Tooltip
.tooltip {
position: relative;
cursor: pointer;
text-decoration: none;
border-bottom: 1px dashed rgba(0, 0, 0, 0.6);
}
.tooltip::before {
content: attr(data-tooltip);
position: absolute;
top: -40px; /* Trochę niżej nad słowem */
left: 50%; /* Wyśrodkowanie */
transform: translateX(-50%);
background-color: rgba(255, 255, 255, 0.9);
color: #333;
padding: 6px 12px;
border-radius: 8px;
white-space: nowrap;
opacity: 0;
visibility: hidden;
transition: opacity 0.3s ease, visibility 0.3s ease;
font-family: ‘Arial’, sans-serif;
font-size: 14px;
box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.1);
z-index: 10;
}
.tooltip:hover::before {
opacity: 1;
visibility: visible;
}
document.addEventListener(‘DOMContentLoaded’, function () {
const wordsToTooltip = {
“Hypertension”: “Nadciśnienie tętnicze”,
“High blood pressure”: “Wysokie ciśnienie krwi”,
“Systolic”: “Ciśnienie skurczowe”,
“Diastolic”: “Ciśnienie rozkurczowe”,
“Silent killer”: “Cichy zabójca”,
“Cardiovascular complications”: “Powikłania sercowo-naczyniowe”,
“Primary hypertension”: “Nadciśnienie pierwotne”,
“Essential hypertension”: “Nadciśnienie samoistne”,
“Genetics”: “Genetyka”,
“Family history”: “Wywiad rodzinny”,
“Age”: “Wiek”,
“Race”: “Rasa”,
“Obesity”: “Otyłość”,
“High salt intake”: “Wysokie spożycie soli”,
“Physical inactivity”: “Brak aktywności fizycznej”,
“Excessive alcohol consumption”: “Nadmierne spożycie alkoholu”,
“Stress”: “Stres”,
“Secondary hypertension”: “Nadciśnienie wtórne”,
“Kidney disease”: “Choroba nerek”,
“Chronic kidney disease”: “Przewlekła choroba nerek”,
“Polycystic kidney disease”: “Wielotorbielowatość nerek”,
“Endocrine disorders”: “Zaburzenia endokrynologiczne”,
“Hyperthyroidism”: “Nadczynność tarczycy”,
“Cushing’s syndrome”: “Zespół Cushinga”,
“Pheochromocytoma”: “Guz chromochłonny”,
“Oral contraceptives”: “Doustne środki antykoncepcyjne”,
“Corticosteroids”: “Kortykosteroidy”,
“NSAIDs”: “Niesteroidowe leki przeciwzapalne”,
“Sleep apnea”: “Bezdech senny”,
“Increased resistance”: “Zwiększony opór”,
“Atherosclerosis”: “Miażdżyca”,
“End-organ damage”: “Uszkodzenie narządów końcowych”,
“Sympathetic nervous system activity”: “Aktywność układu współczulnego”,
“Abnormal sodium handling”: “Nieprawidłowe gospodarowanie sodem”,
“Renin-angiotensin-aldosterone system”: “Układ renina-angiotensyna-aldosteron”,
“RAAS”: “Układ renina-angiotensyna-aldosteron”,
“Asymptomatic”: “Bezobjawowy”,
“Heart attack”: “Zawał serca”,
“Stroke”: “Udar mózgu”,
“Headache”: “Ból głowy”,
“Visual disturbances”: “Zaburzenia widzenia”,
“Blurred vision”: “Zamazane widzenie”,
“Retinal hemorrhages”: “Krwotoki siatkówkowe”,
“Hypertensive retinopathy”: “Retinopatia nadciśnieniowa”,
“Pulmonary edema”: “Obrzęk płuc”,
“Nosebleeds”: “Krwawienia z nosa”,
“Hypertensive crisis”: “Przełom nadciśnieniowy”,
“Blood pressure measurement”: “Pomiar ciśnienia krwi”,
“Ambulatory”: “Ambulatoryjne”,
“Kidney function”: “Funkcja nerek”,
“Creatinine”: “Kreatynina”,
“Electrolytes”: “Elektrolity”,
“Lipid profile”: “Profil lipidowy”,
“Urinalysis”: “Badanie moczu”,
“Proteinuria”: “Białkomocz”,
“Electrocardiogram”: “Elektrokardiogram”,
“Left ventricular hypertrophy”: “Przerost lewej komory serca”,
“Heart strain”: “Przeciążenie serca”,
“Echocardiogram”: “Echokardiogram”,
“Cardiac damage”: “Uszkodzenie serca”,
“Lifestyle modifications”: “Zmiany stylu życia”,
“DASH diet”: “Dieta DASH”,
“Aerobic activity”: “Aktywność aerobowa”,
“Weight loss”: “Utrata masy ciała”,
“Diuretics”: “Diuretyki”,
“Thiazide diuretics”: “Diuretyki tiazydowe”,
