VASCULAR SYSTEM, DISEASES OF. Arteries, Disorders of.
Arteriosclerosis (Arteriofibrosis; Ath eroma).
Definition. — Arteriosclerosis is char acterized by thickening of the walls of the arteries, due to morbid changes in the intima and giving rise to localized or general narrowing of their lumen.
Three varieties of arteriosclerosis may be recognized: the nodular, in which the morbid changes are localized, though widely disseminated; the senile form, which may be localized or general, and is a manifestation of physical degenera tion attending old age; and the general form, which may occur during middle age or even youth, through inherited predilection or as a result of various etiological factors.
Symptoms.—These depend to a great degree upon the regions which have be come the seat of the morbid changes. As a rule, a high-tension pulse is indic ative of arteriosclerosis: but this is not invariably the case, as high tension may exist with little or no sclerotic change. The vessel-wall is hard, and it is often difficult to obliterate the pulse even upon pressure. Sphygmographic trac ings show a short, sloping upstroke, a wide top, and a slow, gradual down stroke. The left ventricle becomes hypertrophied as a result of peripheral resistance. In advanced cases the apex beat is displaced and the second sound is accentuated and ringing in character. Subjective symptoms may be absent for a variable period until the heart, kid neys, lungs, or brain call attention to the disease. Following the cardiac hypertrophy may be cardiac dilatation, with symptoms of valvular insufficiency. Dyspncea, palpitation, and initial mur mur are prominent. Angina pectoris may also be noted as a complication.
When the arteries of the kidney are especially affected, this organ atrophies from want of sufficient blood-supply, and the symptoms are the same as those of the atrophic form of nephritis. The amount of albumin may be small and casts few.
The cerebral symptoms may consist of persistent headache, vertigo, luemor rhage, aphasia, transient hemiplegia, and other palsies. The arcus senilis is com
monly observed in cases of arteriosclero sis.
Embolus is infrequent, and is usually secondary to the cardiac complications. Spasm of the arteries, including the coro nary, is thought to occur often and to account for the attacks of angina pee toris occasionally observed. The heart's rhythm and regularity are usually im paired in such cases, and the pulse may differ on the two sides. Rupture of the cardiac wall into the pericardium and death may occur during one of these seizures.
Diagnosis. — E. N. Whittier (Boston Med. and Surg. Jour., Dec. 1, '96) alludes to two periods in this disorder which are pregnant with errors in diagnosis. In the first, there is poverty of symptoms by which localization may be accurately mapped out; in the second, such pro fusion of rational and physical signs, such evidences of structural changes,— cardiac, renal, and cerebral,—that the underlying and causal relation of the con dition of the vascular channels may be altogether lost sight of in the study of the effects of the arteriosclerosis. Sphyg mographic tracings, as aids in the diag nosis of disorders of the circulatory appa ratus, are important. Whittier found in all tracings of radial sclerosis evidence of cardiac involvement in the sharp rise, in the lessening of the primary wave, in the lifting of the tidal wave, in the lowering of the aortic notch, and in a flattening of the curves and shortening of the diastolic portion of the tracing.
Careful attention to the history of the patient with particular reference to the etiological influence of the chronic in toxications arising from alcohol, syphilis, lead, rheumatism, malaria, etc., will give the largest opportunity for correct treat ment during the primary stages, and far in advance of the time when the disease is confessedly unmanagvalde by reason of tire secondary complications—cardiac, vasorennl, or cerebral.