Tag Archives: Blood Vessels

THE DOCTORS 101 CHRONIC SYMPTOMS AND CONDITIONS #26: HYPERTENSION

Hypertension places an extra load on the blood vessels and heart, and eventually causes them to become diseased. High Blood Pressure is therefore bad for the entire body, which depends on the blood vessels for delivering the nutrients and oxygen necessary for life.

Most hypertension happens from subtle changes in the body’s signalling systems, and often runs in families; This is called “essential hypertension”. Additionally, there are a number of diseases and conditions of which hypertension is a symptom. It is important to know if you have hypertension, and fortunately it is easy to discover.

A visit to the doctor, or even to the pharmacy will make a reading available, and if you are concerned, an automatic cuff is available for $20. A healthy lifestyle and weight Will help prevent and treat hypertension, as in so many other chronic conditions.

A variety of medications are available to treat hypertension, but ANY MEDICATION CAN PRODUCE SIDE EFFECTS. It is rare for an effective medication to produce only a single, desired effect on the body. I have never known a person who at some time did not experience some side effect from antihypertensive medications.

Be sure to maintain contact with your Doctor. The dose may be too high, causing episodes of LOW blood pressure with fainting. When I was in practice, any number of patients came to me with a chronic cough, which I “cured” by having their doctor replace their ACE Inhibitor with another medication.

Please read the accompanying Mayo Clinic article for a complete discussion of this important condition.

–Dr. C.

Mayo Clinic article

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #16: NOSEBLEEDS (EPISTAXIS)

Nosebleeds afflict almost everybody at one time or another. The nose is well supplied with blood vessels, and sticks out from the face, often into other people’s business. Fistfights and falls will often cause nosebleeds in children. Kids will often pick their noses.

Dry air and allergies make the nose bleed more often. Sometimes, nosebleeds just happen. The bleeding usually comes from the front of the septum, the cartilaginous divider of the nose, and the best way to stop the bleeding is to lean forward and pinch the nostrils together.

This most likely compresses the bleeding area, and if held for 5 minutes or so will usually stop the bleeding. Sometimes, even after repeating this several times, and even putting ice on the bridge of the nose, the bleeding won’t stop, you may need to seek help. If the bleeding is voluminous it may originate from larger vessels at the back of the nose, and an ENT Doctor may be needed to put in a “posterior pack” of gauze.

Infrequent nosebleeds from identifiable causes are not too disturbing, but if they become CHRONIC and unexplained, a visit to the doctor and further investigation may be needed.

High blood pressure can be a cause of regular nosebleeds. High altitudes and the accompanying dry air can be a contributory cause. Cocaine use may irritate the nose and cause “Kiesselbach’s plexus” on the anterior nasal septum to bleed.

If you bleed a lot from your nose, especially if you have trouble with clotting from cuts or periods, you may have a coagulation problem, of which there are several, such as Von Willebrands disease.

Blood thinners are commonly used these days, and the dosage may need adjusting. For more information, please consult the accompanying article on “epistaxis” by the Cleveland Clinic, which usually has good articles on medical problems.

–Dr. C.

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BLOOD CIRCULATION: THE “LYMPHATIC SYSTEM”

The pulmonary circuit oxygenates and the systemic arterial circuit circulates several Liters of blood per minute. As this blood trickles through the capillaries, some of it oozes out through the thin endothelial lining, becoming interstitial fluid.

Most of this flud gets back into the capillaries and returns to the heart in the venous return. About 20% of the fluid drains into the LYMPHATIC SYSTEM, through the Lymph nodes, and back into the thoracic duct, into the vena cava, and eventually back into the general blood supply, which recirculates.

The Lymphatic System

The Return of the residual interstitial fluid by the Lymphatic vessels back to the general circulation is important, and if BLOCKED by such things as surgery and parasites, produces a swelling known as LYMPHEDEMA.

But the major importance of the lymphatic vessels is their characteristic cells, LYMPHOCYTES, and their accessory structures, The THYMUS, SPLEEN, LYMPH NODES, AND LYMPHATIC TISSUES is in the development and training of the IMMUNE SYSTEM. The THYMUS can be regarded as an organ to TRAIN Lymphocytes to be functional members of the immune system.

SomeT-cells operate to Help B-cells to produce antibody. These are called Th-4 cells. Others, called Th-8 cells. function to delete cells,

The thymus POSITIVELY selects cells that are prepared to recognize pathogens, and gets rid of cells (NEGATIVELY selects) cells that recognize the body’s own cells.

