ARTERY DISEASE

Prof. Dr. dr. Moch. Fathoni, Sp. JP, FIHA, FAsCC, FAPSC
 Takayasu's arteritis Is rare type of vasculitis, a
group of disorders that cause blood vessel
inflammation.
 In Takayasu's arteritis, the inflammation
primarily damages the aorta — the large artery
that carries blood from your heart to the rest of
your body — and the aorta's main branches.
 The disease can lead to blockages or
narrowed arteries (stenosis) or abnormally
dilated arteries (aneurysms).
 Takayasu's arteritis can also lead to arm or
chest pain and high blood pressure and
eventually to heart failure or stroke
 Stage 1 symptoms
 Takayasu's arteritis symptoms often occur in
two stages. In the first stage, you're likely to
feel unwell with:
 Fatigue
 Fast and unintentional weight loss
 Muscle aches
 Joint pain
 Slight fever
 Not everyone has these early symptoms,
however. It's possible for inflammation to
damage arteries for years before you
realize something is wrong.
 Stage 2 symptoms
 Second-stage symptoms begin to develop when inflammation
has caused arteries to narrow. At this point, there's less blood,
oxygen and nutrients reaching your organs and tissues. These
signs and symptoms may include:
 Arm or leg weakness or pain with use (claudication)
 Lightheadedness or dizziness
 Fainting
 Headaches
 Memory problems
 Trouble thinking
 Shortness of breath
 Visual problems
 High blood pressure
 Difference in blood pressure between your arms
 A difficult-to-find or absent pulse in the wrists — Takayasu's
arteritis is sometimes called pulseless disease because narrowed
arteries can make normal pulses difficult or impossible
 In Takayasu's arteritis, the aorta and other major
arteries, including those leading to your head and
kidneys, become inflamed.
 Over time, the inflammation causes changes in
these arteries, including thickening, narrowing and
scarring. The result is reduced blood flow to vital
tissues and organs, which can lead to serious
complications and even death. Sometimes arteries
become abnormally dilated, leading to aneurysms
that may rupture.
 Just what causes the initial inflammation in
Takayasu's arteritis isn't known. It's likely that
Takayasu's arteritis is an autoimmune disease in
which your immune system malfunctions and
attacks your own arteries as if they were foreign
substances. The disease may be triggered by a
virus or other infection
 Hardening and narrowing of blood vessels,
which can cause reduced blood flow to
organs and tissues
 High blood pressure, usually as a result of
decreased blood flow to your kidneys
 Inflammation of the heart, which may affect
the heart muscle (myocarditis), the heart
valves (valvulitis) or the sac around the
heart (pericarditis)
 Heart failure due to high blood pressure,
myocarditis or aortic regurgitation — a
condition in which a faulty aortic valve
allows blood to leak back into your heart —
or a combination of these
 Ischemic stroke, a type of stroke that occurs as
a result of reduced or blocked blood flow in
arteries leading to your brain
 Transient ischemic attack, a temporary stroke
that has all the symptoms of an ischemic stroke
without causing lasting damage
 Aneurysm in the aorta, which occurs when the
walls of the blood vessel weaken and stretch
out, forming a bulge that has the potential to
rupture
 Heart attack, an uncommon event that may
occur as a result of reduced blood flow to the
heart
 Lung involvement when the arteries to the lungs
(pulmonary arteries) become diseased
 Takayasu's arteritis can be challenging to detect,
and some people go years without an accurate
diagnosis. Your doctor may use some of the
following steps and tests to help rule out other
conditions that closely resemble Takayasu's arteritis
and to confirm the diagnosis:
 Medical history and physical exam. Your doctor
will examine you and ask you questions about your
general health, including questions about heart
and vascular disease.
 Blood tests. Your doctor may order blood tests to
check for signs of inflammation in your body, such
as a high white blood cell count or high levels of C-
reactive protein, an inflammatory substance
produced by your liver. Another blood test
commonly used to help identify inflammatory
disorders is called the erythrocyte sedimentation
rate (sed rate). Your doctor may also check for
anemia.
 Angiography. Traditionally, doctors have
used an X-ray test called an angiogram
as one of the more definitive tests for
diagnosing Takayasu's arteritis. During an
angiogram, a thin, flexible tube called a
catheter is inserted into a large blood
vessel. A special dye (contrast medium)
is then injected into the catheter, and X-
rays are taken as the dye fills your
arteries or veins.
 Magnetic resonance angiography (MRA).
Increasingly, doctors are using this less invasive
form of angiography in place of traditional
angiography as a test for Takayasu's arteritis. MRA
produces detailed images of your blood vessels
without the use of catheters or X-rays
 Magnetic resonance imaging (MRI). An MRI is
similar to an MRA in that it uses radio waves and a
magnetic field to create detailed images of organs
in the body and allows your doctor to check for
possible damage.
 ECHOCARDIOGRAPHY. Doppler
ultrasound, a more sophisticated version
of the common ultrasound, has the
ability to produce very high-resolution
images of the walls of certain arteries,
such as those in the neck (carotid
arteries) and those in the shoulder
(subclavian arteries). It may be able to
detect subtle changes in these arteries
before other imaging techniques can.
