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Vascular Disease

Vascular Disease is a general term for a group of disorders that affect blood vessels that make up the circulatory system of the body. Healthy arteries carry oxygen-rich blood to all parts of the body, and veins carry the blood back to the heart and lungs to replenish its oxygen. Vascular diseases affect the vessels’ ability to carry enough blood to the organs, muscles, bone and other tissues of the body to keep them working properly. The areas of the body most likely to be harmed by vascular diseases are the heart, brain, kidneys, other vital organs, and arms and legs.

The most common type of vascular disease involves the arteries and is known as arteriosclerosis. In arteriosclerosis, the walls of the blood vessels become thick and less flexible. Atherosclerosis is the most common type of arteriosclerosis. In atherosclerosis, a medium or large artery becomes roughened on the inside, allowing buildup of a fat called plaque. The plaque partly or completely blocks the artery, stopping or reducing the flow of blood.

The second type of vascular disease involves the veins. The vein walls become weak and blood flow becomes sluggish causing blood clots. A blood clot in the arteries or veins is known as a thrombus.

Vascular disease can happen at any age. Patients who have vascular disease and risk factors are at a higher risk of developing a stroke, abdominal aneurysm, and poor circulation in the legs.

Learn more about Peripheral Venous Disease (PVD)

Patent Foramen Ovale (PFO)

What is a PFO? Patent Foramen Ovale (PFO). In the womb, a fetus is not yet breathing, so it doesn’t need much blood flowing through its lungs. This is where the efficiency of nature takes over. There is a “shortcut” through which the mother’s blood is mostly diverted away from the lungs and into the body of the fetus.The shortcut is called the foramen ovale. It’s a small hole between the upper left and upper right chambers, or atria, of the heart. The hole is generally higher up on the wall (septum) between the chambers, just above where a secundum-type Atrial Septum Defect (ASD) would be located.

The foramen ovale should grow closed at birth or shortly afterward. This change accommodates the increasing blood pressure in the aorta and left side of the infant’s heart as it begins its normal stage of development. If the foramen ovale doesn’t close, as it should, blood can flow through it from right to left. This condition is referred to as Patent Foramen Ovale (PFO). The word “patent” is a medical term that means “open.” Patent foramen ovale is suspected as a pathway for blood clots which can potentially lead to a stroke or transient ischemic attack (TIA). If you have suffered a stroke, your neurologist will attempt to locate the source of the embolus. When the source of the clot or embolus cannot be found through diagnostic testing, the stroke may be labeled as “cryptogenic” (unknown source) in nature. Stroke or TIA that is cryptogenic in nature may lead your neurologist to refer you for ultrasound imaging of your heart. If a Patent Foramen Ovale is found in conjunction with an unknown source of stroke, you may be referred for medical treatment or Amplatzer device closure of your PFO. The Amplatzer PFO Occluder is designed to close a PFO that is suspected as a pathway of embolic material with an unknown source.

Valvular Disease

Aortic Regurgitation

Aortic Regurgitation or Insufficiency is a condition where the aortic valve leaks blood back into a relaxed left ventricle. As a result the left ventricle must work twice as heard to pump not only the blood that normally enters from the left atrium but that blood which is leaking backwards. As the left ventricle struggles to push blood through the leaky valve, not enough blood is pumped to the rest of the body. Blood may back up into the left atrium and eventually into the lungs. Over time this enlarges the ventricle. The inability of the aortic valve to seal properly can result from rheumatic fever, congenital disorders (Marfan’s, bicuspid valve), infections (endocarditis), or be unknown. Common symptoms may not appear until the heart has been taxed to its limit. These symptoms may include:

  • shortness of breath
  • fatigue
  • chest pain
  • swelling in ankles
  • fast heart rate

Medications that can help prevent or minimize damage done to the heart include:

  • Digoxin which helps with contractions of the heart
  • Diuretics helps relieve congestion
  • Ace Inhibitors helps open arteries and reduces resistance of blood flow through those arteries. By doing this it lowers the workload on the heart.

While medication helps relieve many symptoms, it is unknown if they change the course of aortic regurgitation. As the heart enlarges and starts losing function, surgery to replace the valve may be the only treatment.

Mitral Regurgitation

Mitral Regurgitation is a condition which causes backflow of blood into the left atrium. This backflow can cause pressure to build in the lungs. Eventually, this leads to heart muscle enlargement. Backflow is a result of the valve leaflets inability to seal properly. This can be caused by Rheumatic fever, heart attack or injury from a bacterial infection (endocarditis). Symptoms can include:

  • shortness of breath
  • palpitations
  • rapid breathing
  • coughing
  • fatigue

Antibiotics can be prescribed to help prevent future infections prior to general surgical or dental procedures. Medications can help minimize the symptoms. They include:

  • Blood thinners to help minimize the formation of blood clots
  • Digoxin which helps with the contractions of the heart
  • Diuretics which help relieve congestion in the lungs
  • Ace Inhibitors

These help open arteries and reduces the resistance of blood flow through those arteries. By doing this, it lowers the workload on the heart.Heart valve replacement or repair may also be appropriate.

Mitral-Valve Prolapse

The heart’s valves work to maintain the flow of blood in one direction, ensuring proper circulation. The mitral valve controls the flow of blood into the left ventricle. Normally, when the left ventricle contracts, the mitral valve closes and blood flows out of the heart through the aortic valve and into the aorta to start its journey to all other parts of the body.

In MVP, the shape or dimensions of the leaflets of the valve are not ideal; they may be too large and fail to close properly or they balloon out, hence the term “prolapse.” When the valve leaflets flap, a clicking sound may be heard. Sometimes the prolapsing of the mitral valve allows a slight flow of blood back into the left atrium. This is called “mitral regurgitation,” and may cause a sound called a murmur. Some people with MVP have both a click and a murmur and some have only a click. Many have no unusual heart sounds at all; those who do may have clicks and murmurs that come and go.

Mitral-valve prolapse (MVP) is frequently diagnosed in healthy people and is, for the most part, harmless. Most people suffer no symptoms at all. New estimates are that about 2 percent of the adult population has the condition. MVP is also called floppy valve syndrome, Barlow’s or Reid-Barlow’s syndrome, ballooning mitral valve, Midsystolic-click-late systolic murmur syndrome, or click murmur syndrome. MVP can be present from birth or develop at any age and occurs equally in both men and women. MVP is one of the most frequently made cardiac diagnoses in the United States.

The mitral valve is the heart valve between the left atrium and left ventricle. It has two flaps, called leaflets or cusps, which open and close when the heart contracts (beats) and rests.