Failure to do so would result in “horror autotoxicus”, or AUTOIMMUNITY. The Thymus performs most of its functions when we are young.

The LYMPH NODES act as a type of filter for the Lymphatic channels, and intercept most bacteria and other pathogens coming through the lymphatic channes to keep them out of the blood stream. Lymph nodes are present at predictable locations throughout the body.

The Spleen acts as a big lymph node to filter the blood directly, and can intercept organisms that have escaped the lymph nodes. The Spleen can enlarge with certain infections, as with the EB Virus that causes mononucleosis.

Rupture of the spleen is not uncommon with direct blunt trauma to the abdomen. Removal of the spleen can increase susceptibility to blood stream infection. Lymph tissue is scattered throughout the body, like in the Tonsils, adenoids and Intestinal tract.

This Lymphocyte-containing tissue can expand with exposure to infection, and can become cancerous with Lymphomas. It can also enlarge enough to produce local Blockage, as with Adenoids. Lymph tissue should not be removed wantonly, since it may provide protection. There are 2 arms of our immune system.

I have been discussing the ADAPTIVE immune system which recognizes the pathogen, and stores memory of this interaction in “memory T-cells”. The helper T-cells( Th-4) start to multiply and stimulate the B-cells to “clonally” proliferate and differentiate into Antibody-producing Plasma Cells. The Cytotoxic T-cells, which can directly kill Pathogens, also multiply.

The first time this happens with a new Pathogen, Like SARS CoV-2, this adaptive process takes a week or so. But if the same Pathogen comes later, The adaptive immune system is ready, via the Memory T-cells, and springs rapidly into action. The 2nd arm of our immune system, shared with all of our vertebrate relatives, is the INNATE immune system.

The innate system is prepared IMMEDIATELY to recognize certain foreign molecules common to many invaders, and foreign our own bodies. It usually does not have the Power of the innate immune system, but in healthy people does an amazingly good job.

Some people just don’t get sick very often. Do the best you can to be one of these healthy people by getting proper SLEEP, DIET. AND EXERCISE!

BLOOD VESSELS: HUMAN “PULMONARY CIRCULATION”

Humans have a high energy requirement. Like a sports car we need to be turbosupercharged. We need an entirely separate Pulmonary circulation to handle our great oxygen demand.

Fish can get by on a single heart and circulation. They are “cold-blooded” and have no elevation of temperature above that in the environment. The water buoys them up, and they don’t need to constantly fight gravity.

Birds, and by extension, therapod dinosaurs, need more efficiency, and have a separate pulmonary circulation, just like we do. They share with us a DOUBLE CIRCULATION, a 4-chambered heart, with 2 entirely separate circuits.

In my residency, I saw a lot of congenital heart disease. In the process of development, the very early human embryo has a single circulation, just like “early” vertebrates, like fish.

In the process of development, the Systemic and Pulmonary circulations divide the previously unitary system into 2 separate systems, by a continuous spiral of partitions, or “septae”.

Ontogeny recapitulates Phylogeny: Development recaps Evolution. If this process of separation fails to happen in a given child, Congenital Heart Disease is the result:

  • IASD. Interatrial Septal Defect is failure to separate the Atria, the upper chambers of the heart;
  • IVSD, Interventricular Septal Defect, is failure to separate the Ventricles, the lower chambers of the heart;
  • AV Communis is both of the above, plus failure of Atria and Ventricles, the upper and lower chambers, to separate, giving one big inefficient chamber.

When you listen to the hearts of these children, there are prominent murmurs, or noises, which betray the presence of turbulence and inefficiency, the very thing that evolution “tried” to prevent.

In the normal Human Heart, the blood returns from it’s systemic circuit through the capillaries, depleted of oxygen, into the vena cava. It passes to the Right Atrium, through the tricuspid valves, to the right ventricle.

With the contraction of the heart, the blood goes through the pulmonary artery, into the pulmonary capillaries, into close contact with air-containing alveoli. The oxygen passes through the alveolar membrane into the capillary blood, which becomes red. The oxygenated blood then passes into the pulmonary veins and on into the left atrium, and the systemic circulation.

It is interesting, and essential that the systemic arteries contain red, oxygenated blood, and the Pulmonary artery contains blue, oxygen-depleted blood. The “tired” blood, returning from the body must be “pepped up” by passing through the pulmonary circuit, picking up oxygen in the process.

Similarly a clot, originating in a quiet vein, perhaps a dilated, or varicose vein, is pumped into the Pulmonary circuit, where it lodges in the tiny capillaries and produces a PULMONARY EMBOLISM.