“ACE inhibitors”: “Inhibitory ACE”,
“Calcium channel blockers”: “Blokery kanałów wapniowych”,
“Beta-blockers”: “Beta-blokery”,
“Angiotensin receptor blockers”: “Blokery receptora angiotensyny”,
“Heart failure”: “Niewydolność serca”,
“Myocardial infarction”: “Zawał mięśnia sercowego”,
“Aortic aneurysms”: “Tętniaki aorty”,
“Peripheral artery disease”: “Choroba tętnic obwodowych”,
“Circulatory problem”: “Problem krążeniowy”,
“Plaque”: “Blaszka miażdżycowa”,
“Peripheral arteries”: “Tętnice obwodowe”,
“Smoking”: “Palenie tytoniu”,
“Diabetes mellitus”: “Cukrzyca”,
“High cholesterol”: “Wysoki poziom cholesterolu”,
“LDL cholesterol”: “Cholesterol LDL”,
“Systemic atherosclerosis”: “Układowa miażdżyca”,
“Endothelial dysfunction”: “Dysfunkcja śródbłonka”,
“Luminal narrowing”: “Zwężenie światła naczyń”,
“Intermittent claudication”: “Chromanie przestankowe”,
“Cramping pain”: “Skurczowy ból”,
“Critical limb ischemia”: “Krytyczne niedokrwienie kończyn”,
“Peripheral pulses”: “Tętno obwodowe”,
“Non-healing wounds”: “Niegojące się rany”,
“Gangrene”: “Zgorzel”,
“Skin changes”: “Zmiany skórne”,
“Hair loss”: “Utrata owłosienia”,
“Shiny skin”: “Błyszcząca skóra”,
“Thickened toenails”: “Zgrubiałe paznokcie”,
“Angioplasty”: “Angioplastyka”,
“Stenting”: “Stentowanie”,
“Bypass surgery”: “Operacja pomostowania”,
“Cardiovascular risk”: “Ryzyko sercowo-naczyniowe”,
“Abdominal aortic aneurysms”: “Tętniaki aorty brzusznej”,
“Thoracic aortic aneurysms”: “Tętniaki aorty piersiowej”,
“Marfan syndrome”: “Zespół Marfana”,
“Ehlers-Danlos syndrome”: “Zespół Ehlersa-Danlosa”,
“Trauma”: “Uraz”,
“Inflammation”: “Zapalenie”,
“Oxidative stress”: “Stres oksydacyjny”,
“Connective tissue”: “Tkanka łączna”,
“Abdominal pain”: “Ból brzucha”,
“Pulsatile abdominal mass”: “Pulsujący guz w jamie brzusznej”,
“Chest pain”: “Ból w klatce piersiowej”,
“Recurrent laryngeal nerve”: “Nerw krtaniowy wsteczny”,
“Aortic dissection”: “Rozwarstwienie aorty”,
“Thromboembolism”: “Zakrzepowo-zatorowy”,
“Carotid artery stenosis”: “Zwężenie tętnicy szyjnej”,
“Transient ischemic attacks”: “Przemijające ataki niedokrwienne”,
“Amaurosis fugax”: “Przemijająca utrata wzroku”,
“Slurred speech”: “Bełkotliwa mowa”,
“Aspirin”: “Aspiryna”,
“Clopidogrel”: “Klopidogrel”,
“Carotid endarterectomy”: “Endarterektomia tętnicy szyjnej”,
“Carotid artery stenting”: “Stentowanie tętnicy szyjnej”,
“Restenosis”: “Restenoza”,
“Cranial nerve injury”: “Uszkodzenie nerwów czaszkowych”,
“Chronic medical condition”: “Przewlekła choroba”,
“Untreated”: “Nieleczony”,
“Symptoms”: “Objawy”,
“Underlying condition”: “Choroba podstawowa”,
“Medications”: “Leki”,
“Dull ache”: “Tępy ból”,
“Shortness of breath”: “Duszność”,
“Cardiac output”: “Rzut serca”,
“Follow-up visits”: “Wizyty kontrolne”,
“Hemorrhagic”: “Krwotoczny”,
“Ischemic”: “Niedokrwienny”,
“Cerebral arteries”: “Tętnice mózgowe”,
“Renal blood vessels”: “Naczynia krwionośne nerkowe”,
“Aneurysms”: “Tętniaki”,
“Vision loss”: “Utrata wzroku”,
“Life expectancy”: “Oczekiwana długość życia”,
“Antihypertensive therapy”: “Terapia przeciwnadciśnieniowa”,
“10-year cardiovascular event risk”: “10-letnie ryzyko zdarzeń sercowo-naczyniowych”,
“Morbidity”: “Zachorowalność”,
“Mortality”: “Śmiertelność”,
“Artery occlusion”: “Niedrożność tętnicy”,
“Ischemia”: “Niedokrwienie”,
“Ankle-Brachial Index”: “Wskaźnik kostkowo-ramienny”,
“Doppler Ultrasound”: “Ultrasonografia Dopplerowska”,
“Angiography”: “Angiografia”,
“Claudication”: “Chromanie przestankowe”,
“Arterial narrowing”: “Zwężenie tętnic”,
