This is a guest post by Dr. Bhagat Reddy. Dr. Reddy is the Director of Vascular Medicine & Endovascular Interventions at Piedmont Heart Institute in Atlanta, Georgia.

Danger level: High

What is it?

Peripheral Arterial Disease (PAD) occurs when a patient’s blood vessels narrow over time as a result of several different factors pertaining to the build up of atherosclerotic or claudic materials. This can affect many major blood vessels supplying the organs and the limbs.

Who gets it?

Patients who have a history of high blood pressure, diabetes, high cholesterol, and smoking are particularly at risk. Also at risk are patients who have had blockages in other areas of the body or patients with a family history of conditions like heart disease or aneurysms. These are the most important risk factors patients should look for and physicians should screen for.

Of course, PAD is a disease with high correlations to advanced age. It does not matter if you are male or female, as you age you have an increased chance of developing it. The disease also appears to affect patients worldwide, including in Third World countries. In fact, it appears more quickly in patients in non-western regions due to high rates of smoking and diabetes in those countries, specifically India and China.

What causes it?

Over time, and for reasons we are continuing to understand today, PAD is caused by an accumulation and deposition of cholesterol in the lining of blood vessel walls. This can happen in any part of the body, whether the vessel is supplying a major organ like a kidney, the brain, the intestines or stomach, or even the upper and lower limbs. A lot of the risk factors mentioned above don’t just cause the problem but instigate and propagate the issue.

A normal artery and an artery with an accumulation of cholesterol in its lining.

How does it feel?

Symptoms usually depend on where the affected blood vessel is located.

Upper extremity – patients experience pain, fatigue, weakness, numbness, or difficulty using the arm. In some situations the patient may also notice instability in gait or difficulty walking in a straight line.

Lower extremity – If the blood vessel involved affects the lower limbs, the patient usually has pain in the buttocks, calf, or foot, depending upon the location and extent of the blockage. The patient might also experience fatigue, tiredness, weakness, or numbness either during exercise or at rest if the case is severe. Some important signs in patients with critical disease in the lower extremities, apart from severe pain, include non-healing sores, especially in patients with diabetes, and/or discoloration of their toes and foot (which would indicate gangrene).

Kidney – If the blood vessel to the kidney is involved, the disease is mostly silent and symptomless. However, patients may have early or late onset of hypertension and/or difficulty controlling blood pressure despite reasonable treatment with medications. Patients may also have an abnormal kidney function detected on routine blood tests.

Abdomen – If the blockage restricts blood flow to the belly, patients experience significant abdominal pain after eating and significant weight loss over time.

Neck/Brain – If the blockage restricts blood vessels supplying the neck or brain, patients usually exhibit stroke-like symptoms.

How is it discovered?

The best way to detect PAD, apart from asking questions about risk factors, is to examine the patient and feel pulses. Physicians should examine the patient with the stethoscope and listen for abnormal, “squishy” sounds that could indicate blockages in any part of the body. Next, an ABI, or Ankle Brachial Index, can be conducted to measure the blood pressure in the arms and the legs. Blood pressure is supposed to be equal in the arms and legs: if it’s lower in the legs, it means the patient could have reduced blood due to blockages. Clinical studies have shown that an abnormal ABI measurement, meaning lower blood pressure in the legs, is a sign of heart and vascular disease, and therefore also signifies a chance of early death due to these conditions.

How is it treated?

PAD is treated first and foremost by understanding, addressing and correcting risk factors for the disease, because if uncorrected, the disease continues to propagate in different areas of the body. So the treatment of hypertension, diabetes and smoking are important upfront. There are also certain medications designed to help reduce hypertension and cholesterol, such as aspirin and Plavix, that appear to significantly help these patients.

What is key is to not just recognize the problem, but to recognize the intensity and severity of the problem at the time. Based on a physician’s detailed examination, when severity is detected, the physician should focus on which part of the body needs priority in treatment by opening the blockages. Blockages are opened most of the time in a nonsurgical fashion using catheters or devices through a small needle stick.

