Cardiovascular illnesses







ACROCYANOSIS

When the hands or feet are permanently cold and uniformly, purplish, painless and sweaty, it is probably an acrocyanosis, a benign but unsightly condition, which worsens when exposed to the cold and diminishes with reheating.

Please note, the sudden onset of pain in a foot or hand, which becomes cold and cyanic, suggests an arterial obstruction. This is an extreme emergency which must lead you to consult your doctor.

When the attack on the hands is paroxysmal, occurring by crises, it is probably a Raynaud's syndrome. Attacks occur when the hands are exposed to the cold. They consist of three successive phases : the fingers become white, numb, then blue, finally red and painful. This phenomenon requires consulting your doctor because, although in the vast majority of cases, it is a perfectly mild condition, it is sometimes the expression of drug intolerance (beta blocker, anti migraine, contraceptive pill) ) or one of the symptoms of more complex diseases called "system diseases": scleroderma, rheumatoid arthritis, lupus erythematosus etc.

Capillaroscopy, which allows using a microscope to observe the capillaries of the nail bed, is sometimes an aid to diagnosis.

Copyright photo : Par James Heilman, MD — Travail personnel, CC BY-SA 3.0

Bibliography: Dermatologie, Vitropression, Acrocyanose, Mononucléose infectieuse, Rougeole, Rubéole, Érythème infectieux aigu de de Frederic P. Miller (Sous la direction de), Agnes F. Vandome (Sous la direction de), John McBrewster (Sous la direction de).

AORTA ANEVRYSM

The aorta is the artery that arises from the heart and extends to the abdomen : it distributes oxygenated blood through its branches to the whole body. An aortic aneurysm or ectasia is a dilation with blistering of the walls of this vessel: although the affection is rare, it is feared because of the risk of rupture. Your doctor will be concerned if you experience certain abdominal pain.

Palpation of the abdomen makes it possible to note the puffy, broad, expansive character of the aorta; the auscultation recognizes the presence of a breath at this place. The diagnosis is confirmed by X-rays and, above all, by an arteriography.

The recent possibility of performing simple digital angiography exams with injection into a vein in the arm has greatly facilitated the diagnosis.

As soon as an aneurysm is large, surgery should be considered, even in the absence of symptoms, to avoid rupture, which is very often fatal. Small aneurysms should simply be monitored regularly. The type, difficulty and therefore the risk of the interventions depend on the location of the aneurysm (thorax or abdomen).

Copyright photo : National Institutes of Health http://www.nhlbi.nih.gov/health/health-topics/topics/arm/types.html, Domaine public.

Bibliography : Mémoire Sur Le Diagnostic Des Anevrysmes Des Grosses Artères de Augustin Nicolas Gendrin 

ARTERIOSCLEROSIS

Arteriosclerosis is the consequence of a degenerative process of aging of the arteries by accumulation of fat deposits in their wall. The latter thickens, loses its normal flexibility and shrinks in size, or even completely clogs. Arteriosclerosis is commonly called: "narrowing of the arteries.

It is easy to see that, under such conditions, the blood flow in these arteries is slowed down. Sometimes, it even becomes very insufficient to normally irrigate the organ for which it is intended and causes its dysfunction.

Arteriosclerosis, a generally slow process of formation, perhaps completely slow, perhaps latent at first, causing no abnormal signs. At a later stage, its symptoms will depend on the injured vascular territory, and therefore on the organ concerned. Thus, reaching the coronary arteries can lead to angina pectoris, that of the arteries of the limbs, called arteritis of the lower limbs, can cause painful cramps in the calves, that of the arteries to the cerebral destination causing dizziness.

High blood pressure and obesity increase the risks of installation and development of arteriosclerosis. The same is true of metabolic diseases such as diabetes mellitus and hypercholesterolomy. Tobacco is also harmful to the arteries.