“Antiplatelet agents”: “Leki przeciwpłytkowe”,
“Statins”: “Statyny”,
“Cilostazol”: “Cilostazol”,
“Non-healing”: “Nieulegający wygojeniu”,
“Limb loss”: “Utrata kończyny”,
“Ulcers”: “Owrzodzenia”,
“Diabetes”: “Cukrzyca”,
“Comorbidities”: “Choroby współistniejące”,
“Surgical”: “Chirurgiczny”,
“Endovascular intervention”: “Interwencja wewnątrznaczyniowa”,
“Rupture”: “Pęknięcie”,
“Internal bleeding”: “Krwawienie wewnętrzne”,
“Aneurysm”: “Tętniak”,
“Abdomen”: “Brzuch”,
“Throbbing ache”: “Pulsujący ból”,
“Cough”: “Kaszel”,
“Hoarseness”: “Chrypka”,
“CT Angiography”: “Angiografia tomografii komputerowej”,
“Ultrasound”: “Ultrasonografia”,
“MRI”: “Rezonans magnetyczny”,
“Chest X-ray”: “RTG klatki piersiowej”,
“Dye”: “Środek kontrastowy”,
“Mediastinum”: “Śródpiersie”,
“Thoracic aneurysms”: “Tętniaki aorty piersiowej”,
“Antihypertensives”: “Leki przeciwnadciśnieniowe”,
“Graft”: “Przeszczep”,
“Endovascular Aneurysm Repair”: “Wewnątrznaczyniowa naprawa tętniaka”,
“Stent graft”: “Stentgraft”,
“Dissection”: “Rozwarstwienie”,
“Dysphagia”: “Trudności w połykaniu”,
“Carotid Ultrasound”: “Ultrasonografia tętnicy szyjnej”,
“Magnetic Resonance Angiography”: “Angiografia rezonansu magnetycznego”,
“Cerebral Angiography”: “Angiografia mózgowa”,
“TIA”: “Przemijający atak niedokrwienny”,
“Carotid artery”: “Tętnica szyjna”
};
// Normalize keys in the dictionary
const normalizedWordsToTooltip = {};
for (const [key, value] of Object.entries(wordsToTooltip)) {
const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses
normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value;
}
function processNode(node) {
if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) {
let content = node.nodeValue;
// Regex to match only the main words (ignores parentheses)
const regex = new RegExp(
`\b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})\b`,
‘gi’
);
if (regex.test(content)) {
const wrapper = document.createElement(‘span’);
wrapper.innerHTML = content.replace(regex, (match) => {
const tooltip = normalizedWordsToTooltip[match.toLowerCase().trim()];
return `
${match}`;
});
node.replaceWith(wrapper);
}
} else if (node.nodeType === Node.ELEMENT_NODE) {
Array.from(node.childNodes).forEach(processNode);
}
}
document.querySelectorAll(‘body *:not(script):not(style)’).forEach((element) => {
Array.from(element.childNodes).forEach(processNode);
});
});
Podświetlanie tekstu z notatkami
body {
margin: 0;
padding: 0;
font-family: Arial, sans-serif;
}
.highlight {
background-color: #cce7ff; /* Highlight color without notes */
position: relative;
display: inline;
}
.highlight.with-note {
background-color: #ffeb3b; /* Highlight color with notes */
}
.note-box {
position: absolute;
background-color: #f9f9f9;
color: #333;
font-size: 14px;
line-height: 1.6;
padding: 10px 15px;
border: 1px solid #ddd;
border-radius: 5px;
box-shadow: 0 2px 5px rgba(0, 0, 0, 0.2);
max-width: 250px;
z-index: 1000;
white-space: normal;
text-align: left;
display: none; /* Hidden by default */
}
.note-controls {
position: absolute;
top: -30px;
right: -30px;
display: flex;
gap: 10px;
z-index: 10;
opacity: 0;
pointer-events: none;
transition: opacity 0.3s;
}
.note-controls.visible {
opacity: 1;
pointer-events: all;
}
.note-controls span {
cursor: pointer;
background-color: gray;
color: white;
padding: 5px 10px;
border-radius: 5px;
font-size: 16px;
font-weight: bold;
}
.note-controls span:hover {
background-color: darkgray;
}
document.addEventListener(“DOMContentLoaded”, () => {
/**
* Checks if an element is a header.