Fortunately, we are able to provide most of the procedures on an outpatient basis without sedation. Patients do not need anesthesia and have a very quick recovery; plus, the chances of having major complications or infections is very low. The other significant advantage is that these procedures can be performed on a patient multiple times over a lifetime if additional blockages appear throughout the body.

What happens after treatment?

The outcome is fairly good for PAD patients, depending upon the extent and location of blockages. Outcome can also vary on a patient-to-patient basis. Most times, if the disease is treated effectively and the patient addresses and corrects risk factors with the help of a healthcare practitioner, the outcome appears to be very good. However, most patients will need to follow up with their vascular consultant for the rest of their lives, because this is a disease in progress. Even though the most serious problem has been fixed, a patient may develop a problem in another location in the body that could and should be treated before it proves serious. So – early detection and treatment should always be the priority.

The bottom line – How do I avoid it?

Most people, at least in the US, die of cardiovascular causes. It’s important to recognize this, because recognition and treatment of these patients is of significant value: if these patients are not treated, they will die much earlier than most people who do not have vascular disease.

People cannot necessarily avoid PAD, but they can be vigilant in early detection, treatment and managing risk factors. If a patient has already identified his/her risk factors, the next step is to aggressively continue toward improving or resolving the risk. Most importantly, patients need to be on the lookout for any vascular condition to get treated before it causes severe organ damage and/or death.

Related posts:

1. Preeclampsia – A Dangerous Rise in Blood Pressure During Pregnancy
2. Aortic Dissection – A Life Threatening Tear in Your Aorta
3. Hypertension (High Blood Pressure) – All You Need To Know

Danger level: High

What is it?

Temporal arteritis (also known as giant cell arteritis) is a disease in which there is an inflammation of your blood vessels (which in medical terms is called vasculitis). Most often it affects the arteries in our head.

Who gets it?

Temporal arteritis (TA) affects women about 2-3 as much as men. It’s usually seen after age 50 (90% of people with TA are over 60), and happens to 1-5 in 10,000 people.

It’s more common in white people, especially if their origin is northern European.

What causes it?

Vasculitis is a condition in which our blood vessels get inflamed, which damages them and causes various diseases. It can affect blood vessels of any size: small, medium and large.

In TA, medium and large sized arteries are involved. It is called “temporal arteritis” is it most commonly involves the superficial temporal arteries, located on our temples.

The superficial temporal artery (marked by a line above). It’s the artery most commonly involved in TA.

The disease’s other name, “giant cell arteritis”, means that it involves other medium and large arteries, including the aorta, carotid, subclavian and others.

No one knows for sure what causes the inflammation in these arteries.

How does it feel?

The most common symptom is a headache, and tenderness around the temples, where these arteries lie. The pulses in these arteries may vanish as well.

Other things which can be felt include:

• Jaw pain when you chew – This is called jaw claudication in medical language.
• Low grade fever – Meaning you have a fever, but it’s not too high (around 99.5F or 37.5C).
• Fatigue
• Weight loss
• Muscle pain
• Lack of appetite

One of the most feared things which can happen in this disease is the involvement of another nearby artery – the opthalmic artery. This artery sends blood to our eye nerves, and damage to it can cause blindness, which is why treating this disease on time is very important.

About half the people with TA also have a condition called polymyalgia rheumatica. It involves pain and stiffness in the neck, arms or hips. It’s usually worse in the morning before going out of bed.

How is it discovered?

There are two main things done to discover TA:

1. Blood tests – Two tests, called ESR and CRP hint at TA when they are high.
2. Biopsy – This is a procedure in which a piece of the temporal artery is taken and seen under a microscope to see if it is inflamed.

How is it treated?

The drug of choice to treat TA is steroids. Since the vision is threatened here, many doctors give these even before they are certain you have TA, to save your eye sight.

What happens after treatment?

Usually, if treated on time, the disease tends to go away. It may last up to 2 years.

There’s currently no known way to prevent TA.

Related posts:

1. Kawasaki Disease – A Childhood Disease That Can Endanger The Heart
2. Familial Mediterranean fever – Fever and Inflammation Inside The Body
3. Crohn’s Disease – Inflammation in The Intestines Which Can Influence Your Whole Life

Danger level: High

What is it?

