVM.

Stereotactic radiosurgery for cerebral AVMs uses highly focused radiation beams to eradicate lesions. This is a minimally invasive treatment that is bloodless and is usually an outpatient procedure. It can be very effective for smaller AVMs, but results are not immediate. The experienced neurosurgeons at NSPC can come up with a personalized treatment plan that takes into account your unique situation.

Carotid stenosis
When atherosclerosis, the buildup of plaque in the arteries, of the carotid restricts the blood to the brain, it is called carotid stenosis . If less conservative treatments such as medications do not halt the intracranial stenosis, your doctor may recommend surgical treatment to repair the narrowing of the blood vessels.

Carotid endarterectomy is the direct surgical removal of plaque from the walls of the carotid artery. A less invasive surgical procedure, carotid angioplasty and stenting involves inserting a balloon-tipped catheter to widen the constricted blood vessel and placing a stent in the artery to keep the artery open.

Moyamoya disease
This rare, progressive disease involves the narrowing of the carotid artery but is not caused by the accumulation of fatty deposits on the walls of the blood vessel. With Moyamoya disease, the blood vessels at the base of the brains become blocked and new blood vessels develop in an attempt to transport blood. The surgical treatments for Moyamoya include direct and indirect revascularization procedures to re-establish blood flow to the brain. During an STA-MCA bypass, your surgeon attaches a superficial temporal artery (STA) to the middle cerebral artery (MCA) to restore blood flow. For an EDAS (encephaloduroarteriosynangiosis) procedure, the superficial temporal artery is attached to the brain’s surface, encouraging new vessels to develop. With an EMS (encephalomyosynangiosis), the neurosurgeon places a tiny part of the temporalis muscles from the head and attaches it to the brain’s surface to stimulate proper blood flow.

Stroke
A stroke is a sudden disruption in the flow of blood circulating in the brain. If caused by a blockage, it may be an ischemic stroke. A transient ischemic attack (TIA) is a collection of stroke symptoms that themselves resolve in 24 hours. A hemorrhagic stroke involves bleeding in the brain.
Emergency medical care is critical in treating a stroke. Medications may be introduced to dissolve a clot, to reduce intracranial pressure, to halt vasospasm, or to avert a seizure. Other surgical procedures to repair the blood vessel may be warranted such as

• Carotid endarterectomy,
• Balloon angioplasty and stenting,
• Intracranial bypass,
• Stereotactic surgery, or
• Surgical clipping to treat ischemic and hemorrhagic strokes.

State-of-the-Art Treatments for Cerebrovascular Disease at NSPC

Our team of NY-based neurosurgeons, neurologists, and interventional neuroradiologists have expertise in diagnosing and the accompanying treatments of complex cerebrovascular diseases. Our neurosurgical practice also has deep expertise in a range of related subspecialties including endovascular therapy of brain aneurysms, neoplasms and cerebral AVMs, acute stroke intervention, and extra-cranial/intra-cranial angioplasty and stenting of obstructions in the brain’s blood vessels.

Our premier neurosurgical group has extensive experience in treating complex cerebrovascular disorders employing computer-assisted cranial surgery and in using less invasive techniques such as endovascular therapy and stereotactic radiosurgery.

The brain specialists at NSPC’s offices in Long Island and the surrounding New York area provide state-of-the-art surgical solutions to cerebrovascular diseases and other cerebral conditions. Contact us to find out how our surgical expertise can improve your health and life.

Reference: https://vascular.cmesociety.com/

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Blockages of the Arteries of the Upper Extremities

