Intermittent Claudication

The medical term for intermittent claudication is intermittent claudication – translated: intermittent limping. Just like the colloquial term intermittent claudication, this term indicates the typical symptoms of this condition. Those affected can only run or walk short distances painlessly. After a few meters, the pain forces patients with intermittent claudication to stand. So that this is not so noticeable, those affected like to stand in front of shop windows and look apparently interested in the displays. Actually, they are just waiting for the pain to pass and for them to continue on their way.

Intermittent claudication as stage II of PAVK

Intermittent claudication is stage II of PAVK. Information on stages I, III, and IV can be found in the paVK clinical picture.

Stage II is divided again into II a and II b. The subdivision is based on the walking distance that those affected can walk without pain. In stage II a it is more than 200 meters, in stage II b the legs already hurt at a distance of less than 200 meters.

Symptoms

In addition to the typical calf pain when walking, some patients with intermittent claudication also experience pain in the thighs and buttocks. Often there is also a feeling of weakness in the legs (tired legs). As a result of the lack of blood circulation, the skin on the lower leg sometimes appears pale and cool. Dark spots, wounds, and inflammation on the lower leg are also possible symptoms of intermittent claudication.

Intermittent Claudication

Causes

As with paVK, atherosclerosis and the resulting insufficient blood flow are the main causes of the disease in intermittent claudication. Risk factors such as smoking, diabetes, elevated blood lipid levels, and high blood pressure or metabolic syndrome increase the risk of intermittent claudication.

Treatment

Therapy for intermittent claudication consists in the treatment of peripheral arterial circulatory disorder. You can find out more about the different therapy options in the paVK guide.

Arteriosclerosis

Atherosclerosis is a pathological narrowing of the arteries that can lead to circulatory disorders and heart disease. Find out more about the causes, symptoms, and treatment of atherosclerosis here.

Medical professionals describe pathological (degenerative) narrowing of the arteries as arteriosclerosis. A similar term is or atherosclerosis. He basically means the same thing. But there is a small difference: medical professionals refer to the deposits of plaques in the blood vessels as or atherosclerosis. In colloquial language, arteriosclerosis and/or atherosclerosis are often referred to as hardening of the arteries or hardening of the arteries.

Atherosclerosis: plaques in the inner wall of the blood vessels

Healthy arteries are elastic and muscular and can adapt to different blood pressure situations. The arteries (excluding the pulmonary arteries) carry fresh, oxygen-rich blood from the heart throughout the body. In arteriosclerosis, substances dissolved in the blood (initially cholesterol, for example) are deposited in the inner wall of the blood vessels. In the further course, other substances such as calcium also accumulate at these points – so-called plaques are formed. These deposits change the inner wall of the vessel. It becomes rigid and swells. This narrows the vascular opening. The result is circulatory disorders in the areas that are supplied by the affected artery. A particular danger of atherosclerosis is that narrowed vessels can more easily be closed by a blood clot. The consequences of this are, for example, heart attacks or strokes. Men suffer from circulatory disorders more often than women.

Frequency

Atherosclerosis is a so-called widespread disease because it is particularly common. With increasing age, almost everyone is affected by a pathological narrowing of the arteries. The number of deaths caused by atherosclerosis in Germany is around 360,000 per year. At the same time, the hardening of the arteries is the most common cause of serious secondary diseases such as heart attacks or strokes.

Symptoms

The symptoms of atherosclerosis, once they become noticeable, are usually severe. The symptoms depend on where the arteries are narrowed.

Circulatory disorders in the legs

Circulatory disorders in the legs lead to so-called peripheral arterial occlusive disease (PAOD), the 2nd stage of which is known as intermittent claudication. The legs hurt at first when walking, later also when resting. The disease got its name because patients repeatedly take breaks while walking and look in shop windows, for example.

Another circulatory disorder in the legs is the so-called smoker’s leg. In the smoker’s leg, the tissue on the toes, ankles, and legs slowly dies off because the narrowed arteries do not provide enough oxygen. Amputation may be necessary under certain circumstances.

Angina and heart attack

A narrowing of the coronary arteries leads to angina pectoris, and if one of the arteries is completely blocked, it leads to a heart attack. These heart problems are among the most feared complications of arteriosclerosis. This also applies to strokes, which are often caused by a vascular blockage in the brain.

Arteriosclerosis

Stroke due to atherosclerosis

Circulatory disorders in the brain lead to declining brain functions such as memory disorders, dizziness, or confusion. Depending on which brain region is affected, other failure symptoms can also occur in other parts of the body. Examples of this are numbness in the arms or legs or impaired vision. If the vascular narrowing is very severe or if a brain vessel bursts, a stroke occurs.