The aorta is the largest blood vessel in our body, and it responsible for supplying blood to all of our organs. Aortic dissection is a life-threatening situation which occurs when a tear develops in the inner layer of the aorta.

Who gets it?

Aortic dissection is 3 times more common in men than in women. Mostly it tends to occur between the ages 40 and 70, with most cases occurring between ages 50-65.

Aortic dissection is more common in African Americans than in white people, and is even less common in people of Asian origin.

There are a few risk factors which put you at risk of having an aortic dissection:

1. High blood pressure – In more than 70% of the cases of aortic dissection, it happens to people with high blood pressure.
2. Diseases in the connective tissue – Connective tissue is a material of which certain things in our body are built, such as tendons, bones and cartilage. There are a few diseases that are specific to this tissue, including Marfan syndrome, Ehlers-Danlos and others. People with these conditions are at risk of having an aortic dissection.
3. Problems in the aorta from birth – There are all sorts of variations in the build of the aorta, with which we can be born (such as a bicuspid aortic valve and others). Having them puts you at risk of having a dissection.
4. Inflammation in your aorta – There are diseases which can cause this, including syphilis, Takayasu, Giant cell arteritis and Behcet’s disease.
5. Pregnancy – If it occurs during pregnancy, it is more common in the 3rd trimester.
6. Injury to the aorta – Such as during a motor vehicle accident.

What causes it?

Our blood vessels, including the aorta, are made of 3 layers. The innermost layer (the one in touch with the blood) is called the intima. The middle layer is called the media, and the outermost layer is called the adventitia.

In aortic dissection, a tear develops in the innermost layer – the intima. Blood enters through the tear, which causes the inner and middle layers to separate.

In an aortic dissection, there is a tear in the innermost layer, through which blood enters the middle layer. Drawing by J. Heuser.

After the blood enters between these two layers, there is a lot of pressure there, caused by the force of the blood flow. This can cause the split between the two layers to continue further down or up the aorta.

This video shows the process:

The tear which runs backwards or forwards along the aorta can cause tears in blood vessels coming out of the aorta and supplying organs in our body. This can lead to a heart attack if it gets to the blood vessels supplying the heart; a stroke, if the blood vessels supplying the brain are involved; kidney failure if it reaches the arteries supplying the kidney, and so on.

Besides that, the main risk in an aortic dissection is that the outer layer (the adventitia) will give way and tear, causing a massive blood loss and death.

How does it feel?

The main thing felt in aortic dissection is a sudden and severe chest pain. It feels as if you have been stabbed with a knife, and radiates to your back. The pain can be associated with cold sweat.

As the dissection gets worse, the pain tends to move with it.

How is it discovered?

There are a few things a doctor can do to discover if you have an aortic dissection:

1. X-rays or CT scans of the chest – They will show the problem in the aorta.
2. Echocardiography – This is an ultrasound of the heart and the area around it. It will also show if you have a dissection.

There are other methods as well, which are used less frequently to detect if you have a dissection.

How is it treated?

An aortic dissection is considered an emergency and requires an immediate treatment. According to the area in the aorta in which the tear occurred, there are two options for treating it:

1. Surgery – In the surgery, the problematic area is taken out, the tear area is blocked, and then a tube is inserted into the aorta – this “builds” the shape of the aorta again. The tube is called a graft.
2. Medications – These are drugs which take down the blood pressure, causing less stress in the area of the tear.

What happens after treatment?

About 20% of people with a dissection die before reaching the hospital. If not treated, the chances of dying from it are high.

After treatment many people will need to take medications to lower their blood pressure for the rest of their lives, in order to prevent this from happening again.

The bottom line – How do I avoid it?

The most important things is to lower your blood pressure if you have hypertension.

If you have any of the conditions mentioned above in the risk factors, you should consult your doctor on how to prevent a future dissection.

Also, when in a car, be sure to wear a seatbelt. This will reduce the risk of injury to your chest.

Related posts:

1. Peripheral Arterial Disease – A Narrowing of Blood Vessels that Will Shorten Your Life
2. Migraine Headaches – How To Tell If Your Headaches Are Life Threatening, and What You Can Do About Them
3. Arteriovenous Malformation – The Blood Vessel Defect That Can Change Your Life (As Seen on House MD)

Danger level: High

What is it?