*/
const isHeaderElement = (node) => {
while (node) {
if (node.nodeType === 1 && node.tagName.match(/^H[1-5]$/)) {
return true;
}
node = node.parentNode;
}
return false;
};
/**
* Checks if an element is inside a table cell.
*/
const isInsideTable = (node) => {
while (node) {
if (node.tagName === “TD” || node.tagName === “TH”) {
return node;
}
node = node.parentNode;
}
return null;
};
/**
* Checks if an element belongs to the same list item.
*/
const isWithinSameListItem = (selection) => {
if (selection.rangeCount === 0) return false;
const range = selection.getRangeAt(0);
const startContainer = range.startContainer;
const endContainer = range.endContainer;
const getClosestListItem = (node) => {
while (node) {
if (node.nodeType === 1 && node.tagName === “LI”) {
return node;
}
node = node.parentNode;
}
return null;
};
const startListItem = getClosestListItem(startContainer);
const endListItem = getClosestListItem(endContainer);
// Ensure selection is within the same list item
return startListItem === endListItem;
};
/**
* Validates the selection.
* Ensures the selection is within a single header, table cell, or list item.
*/
const isSelectionValid = (selection) => {
if (selection.rangeCount === 0) return false;
const range = selection.getRangeAt(0);
const startContainer = range.startContainer;
const endContainer = range.endContainer;
const startInHeader = isHeaderElement(startContainer);
const endInHeader = isHeaderElement(endContainer);
// Block selection spanning headers
if (startInHeader !== endInHeader) {
return false;
}
const startCell = isInsideTable(startContainer);
const endCell = isInsideTable(endContainer);
// Block selection spanning table cells
if (startCell && endCell && startCell !== endCell) {
return false;
}
// Block selection spanning multiple list items
if (!isWithinSameListItem(selection)) {
return false;
}
return true;
};
/**
* Highlights the selected text.
*/
const wrapTextWithHighlight = (range) => {
const fragment = range.extractContents();
const highlight = document.createElement(“span”);
highlight.className = “highlight”;
highlight.appendChild(fragment);
range.insertNode(highlight);
const noteControls = document.createElement(“div”);
noteControls.className = “note-controls visible”;
const editNote = document.createElement(“span”);
editNote.textContent = “✎”;
editNote.title = “Edit note”;
noteControls.appendChild(editNote);
const removeHighlight = document.createElement(“span”);
removeHighlight.textContent = “x”;
removeHighlight.title = “Remove highlight”;
noteControls.appendChild(removeHighlight);
highlight.style.position = “relative”;
highlight.appendChild(noteControls);
let noteBox = null;
const updateNotePosition = () => {
const rect = highlight.getBoundingClientRect();
if (noteBox) {
noteBox.style.top = `${rect.height}px`;
noteBox.style.left = `${rect.width / 2}px`;
}
};
const hideControlsAndNoteAfterDelay = () => {
setTimeout(() => {
noteControls.classList.remove(“visible”);
if (noteBox) noteBox.style.display = “none”;
}, 3000);
};
// Show controls for 3 seconds after highlighting
hideControlsAndNoteAfterDelay();
highlight.addEventListener(“click”, () => {
noteControls.classList.add(“visible”);
if (noteBox) noteBox.style.display = “block”;
hideControlsAndNoteAfterDelay();
});
editNote.addEventListener(“click”, () => {
const noteText = prompt(“Add or edit a note:”, noteBox?.textContent || “”);
if (noteText) {
if (!noteBox) {
noteBox = document.createElement(“div”);
noteBox.className = “note-box”;
highlight.appendChild(noteBox);
}
noteBox.textContent = noteText;
noteBox.style.display = “block”;
highlight.classList.add(“with-note”);
updateNotePosition();
hideControlsAndNoteAfterDelay();
}
});
removeHighlight.addEventListener(“click”, () => {
const parent = highlight.parentNode;
while (highlight.firstChild) {
parent.insertBefore(highlight.firstChild, highlight);
}
parent.removeChild(highlight);
if (noteBox) noteBox.remove();
});
};
/**
* Handles the mouseup event to validate and apply highlighting.
