What Is Macrovascular Disease?

Macrovascular disease is a very dangerous disease with rapid onset, rapid progress, and high mortality. The large blood vessels mentioned here mainly refer to the aorta of the human body-the main artery. From the appearance, the diameter of these blood vessels is large, and the diameter of the blood vessels is thick. From a functional point of view, the functions of these blood vessels are also great, and the blood supply of all human tissues and organs comes from it.

Macrovascular disease

Macrovascular disease is a very dangerous disease with rapid onset, rapid progress, and high mortality. The large blood vessels mentioned here mainly refer to the aorta of the human body-the main artery. From the appearance, the diameter of these blood vessels is large, and the diameter of the blood vessels is thick. From a functional point of view, the functions of these blood vessels are also great, and the blood supply of all human tissues and organs comes from it.

Chinese name

Macrovascular disease

Category

level

Aorta

Large blood vessels

Country

China

Macrovascular diseases fall into two broad categories: stenotic and dilated. The causes of stenosis can be congenital (aortic constriction) or acquired (syphilis, tuberculosis, arteritis, trauma, rheumatic fever, atherosclerosis, etc.). Dilated macrovascular disease is what we usually call aneurysms. The causes include Marfan syndrome (congenital), syphilis or bacterial infections, atherosclerosis, hypertension, trauma and so on.

Macrovascular diseases fall into two broad categories: stenotic and dilated.

The clinical manifestations of stenotic macrovascular disease depend on the blood supply organs corresponding to the stenosis. Aortic constriction is mainly manifested by hypertension and congestive heart failure. If the blood supply to the brain is involved, it can manifest as dizziness, headache, tinnitus, visual impairment, speech impairment, and even confusion and paralysis; if it affects the blood supply to the limb, it can manifest as pain and intermittent claudication.

Dilated macrovascular disease is what we usually call aneurysms. According to pathological changes, aneurysms are divided into true aneurysms, pseudoaneurysms, and aortic dissections. True aneurysms and pseudoaneurysms are mainly symptoms of compression of adjacent organs, such as hoarseness, difficulty swallowing, wheezing, etc., and sometimes they can feel abnormal blood vessels pulsating or touching the mass. Aortic dissection is typically a sudden onset of severe chest and back pain, often described as a "tear-like" pain with pale, sweating, syncope, and even stroke.

Large vessel aneurysms, also known as "time bombs" of the human body, pose a great threat to human life and health, and are extremely dangerous. Often, patients can't be treated because of tumor rupture and bleeding. 48-hour mortality after formation of a dissection aneurysm is 36-72%, and only 8% of patients who have not been treated can survive for more than one month.

Cardiac examination: Aortic sinus aneurysm broken into the right ventricle, tremors in the 3rd and 4th intercostal space of the left margin of the sternum to tremor and a rough grade IV continuous murmur, which is transmitted to the apex of the heart; Deviation towards the middle or right edge of the sternum. There may be signs of peripheral blood vessels such as widening of pulse pressure, water flushing, gunshots, etc., and signs of right heart failure such as hepatomegaly.

ECG: left axis deviation, left ventricular hypertension, hypertrophy, or left and right ventricular hypertrophy. X-ray examination: enlarged heart shadow, prominent pulmonary artery segment, hilar congestion, and deepening of lung veins.

Echocardiography: The diseased aortic sinus showed a localized bulge, the waveform was interrupted, and it was removed from the right ventricular outflow tract or the lower edge of the right atrium during diastole. Two-dimensional can show aortic sinus deformity rupture. Doppler confirmed shunting.

Diagnosis is based on medical history, nature of heart murmur, and conduction direction. Combining ECG, X-rays, and echocardiography can make a diagnosis. Differential diagnosis is required: open ductus arteriosus, high ventricular septal defect with aortic valve insufficiency, coronary fistula, and left coronary artery originating from the pulmonary artery. A careful analysis of the signs combined with echocardiography is not difficult to distinguish. Retrograde ascending aorta angiography is characterized by right coronary anomaly with or without coronary sinus enlargement, early visualization of right ventricular outflow tract and pulmonary artery or right atrium, which can be identified.

There are multiple classification methods for macrovascular disease, and different classifications contain multiple concentrations. Therefore, the complications of macrovascular disease cannot be generalized, and they vary from disease to disease.

At present, there are two main types of repair and treatment of macrovascular diseases: surgery and endovascular stent: Generally speaking, whether it is an aortic dissection or an aneurysm, and the lesion is in the descending aorta, endovascular stent surgery can be considered; Surgery may be considered in the ascending aorta and arch and in patients who are not suitable for endovascular stents. Intravascular repair is to use a metal stent to block the dissection breach or strengthen the arterial wall. The surgical trauma is small and the risk is small. Surgery is the replacement of diseased blood vessels with artificial blood vessels, which is traumatic and risky, but the treatment is more thorough.

(1) Antihypertensive treatment. It is the key to the acute phase and a very effective treatment, which can often greatly improve the survival rate of patients. Commonly used are sodium nitroprusside.

(2) Absolute bed rest, analgesia, and sedation are important auxiliary measures for antihypertensive treatment. Morphine drugs can be given when the pain is severe.

(3) Closely observe the changes of the condition and deal with complications at any time. Closely observe the patient's heart rate, blood pressure, breathing and its changes, understand the effect of drug treatment, pay close attention to the patient's consciousness and nervous system, pay attention to limb blood pressure, pulse is symmetrical, pay attention to changes in electrocardiogram, urine volume, should be carried out in time when the condition is relatively stable Echocardiography, MRI or aortic angiography DSA examination to make a clear diagnosis in time.