Hypertension is an elevated level of the blood pressure, which can lead to serious complications.

Who gets it?

Hypertension affects about 60 million people in the US (30% of the population), and about 1 billion worldwide. It’s been estimated that hypertension is responsible for 6% of deaths worldwide.

The older you are, the more likely you are to have hypertension (after age 60, about 65% of the population has it).

There are certain risk factors which increase your risk of having a hypertension. These include:

1. Obesity – The more overweight your are, the more likely you are to get hypertension.
2. Eating foods rich in salt.
3. Having a family history of high blood pressure, heart disease or diabetes.
4. African American origin.
5. Being sedentary – Not doing any physical activity can raise your risk
6. Drinking alcohol excessively
7. Smoking
8. Using certain medications

What causes it?

First of all, what is a blood pressure?

It’s the force of blood pushing against our arteries as the blood flows through the body. You can understand it better if you think about a garden hose. As more water passes through the hose at a certain time, the more force works against the hose. This can damage the hose, or in real life, damage the blood vessels.

The reason for the development of hypertension in a person isn’t always known. Most of the time (95% of cases), the cause is unknown. In such cases, the condition is called essential hypertension.

The other, less common, type of hypertension is called secondary hypertension, since it’s secondary to other conditions. Causes here include Cushing’s syndrome, sleep apnea, drugs, kidney diseases, pheochromocytoma, thyroid problems and others (we will cover all of those in the future).

How does it feel?

That’s the main problem: Usually you don’t feel a hypertension. That’s why it’s been called “the silent killer” – you may walk around not knowing you have it until something happens.

That’s why regular checkup at your doctor’s office are important.

How is it discovered?

The doctor uses a cuff which they put around your arm to measure your blood pressure.

A blood pressure cuff.

When measured, the blood pressure appears as 2 numbers: The first (and higher) one is called the systolic blood pressure (this is the pressure that is measured when the heart beats and fills the arteries with blood). The second one is called the diastolic blood pressure (the pressure that’s measured when the heart rests between beats).

Generally speaking, when you have a blood pressure reading of 140/90 or higher (taken at least twice) you are said to have a high blood pressure.

How is it treated?

Treating a high blood pressure contains a few stages:

First – Modifying your lifestyle

Before starting with drugs, hypertension is usually treated first with lifestyle modifications. These include:

1. Weight loss – In people who are overweight or obese.
2. Starting a healthy diet – The diet recommended for people with hypertension is called the DASH diet (short for Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables and low-fat dairy products, with reduced fats.
3. Taking off salts in your diet
4. Physical activity
5. Drinking less alcohol

Each of these things can contribute to lowering your blood pressure. If that’s not enough, the next step follows.

Second – Medications

There are many types of drugs to treat hypertension, and they are beyond the scope of this article. Your doctor will recommend which ones to start with, and what drugs to add if the first one doesn’t do the trick.

What happens after treatment?

If the blood pressure is treated, everything is fine and dandy. The problem is, a lot of people don’t stick to their pills. Like we said above – you don’t feel hypertension, so why should you stick with those pills (and their side effects)?

Which takes us to the “silent killer” part. Untreated, hypertension can cause damage to organs in our body:

1. The heart – Hypertension can lead to atherosclerosis and heart attacks.
2. The brain – Hypertension can lead to strokes, especially those caused by bleeding to the brain.
3. The kidneys – Hypertension can lead to kidney failure.

Yes, 30% of the population has a high blood pressure. It doesn’t mean that YOU have to be one of them. There are certain things you can do today to lower your risk of developing hypertension:

1. Maintaining a normal weight – Your target BMI should be 18.5 to 24.9 (for explanations about that and for a starter’s guide for losing weight, you can visit our article about using the Internet to lose weight).
2. Reducing salt in your diet – The nutrition labels on foods you buy can help you. You should aim at less than 2,300mg of sodium (salt) a day. This is the equivalent of about 1 teaspoon of salt.
3. Exercising – For at least 30 minutes on most days of the week.
4. Limiting your alcohol intake – To 2 drinks a day if you’re a man or 1 if you’re a woman.
5. Following the DASH diet

This video sums it up (it talks mostly about Canada, but applies to every country) -

Got any tips of your own? Share them in the comments.