Causes

Unfortunately, it cannot be glossed over: the majority of the causes of arteriosclerosis are our own responsibility. Because the risk is primarily shaped by individual behavior. The following risk factors promote the development of arterial constrictions:

    • Blood fat levels (cholesterol and other fats) are too high because fats are deposited in the blood vessels, and high LDL concentrations in particular increase plaque formation
    • High blood pressure, because the blood vessels are exposed to greater pressure and wear out faster
    • Obesity because is often linked to high blood pressure or high cholesterol
    • Smoking, as nicotine narrows blood vessels and reduces blood flow
    • Stress (which in turn can cause high blood pressure)
    • Diabetes, as blood lipids are increasingly “saccharified” and are more heavily deposited in the blood vessel walls
    • Age, because the risk of arteriosclerosis increases significantly with age
    • Lack of exercise because it promotes obesity and does not train the vascular system
    • Genetic predisposition: Genes seem to play a role as a disease risk in arteriosclerosis.

Examination

For a more precise diagnosis of a narrowing of the arteries, your doctor will first use special examination methods to determine the location and extent of the narrowing of the arteries. This diagnosis of arteriosclerosis can turn out to be quite complex if, for example, the condition of arteries has to be assessed by a catheter examination.

Treatment

For the drug therapy of arteriosclerosis, your doctor can use a whole range of active substances that relieve the blood circulation and the arteries in different ways. These are, for example, drugs that stimulate blood circulation, lower blood pressure, or thin the blood. Medicines are also available to treat high cholesterol or high levels of blood lipids. In addition, doctors usually recommend changing your diet and getting more exercise.

Surgical Therapy Of Atherosclerosis

Surgical treatment of atherosclerosis comes into play when medication and behavior change no longer help.

Stent Stabilizes Arteries

In the not-too-advanced stages of arteriosclerosis, the doctor has the option of making the affected vessels more accessible again. For this purpose, the affected artery is stabilized with a stiffener, the so-called stent, in an operation. In order to be able to place a stent, however, the artery still has to be narrowed enough so that the surgeon can reach the narrowing with an endoscope. If this is not possible, bypass surgery usually occurs.

Bypass Surgery

In particularly severe cases of atherosclerosis, there is no choice but to have surgery to detour around the narrowed or blocked artery or to replace the narrowed artery. This is called a bypass operation.

Self Help

Self-help for atherosclerosis is particularly effective if it reduces the risk factors. Eating a low-fat diet, losing excess weight, getting more exercise, and not smoking will support treatment and reduce the severity of the course of atherosclerosis.

Over-The-Counter Drugs For Atherosclerosis

    • Taking ginkgo preparations has a positive effect on blood circulation.
    • Taking garlic supplements in sufficient doses improves the flow properties of the blood and is also said to lower the cholesterol level.
    • Preparations with omega-3 fatty acids e.g. obtained from cold-water fish, reduce the risk of deposits in the arteries. They are also said to improve the flow properties of the blood and lower cholesterol levels and blood pressure.
    • Regular intake of acetylsalicylic acid (ASA) in low doses improves blood flow. Discuss this with your doctor.

Prevention

There are a number of ways you can help prevent atherosclerosis. In any case, you should do everything possible to minimize the risk factors mentioned under arteriosclerosis. In a nutshell, the best way to help yourself is to eat a low-fat, varied, and fresh diet, exercise regularly in the fresh air (as early as 20 minutes a day), consume luxury foods such as alcohol and coffee in moderation, and refrain from smoking (For tips, see quitting smoking). The following tips will also help prevent atherosclerosis:

    • Regular monitoring of blood pressure, cholesterol, and blood lipid levels.
    • If the cholesterol level is high, pay attention to a low-cholesterol diet, i.e. reduce butter, eggs and the amount of meat, especially avoid saturated fats (e.g. high-fat sausage) and trans fats (especially in fried products such as french fries or potato chips), for the diet guide with high cholesterol levels
    • Diabetics should always make sure that their sugar levels are set correctly.
    • Obese people should definitely lose weight.
    • Avoid stress and learn relaxation techniques such as autogenic training, yoga, or Jacobsen’s progressive muscle relaxation.

Cardiomyopathy

Doctors refer to a whole group of diseases as cardiomyopathies in which the heart muscle, the myocardium, is affected. The colloquial term is a heart muscle disease.

