Hello! This is the final lecture in the basic
series of vascular medicine.
We’re going to do a very, very brief overview
of all of the diseases that affect the vascular
system. For those of you who go onto the advanced
course, we will take each of these diseases
in considerably more detail. But let’s get
the overview to start with.
The learning objectives are: to understand
the terminology and the word disambiguation.
That is the clarification of what the words
mean. Then we’ll talk about the disease
criteria, an overview of the course and an
actual going through of the different diseases
that are going to be covered in the advanced
So, of course, we’re talking about diseases
that affect arteries and veins or both. And
indeed we’ll also talk a bit at the end
about diseases that affect the lymphatic system
although those are much, much less common
compared to diseases that affect the arteries
and the veins, which are extremely common.
As I think I’ve already stressed, for example
ischemic heart disease and ischemic peripheral
vascular disease are the number one causes
of death in the world. And venous thrombosis,
that is clots forming with pulmonary embolism,
deep venous thrombosis are also exceedingly
common. These are some of the commonest diseases
that physicians deal with and often require
hospitalization when they’re acute.
So as the blood vessels carry blood throughout
the body, the vascular diseases by obstructing
this or by forming clots can cause symptoms
in a variety of different places in the body.
Of course in the heart, obstruction in the
heart can lead to symptoms of angina, which
is a pressing feeling in the chest when one
tries to exert oneself. One can have symptoms
in the head and neck if blood clots got to
the brain. One can have problems with either
upper extremity or lower extremity if one
obstructs blood flow through the arteries
or if one gets blood clots there. Much less
common are symptoms from obstruction in the
abdomen. That is the celiac, which supplies
the stomach and organs around the stomach,
and the mesenteric, which supplies the bowel.
Those can become obstructed as well and, in
fact, they can cause death of bowel tissue
which is often fatal. But, fortunately, that
Let’s talk about some important terms here.
I’ve already mentioned a term, sclerosis.
It’s as in atherosclerosis. Sclerosis means
stiffening which is usually caused by replacement
of the normal organ wall – the normal blood
vessel artery wall, for example – with tissue
that often has a lot of lipid in it, lots
of cholesterol and also lots of scar tissue.
I’ve also mentioned embolism. Embolism means
a blood clot travelling in the blood stream.
It can travel on the venous side to the lung
– and then it’s a pulmonary embolism – or
it can break off as we’ve talked about before
from the left atrium in atrial fibrillation,
travel in the body and cause a stroke or can
cause kidney damage.
Thrombosis means clotting. The word thrombus
means a blood clot and thrombosis is actual
clotting. In thrombosis, there’s a thrombus
in a blood vessel or an artery.
Stenosis is a narrowing or tightening in the
blood vessel very frequently due to atherosclerosis.
Occlusion means obstruction or blocking of
an artery. So, if a blood clot forms in an
artery and completely obstructs the lumen,
one has a total occlusion of that artery.
A dissection is a tear or a rupture in a blood
vessel. This occurs in arteries and these
can actually be fatal. We’re going to talk
much more about them in more detail in the
advanced section. But, when they tear into
the blood vessel, they can actually rupture
through the wall and cause fatal haemorrhage.
Necrosis is death of tissue. For example,
in ischemic heart disease when the atherosclerotic
narrowing gets severe and a blood clot forms
and totally blocks the artery, the heart muscle
– or myocardium – that’s beyond that
obstruction starts to die because of lack
of oxygen and nutrients. When it dies, that
is called necrosis or death of tissue. And
when it happens in the heart we have myocardial
necrosis – that is death of heart tissue
– or a heart attack: myocardial infarction.
Ischemia, on the other hand, is lack of blood
flow but usually not total obstruction. So
there’s lack of blood flow but the heart
muscle cells survive. This is often associated
with an exertional symptom called angina – that
is a pressing heavy feeling in the chest when
people exert themselves. But their artery
is narrowed by atherosclerosis.
We will, as we go through the advanced course,
cover each of these areas. We’ll talk about
the definitions, the etiology – or the
causes of these diseases – the epidemiology
– that is how common they are. As I mentioned
before, ischemic heart disease, atherosclerotic
heart disease is the commonest cause of death
in the world. But then there are some very
rare diseases, like certain vascular malformations
– where children are born with these – or
such as lymphatic disease. We’ll talk about
the prognosis – in other words, what’s
the outlook? What’s the short-term and long-term
Pathogenesis tells you what is going to be
the abnormal pathology that goes with this
particular illness. We’ve already talked
about diagnosis, symptoms and the history,
therapy – both surgical, medical or catheter.
And then finally, how can one prevent the
development of these diseases.
So each of the advanced lectures is going
to cover each of the topics that you see right
here. These are all of the vascular diseases
that will be covered in the advanced part
of the lecture series. You can see arterial
diseases; there are inflammatory diseases
of both the arteries and the veins; diseases
of the aorta, for example dissection – a
tear in the aorta; venous disease such as
thrombosis – that is a clot forming there
that can break off and cause pulmonary embolism;
we’ll talk about congenital malformations
– that is abnormal constructions in the arteries and veins
that are in the infant when the infant is born;
and, finally, the much rarer diseases of the
And here are some examples of what we’ll
talk about in each of these areas in the advanced
In arterial diseases, we’ll talk about Raynaud’s
disease, Buerger's disease, carotid-artery
stenosis and PAD – which is peripheral arterial
Under inflammatory diseases, we’ll talk
about inflammation of large vessels – so
called vasculitis – or inflammation of medium-sized
vessels – vasculitis – or inflammation
of small vessels – vasculitis.
In the area of diseases of the aorta, we’ll
talk about aortic dissection, aortic aneurysms
and renal artery stenosis or narrowing. There’s
two forms there: one form from atherosclerosis
and one form that’s congenital.
We’ll talk about venous disease: pulmonary
embolism, deep venous thrombosis – that
is clots in the veins – and even varicose
veins, which are usually a cosmetic problem
but can develop clots and give some problems
that are more severe than just cosmetic.
We will also be talking about congenital malformations
such as hemangiomas, cavernomas and malformations
of the aorta. Hemangiomas and cavernomas
can be sometimes seen on the skin and sometimes
can be in the brain and can bleed and cause
strokes. And that can be quite serious.
And finally, we’ll talk about diseases of
the lymphatic system: elephantiasis. That
is usually the result of a parasite infection
usually seen only in Africa. And then we’ll
also talk about lymphatic cysts, which are
congenital and, usually, much more benign.
So this is what you can look forward to if
you follow through with the advanced part
of this lecture series.
So, in summary, we’ve talked about terminology
such as sclerosis, embolism, thrombosis, stenosis,
occlusion, dissection, necrosis and ischemia.
Ischemia = lack of blood flow. I’ve mentioned
that a number of times, ischemic heart disease
being the number one cause of death in the
And then we’ve talked about the various
criteria that we’re going to use when we
talk about each disease: the definition, the
epidemiology, the etiology – or cause – the
pathogenesis – that is the abnormal pathology
that goes on, both in physiology and in anatomy
– symptoms, diagnosis, therapy, prognosis
– or outlook – and, finally, how to prevent