Related posts:

1. Preeclampsia – A Dangerous Rise in Blood Pressure During Pregnancy
2. Peripheral Arterial Disease – A Narrowing of Blood Vessels that Will Shorten Your Life
3. Waldenström’s macroglobulinemia – A Rare Blood Cancer That Can Lead To Strokes

Danger level: High

What is it?

Deep vein thrombosis (DVT for short) is a blood clot (or thrombus in Greek) that forms in a deep vein in the body.

Who gets it?

There are a few risk factors for developing DVT:

1. Conditions that cause the blood to move slower– For example if you are bedridden for a long time or paralyzed, or if you sit in an airplane for a prolonged time (usually for more than 8 hours).
2. Injury to our blood vessels: This can happen after a trauma or after a major surgery (such as orthopedic surgeries).
3. A propensity for clotting – In some people, clots can form more commonly than in others. This includes people with blood disorders which can cause this, as well as women taking contraceptive pills (and those taking hormones after menopause), and it can also happen after taking other types of drugs.
4. Cancer – Can raise your risk of developing DVT.
5. Pregnancy
6. People who have had it before – Are more prone to developing DVT again.

Oral contraceptive pills. They can cause DVT. Photo by Gnarls Monkey.

What causes it?

Our body has a clotting system. This is the system that’s responsible for the clot that forms when you are wounded. Platelets (a type of blood cell) in our blood aggregate in the area of the wound, and along with other materials in the blood form the clot. Usually in our body there is a balance between the system that forms clots and systems that prevent clots from happening or dissolve them when they do.

In DVT, as a result of the risk factors above, the clotting system works more than the systems which prevent or melt clots, which causes the clot to form inside the blood vessel.

A blood clot inside a vein.

How does it feel?

Clots form mostly in the veins of the legs or in the pelvis (the hip area). Less commonly, they can form in our arms.

As a result of the clot, the leg gets swollen, and may feel warm and look redder than the other leg. It can also hurt or be tender to touch.

You can see above that this disease is tagged as danger: high. If all it does is pain in the leg, you might ask yourself what’s so dangerous. The danger is that these clots can break loose from their original location, travel through the bloodstream to the lungs, and block the blood flow in the lungs (a condition called pulmonary embolism). This is life threatening.

Other than that, DVT can damage the veins in the leg in the long run (a condition called chronic venous insufficiency).

How is it discovered?

There are a few ways to discover DVT:

1. An ultrasound of the legs – It can detect the blood flow in the legs and show if it’s blocked by the clot.
2. A blood test – Which can discover if you have DVT (the test is called D-Dimer).
3. Venography – This is an X-ray picture of the blood flow through your veins.

How is it treated?

There are 2 ways to treat DVT:

1. Above we mentioned that as well as the system in our body which is responsible for clotting, there are systems responsible for stopping the clotting process and for dissolving the clots.

   There are drugs which help these other systems. These drugs are called blood thinners (or in their medical name, anticoagulants). Examples of such drugs are heparin and warfarin. These drugs are usually given for at least a few months until you are out of risk (and if you have a permanent condition which makes your blood clot, you may have to take it for life).

2. Inferior vena cava (IVC) filter – There are people who can’t get blood thinners, and there are also people who still get DVTs although they take these drugs. For these people, a type of filter is inserted into our vena cava, which is a vein in which the blood travels from the lower body to the heart. Putting the filter there prevents clots from reaching the heart and the lungs.

What happens after treatment?

Treating this condition on time prevents its complications (pulmonary embolism and venous insufficiency).

The bottom line – How do I avoid it?

There are a few things you can do to prevent DVT:

1. On long flights – Some doctors recommend that you wear compression stockings (they’re available at medical supply stores) during the flight. On long flights you should walk up and down the aisle hourly (working your leg muscles squeezes the veins and moves the blood in them), drink plenty of water (since dehydration, which is more common when you’re on an airplane, can make your blood thicker and drive clot formation), flex and point your feet occasionally, and avoid alcohol and drinks which contain caffeine (since they contribute to dehydration).