The word cardiomyopathy is derived from Greek. “Cardio” stands for heart, “myo” for muscle, and “pathie” for sick. Cardiomyopathy is a collective term for various heart diseases. A common feature of these diseases are changes in the heart muscle (myocardium), which are associated with a decline in cardiac output.

Cardiomyopathies are almost always very serious diseases which, without appropriate therapy, lead to heart failure.

Forms Of Cardiomyopathy

There are a number of cardiomyopathies. First of all, medical professionals differentiate between primary and secondary cardiomyopathies. Primary cardiomyopathies are caused by a disease or congenital malformation of the heart muscle. If other diseases affect the myocardium, doctors speak of secondary cardiomyopathies. In addition to the pure forms, there are also mixed forms.

Furthermore, medical professionals divide cardiomyopathies into four main types.

    • dilated cardiomyopathy
    • hypertrophic cardiomyopathy
    • restrictive cardiomyopathy
    • arrhythmogenic right ventricular cardiomyopathy (ARVC).

There are also other sub-forms such as

    • Non-compaction cardiomyopathy
    • Broken Heart Syndrome (Tako Tsubo Cardiomyopathy, Broken Heart Syndrome)
    • hypertensive cardiomyopathy (damage to the heart muscle caused by high blood pressure)

Frequency

By far the most common form is hypertrophic cardiomyopathy. There are around 200 cases for every 100,000 inhabitants (prevalence). The number of new cases per 100,000 inhabitants per year (annual incidence) is 19.

The second most common form is dilated cardiomyopathy, with a prevalence of 40 cases per 100,000 population and an annual incidence of 6 new cases.

Cardiomyopathies affect people of all ages. However, there are frequency peaks between 20 and 50 years on average for all forms. In men, the incidence is about twice as high as in women.

Symptoms

The common symptom of all cardiomyopathies is a more or less restricted beating and pumping power of the heart. Heart failure often occurs as the disease progresses. In the case of some heart muscle diseases, the symptoms resemble the symptoms of cardiac insufficiency at the onset of cardiomyopathy.

Complications

Cardiomyopathies are often very slow to develop and therefore often go unnoticed for many years. Without timely diagnosis and suitable therapy, the cardiac output – and with it the oxygen supply to the body – continues to decline.

The human heart is a very finely tuned system. When a component like the heart muscle itself changes, it has a variety of possible effects. An example: In the case of an emerging cardiac insufficiency, the heart compensates for the decreasing impact force by increasing the frequency and strength of the impact. This increases the mass of the heart muscle. If the heart muscle becomes too thick (heart muscle hypertrophy), mobility is restricted on the one hand. In addition, the blood flow in the heart changes. This can promote blood clots, which in turn can trigger a pulmonary embolism.

The extremely sensitive heart valves are also endangered by myocardial growth. Any heart valve defects increase the risk of heart failure.

Sometimes the heart expands as a result of the additional stress caused by cardiomyopathies, doctors speak of dilation. Then the heart chambers literally wear out. As a result, the heart’s pumping power and ejection performance drop drastically.

But cardiomyopathies also disrupt the heart’s excitation lines. This is a possible cause of cardiac arrhythmias, which can lead to ventricular fibrillation and sudden cardiac death.

Cardiomyopathy

Causes

Many primary cardiomyopathies are congenital. This does not necessarily mean that the heart muscle changes exist from birth. They can also only develop over the years. Most common, however, are primary cardiomyopathies with no apparent cause. In this case, medical professionals speak of idiopathic cardiomyopathies.

There are also acquired primary heart muscle diseases and secondary cardiomyopathies.

Acquired primary cardiomyopathies result from other diseases or are sometimes the result of pregnancy. Examples of such causes are:

    • Viral infections, such as a badly healed cold or flu, can lead to viral myocarditis. Infections with the mump pathogen during childbirth sometimes cause restrictive cardiomyopathy in children for years afterward.
    • Bacterial infections such as repeated inflammation of the inner lining of the heart also cause cardiomyopathies. Typical bacterial pathogens that cause myocardial disease are meningococci, streptococci, and diphtheria bacteria.
    • Fungi and parasites such as candida infections or toxoplasmosis
    • Tumor diseases
    • autoimmune connective tissue diseases such as scleroderma or sarcoid
    • Damage to the heart muscle due to deposits of foreign substances or metabolic products such as amyloidosis or hemochromatosis (iron storage disease)
    • Alcohol and drug abuse (toxic cardiomyopathy)
    • increased stress from pregnancy or competitive sport
    • Postmenopause or increased emotional stress (stress cardiomyopathy or, colloquially, broken heart syndrome).

Many other causes are conceivable, depending on the type of cardiomyopathy.