 An aneurysm is an abnormal bulge in the
wall of an artery. Normally, the walls of
arteries are thick and muscular, allowing
them to withstand a large amount of
pressure. Occasionally, however, a
weak area develops in the wall of an
artery. This allows the pressure within the
artery to push outwards, creating a
bulge or ballooned area called an
"aneurysm."
 Aneurysms can form in any blood vessel, but they
occur most commonly in the aorta (aortic
aneurysm). The aorta is the largest artery in the
body. It carries blood from the heart to the rest of
the body. Aortic aneurysms can occur in two main
places:
 Recommended Related to Heart Disease

 Abdominal aortic aneurysms occur in the part of

the aorta that passes through the middle to low
abdomen.
 Thoracic aortic aneurysms occur on the aorta as it
passes through the chest cavity. These are less
common than abdominal aneurysms.
 Aortic aneurysms may be caused by:
 Atherosclerosis, or hardening of the arteries,
which weakens arterial walls
 Hypertension (high blood pressure)
 Local injury to the artery
 Congenital abnormality. A number of
conditions, such as Marfan syndrome or
bicuspid aortic valves are present at birth and
can cause weakness of the artery walls.
 Aging
 Syphilis used to be a common cause of
thoracic aneurysms, but it is no longer as
common
 Aortic aneurysms often cause no symptoms at all.
But if present, symptoms include:
 Tearing pain in the chest, abdomen, and/or middle
of the back between the shoulder blades.
 Thoracic aneurysms may cause shortness of breath,
hoarseness, cough (due to pressure on the lungs and
airways), and difficulty swallowing (pressure on the
esophagus)
 Rupture of an aneurysm can cause loss of
consciousness, stroke, shock, or a heart attack
 If you are experiencing sudden unexplained chest,
abdominal, or back pain, or any of the other
symptoms mentioned above, seek medical attention
 The diagnosis of an aortic aneurysm is difficult
because often there are no symptoms.
 A doctor may find one incidentally during an
exam. A thoracic aneurysm may cause a heart
murmur. An abdominal aneurysm feels like a
pulsating mass in the stomach.
 If one is detected, it must be monitored.
Aneurysms are at higher risk of rupture as they
grow larger. Doctors will monitor them carefully
and may recommend repair when they are more
than 5 cm wide.
 Tests to detect them include:
 Ultrasound
 Angiography (dye test to look at the aorta)
 Magnetic resonance imaging (MRI)
 Computed tomography (CT scan
 Small aortic aneurysms that aren't causing
any symptoms are monitored over time until
they become large and at a higher risk for
rupture.
 When an aortic aneurysm is large or
associated with symptoms, the weakened
section of the vessel can be surgically
removed and replaced with a graft of
artificial material. If the aneurysm is close to
the aortic valve, valve replacement may
also be recommended
 In an aortic dissection, a small tear occurs in
the tunica intima (the inside layer of the aortic
wall in contact with blood).
 Blood can enter this tear and cause the intima
layer to strip away from the media layer, in
effect dividing the muscle layers of the aortic
wall and forming a false channel, or lumen.
 This channel may be short or may extend the
full length of the aorta. Another tear more distal
(further along the course of the aorta than the
initial tear) in the intima layer can let blood re-
enter the true lumen of the aorta
 While there have been different historic
classifications of aortic dissection, the
Stanford classification is now most
commonly used.
 Type A dissections involve the ascending
aorta and arch.
 Type B involves the descending aorta.
 A patient can have a type A dissection,
type B dissection, or a combination of
both
 It is uncertain as to why the initial tear (rent)
occurs in the intima layer of the aortic wall.
Aortic dissection tends to occur most
commonly in men between the ages of 50 and
70.
 High blood pressure: Most cases are
associated with high blood pressure
(hypertension). The aorta has to withstand
significant pressure changes with each
heartbeat, and it may be that over time with
hypertension, a weakening of an area of the
intima will occu
 What are the causes of aortic dissection?
 It is uncertain as to why the initial tear (rent)
occurs in the intima layer of the aortic wall.
Aortic dissection tends to occur most
commonly in men between the ages of 50 and
70.
 High blood pressure: Most cases are
associated with high blood pressure
(hypertension). The aorta has to withstand
significant pressure changes with each
heartbeat, and it may be that over time with
hypertension, a weakening of an area of the
intima will occu
 Some conditions increase the risk of aortic
dissection or are associated with the
condition, including:
 Bicuspid aortic valve (a congenital
abnormality of the aortic valve)
 Marfan syndrome
 Ehlers-Danlos syndrome
 Turner syndrome
 Syphilis
 Cocaine use
 Aortic dissection symptoms may be similar to
those of other heart problems, such as a heart
attack. Typical signs and symptoms include:
 Sudden severe chest or upper back pain, often
described as a tearing, ripping or shearing
sensation, that radiates to the neck or down the
back
 Loss of consciousness
 Shortness of breath
 Sudden difficulty speaking, loss of vision,
weakness or paralysis of one side of your body,
similar to those of a stroke
 Or if the dissection affects the anterior
spinal artery and blood supply to the
spinal cord, the patient may present
with paraplegia.