   This also applies to long travels by car, when you sit most of the time.

2. If you have a family history of blood clotting, inform your doctor – This can potentially prevent conditions which run in families and cause blood clotting from putting you at risk for DVT.
3. When you undergo a surgery or when bedridden – You will be given medications and other measures to prevent DVT from occurring.

This video sums it up:

Related posts:

1. Wilson Disease – The Return (As Seen on House MD)
2. Understanding Heart Attacks – Part 3 – Myocardial Infarction
3. Stroke – A Heart Attack In The Brain

Danger level: High

What is it?

Kawasaki is a disease that causes inflammation of blood vessels.

Who gets it?

Kawasaki is mostly a children’s disease, and occurs mostly between the ages 1 and 8. 80% of cases occur before age 4.

Kawasaki is most common in children of Japanese descent, but can happen to others as well. It’s more common in boys than girls.

What causes it?

In Kawasaki there’s an inflammation of blood vessels. Since in medicine an inflammation’s name usually contains “is” in the end, inflammation of blood vessels is called a vasculitis.

Our arteries, much like shirts, come in 3 sizes: Large, medium and small. There are many types of vasculitis, with each affecting different artery sizes. Kawasaki is an inflammation of medium sized arteries. Our coronary arteries (the arteries that run on our heart and supply it with oxygen) are also involved here, putting the heart in danger.

Our heart and the coronary arteries that run on it. They’re in danger in Kawasaki disease.

No one knows why, but in Kawasaki the body attacks the blood vessels by the immune system, which is usually responsible for attacking infections (a process which is called auto-immune. We covered other auto-immune diseases here in the past, such as Hashimoto, Myasthenia Gravis, Vitiligo and Graves disease).

How does it feel?

There are a few things that happen in this disease:

1. Fever – This is the most characteristic sign. There’s a fever here that persists for 5 days or more.
2. Red eyes – This usually starts within 1-2 days after the fever begins.
3. A body rash
4. Swollen, red lips and tongue – The tongue here looks like a strawberry, and so is called a “strawberry tongue”.
5. Swollen, red feet and hands – Which later undergo desquamation (peeling of the skin, like in a snake).
6. Swollen lymph nodes in the neck

Other things that might occur are joint pain, a rapid heart beat and other things.

Since the heart can be involved in the disease, about 1-4 weeks after it begins, symptoms related to the heart can occur. Examples of these include failure of the heart to function properly, heart rhythm problems, inflammation of the heart and more.

The most feared complication in the heart is an aneurysm in the coronary arteries, which means a widening of the artery. This can leas to serious complications.

Recently Kawasaki disease was brought to the headlines after the death of John Travolta’s son, Jett, but it was later claimed that his death did not have anything to do with the disease.

This video shows the story of Nicky O’Donnell, a kid who was diagnosed with Kawasaki, a diagnosis which saved his life:

How is it discovered?

There is no lab test that can confirm the presence of Kawasaki disease, and the diagnosis is made by recognizing the above symptoms.

Also, an EKG and a heart imaging (echocardiogram) will be done to see the state of the heart and rule out any complications as a result of the disease.

How is it treated?

The treatment of Kawasaki can includes two things:

1. IVIG – These are immunoglobulins, or molecules that are given through the veins, which help to reduce the inflammation of the blood vessels.
2. Aspirin – It lowers the risk of blood clots, which can form here. (Please note: Aspirin is usually not recommended for children since it can cause a condition called Reye’s Syndrome. Kawasaki is about the only disease when it is given to them).

Blood thinners may also be required.

What happens after treatment?

Most children get better and have no long-term effects. About 20% of people who are not treated will have problems with their coronary arteries, which in rare cases can even lead to a heart attack.

The bottom line – How do I avoid it?

There is no known way to prevent Kawasaki disease from occurring.

Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Understanding Heart Attacks – Part 3 – Myocardial Infarction
3. Chest Pain – Is It a Heart Attack?