*/
document.body.addEventListener(“mouseup”, () => {
const selection = window.getSelection();
if (selection.rangeCount > 0 && selection.toString().trim()) {
if (!isSelectionValid(selection)) {
alert(“Zaznaczenie musi być w obrębie jednego akapitu, komórki tabeli lub punktu listy!”);
selection.removeAllRanges();
return;
}
const range = selection.getRangeAt(0);
wrapTextWithHighlight(range);
selection.removeAllRanges();
}
});
});
Szacowany czas lekcji:
36 minut
.lesson-duration-container {
background-color: #f0f4f8; /* Szarawe tło dopasowane do reszty strony */
padding: 8px 15px; /* Wewnętrzny odstęp */
border-radius: 8px; /* Zaokrąglone rogi */
font-family: ‘Roboto’, Arial, sans-serif; /* Czcionka Roboto, jeśli dostępna */
font-size: 16px; /* Rozmiar tekstu */
color: #6c757d; /* Ciemny szary kolor tekstu */
display: inline-block; /* Wyświetlanie jako element blokowy */
margin-bottom: 20px; /* Odstęp na dole */
border: none; /* Bez obramowania */
}
.lesson-duration-label {
font-weight: 700; /* Pogrubienie dla etykiety */
color: #6c757d; /* Ciemny szary kolor dla etykiety */
margin-right: 5px; /* Odstęp od wartości */
}
.lesson-duration-value {
color: #6c757d; /* Ciemny szary kolor dla wartości */
font-weight: 700; /* Pogrubienie dla wartości */
}
Hypertension
Hypertension, commonly known as high blood pressure, is a chronic medical condition characterized by persistently elevated blood pressure in the arteries. It is often referred to as the “silent killer” because it frequently presents without symptoms but can lead to severe cardiovascular complications if left untreated.
Hypertension is diagnosed when blood pressure values are:
- Systolic (upper number): ≥140 mm Hg
- Diastolic (lower number): ≥90 mm Hg
Etiology and Risk Factors
- Primary (Essential) Hypertension: No identifiable cause, accounting for 90-95% of cases. Risk factors include:
- Genetics: A family history of hypertension increases risk.
- Age: Blood pressure typically rises with age.
- Race: More prevalent and severe in African Americans.
- Lifestyle Factors: Obesity, high salt intake, physical inactivity, excessive alcohol consumption, and stress.
- Secondary Hypertension: Caused by an underlying condition, such as:
- Kidney Disease: Chronic kidney disease, polycystic kidney disease.
- Endocrine Disorders: Hyperthyroidism, Cushing’s syndrome, pheochromocytoma.
- Medications: Oral contraceptives, corticosteroids, NSAIDs.
- Sleep Apnea: Can contribute to elevated blood pressure.
Pathophysiology
Hypertension occurs when there is increased resistance in the arteries, causing the heart to work harder to pump blood. Chronic elevation in blood pressure leads to damage of the arterial walls, promoting atherosclerosis and end-organ damage. Key mechanisms include increased sympathetic nervous system activity, abnormal sodium handling by the kidneys, and overactivation of the renin-angiotensin-aldosterone system (RAAS).
Clinical Manifestations
Asymptomatic: Often referred to as the “silent killer,” hypertension usually presents with no noticeable symptoms. Most individuals remain unaware of their elevated blood pressure until it leads to serious complications like a heart attack or stroke.
- In severe cases:
- Headache: Typically described as a dull ache, occurring primarily in the morning, and common only in very high blood pressure.
- Visual Disturbances: Blurred vision or retinal hemorrhages may develop, usually in the context of significantly elevated blood pressure or advanced hypertensive retinopathy.
- Shortness of Breath: Generally appears when hypertension has progressed to heart failure or is accompanied by pulmonary edema.