It is relatively rare for atherosclerosis to affect the upper extremities and cause symptoms. Even diabetic patients, who are frequently affected by circulation disturbances of the legs, are rarely troubled by occlusion of the arteries to the upper extremities. The reason for the sparing of the upper extremities from arterial occlusive problems is not entirely clear, but it is a well-documented observation. Having said that, there are a few exceptions. Atherosclerotic occlusive disease of the subclavian artery is seen and occasionally will cause pain in the upper extremities. This pain is typically brought on by exercise and especially with repetitive movements of the upper extremity such as brushing one's hair. For reasons that again are unclear, it is more common for the atherosclerotic plaque to accumulate on the left side than it is on the right side. An examining physician may be alerted to this phenomenon by a difference in the quality of the pulse between the left wrist and the right wrist. The pulse on the left side may appear weaker and this can be confirmed by measuring the blood pressure in both upper extremities. It is common enough for older individuals to have a difference in the blood pressure of their arms that it is a worthwhile test for a physician to check the blood pressure in both upper extremities to be certain that there is not a difference between the two sides. If in fact, there is a difference between the blood pressure in the right and left upper extremity, the arm with the higher blood pressure is considered the accurate blood pressure for that individual. As mentioned, it is rare for patients to actually notice that they have atherosclerotic occlusive disease affecting the upper extremities and most of the time this relatively uncommon condition goes unrecognized. In certain instances, however, the repetitive exercise of the left upper extremity can cause not only pain in the left arm but also dizziness and, in fact, patients have been known to actually faint. This condition is called "subclavian steal syndrome". The anatomical situation is one in which there is a build-up of atherosclerotic plaque in the subclavian artery on the left side with the decreased flow to the left arm. With exercise, the left upper extremity can actually "steal" blood from the brain through the vertebral artery by causing a reversal of blood flow from the brain and down into the left arm. This can result in "syncope". The diagnosis is suspected by the history and confirmed by the finding of a markedly decreased blood pressure in the left upper extremity compared to the right side and further confirmed by noninvasive testing and ultimately by angiography. Treatment is readily available for this condition and consists of revascularizing the left upper extremity by either balloon angioplasty/stenting or surgical bypass from the carotid artery to the subclavian artery (carotid-subclavian bypass), which is a very durable procedure and serves to restore the circulation to the left arm and eliminate the risk of syncope.

Finally, upper extremity arterial insufficiency can be caused by emboli. In this situation, clots can form on the heart valves or in the "great vessels" leading out of the heart (such as the aorta or subclavian arteries) and this can lead to particles of cholesterol debris or blood clot moving "downstream" into the arteries of the arms or hands and causing an acute decrease in circulation. This acute interruption of blood flow can sometimes create an urgent situation requiring surgical intervention. Surgical treatment is usually highly effective in removing the emboli and restoring circulation. Efforts must be made to identify the source of the emboli however, so that recurrence of the emboli can be prevented. Patients will typically undergo transthoracic echocardiography or transesophageal echocardiography and occasionally may need a formal angiogram to assess the arteries in the chest, which lead from the heart to the upper extremities.

Leg Arteries

Peripheral Arterial Disease (PAD):

PAD is blockage of the arteries in the legs, caused by accumulation of atherosclerotic plaque. Risk factors associated with development of plaque in the arteries of the lower extremities include cigarette smoking, high cholesterol levels in the blood, diabetes, and family history. Peripheral arterial disease usually presents with the symptom of "claudication," which is pain in the leg, usually in the calf or thigh, after walking varying distances. Some patients develop "claudication" after just a few steps, while others can walk up to a half of a mile or more before pain forces them to stop. Typically, after a rest period of a few minutes, the patient is able to resume walking again for an equal distance before the pain returns. PAD is most commonly associated with aging. Approximately 30% of people over the age of 70 have some degree of PAD. While claudication caused by PAD is not necessarily a reason to proceed with surgical therapy, evaluation by a vascular surgeon is necessary when a patient has claudication to ascertain the seriousness of the condition. While claudication can be extremely painful and lifestyle limiting, it does not necessarily indicate that limb loss is imminent or even likely. Most patients with claudication due to PAD do not progress to limb loss. When claudication deteriorates into a condition of "rest pain" however , limb loss is a distinct probability. Rest pain means that the patient has pain even when not walking. Typically, rest pain is most intense when a person is attempting to sleep. When we sleep, our blood pressure tends to decrease and this blood pressure reduction leads to a decrease in the head of pressure which is driving blood into the legs around the areas of blockage. 

Testing for PAD:

The patient should been seen by a vascular surgeon. A complete medical history should be obtained and the surgeon will examine the arterial pulses in the lower extremities at the level of the groin, behind the knee, and in the feet. An arterial noninvasive blood flow study may be obtained, which is a noninvasive measurement of the amount of blood which is being delivered to the legs. If a blockage is suspected on the basis of the noninvasive arterial blood flow studies (sometimes called a "Doppler test"), an ultrasound examination of the arteries may be obtained, an MRA (magnetic resonance angiogram) may be obtained, and finally an angiogram may be necessary to obtain a "road map" of the circulation.