The embolus clogs the pulmonary circuit, increasing resistance, raises the normally-low pulmonary artery pressure and produces PULMONARY HYPERTENSION, placing more load and strain on the Right Ventricle.

Pulmonary Hypertension is also caused by a variety of Lung, heart, inherited and kidney diseases, as well as by certain drugs, high altitude, and Obstructive Sleep Apnea.

Please check the Mayo Clinic discussion that follows.

–Dr. C

Pulmonary Hypertension Article

BLOOD VESSELS: THE “SYSTEMIC ARTERIAL SYSTEM”

BLOOD VESSELS; it is hard to overestimate their importance. They are literally our lifelines, delivering the oxygen and nutrition necessary for life. We are as old as our blood vessels.

I will divide blood vessels into 4 components with rather separate domains: The Systemic Arterial system, the Pulmonary circulation, the Venous system, and the Lymphatic system, and will discuss these separately.

SYSTEMIC ARTERIAL SYSTEM

The Boy Scouts taught me the pressure points; The radial, at the thumb-side of the wrist, the brachial, on the inside of the upper arm, and the inguinal in the groin area. Pressure on these sites will stop arterial bleeding distally.

You should be able to locate the radial artery pulse, and begin to appreciate its strength and regularity. Strength in case you encounter a person who isn’t moving, and regularity for yourself; many older people develop an irregularity called Atrial Fibrillation, and you might be the first to discover it..

ANEURISMS are swelling of the arteries, and the swelling may thin the arterial wall so that it can burst. A Cerebral aneurysm can burst and cause a stroke-like problem. If an aortic aneurism bursts, the internal blood loss can be fatal.

RAYNAUD’S Phenomenon is fairly common, and consists of an over-reaction to cold, where arteries of the hands constrict, and the fingers get white and cold. Burger’s disease involves small arteries, and often is associated with Raynaud’s. The arteries carry the blood distally (away from the heart), continuing to divide into ever smaller arterioles which terminate in capillaries, which branch out in such an arborization as to supply all cells except cartilage and parts of the eye.

HYPERTENSION develops when the arterioles, under hormonal or neural influence, constrict, increasing the resistance to blood flow, and so the pressure. Increase in sodium retention and therefore the blood volume can also increase pressure.

ATHEROSCLEROSIS is the common disease of western life style. Excessive calories and sedentary life style combined with genetic defects in fatty metabolism produce cholesterol plaques which narrow and stiffen the arteries, often leading to BLOCKAGE of blood flow. Blockage of flow to the HEART, BRAIN, KIDNEYS, BOWEL, or EXTREMITIES each produce their separate disorders of Myocardial Infarction, Stroke, Renal artery Disease. Intestinal ischemic syndrome, and Claudication.

Atherosclerosis

These disorders will each be separately discussed. I have always thought of vascular disease as a special class of CAUSATIVE MECHANISMS when trying to develop a DIFFERENTIAL DIAGNOSIS of a patient’s problems. Blockage to an area results in PAIN or LOSS OF FUNCTION.

Stroke is usually painless with blockage, since the brain has no pain sensors. Blockage of the renal artery often causes complex difficulties including Hypertension, because the kidney is an endocrine organ in addition to its excretory function.

A good Friend and patient showed what careful self-care can accomplish. It all started with a myocardial infarction, the first sign of his blood vessel disease. He had a complication in his workup, and had to have emergency bypass surgery. There had been damage to the heart muscle, with a large reduction in his EJECTION FRACTION.

His cardiologist gave him at most 5 years to live. That was 25 years ago, before the development of the statin drugs. He was given a draconian low cholesterol diet, which he followed exactly. One one visit to the cardiologist, he inquired whether he could have other areas of arterial blockage. His doctor then listened to his neck and discovered a bruit (noise) in the carotid artery, after which he had a Carotid endarterectomy.

In an orthopedist office for back pain, the orthopedist left the room, and my friend noticed in the CT scan report mention of cysts in the kidneys.

The Orthopedist cared mainly about his bones, and had overlooked the “incidental finding”. His brother had died of mesenteric artery blockage from atherosclerosis, he had stomach symptoms, and sure enough he also had arterial blockage to the intestines.

Bottom line: it pays to be an ACTIVE PARTICIPANT in our medical treatment, and even though we all have genetic determinants, we can make our health BETTER with attention to our health, especially SLEEP, DIET and EXERCISE.

–DR. C