The treatment of arteriosclerosis is above all preventive. It is now clearly accepted that it begins early in life, from childhood, that it evolves silently and insidiously during youth and does not generally become obvious until around fifty or more. This is the reason why the majority of doctors believe that effective prevention should be implemented from adolescence. It consists of a reduction in the intake of nutritional fats, a weight loss treatment in the event of overweight, a radical suppression of any smoking and regular monitoring of blood pressure.

The curative treatment depends on the injured area; vasodilator treatment, analgesic treatment, often combined with lipid-lowering treatment, to reduce the level of fat in the blood and possibly hypotensive. And sometimes, the specific treatment of angina pectoris, arteritis of the lower limbs.

Copyright photo : Par Manu5 — http://www.scientificanimations.com/wiki-images/, CC BY-SA 4.0

Bibliography : Bircher-benner Manual: For Patients With Hypertension, Cardiovascular Diseases and Arteriosclerosis by Dr. Andres Bircher

ARTERITY

Arteritis is characterized by an arterial obstruction that causes a decrease in blood flow from the artery to the corresponding part of the body. Obstruction of arteries may be due to:

- either to their inflammation, as in Takayashu's disease or "pulseless women" disease; this rare condition affects young people and most often involves the arteries of the arm and neck;

- either to a deposit of fat on their wall (arteriosclerosis); it is the vast majority of cases.

We will deal here with arthritis that affects the lower limbs.

The medical consultation is essential if you experience:

- pain, perceived in the muscles deprived of blood supply, in the calf, or even in the thigh, or even in the buttock in certain cases; they must attract attention if they concern only one leg and occur while walking; however pain occurring on both legs at rest is possible;

- cooling of the foot or leg.

When you see your doctor, he usually reassures you, because most leg pain is not due to arteritis. His diagnosis will be based on an examination of the arteries he feels. The decrease or disappearance of the pulse of an artery in the leg is evidence of its obstruction. In case of doubt, he will request a Doppler, a simple, harmless examination, giving excellent information. This examination makes it possible to confirm the obstruction of the large arteries, to explore the small arteries that cannot be felt with the hand, and also to follow, from year to year, the evolution of the lesions.

In some cases, an arteriography is necessary; it makes it possible to judge the caliber of the arteries, when the possibility of a surgical operation is considered.

Once the diagnosis has been established, a complete arterial assessment is required. the obstruction can take place on other arterial routes, systematically, we will look for an aortic aneurysm, coronary insufficiency, obstruction of the arteries of the brain.

At the end of this assessment, a treatment will be offered to you.

It is necessary to prevent the progression of a possible arteriosclerosis, in order to avoid aggravation of the lesions.

You should be alert to the symptoms that could indicate an atheroma of the coronary or cerebral arteries.

If you experience chest pain while running or walking, exposure to cold and emotions. Talk to your doctor quickly if you experience dizziness, sudden loss of speech, even incomplete and transient paralysis of a leg or arm or part of the face. and do a full review, because what happened to the legs can happen elsewhere.

You need to improve the blood circulation in your legs.

Certain cures can be beneficial.

A number of vasodilator or anti-ischemic medications are helpful and will be prescribed by your doctor.

Above all, you have to make your body work which will gradually develop collateral circulation; so your leg will continue to receive blood through small arteries that will go around the blocked artery. The development of this collateral circulation explains that in the vast majority of cases the symptoms improve in the year following their first appearance. For this, it is better to work your muscles by imposing yourself a daily exercise, walking without going fast and without forcing, gradually increasing the distance.

Finally, if you are embarrassed for a short walk, you should consider an intervention which can be an endarterectomy, removal of the obstructive fatty layer, or bypass surgery which is the placement of a vein or prosthetic tube which provides blood beyond the obstructed area). These interventions will only be considered after the arteriography which makes it possible to visualize the lesions and the arteries downstream, and to judge the surgical possibilities.

Copyright photo : Par Wfnicdao — Personal work, Public domain.

