In a few large and an infinite number of small arteries and veins, the blood flows through our body – a total of six liters of blood are thus constantly moved by the heart. Yet cardiovascular disease is the most common cause of death in Germany – because hardening of the arteries and high blood pressure put pressure on the vessels.
Blood vessels: structure and function
The heart pumps oxygen-enriched blood with powerful pressure to the most distant parts of the body. In the process, the blood flows through the aorta into other large arteries, which divide into smaller and smallest arteries. These smallest arteries finally end in the organs, where the blood components fulfill their task: Supply of oxygen and nutrients to the cells or defense against pathogens. The return transport of the blood towards the heart takes place in other vessels, the veins. While arteries have a relatively thick, elastic wall because of the strong blood pressure, veins are only covered by a thin wall and have door-like valves. Blood is pushed in the veins toward the heart by the movement of nearby muscles – backflow is prevented by the valves. In people who do not move much, blood flows slowly from the legs back to the heart – so varicose veins develop easily.
Lymphatics and lymphatic fluid
Blood represents the most important body fluid, but in addition there is lymphatic fluid, which flows through the tissues in the finest lymphatic channels and transports metabolic waste products and defense cells. The importance of this lesser-known fluid transport is usually only noticed in the case of disease – as in lymphedema or elephantiasis.
Vascular complaints
Narrowing to complete occlusion or bleeding may occur in the arteries. Narrowed vessels mean impaired circulation (ischemia) with less oxygen and nutrients to the organs – pain, pallor and weakness are the consequences. This is how CHD develops in the heart, stroke in the brain and arterial occlusive disease in the legs. Typical vein complaints are thick legs after long periods of standing or spider veins and varicose veins. If the blood flow becomes too slow, clots can form – this is how thrombosis develops. Thromboses are also venous diseases, rather rarely they also occur in a calcified and narrowed artery. In addition, deviations of blood pressure from the normal range cause discomfort:
- Too low blood pressure can cause dizziness or circulatory collapse
- Too high blood pressure can cause palpitations, sweating or even nosebleeds – and in the long term is a breeding ground for stroke, heart failure and kidney failure
Diagnostics: what does the doctor do for vascular problems?
The doctor has a variety of examination methods to diagnose vascular problems:
- Medical history
- Inspection and auscultation
- Blood pressure measurement
- Examinations of blood and urine
- Imaging procedures
Anamnesis: the asking of the medical history.
All complaints can be further narrowed down by asking specific questions. For example, leg pain may occur after walking a short distance or only after walking for a long time. The onset and localization of the pain (whether in the lower or upper leg) thereby indicate at what level the arteries are blocked. Therefore, every medical examination begins with a medical history.
Inspection and auscultation: viewing and listening.
A visible sign of ischemia in the legs is pallor. Narrowed neck arteries sometimes make a whirring sound – and a bulge (aneurysm) in the abdominal aorta can be gently palpated.
Blood pressure measurement
Measuring blood pressure is a standard part of any examination. However, a single measurement is not sufficient to diagnose hypertension, for example. This is because for some people, the presence of a doctor, for example, is enough to drive blood pressure up. This is then referred to as “white coat hypertension.”
Blood and urine tests
These tests determine risk factors such as high blood sugar, high blood lipids, or cholesterol levels, and then check for medications. Protein in the urine indicates how much high blood pressure has damaged the kidney.
Imaging techniques
A variety of imaging techniques are available here:
- X-ray: Vessels can be seen clearly in an X-ray image if they are filled with contrast medium. This examination exists for arteries (angiography) and for veins (phlebography).
- Ultrasound: modern ultrasound machines are able to show the blood flow in the vessels and deposits on the vessel walls such as calcium or blood clots very accurately.
- Computed tomography and magnetic resonance imaging: these methods are used in the event of a stroke or arterial outpouching, for example, to determine the spread.
Consequences of arterial stenosis
Too high blood pressure or an unhealthy change in blood components with too much blood sugar, high blood fats and cholesterol or too little homocysteine lead to arteriosclerosis in the long term – this is usually the reason for arterial stenosis. But a blood clot can also block the bloodstream. Narrowed arteries lead to a reduced oxygen supply (ischemia) and, in the worst case, to the death (infarction) of organs. Ischemia of the legs, for example, manifests itself in window-shopping disease, and ischemia of the heart (CHD) in an attack of angina pectoris. A particular problem is stroke, which is triggered by ischemia in the brain. This is usually caused by arterial occlusion, more rarely by cerebral hemorrhage. A stroke may be heralded by tingling or numbness in the arms or legs, followed by paralysis, speech and vision difficulties. Too low blood pressure is a nuisance – but too high blood pressure leads to massive vascular impairment in the long term and has serious consequences such as heart failure, hypertensive retinopathy or chronic kidney failure. Diabetes mellitus is an important risk factor for high blood pressure and arteriosclerosis. Already during the preliminary stage of insulin resistance, the vessels are damaged by high blood sugar. In addition, the risk factor of obesity – when fat is dangerously distributed – also plays an important role in vascular damage. An aortic aneurysm usually occurs when the wall of the aorta is so damaged by calcification that a bulge can form.
Diseases of the veins
Venous diseases range from cosmetically unsightly spider veins to an open leg – depending on how badly the veins and venous valves are damaged. When lymphatic drainage is disrupted – from injury, radiation (for example, as part of cancer treatment), or pressure on the lymphatics (for example, from tight clothing or a tumor) – swelling of the affected body part occurs, called lymphedema. Since vascular diseases often occur together with the “deadly quartet,” reduction of excess weight, drug treatment of a lipid metabolism disorder with a statin, treatment of high blood pressure, diabetes, or insulin resistance are the first therapeutic measures.
Treatment of vascular disease
Common medications include beta-blockers to normalize blood pressure and acetylsalicylic acid to reduce the risk of heart attack and “thin” the blood. When taking tablets, the correct time to take them must be observed, otherwise the drug will not have sufficient effect. Today, clogged arteries in the neck, arms and legs can often be dilated minimally invasively with a catheter – similar to what is commonly done on the heart with a cardiac catheter and just as heart operations are now also performed minimally invasively. If blood flow cannot be restored, the body part dies – it must be amputated. This often results in phantom pain in the legs and arms. After a stroke, optimal care in a stroke unit is particularly important to keep brain damage to a minimum. In this context, ultrasound seems to be a promising new treatment method. Venous diseases are treated with various types of surgery – sclerotherapy, laser therapy and radio waves are just a few of many. Of course, for each disease there is a special procedure with medication or surgery.
Preventive measures
In order to prevent arteriosclerosis and high blood pressure, it is best to eat a healthy diet, be aware of cholesterol, get plenty of exercise and reduce stress as a matter of course, starting in adolescence. Mediterranean food with olive oil, onions and garlic as well as red wine (correctly dosed) is particularly recommendable. Lifestyle is crucial, especially in the case of high blood pressure: stopping smoking and a sensitive approach to salt and foods such as licorice should be a matter of course.It is also important to have regular health checks and to see your doctor if you suspect you have heart disease. In summer, cardiovascular patients should take extra care of themselves – and did you know that the flu shot apparently lowers the risk of heart attack? If you’re flying, remember the risk of thrombosis and help your body with exercise and plenty of fluids. Tired or diseased veins can be well addressed with fitness – compression stockings and horse chestnut or vine leaf extracts can also help.
