The endothelium is a thin membrane that lines the inside of the heart and blood vessels. Endothelial cells release substances that control vascular relaxation and contraction as well as enzymes that control blood clotting, immune function and platelet (a colorless substance in the blood) adhesion. Show Endothelial dysfunction has been shown to be of significance in predicting stroke and heart attacks due to the inability of the arteries to dilate fully. The dysfunction may be a result of high blood pressure, diabetes, high cholesterol and smoking. Studies have shown that endothelial dysfunction precedes the development of artherosclerosis, a chronic disease characterized by abnormal thickening and hardening of the arterial walls with resulting loss of elasticity. Artherosclerosis may cause a stroke or heart attack. What Tests Are Used to Determine Endothelial FunctionAcetylcholine endothelial function and adenosine coronary flow reserve tests enhance a physician's ability to diagnose and treat patients with endothelial dysfunction. The two-step test consists of:
If either test shows decreased blood flow to the heart muscle, a diagnosis of endothelial dysfunction and microvascular disease can be made. With evidence of insufficient blood flow to the heart muscle and open coronary arteries, medical treatment can be directed at the specific problem. Physicians also may use non-invasive procedures to determine an artery's health and elasticity:
Treating Endothelial DysfunctionEndothelial dysfunction responds favorably to a healthful diet and exercise. Exercising to maintain a healthy weight decreases a person's risk of developing certain diseases, including type 2 diabetes and high blood pressure. Aerobic Exercise: The heart is a muscle and needs a good workout. Aerobic exercise gets the heart pumping and quickens breathing, resulting in a more efficient delivery of oxygen-carrying blood cells. Strength and flexibility training are of benefit too. Patients should always check with their physician before instituting a new exercise regimen or ratcheting up their existing routine. Pharmacologic interventions may include:
External counter pulsation (ECP) therapy is another treatment option. Lying on a table or bed, pressure cuffs are fitted to the patient's thighs, hips and calves. The cuffs inflate and deflate in sync with the patient's heart rhythm, supplying the heart with extra oxygen-rich blood in the resting phase. The extra blood supply stimulates growth of the surrounding blood vessels, improving the supply of blood to the heart. Have Questions or Need Help?For more information or physician consultations, call us or send a message to the Women's Heart Center team. You can also have us call you back at your convenience. Available 24 hours a day(1-800-233-2771) Monday–Friday, 8 a.m.-5 p.m., Pacific Time (U.S.)OverviewClaudication is pain caused by too little blood flow to muscles during exercise. Most often this pain occurs in the legs after walking at a certain pace and for a certain amount of time — depending on the severity of the condition. The condition is also called intermittent claudication because the pain usually isn't constant. It begins during exercise and ends with rest. As claudication worsens, however, the pain may occur during rest. Claudication is technically a symptom of disease, most often peripheral artery disease, a narrowing of arteries in the limbs that restricts blood flow. Treatments focus on lowering the risks of vascular disease, reducing pain, increasing mobility and preventing damage to tissues. SymptomsClaudication refers to muscle pain due to lack of oxygen that's triggered by activity and relieved by rest. Symptoms include the following:
The pain may become more severe over time. You may even start to have pain at rest. Signs or symptoms of peripheral artery disease, usually in more-advanced stages, include:
When to see a doctorTalk to your health care provider if you have pain in your legs or arms when you exercise. Claudication can lead to a cycle that results in worsening cardiovascular health. Pain may make exercise intolerable, and a lack of exercise results in poorer health. Peripheral artery disease is a sign of poor cardiovascular health and an increased risk of heart attack and stroke. Other conditions involving the blood, nerves and bones can contribute to leg and arm pain during exercise. It's important to have a complete exam and appropriate tests to diagnose potential causes of pain. CausesClaudication is most often a symptom of peripheral artery disease. The peripheral arteries are the large vessels that deliver blood to the legs and arms. Peripheral artery disease is damage to an artery that restricts the flow of blood in an arm or leg (a limb). When you're at rest, the limited blood flow is generally enough. When you're active, however, the muscles aren't getting enough oxygen and nutrients to work well and remain healthy. Damage to peripheral arteries is usually caused by atherosclerosis. Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause the arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot. Risk factorsPotential risk factors for peripheral artery disease and claudication include:
ComplicationsClaudication is generally considered a warning of significant atherosclerosis, indicating an increased risk of heart attack or stroke. Other complications of peripheral artery disease due to atherosclerosis include:
PreventionThe best way to prevent claudication is to maintain a healthy lifestyle and control certain medical conditions. That means:
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