- Nosebleeds: An uncommon symptom but may occur during a hypertensive crisis.
Diagnostic Approach
- Blood Pressure Measurement: Confirmed with repeated readings over time. Ambulatory blood pressure monitoring may be used for more accurate assessment.
- Blood Tests: Check for kidney function (creatinine), electrolytes, and lipid profile.
- Urinalysis: To detect kidney damage or proteinuria.
- Electrocardiogram (ECG): May show left ventricular hypertrophy or signs of heart strain.
- Echocardiogram: Assesses for cardiac damage due to chronic hypertension.
Treatment
- Lifestyle Modifications:
- Diet: Low-sodium, heart-healthy diet (DASH diet).
- Exercise: At least 150 minutes of moderate aerobic activity per week.
- Weight Loss: Reduces blood pressure significantly.
- Limit Alcohol Intake: No more than one drink per day for women and two for men.
- Medications:
- Diuretics: Thiazide diuretics to decrease fluid volume.
- ACE Inhibitors: Reduce RAAS activity and lower blood pressure.
- Calcium Channel Blockers: Relax blood vessel walls.
- Beta-Blockers: Reduce heart rate and cardiac output.
- ARBs (Angiotensin Receptor Blockers): Alternative to ACE inhibitors.
- Regular Monitoring: Routine follow-up visits to assess blood pressure control and monitor for complications.
Complications
- Heart Disease: Left ventricular hypertrophy, heart failure, myocardial infarction.
- Stroke: Hemorrhagic or ischemic due to damaged cerebral arteries.
- Chronic Kidney Disease: From damage to renal blood vessels.
- Aneurysms: Weakened arterial walls can lead to aortic aneurysms.
- Vision Loss: Due to hypertensive retinopathy.
Prognosis for Hypertension
Controlled Hypertension
- With Effective Management: Adhering to lifestyle changes and antihypertensive therapy significantly reduces the risk of cardiovascular complications. Long-term control lowers the chances of heart disease, stroke, and kidney damage, with a generally favorable prognosis if blood pressure remains within the target range.
Uncontrolled Hypertension
- Without Proper Treatment: Carries a high risk of life-threatening complications like myocardial infarction, heart failure, stroke, and chronic kidney disease. The prognosis is poor, with a significant likelihood of organ damage and reduced life expectancy, especially in patients with additional risk factors, increasing the 10-year cardiovascular event risk.
Peripheral Artery Disease (PAD)
Peripheral Artery Disease (PAD) is a common circulatory problem where narrowed arteries reduce blood flow to the limbs, typically the legs. It is a manifestation of systemic atherosclerosis and a significant marker for cardiovascular morbidity and mortality.
Etiology and Risk Factors
- Atherosclerosis: The primary cause, characterized by plaque buildup in the peripheral arteries.
- Smoking: A major risk factor that accelerates atherosclerosis.
- Diabetes Mellitus: Increases the risk of PAD and worsens outcomes.
- Hypertension: Contributes to arterial damage and atherosclerosis.
- High Cholesterol: Elevated LDL cholesterol accelerates plaque formation.
- Age: Higher prevalence in people over 50 years old.
- Family History: Genetic predisposition to atherosclerosis.
Pathophysiology
PAD occurs when atherosclerotic plaques build up in the peripheral arteries, leading to reduced blood flow and oxygen delivery to the muscles during activity. The progression of atherosclerosis causes luminal narrowing, endothelial dysfunction, and, in severe cases, complete artery occlusion. This results in tissue ischemia and potential limb-threatening complications.
Clinical Manifestations
- Intermittent Claudication: Cramping pain in the legs or hips during walking, relieved by rest.
- Rest Pain: Severe pain in the feet or toes, especially at night, indicating critical limb ischemia.
- Decreased Peripheral Pulses: Weak or absent pulses in the feet.
- Cold or Numb Limbs: Due to poor blood circulation.
- Non-Healing Wounds or Ulcers: Common on the feet or toes, can progress to gangrene.
- Skin Changes: Hair loss, shiny skin, thickened toenails.
Diagnostic Approach
- Ankle-Brachial Index (ABI): Compares blood pressure in the ankle and arm. An ABI <0.9 indicates PAD.
- Doppler Ultrasound: Measures blood flow and identifies blockages.
- Angiography: CT or MR angiography to visualize arterial narrowing.
- Exercise Testing: Assesses the severity of claudication and exercise tolerance.
Treatment
- Lifestyle Modifications:
- Smoking Cessation: Most critical lifestyle change.