Bibliography : Dermatologia de Fitzpatrick: Atlas e Texto de Klaus Wolff

CEREBRAL VASCULAR ACCIDENT BY HEMORRHAGIA

A subject, hypertensive for a long time, suddenly presents an attack with complete loss of consciousness. The doctor called in emergency notes a more or less deep coma, which hinders the demonstration of hemiplegia (paralysis of a hemi body), a deviation of the head and eyes on the side of the lesion. Breathing is often noisy and the blood pressure is always very high.

Emergency hospitalization is essential. The CT scan will confirm the cerebral hemorrhage which is often a hematoma.

The treatment for cerebral hemorrhage is sometimes disappointing. With regard to coma and neurovegetative disorders, resuscitation in most cases makes it possible to pass the vital course, but the neurological sequelae often remain serious (hemiplegia, aphasia), despite prolonged rehabilitation. Surgical evacuation of the hematoma is necessary if it is superficial and compressive. The treatment of high blood pressure should partly prevent the occurrence of these serious accidents.

This serious cerebral hemorrhage, either by its lethal course or by its neurolic sequelae, is a complication of hypertensive disease. It is therefore necessary to treat and correct all arterial hypertensions.

Crédit photo : Par Bobjgalindo — Travail personnel, CC BY-SA 4.0,

Bibliography

Maladies des vaisseaux, Éditions Doin, 1998, Joseph Emmerich,(ISBN 978-2-7040-0863-6)

CEREBRAL VASCULAR ACCIDENT BY ISCHEMIA

You have just had discomfort during which, for a few minutes, you presented a paralysis of the right hand with language difficulties. It's probably a transient stroke: you need to see your doctor.

But other transient neurological symptoms can appear: paralysis of a hemi-body, language disorder (aphasia), blindness of one eye, which last from a few minutes to a few hours.

Before this stroke by ischemia, your doctor will discuss either a carotid origin (narrowing or stenosis of the carotid),

During the consultation:

- the neurological examination has most often returned to normal;

- auscultation of the neck sometimes allows you to find a breath very suggestive of a carotid stenosis;

- cardiac auscultation can evoke a rhythm disorder sometimes responsible for embolism;

- blood pressure is often high.

Additional examinations are necessary to confirm the origin of the accident.

- the diagnosis of carotid stenosis requires the cervical doppler and ultrasound to confirm the narrowing of the carotid caliber, with possible discovery of atheroma plaque; digital venous angiography to safely explore the carotid bifurcations; arteriography to clarify the appearance of the stenosis and assess cerebral vascular circulation.

- the diagnosis of embolism of cardiac origin requires: an electrocardiogram with often a continuous recording of Hotler to detect the disturbance of the cardiac rhythm to possibly find an embologenic cardiac lesion.

- in all cases, research of risk factors for arteriosclerosis is essential.

The treatment of transient ischemic attacks must prevent a recurrence and especially a definitive accident responsible for serious neurological sequelae.

On carotid stenosis, endarterectomy is now a well-coded intervention which most often protects the patient from recurrence

When treating embologenic heart disease, effective and well-monitored anticoagulant therapy should be instituted and the causative heart disease treated.

Carotid stenosis, responsible for an ischemic attack that is first of all transient and then often not reversible, is a complication of atheromatous disease, its prevention therefore includes monitoring and treating lipid abnormalities and blood pressure, with suppression tobacco.

Photo copyrigth : Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. — Travail personnel, CC BY 3.0,

HEMORRHOIDS

Hemorrhoids are the most common anal pathology. If you have a bleeding of red blood (rectal bleeding) after the stools or on the paper while wiping yourself, there is a good chance that it is only this banal pathology; but only examination by the doctor will rule out another disease. An endoscopy is also necessary: anoscopy which visualizes internal hemorrhoids that one does not feel well with digital rectal examination; rectoscopy and / or colonoscopy and sometimes x-ray of the colon by barium enema in double contrast (ie barium + air) to eliminate a tumor lesion such as a polyp, or even cancer, or colitis (amebiasis, ulcerative colitis) .

Copyright photo : by Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0,

Bibliography : Hemorrhoids de Hyung Kyu Yang 

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