Peripheral Vascular Disease

Peripheral Vascular Disease(PVD) or Peripheral artery disease (PAD) is a condition where the arteries supplying blood to the limbs and internal organs get blocked as a consequence of atherosclerosis. Fatty deposits get built up in the arteries and reduce the flow of blood to the organs being supplied by the peripheral arteries. Atherosclerosis is by far the leading cause for Peripheral Vascular Disease. Diabetes is a condition that puts a person at high risk for PVD. Smoking and obesity increases the risk for Peripheral Vascular Disease. Persons who are obese and suffer from hypertension are at higher risk for Peripheral Vascular Disease. A sedentary lifestyle without any exercise should be avoided.

Intermittent Claudication is noticed in patients suffering from Peripheral Vascular Disease. Symptoms associated with Peripheral Vascular Disease include numbness or tingling in the limbs, sores that do not heal and pain in the buttocks. A patient suffering from Peripheral Vascular Disease notices changes in skin color and temperature. There may be a dull and cramping pain in the calf, thigh and hip muscles. Ankle Brachial Index (ABI) involves a ratio of the blood pressure in your ankle to the pressure in your arm. Angiogram is a dye test that reveals any possible blockage in the arteries. Ultrasound Doppler Test uses imaging to check for plaque build-up in the arteries. Duplex ultrasound helps in accurate detection of the size of the artery stenosis and the extent of blockage.

Medication is prescribed to eliminate the narrowing of the arteries thereby improving the heart efficiency. Anti-platelet or anti-clotting agents such as cilostazol and pentoxifylline or aspirin and Clopidogrel help in improving blood supply to the extremities. Heparin and Warfarin are anticoagulant drugs that can prevent blood clotting. Blood viscosity is controlled to improve blood flow. Drugs to control hypertension and cholesterol may also be prescribed. Bypass surgery allows a new blood route that circumvents the blocked areas of the peripheral arteries. Endarterectomy is a surgical procedure whereby a surgeon cleans out plaque buildup inside the artery of the affected leg or arm. Cryoplasty, a newer form of Angioplasty uses liquid nitrous oxide to open a narrowed artery and destroy the plaque within. Regular supervised exercise can reduce symptoms of intermittent Claudication.

Alpha Blockers

The muscles of our blood vessels contain alpha receptors and muscles tend to tighten when these alpha receptors are stimulated. The blood does not flow smoothly when the muscles of the blood vessels contract leading to hypertension. Alpha blockers or α-blockers also called alpha adrenergic antagonists reduce the nerve impulses and keep the small blood vessels open.

They work by blocking peripheral alpha receptors that are present in blood vessels. Alpha blocker drugs attach themselves to the alpha-adrenergic receptors and thus stop the stimulation. Thus blood vessels remain relaxed and open and allow the blood to flow through them lowering blood pressure. The generic names of alpha blockers are Doxazosin, Phenoxybenzamine, Prazosin, Terazosin. Alpha blockers do not cure high blood pressure but help to keep it under check. These medications are most often prescribed to patients suffering hypertension, peripheral vascular disease and hyperplasia.

Some of the common side effects produced by the α blockers are orthostatic hypotension, dizziness, tiredness, retrograde ejaculation, rhinitis, poor vision, headache, lightheadedness and peripheral swelling.

α-Adrenoceptor Antagonists: Long term use of Alpha blockers may result in tachyphylaxis (sudden loss of response) with other side effects as mentioned above - for some patients. Cataractectomy in patients using α-blockers can be complicated by the Floppy Iris Syndrome. The operating ophthalmologist should be alerted to the use of Alpha blockers.

Aspirin Resistance Blood Test

Close to 26 million Americans or 20% of adults in USA take low-dose Aspirin daily to prevent heart attacks and strokes. Doctors prescribe Aspirin in low doses to patients to lower the risk of heart attack or stroke, primary or secondary in nature. Aspirin benefits the heart in many ways.

Checks inflammation: Inflammation in the heart is a result of plaque build-up. Over time the plaque build-up narrows the arteries and restricts blood flow. There are chances of blood clot formation which can obstruct blood flow or break off the plaque. This can deeply affect the organ connected to the artery. There is also a possibility of the plaque to break off and cause an obstruction. Clogged arteries increase the chances of heart attack, stroke and sometimes even death. Low dose aspirin becomes essential.

Acetylsalicylic Acid fights inflammation by blocking the action of an enzyme called cyclooxygenase. By blocking this enzyme, the body finds it hard to produce prostaglandins, the chemicals that facilitate the inflammatory response.

Stalls blood clots: Aspirin interferes with and stalls the formation of blood clots. It blocks the action of chemicals that produce blood clots. With specific reference to the heart, blood clot formation can block the artery, the blood vessels that carry oxygen and nutrients to the heart muscle tissue. This increases the risk of heart attack and stroke. If Aspirin is taken, it prevents artery-blocking blood clot formation and the risk is considerably reduced.

Every patient who is prescribed Aspirin need not necessarily respond well and get the preventive benefits. In spite of a daily aspirin, patients with continued high levels of thromboxane are considered to be at increased risk of heart attack or stroke compared to patients without elevated levels. To determine and evaluate that the non-response is due to Aspirin resistance, a test is required. One way to determine is through Aspirin resistance blood test.

People who are likely to be categorized as Aspirin resistance include:

• If diagnosed with a disease such as peripheral vascular disease and other inflammatory processes that produce chemicals (thromboxane) that can reduce aspirin's beneficial effect.
  
  
• Those taking medications (such as ibuprofen, Naproxen) that interfere with the intended anti-clotting effect of aspirin.
  
  
• Those undergoing high levels of stress
  
  
• If genetically poor responders to NSAID therapy
  
  
• If the dosage is far too low
  
  
• Diabetic persons
  
  
• Overweight people
  
  
• Older adults.

A blood test using a specific device is used to diagnose Aspirin resistance. The test measures the thromboxane levels (higher levels indicate that aspirin is less effective). The purpose of the test is to determine if a patient is likely to benefit from aspirin. If the blood sample shows that aspirin doesn't inhibit blood clotting as it should, the patient is deemed aspirin resistant. Test results are available in less than 10 minutes.