- Diet: Low-fat, low-cholesterol diet to manage atherosclerosis.
- Exercise Therapy: Supervised walking programs to improve symptoms.
- Medications:
- Antiplatelet Agents: Aspirin or clopidogrel to prevent blood clots.
- Statins: To lower cholesterol and stabilize plaques.
- Cilostazol: Improves blood flow and reduces claudication symptoms.
- Revascularization Procedures:
- Angioplasty and Stenting: To open narrowed arteries.
- Bypass Surgery: For severe cases where blood flow needs to be rerouted.
Complications
- Critical Limb Ischemia: Severe reduction in blood flow, leading to non-healing ulcers, gangrene, and potential limb loss.
- Increased Cardiovascular Risk: PAD patients are at higher risk for heart attack and stroke.
- Infection: Due to poor healing of wounds and ulcers.
Prognosis for Peripheral Artery Disease (PAD)
Intermittent Claudication (Mild to Moderate PAD)
- Management and Survival: Patients who quit smoking, manage diabetes, and adhere to antiplatelet therapy can see symptom stabilization or improvement. The 5-year survival rate is approximately 80-85%, with a favorable prognosis if managed properly. However, PAD remains a marker for widespread atherosclerosis, so cardiovascular risk persists.
Critical Limb Ischemia (Severe PAD)
- Complication Risks and Mortality: Without revascularization, there is a high risk of limb loss, and the 1-year mortality rate is around 20-25%. The prognosis is guarded, particularly in patients with multiple comorbidities, although surgical or endovascular intervention can improve outcomes.
Aortic Aneurysms
Aortic aneurysms are abnormal dilations of the aorta, the largest artery in the body. They are classified based on their location: abdominal aortic aneurysms (AAA) and thoracic aortic aneurysms (TAA). If left untreated, aneurysms may continue to expand and eventually rupture, leading to life-threatening internal bleeding.
Etiology and Risk Factors
- Hypertension: High blood pressure contributes to the weakening of the aortic wall.
- Atherosclerosis: The buildup of plaque damages the arterial wall and promotes aneurysm formation.
- Genetic Factors: Conditions like Marfan syndrome, Ehlers-Danlos syndrome, and familial history increase risk.
- Smoking: A major risk factor, particularly for abdominal aortic aneurysms.
- Age and Gender: More common in men over the age of 60.
- Trauma: Severe chest or abdominal trauma can also cause aneurysms.
Pathophysiology
Aortic aneurysms develop when structural integrity is lost in the aortic wall, often due to a combination of inflammation, oxidative stress, and degeneration of the arterial wall’s connective tissue. This causes the aorta to weaken and expand. As the aneurysm enlarges, wall tension increases, raising the risk of rupture.
Clinical Manifestations
- Asymptomatic: Aneurysms are often discovered incidentally during imaging for unrelated conditions.
- Abdominal Aortic Aneurysm (AAA):
- Abdominal Pain: A persistent or intermittent pain in the abdomen, back, or flank.
- Pulsatile Abdominal Mass: A palpable, pulsating mass may be felt in the abdomen in thin patients.
- Rupture Symptoms: Sudden, severe abdominal or back pain, hypotension, and signs of shock.
- Thoracic Aortic Aneurysm (TAA):
- Chest Pain: Often described as a deep, throbbing ache in the chest or back.
- Shortness of Breath and Cough: Due to compression of surrounding structures.
- Hoarseness: From pressure on the recurrent laryngeal nerve.
Diagnostic Approach
- Ultrasound: First-line imaging for screening and monitoring abdominal aortic aneurysms.
- CT Angiography: Provides detailed images of the aneurysm’s size, shape, and location; crucial for surgical planning.
- MRI: Useful for assessing thoracic aneurysms and for patients who cannot tolerate contrast dye.
- Chest X-ray: May show widening of the mediastinum in thoracic aneurysms.
Treatment
- Monitoring: Small aneurysms (<5.5 cm) are regularly monitored with imaging.
- Medications:
- Blood Pressure Control: Antihypertensives to reduce stress on the aortic wall.
- Statins: To manage cholesterol and slow the progression of atherosclerosis.
- Surgical Repair:
- Open Repair: Replacement of the affected aortic segment with a graft.
- Endovascular Aneurysm Repair (EVAR): A minimally invasive procedure using a stent graft to reinforce the aorta.
Complications
- Rupture: Life-threatening emergency with a high mortality rate.
