April 4, 2023: Peripheral Artery Disease (PAD) is a chronic circulatory condition, which, if not treated, can lead to limb amputations. PAD affects nearly 20 million Americans. An estimated 200,000 people, disproportionately from minority communities, suffer avoidable amputations every year.
What is peripheral artery disease?
Peripheral artery disease (PAD) is plaque buildup in your leg arteries. Your leg arteries carry oxygen and nutrient-rich blood from your heart to your arms and legs. Other names for this are peripheral vascular disease or peripheral arterial disease.
Shaped like hollow tubes, arteries have a smooth lining that prevents blood from clotting and promotes steady blood flow. When you have peripheral artery disease, plaque (made of fat, cholesterol and other substances) forms gradually inside your artery walls. Slowly, this narrows your arteries. This plaque is also known as atherosclerosis.
Many plaque deposits are hard on the outside and soft on the inside. The hard surface can crack or tear, allowing platelets (disc-shaped particles in your blood that help it clot) to come to the area. Blood clots can form around the plaque, making your artery even narrower.
If plaque or a blood clot narrows or blocks your arteries, blood can’t get through to nourish organs and other tissues. This causes damage ― and eventually death (gangrene) ― to the tissues below the blockage. This happens most often in your toes and feet.
PAD can get worse faster in some people more than others. Many other factors matter, including where in your body the plaque forms and your overall health.
Mayo Clinic – Chest discomfort and pain account for more than 6.5 million emergency department visits in the U.S. each year. Discomfort can be the first sign of a serious heart event or a symptom of other medical conditions. Dr. Regis Fernandes, a Mayo Clinic cardiologist, says people should seek medical care at the first sign of chest pain.
A thoracic aortic aneurysm is a weak spot in the aorta, the main pipeline for blood from the heart to the body. The weak spot has the potential to dissect or rupture, cutting off the supply of life-sustaining blood to the rest of the body. Thoracic aortic aneurysms are often harder to detect and diagnose compared to the more common abdominal aortic aneurysms.
The aorta begins deep in the heart. It emerges from the top of the powerful left ventricle, curves up and over the heart in a gentle arch, then descends into the chest and through the muscular diaphragm into the abdomen (see “Thoracic aorta”). It ends around the belly button, where it splits into two smaller arteries, one for each leg.
From start to end, arteries branch off to nourish the heart, brain, arms, kidneys, liver, stomach, intestines, and every other part of the body. The stretch of the aorta from its start in the heart to the top of the diaphragm is called the thoracic aorta; the section below the diaphragm is the abdominal aorta.
Some aneurysms are relatively harmless. Others can lead to the catastrophic problems known as dissection or rupture. For now, size is the best and only guide to the health threat posed by an aneurysm.
Dissection. The most common consequence of an aortic aneurysm, dissection occurs when a tear develops in the inner lining of the aortic wall. The inner and outer layers peel apart, creating an extra channel for blood inside the aorta. It may do no harm, or it may allow blood to bypass the outflow to certain organs or tissues, leaving them without a blood supply. This can cause a heart attack, stroke, kidney damage, and other problems.
Rupture. A break in all three layers of the aortic wall is termed a rupture. Blood pours from the aorta into the chest. This massive internal bleeding can quickly lead to shock and death.
“The likelihood of needing a pacemaker increases with age,” says Dr. Sunil Kapur, a cardiologist at the Heart and Vascular Center at Harvard-affiliated Brigham and Women’s Hospital. “The good news is that today’s pacemakers have evolved from fixing irregular heartbeats to helping the heart maintain its normal function, which allows many men with certain heart conditions to stay active longer.”
A pacemaker monitors the heart’s rhythm and, when necessary, generates a painless electrical impulse that triggers a heartbeat.
The most common use for a pacemaker is when the heart beats too slowly or pauses, which triggers dizziness, shortness of breath, or fainting. (You should see your doctor immediately if you have any of these symptoms.) A pacemaker also can help your heart chambers beat in sync and improve blood flow if your heart isn’t pumping enough blood. In some cases, a pacemaker may be needed to treat a heartbeat that is too fast or irregular.
These issues can stem from problems with the heart’s electrical signaling, a heart defect, an enlarged or thick heart muscle, heart failure, or a heart attack.
Several tests can help your doctor determine if you need a pacemaker: an electrocardiogram, which measures the heart’s electrical activity; Holter monitoring, in which you wear a small device to track your heart’s rhythm; or an echocardiogram, which uses sound waves to produce images showing your heart’s size, structure, and motion.
In otherwise healthy people, a heart rate at rest should be less than 100 beats per minute at rest. Heart rates that are consistently above 100, even when the person is sitting quietly, can sometimes be caused by an abnormal heart rhythm. A high heart rate can also mean the heart muscle is weakened by a virus or some other problem that forces it to beat more often to pump enough blood to the rest of the body.
Usually, though, a fast heartbeat is not due to heart disease, because a wide variety of noncardiac factors can speed the heart rate. These include fever, a low red blood cell count (anemia), an overactive thyroid, or overuse of caffeine or stimulants like some over-the-counter decongestants. The list goes on and includes anxiety and poor physical conditioning.
B-type natriuretic peptide (BNP) belongs to a family of protein hormones called natriuretic peptides. These natriuretic peptides have an important role in regulating the circulation. They act on blood vessels, causing them to dilate, or widen. They also work on the kidneys, causing them to excrete more salt and water. In addition, the natriuretic peptides reduce the production of various hormones that narrow blood vessels, boost the heart rate, or affect fluid retention; examples include adrenaline, angiotensin, and aldosterone.
AI can pick up on subtle clues from a person’s physiological state such as their heart rate, the time differences between each heartbeat or the electrical signals their heart produces in order to identify irregularities that point to medical conditions.
“Being able to detect atrial fibrillation just by wearing a wristwatch all the time, that kind of relatively simple technology could actually have a massive impact,” explained consultant cardiologist Tim Fairbairn, cardiovascular imaging lead at Liverpool Heart and Chest Hospital in the UK.
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