Treatment Options for PAD:

When PAD is diagnosed, the vascular surgeon will propose a treatment plan. This plan may involve an exercise program (usually consisting of walking on a daily basis to the point of claudication to attempt to build "collateral blood vessels" around the blocked arteries). Other lifestyle changes including cessation of cigarette smoking, better management of diabetes, weight reduction, and cholesterol-lowering medications. Medications which have been shown to have some beneficial effect in patients with claudication caused by PAD include cilostazol (Pletal), which may improve the walking distance. Other drugs that may be prescribed by the vascular surgeon include aspirin or clopidogrel (Plavix). If it is the opinion of the vascular surgeon that the condition has deteriorated to the point where lifestyle changes and an exercise program are no longer satisfactory treatment options, an angiography may be obtained. If the angiogram demonstrates localized blockages of the arteries in the legs, a balloon angioplasty, stenting or bypass surgery may be recommended. The bypass procedure can be performed either using one of the "extra veins" of the lower extremities, or an artificial arterial bypass (made of Dacron or Gortex) may be used. This decision is made by the vascular surgeon and is usually discussed with the patient prior to operation.

In cases where PAD has progressed beyond the point of claudication and beyond the point of rest pain to the situation where actual gangrene of the tissues of the lower extremity has developed, it is sometimes "too late" to salvage the extremity and amputation may be necessary. More than 50,000 amputations are performed annually in the United States . The amputation level may be either at the mid foot (transmetatarsal), below the knee or above the knee. Amputation is the procedure of last resort and is rarely undertaken prior to an attempt at limb salvage, unless the situation clearly has progressed to the point where time is of the essence and the amputation must be performed as a life-saving maneuver.

Smoking, Diabetes Can Increase Risk Of Dementia; Dementia Risk Factors

Smoking is one heinous habit which is responsible for a number of health hazards. Similarly, diabetes is a chronic condition which can affect the quality of life of a person to a great extent. The two have been popular to increase risks of cancer and heart disease. Now, researchers have warned that the two can clog the region of the brain which is crucial to memory and increase the risk for dementia.

Some recent findings have shown that smoking and diabetes can increase the risk of calcification (calcium salt deposits) in the hippocampus – a brain structure which is important for short and long-term memory storage. Any decline in the functioning of the hippocampus can cause Alzheimer’s disease, which is the most common kind of dementia.

The study, which was published in journal Radiology, found out the association between cardiovascular risk factors such as smoking, diabetes, high blood pressure, and hippocampal calcifications. Around 1,991 people aged 78 years participated in the study, reports IANS. Effects of calcification on cognitive function were also assessed in the study. However, the study suggests a link between the two and does not conclusively determine if smoking and diabetes can increase the risk of hippocampal calcifications.

Link: https://vascular.org/patient-resources/what-vascular-disease

Reference: https://vascular.cmesociety.com/

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Vascular Disease

What is Vascular Disease? 

Most Americans are familiar with heart disease and with the consequences of blockages in the vessels that carry blood to and from the heart. But few people realize that blockages caused by a buildup of plaque and cholesterol affect more than coronary arteries. Arteries throughout the body carry oxygen-rich blood away from the heart so blockages can occur in all arteries with serious effects. Three of the most recognized vascular diseases include:

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm (AAA) is an enlargement or “bulge” that develops in a weakened area within the largest artery in the abdomen. The pressure generated by each heartbeat pushes against the weakened aortic wall, causing the aneurysm to enlarge. If the AAA remains undetected, the aortic wall continues to weaken, and the aneurysm continues to grow. Eventually, the aneurysm becomes so large, and its wall so weak, that rupture occurs. When this happens there is massive internal bleeding, a situation that is usually fatal. The only way to break this cycle is to find the AAA before it ruptures.

Carotid Artery Disease - Stroke

Carotid arteries occur when the main blood vessels to the brain develop a buildup of plaque caused by atherosclerosis, or hardening of the arteries. When the buildup becomes very severe, it can cause a stroke. A stroke occurs when part of the brain is damaged by these vascular problems; in fact, 80 percent of strokes are “ischemic strokes” where part of the circulation to the brain is cut off, usually due to blockages in the carotid arteries. The process is similar to the buildup of plaque in arteries in the heart that causes heart attacks. Strokes are the third leading cause of death in the United States according to the National Center for Health Statistics.

Peripheral Arterial Disease

Peripheral arterial disease (PAD) occurs when atherosclerosis, or hardening of the arteries, causes a buildup of plaque in the blood vessels that carry oxygen and nutrients to all the tissues of the body. As these plaques worsen, they reduce essential blood flow to the limbs and can even cause complete blockages of the arteries. Early on, PAD may only cause difficulty walking, but in its most severe forms, it can cause painful foot ulcers, infections, and even gangrene, which could require amputation. People with PAD are three times more likely to die of heart attacks or strokes than those without PAD.

Link: https://vascular.org/patient-resources/what-vascular-disease

Reference: https://vascular.cmesociety.com/

#VascularConference2019    #VascularConferences   #CardiologyConferences   #HeartHealth    #VascularSurgery  #HeartSurgery   #MitralValve    #NewInnovations