Overview of Vascular Diseases

by Joseph Alpert, MD

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    00:01 Hello! This is the final lecture in the basic series of vascular medicine.

    00:06 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.

    00:22 The learning objectives are: to understand the terminology and the word disambiguation.

    00:30 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 section.

    00:45 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.

    01:30 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.

    01:42 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 is rare.

    02:33 Let’s talk about some important terms here.

    02:38 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.

    03:01 I’ve also mentioned embolism. Embolism means a blood clot travelling in the blood stream.

    03:07 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.

    03:26 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.

    03:40 Stenosis is a narrowing or tightening in the blood vessel very frequently due to atherosclerosis.

    03:47 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.

    04:01 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.

    04:21 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.

    04:54 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.

    05:18 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 outlook? 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.

    06:16 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 lymphatic system.

    07:02 And here are some examples of what we’ll talk about in each of these areas in the advanced series.

    07:08 In arterial diseases, we’ll talk about Raynaud’s disease, Buerger's disease, carotid-artery stenosis and PAD – which is peripheral arterial disease.

    07:19 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.

    07:33 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.

    07:47 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.

    08:05 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.

    08:24 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.

    08:41 So this is what you can look forward to if you follow through with the advanced part of this lecture series.

    08:47 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 world.

    09:07 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 this disease.

    About the Lecture

    The lecture Overview of Vascular Diseases by Joseph Alpert, MD is from the course Introduction to the Vascular System. It contains the following chapters:

    • Terminology & word disambiguation
    • Disease criteria
    • Overview of the course
    • Vascular diseases - Summary

    Included Quiz Questions

    1. Necrosis: Injured but surviving tissue
    2. Thrombosis: Clotting
    3. Stenosis: Tightening or narrowing in a vessel
    4. Occlusion: Obstruction, blocking

    Author of lecture Overview of Vascular Diseases

     Joseph Alpert, MD

    Joseph Alpert, MD

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