Risk factors

Risk factors for the development of circulatory disorders are high blood pressure, diabetes mellitus, obesity, elevated blood lipid levels (for example in hypercholesterolemia and hyperlipidemia) and lack of exercise. Circulatory disorders are often triggered by smoking. All these conditions are unfortunately not rare nowadays, but almost the rule of our western lifestyle. Smoking

Symptoms

The symptoms that occur with circulatory disorders are very different. They are mainly dependent on the location and extent of the circulatory disorders. Many people suffer from cold hands and feet, which is often a mild form of circulatory disorder.

A good blood circulation is important so that all organs can be supplied with sufficient oxygen and can perform their function adequately. Since an occlusion usually develops gradually, it is characteristic that, regardless of the location of the occlusion, those affected usually experience no or only very slight discomfort in the initial stage. Initially, the symptoms often only occur during physical exertion, as this results in an increased blood requirement.In the case of high-grade vascular occlusions, the symptoms of excessive occlusion also occur at rest.

Insufficiently perfused tissue can be severely damaged if therapy is not carried out. The most frequent causes are circulatory disorders in the brain, heart and legs. If there is a lack of oxygen during a circulatory disorder, this leads to damage to the brain cells, which then die.

With regard to the symptoms and consequences of a circulatory disorder, a distinction is made between short-term and long-term circulatory disorders. A short-term circulatory disorder in the brain triggers a transitory ischemic attack (TIA). The associated symptoms usually last between two and 30 minutes.

In the longest case, the symptoms persist for 24 hours and then subside again. Temporary blindness of one eye (Amaurosis fugax) is characteristic. The symptoms depend on the affected area of the brain.

Often, double vision, slurred speech, dizziness, loss of balance, fainting, hemiplegia and numbness may also occur. Although such an attack does not correspond to a stroke, it should be perceived as a warning signal, as the probability of suffering a stroke in the future is increased. Non-reversible circulatory disorders can result in a stroke.

In terms of symptoms, a stroke is similar to a transient ischemic attack. However, the symptoms persist for more than 24 hours and in some cases do not regress at all. It is also true that the symptoms depend on the affected area of the brain that is no longer supplied with oxygen.

Among other things, paralysis, numbness in arms and legs, speech or vision disorders, ringing in the ears or dizziness may occur. A sudden drooping of the corner of the mouth is typical and noticeable to outsiders. Patients often also stand out due to confusion.

This could also be interesting for you: By which symptoms can one recognize circulatory disorders in the brain? If an acute circulatory disorder of a limb occurs, a sudden and strong symptomatology follows. Characteristically, there are six different symptoms, the so-called six “Ps”.

These include: Loss of pulse, pain, paleness and cold (paleness), sensory disturbances and numbness (paraesthesia), muscle weakness and paralysis (paralysis) and shock symptoms (prostration) in the sense of palpitations and clouding of consciousness. If the vascular occlusion is not remedied in time, the leg may die with the consequence of amputation. In most cases, however, the symptoms are gradual and then take a chronic course.

In this case, one speaks of peripheral arterial occlusive disease (pAVK), also known as window dressing. The name window display disease comes from the fact that the affected persons often have to take breaks from walking due to chronic circulatory disorders and then often stay in front of shop windows. The term “claudicatio intermittens” is also used for the symptomatology, it describes a recurrent limping of the patient, because the muscles hurt after a short time when under stress.

On the basis of the symptomatology, PADK can be divided into four stages (according to Fontaine). In the first stage there are vascular changes, but no symptoms appear yet. In the second stage, pain occurs under stress.

If the pain-free walking distance is longer than 200m, this is called stage IIa. If it is shorter than 200m, stage IIb is present. In the third stage, the symptoms also occur at rest, especially at night when the legs are raised.

In the last stage, stage IV, the circulatory disorders are so severe that tissue damage occurs. Ulcers and wounds heal poorly due to the lack of oxygen and blood components responsible for wound healing. Open legs develop and in extreme cases the tissue dies off completely – a so-called smoker’s leg is present, since pAVK usually occurs in heavy smokers.

As a rule, both legs are affected, although the symptoms in one leg may also be weaker. In diabetics, the symptoms are often differently pronounced, as they do not notice the pain until later due to disease-related nerve damage, which is why pAOD is often diagnosed only in stage IV. Instead of pain, they often experience a burning sensation.

The symptomatology described so far was related to the occlusion of arteries. However, veins can also be closed or partially closed. This condition is called venous thrombosis.Depending on the height of the venous occlusion, swelling of the entire leg, calf or foot occurs, as the blood accumulates and cannot be pumped back to the heart.

The section under the occluded vessel turns blue. The abbreviation PAVK stands for peripheral arterial occlusive disease. This disease describes the narrowing or partial or complete blockage of arteries.

The severity of the disease is divided into four levels, since PAVK can be very different: A symptomless form is possible, which is then mostly noticed as a random finding, as well as great pain while walking, up to the death of certain body parts due to the long-term undersupply of blood and oxygen. The most common cause for the development of PAVK is an existing arteriosclerosis, i.e. a stiffening and narrowing of the arteries due to deposits in the vessel walls. Arteriosclerosis develops particularly with increasing age, but does not necessarily lead to PAVK.

Further risk factors for arteriosclerosis and PAVK are for example high blood fat values (hypercholesterolemia), smoking, lack of exercise, overweight, as well as diabetes mellitus. In order to treat PAVK, it is recommended to change one’s lifestyle in order to eliminate the above mentioned risk factors. In addition, drugs that have an anticoagulant effect can be given.

