Peripheral Vascular Disease: Pathophysiology
The patient suffers from intermittent claudication that in this case is caused by peripheral artery disease otherwise known as peripheral vascular disease (PVD). PVD affects the arteries in the leg and is also called arteriosclerosis obliterans. Fats accumulate along the artery inner linings and cause the thinning of the opening subsequently reducing blood flow (Bhimji, 2012). A cholesterol core and protein flesh that is firmly held together by an intravascular fibrous covering form the swelling in the artery. Over extended periods of time, the internal swelling may close up major arteries through a gradual atherosclerotic process. In the presence of acute trauma, emboli or thrombi the vascular disease develops into acuteness since such conditions enhance severe reduction in perfusion (Stephens, & Brown, 2015).
Thrombosis is the primary cause of PVD as it limits blood flow through a vein or artery. A blood clot forms from an injured vein or the wearing off the plaque that swells inside the walls of an artery. In the case of the mentioned situation, it is most likely a case of deep vein thrombosis in which, the thrombus lodges inside a blood vessel deep within the calf of the leg. A thrombus forms due to the accumulation of cholesterol inside a vein that corrodes the lining and forms a ‘ball’ of clot and fats. It blocks the flow of blood and causes pain at the location it lodged. Thrombosis occurs more in the lower parts of the body such as below the knees as opposed to the upper torso and limbs. The most common occurrences that expose patients to thrombosis include low cardiac output, sepsis, hypertension, aortic dissection, aneurysms, arterial lumen narrowing and bypass grafts. Thrombus occurs in the absence of bleeding cause by pathological issues. In the indicated case, it could be an arterial thrombus, also called a white thrombus, made from leukocytes and platelets meshed together by fibrin. It is directly connected with atherosclerosis occurrence.
Emboli, on the other hand, are widely known to cause sudden ischemia that may be fatal if it occurs around the heart. Emboli are closely related to PVD in that they lodge or are stuck in areas where the arteries narrow and cause complete and sudden occlusion (Mosquera, 2012). Technically, bad eating habits cause the accumulation of cholesterol in blood vessels. The cholesterol accumulation leads to the narrowing of blood vessels, or fatally causes embolus that cause a complete blockage. PVD occurred when such accumulations trap deoxygenated blood on the lower part of the obstruction that subsequently cause swelling, pain, coldness and bluish colouring of the calf as in the mentioned case. The man’s condition is probably a thrombus related blockage common at lower extremities. Emboli indicate a high morbidity due to their travel capabilities through blood flow throughout the body. It is a primary cause of angina and heart attacks.
Coronary Artery Disease (CAD)
Mr. Jones exhibits signs and symptoms synonymous with that of a person suffering from Coronary Artery Disease (CAD). CAD usually develops in a person living a sedentary life with little or no focus on health issues related to unhealthy eating habits. CAD is quite similar to PVD in that it is caused by atherosclerosis, the buildup of plaque in the blood vessels. The major difference is that while PVD occurs in the lower extremities of the body, in CAD, the plaque builds up in coronary arteries (Chen et al., 2012).Coronary arteries that are naturally elastic and smooth develop rigidness and their openings narrow. The blockage, partial or extreme, causes chest pains as exhibited by Mr. Jones and subsequently, the heart becomes limited in pumping nutrients and oxygenated blood to the rest of the body. Consequently, the body demands more oxygen from the lungs, and the patient suffers shortness of breath and fatigue.
The formation of plaque in coronary artery disease results from excessive cholesterol in the body that is deposited on the inner arterial wall. The cholesterol builds up to form the hard plaque that limits or halts blood flow within the blood vessel (Chen et al., 2012). The plaque buildup inflames the artery walls that in turn result to dangerous blood clots that lead to heart attacks. The inner linings of the arteries become sticky in such a way that other substances such as lipoproteins, calcium, and inflammatory cells are stuck to the walls (WebMD, 2015). The narrowing of the artery grows worse over time that blood finds it difficult to flow freely. It also increases the rate at which the heart pumps to ‘force’ blood through narrowed arteries.
The body may react by developing new blood vessels to bypass the plaque to supply the heart with adequate blood (Chen et al., 2012). However, in times that the patient gets involved in a vigorous physical activity or goes up a flight of stairs, the new arteries may strain to supply oxygenated blood to the heart muscles. In fatal cases or prolonged periods without adequate treatment, the blood clots may completely block the coronary arteries and suddenly halt blood flow. In such a situation, the victim suffers a heart attack if it is a coronary vessel. However, a severe ischemic stroke may occur if the clot blocks a blood vessel that supplies blood to the brain (Brevetti et al., 2010). Since the plaque grows with the age of the victim, Mr. Jones is at an optimum stage of severe atherosclerosis. He is expected to avoid fatty foods, excess sugar, reduce salt intake and most importantly, he should quit smoking and taking alcohol. The coronary arteries are already stiff and thin causing limitations to blood flow and subsequent chest pains as well as shortness of breath.
Peripheral vascular disease and coronary arterial disease are relatively similar in terms of development, causes, and treatment. However, CAD is localized at the heart while PVD affects more of the lower body extremities. Both diseases are primarily caused by high intakes of cholesterol laden foods such as fats, starch, sugar, salt as well as consumption of excessive alcoholic drinks and smoking. Therefore, the victims mentioned in the case have habits of eating unhealthy foods and minimal physical exercise.
Bhimji, S. (2012), “Periphery Artery Disease.” The New York Times. Available at http://www.nytimes.com/health/guides/disease/arteriosclerosis-of-the- extremities/overview.html
Brevetti, G., Giugliano, G., Brevetti, L. & Hiatt, W. R. (2010). “Contemporary Reviews in Cardiovascular Medicine.” American Heart Association. Available at http://circ.ahajournals.org/content/122/18/1862.full
Chen CC, Hung KC, Hsieh IC, & Wen MS.(2012). “Association between peripheral vascular disease indexes and the numbers of vessels obstructed in patients with coronary artery disease”. American Journal Med Sci, 343(1):52-5.
Mosquera, D. (2013). “Intermittent Claudication & Peripheral Vascular Disease.” Vascular. Available at http://www.vascular.co.nz/intermittent_claudication.htm
WebMD (2015.) “Coronary Artery Disease.” Heart Disease Health Centre. Available at http://www.webmd.com/heart-disease/guide/heart-disease-coronary-artery-disease
Stephens, E. & Brown, D.F. (2015). “Peripheral Vascular Disease.” MedScape. Available at http://emedicine.medscape.com/article/761556-overview#a0104