Vascular medicine, advanced inflammatory diseases.
Inflammatory diseases of the blood vessels
can be taken care of by cardiologist or vascular
medicine specialists but many of them are
related to autoimmune diseases and are often
taken care of by rheumatologist or immunologist.
A number of them occur in children and are
taken care of by pediatricians. For the sake
of completeness, I am going to cover all of
the inflammatory diseases but note it's important
to remember that not all of these will come
in the average practice of a vascular medicine
physician or cardiologist.
Well let's start then with the definition.
First let's define inflammation. Inflammation
is the result of either an infection, for
example bacteria or could be a virus, or an
injury usually from the immune system or often
involving attack by leukocytes who are misinterpreting
normal tissue for tissue of an invader. Vasculitis
is of course an inflammatory injury in one
of the blood vessels. It can occur in the
arteries and it can occur in the veins. And
in the previous lecture, we have already discussed
inflammation in one of these systems, phlebitis.
Deep venous thrombosis often starts with inflammatory
reaction in the vein wall that then goes on
to lead to thrombosis and of course eventually
pulmonary embolism. In vasculitis of the arterial
system and the venous system, its usually
involves first the endothelial cells that
become attacked or inflamed and then that
is followed by inflammation in the smooth
muscle layer or the tunica media of the artery
or vein. And as I said before arteries and
veins can be affected by the one of a variety
of inflammatory conditions.
What are the symptoms? The symptoms are often
that of systemic disease. Patients may have
fever, weight loss. There may be headache,
if one of the blood vessels in the brain is
involved, there can be signs of stroke. The
patient may have tinnitus or continuous ringing
or buzzing in the ear. There may be reduced
visual acuity with some visual field loss.
The skin may show palpable areas of blood
collection so called purpura or there may
be lots of little lines, little blue lines
in the skin so called livedo reticularis.
The muscles in the joints may be reported
as symptomatic with muscle pain or even muscle
inflammation and similarly pain in the arthritis
are actually signs of swelling in the joints.
The respiratory tract may be involved with
nose bleeding, a bloody cough, or lung infiltrates.
The GI tract may report abdominal pain, bloody
stools, or even a perforated bowel, and the
kidneys may develop glomerulonephritis. So
again you see, vasculitis is often a systemic
disease, affecting blood vessels in all of
the body’s organ system and it is therefore
a very, very serious condition in many individuals.