In higher stages, operations to treat PAVK can be considered, such as a bypass operation. Circulatory disorders can also be limited to the fingers (and toes). Especially in many women, the blood circulation in the hands and feet is restricted due to low blood pressure, which manifests itself in cold hands and feet.

A typical syndrome of insufficient blood circulation in the hand is Raynaud’s syndrome. Due to cramping of small vessels, mostly as a result of stress or cold, circulatory disorders occur. A typical sequence of symptoms occurs.

First, the fingers turn white due to the lack of blood circulation. This is followed by a blue coloration due to the lack of oxygen. As soon as the fingers are supplied with blood again, a red coloration follows.

One speaks also of the Tricolore phenomenon. Only rarely is this process accompanied by pain. Other symptoms that can occur are a burning sensation in the fingers, tingling and numbness.

Sometimes the symptoms persist for hours and can lead to tissue damage. Raynaud’s syndrome is usually considered harmless, but can also occur in the context of other diseases such as collagenosis or autoimmune diseases. Mostly women are affected.

If there are circulatory disorders of the heart, one speaks of coronary heart disease (CHD). In CHD, the coronary arteries are affected by the circulatory disorders, so that parts of the heart muscle are no longer supplied with sufficient oxygen and nutrients and the heart can no longer work properly. Typical symptoms are pain and a feeling of tightness in the chest, which is often accompanied by a feeling of anxiety.

Sometimes nausea is added. These symptoms are known as angina pectoris, or in extreme cases, if the coronary arteries become completely blocked, they are compatible with a heart attack. The pain in the chest has a burning or cutting character and the tightness in the chest is often described as if a heavy weight or an elephant were sitting on the chest.

The pain usually radiates from the chest into the left arm, but it can also radiate into the neck, jaw and back area, among others. Accompanying it usually comes to a difficulty in breathing. If there is no acute occlusion, this symptomatology only occurs in the context of an angina pectoris attack when the patient is under heavy strain.

Provocative loads can be strong physical activity, high stress potential and cold. In contrast to a heart attack, the symptoms of an angina pectoris attack disappear relatively quickly once the stress is over. As a rule, the symptoms disappear again after a maximum of ten minutes.

Just like pAVK, angina pectoris can also be divided into different classes based on the symptoms. In class 1, the symptoms occur only after long and heavy exertion. In class 2, the symptoms already occur during everyday stress such as climbing stairs, walking uphill or even in cold weather and psychological stress.

In class 3, angina pectoris is described as a condition that occurs even under light physical strain, such as normal walking. Class 4 is reached when the symptoms already occur at rest.Without an adequate blood supply, the retina can no longer fulfil its function. This results in severe visual impairment up to blindness.

Circulatory disorders of the retina can be chronic or acute. If there is a chronic disturbance of the blood circulation, the vision deteriorates gradually. This can be triggered by various diseases, such as a so-called diabetic retinopathy, in which an underlying sugar disease causes damage to the blood vessels that supply the retina.

High blood pressure can also lead to temporary blindness. If an acute circulatory disorder occurs, the affected eye suddenly goes blind without warning signs. The whole eye does not always have to go blind, it can also lead to a severe deterioration of vision or to loss of parts of the visual field, so that areas are only perceived as black spots.

All processes run painlessly. If there is an occlusion of the blood-bearing veins of the retina (retinal vein occlusion), this results in a painless deterioration of visual acuity. This leads to blurred vision.

This is often described as a veil before the eyes. The problem with venous circulatory disorders is that the symptoms appear relatively late. Often the symptoms occur at night, as the blood pressure drops at night and at the same time the pressure in the eye veins increases due to the lying position.

In the morning, those affected then notice a deterioration in their vision, which can improve again over the course of the day. A blockage of the carotid artery can also lead to a lack of blood supply to the retinal vessels. However, an accompanying symptomatology then occurs, similar to a stroke.

The blood has many different tasks in the body: Not only does it distribute oxygen and nutrients throughout the body, it is also an important regulator of the body’s heat balance. As the blood is warmed up during its circulation through the body’s vascular system in the trunk, it helps to transport the temperature to the arms and legs and thus maintain it in the extremities. In cases of circulatory disorders, this mechanism is now disrupted: not enough warm blood from the torso reaches the extremities through the arteries, which then cool down.

Hands and feet – or fingers and toes – are particularly at risk because there is a relatively long path in front of them that the blood has to travel and on which further heat is already lost. Cold hands and cold feet can therefore occur even with minor circulatory disorders. Special caution is required if there are indications that the circulatory disorder affects a larger area, such as an entire lower leg.

Such a more serious circulatory disorder should be clarified as quickly as possible and in an emergency. An initial suspected diagnosis of the circulatory disorder can usually be made on the basis of the typical symptoms. However, there are a number of examination methods that can confirm this suspicion and determine the exact severity of the disease.

Very banal, but also very meaningful, is the comparative blood pressure measurement of the two halves of the body. If, for example, the blood pressure on the right arm is considerably lower than on the left, this is a strong indication of a vascular change in the right extremity. You can also determine the blood pressure values on both upper arms and both ankles and then compare them.

If the ratio of the measured pressures is below a certain value, this also indicates a circulatory disorder. In addition, a so-called angiography can be helpful. During this examination, the patient is injected with an X-ray contrast medium into an artery (Attention: before this, it is essential to rule out any contrast medium allergy!)

On the X-ray image, the interior of the vessel filled with contrast medium then stands out clearly from its surroundings. With the help of this method, the localization of an occlusion can be determined quite accurately. In addition, there are the so-called provocation tests, which are mainly used in the diagnosis of PAD. For example, the physician can ask the patient to walk a certain distance and then determine the severity of the disease on the basis of the steps taken without pain.