- Dissection: A tear in the aortic wall leading to separation of its layers.
- Thromboembolism: Clots from the aneurysm may embolize to other parts of the body.
- Compression: Aneurysms may compress surrounding structures, causing symptoms like hoarseness or dysphagia.
Prognosis for Aortic Aneurysms
Small Aneurysms (<5.5 cm)
- Monitoring and Medical Management: Regular surveillance and blood pressure control can prevent rupture. The risk of rupture is low, and patients may have a normal life expectancy with vigilant monitoring.
- Prognosis: Good, as long as the aneurysm size remains stable.
Large Aneurysms (≥5.5 cm) or Symptomatic Aneurysms
- High Risk of Rupture: The 5-year survival rate without surgical intervention is poor, with a high risk of life-threatening rupture.
- Post-Surgical Repair: Elective surgical repair has a 1-5% perioperative mortality rate but significantly improves long-term survival. The 5-year survival rate after successful repair is around 60-75%.
Carotid Artery Stenosis
Carotid artery stenosis refers to the narrowing of the carotid arteries, usually caused by atherosclerosis. These arteries supply oxygen-rich blood to the brain, and significant narrowing increases the risk of stroke or transient ischemic attacks (TIAs).
Etiology and Risk Factors
- Atherosclerosis: The main cause, where plaque buildup narrows the arteries.
- Hypertension: Damages the arterial walls and accelerates plaque formation.
- Smoking: Increases the rate of atherosclerosis and risk of carotid artery stenosis.
- High Cholesterol: Elevated LDL cholesterol promotes plaque accumulation.
- Diabetes: Increases the risk of vascular disease.
- Age and Gender: More common in older adults and men.
Pathophysiology
Plaque buildup in the carotid arteries leads to progressive narrowing and reduced blood flow to the brain. Plaque can also rupture, causing clot formation, which may block the artery or embolize to cerebral vessels, resulting in stroke or TIAs.
Clinical Manifestations
- Asymptomatic: Many patients are asymptomatic until the stenosis becomes severe or a complication occurs.
- Transient Ischemic Attacks (TIAs): Temporary neurological symptoms, such as:
- Sudden Weakness or Numbness: Usually affecting one side of the body.
- Vision Disturbances: Like temporary blindness in one eye (amaurosis fugax).
- Difficulty Speaking: Slurred speech or trouble finding words.
- Stroke: Sudden onset of severe neurological deficits if the blood supply to part of the brain is cut off.
Diagnostic Approach
- Carotid Ultrasound: A non-invasive test to visualize blood flow and detect the degree of narrowing.
- CT Angiography: Detailed imaging of the carotid arteries, often used before surgical planning.
- Magnetic Resonance Angiography (MRA): Useful for visualizing the carotid arteries without ionizing radiation.
- Cerebral Angiography: An invasive test that provides detailed images of the carotid arteries, used in complex cases.
Treatment
- Lifestyle Modifications: Smoking cessation, dietary changes, regular exercise, and weight management.
- Medications:
- Antiplatelet Therapy: Aspirin or clopidogrel to reduce the risk of clot formation.
- Statins: To lower cholesterol levels and stabilize plaque.
- Blood Pressure Management: Antihypertensive medications to control blood pressure.
- Surgical Interventions:
- Carotid Endarterectomy (CEA): Surgical removal of the plaque from the artery, recommended for significant stenosis (≥70%).
- Carotid Artery Stenting (CAS): A less invasive option involving the placement of a stent to keep the artery open.
Complications
- Stroke: The most severe complication, either due to plaque embolization or complete artery blockage.
- TIA: Warning signs of an impending stroke, requiring prompt intervention.
- Restenosis: Re-narrowing of the artery after treatment.
- Cranial Nerve Injury: A rare complication of carotid endarterectomy affecting nerves near the carotid artery.
Prognosis for Carotid Artery Stenosis
Asymptomatic Stenosis (<70% Narrowing)
- Stroke Risk and Management: The annual risk of stroke is low (less than 1-2%), and aggressive risk factor management can further reduce this risk. Prognosis is generally favorable, especially with antiplatelet therapy and lifestyle changes.
Symptomatic or Severe Stenosis (≥70% Narrowing)
- Elevated Stroke Risk: The risk of stroke or TIA is significantly increased. Carotid endarterectomy or stenting can reduce this risk by 50-70%. Prognosis improves with surgical intervention, and the 5-year stroke risk decreases considerably, though ongoing management of atherosclerosis remains essential.