Secondary cardiomyopathies are mostly caused by other conditions. These can be congenital or acquired. Cause here are, for example, toxic substances, storage diseases, endocrine functional disorders, neurological and neuromuscular changes, autoimmune processes, drugs (especially chemotherapeutic agents), or malnutrition.

Examination

General practitioners, cardiologists, or internists usually suspect cardiomyopathy on the basis of declining physical performance. In pronounced cases, shortness of breath, blue discoloration of the skin (cyanosis), or water retention in the legs (edema) speak for themselves.

The diagnosis of cardiomyopathy is initially confirmed by an electrocardiogram (EKG, recording of heart activity), an X-ray of the chest, and an ultrasound examination of the heart (echocardiography). If the initial suspicion is confirmed, a cardiac catheter examination usually follows. During this procedure, a small piece of myocardial tissue is secured (biopsy) in order to better determine the exact type of cardiomyopathy.

Imaging methods such as computer and magnetic resonance tomography, stress tests, and rhythm diagnostics provide additional insights.

Treatment

Once the cause of the cardiomyopathy can be identified, the first step in therapy is to eliminate the causes. Often, however, therapy for heart muscle disease is limited to relieving symptoms and stopping the progression of cardiomyopathy.

Medical therapy

One of the most important goals of drug therapy for cardiomyopathies is to prevent the development or progression of cardiac insufficiency. For this purpose, drugs are used that relieve and strengthen the heart. It is not uncommon for several active ingredients to be combined.

Beta Blockers

The most commonly used active ingredients for the symptomatic therapy of heart failure come from the group of beta-blockers. Beta-blockers block activating hormones like adrenaline and northern adrenaline. Among other things, this causes the heart’s resting frequency to normalize and the blood vessels to expand. This lowers blood pressure, improves blood circulation and oxygen supply, and relieves the heart. They also reduce the excitability of the heart muscle.

Many used beta-blockers are bisoprolol and metoprolol.

Beta Blockers

ACE inhibitors block the action of the angiotensin-converting enzyme (ACE). This enzyme plays a key role in regulating blood pressure and water balance. ACE inhibitors such as benazepril, captopril, ramipril or zofenopril relieve the heart by widening blood vessels and thus lowering high blood pressure. At the same time, they help promote water excretion. This reduces the blood volume and the heart is relieved.

The excretion-promoting effect of ACE inhibitors is in many cases insufficient to relieve the heart of blood volume and to flush out edema caused by cardiac insufficiency. This task is carried out by the so-called water tablets (diuretics) such as hydrochlorothiazide, spironolactone and furosemide.

Antiarrhythmics

Antiarrhythmics are agents that normalize the heartbeat. As a rule, the aim is to slow down an accelerated heartbeat (tachycardia). Active ingredients such as ajmaline, flecainide, or phenytoin achieve this effect, among other things, by blocking the flow of sodium ions into the cells.

Other antiarrhythmics include potassium channel blockers such as amiodarone and sotalol and calcium channel blockers such as diltiazem and verapramil.

Anticoagulants

Anticoagulants such as Phenprocoumon or Eliquis, Pradaxa, and Xarelto are used in cardiomyopathies to prevent blood clots from forming in the heart. This is because these clots pose a significant risk. They can trigger pulmonary embolisms, for example.

Operative Therapy

If drug therapy for cardiomyopathies does not relieve the symptoms, surgery is another option. For example, damaged heart valves are replaced, parts of the heart muscle are removed or pacemakers are implanted.

The heart transplant remains the last possibility and the only causal therapy option.

Forecast

The prognosis for the course and life expectancy of cardiomyopathies depends on the type and extent of the heart muscle damage and the general state of health. In mild forms of blood pressure-related (hypertrophic) cardiomyopathy, for example, those affected have a normal life expectancy if the high blood pressure is consistently treated.

Dilated and restrictive cardiomyopathies, on the other hand, are often recognized very late and can then often hardly be treated effectively. Up to 80 percent of those affected die within 5 years of diagnosis.

Prevention

Cardiomyopathies are very often the result of cardiovascular disease. To reduce the risk of these diseases, you should lead a heart-healthy lifestyle. Above all, exercise keeps the circulation and the heart fit.

A fresh and varied diet provides the body with all the necessary nutrients and also helps to avoid obesity.

Lung and heart health are closely related. Quitting smoking is, therefore, a cornerstone in the prevention and accompanying treatment of heart muscle disorders. Regular consumption of alcohol is also harmful to the heart.

Finally, the prevention of cardiomyopathies also includes having favorable diseases (see causes) treated consistently.