 The coronary arteries that supply
blood to the heart begin at the origin
of the aorta at the aortic valve. If the
coronary arteries are involved, the
aortic dissection may cause a heart
attack (myocardial infarction) as its
presenting symptom
 An aortic dissection can lead to:
 Death due to severe internal bleeding
 Organ damage, such as kidney
failure or life-threatening intestinal
damage
 Stroke
 Aortic valve damage (aortic
regurgitation) or rupture into the lining
around the heart (cardiac
 Detecting an aortic dissection can be tricky
because the symptoms are similar to those
of a variety of health problems. Doctors
often suspect an aortic dissection if the
following signs and symptoms are present:
 Sudden tearing or ripping chest pain
 Widening of the aorta on chest X-ray
 Blood pressure difference between right
and left arms
 Although these signs and symptoms suggest
aortic dissection, more-sensitive imaging
techniques are usually needed. Frequently
used imaging procedures include:
 Transesophageal echocardiogram (TEE). This test
uses high-pitched sound waves to produce an
image of the heart. A TEE is a special type of
echocardiogram in which an ultrasound probe is
inserted through the esophagus. The ultrasound
probe is placed close to the heart and the aorta,
providing a clearer picture of your heart than
would a regular echocardiogram.
 Computerized tomography (CT) scan. CT
scanning generates X-rays to produce cross-
sectional images of the body. A CT of the chest is
used to diagnose an aortic dissection, possibly
with an injected contrast liquid. Contrast makes
the heart, aorta and other blood vessels more
visible on the CT pictures.
 Magnetic resonance angiogram (MRA). An MRI
uses a magnetic field and pulses of radio wave
energy to make pictures of the body. An MRA
uses this technique to look at blood vessels.
 While many people with peripheral artery
disease have mild or no symptoms, some
people have leg pain when walking
(intermittent claudication).
 Intermittent claudication symptoms include
muscle pain or cramping in your legs or arms
that's triggered by activity, such as walking,
but disappears after a few minutes of rest. The
location of the pain depends on the location
of the clogged or narrowed artery. Calf pain
is the most common location.
 The severity of intermittent claudication varies
widely, from mild discomfort to debilitating
pain. Severe intermittent claudication can
make it hard for you to walk or do other types
of physical activity
 Peripheral artery disease symptoms include:
 Painful cramping in your hip, thigh or calf
muscles after activity, such as walking or
climbing stairs (intermittent claudication)
 Leg numbness or weakness
 Coldness in your lower leg or foot, especially
when compared with the other side
 Sores on your toes, feet or legs that won't heal
 A change in the color of your legs
 Hair loss or slower hair growth on your feet and
legs
 Slower growth of your toenails
 Shiny skin on your legs
 No pulse or a weak pulse in your legs or fee
Risk Factors
Those who are at highest risk for PAD are
Over age 50
Smokers
Diabetic
Overweight
Inactive (and do not exercise)
Have high blood pressure or high cholesterol
or high lipid blood test
Have a family history of vascular disease,
such as PAD, aneurysm, heart attack or
stroke
 Diagnosis
The most common test for PAD is the ankle-
brachial index (ABI), a painless exam in which
ultrasound is used to measure the ratio of blood
pressure in the feet and arms.
Based on the results of an ABI—as well as one’s
symptoms and risk factors for PAD—a doctor can
decide if further tests are needed.
PAD also can be diagnosed noninvasively with
an imaging technique called magnetic
resonance angiography (MRA) or with computed
tomography (CT) angiography.
 Ankle-Brachial Index
The blood pressure in your arms and ankles is checked using
a regular blood pressure cuff and a special ultrasound
stethoscope called a Doppler. The pressure in your foot is
compared to the pressure in your arm to determine how well
your blood is flowing and wThhether further tests are
needed.
Because atherosclerosis is a systemic disease, individuals
developing plaque in their legs are likely to have plaque
building up in the carotid arteries, which can lead to stroke,
or the coronary arteries, which can lead to heart attack.
Early detection of PAD is important because these
individuals are at significantly increased risk, and preventive
measures can be taken.
An individual with an ABI of 0.3 (high risk) has a two- to
three-fold increased risk of five-year cardiovascular death
compared to a patient with an ABI of 0.95 (normal or low
risk).
Treatments
Lifestyle Changes
Often PAD can be treated with lifestyle changes.
Smoking cessation and a structured exercise
program are often all that is needed to alleviate
symptoms and prevent further progression of the
disease.
Medication
Medications that lower cholesterol or control high
blood pressure may be prescribed. Medication also
is available that been shown to significantly increase
pain-free walking distance and total walking
distance in individuals with intermittent claudication.
Other medications that prevent blood clots or the
buildup of plaque in the arteries are available
THANK YOU
FOR YOUR
ATTENTION