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Mansa Musa was the ruler of the Mali Empire in West Africa. Details recorded here should be sourced; unknown information is left blank.
MORE →Reflects the personal views, recollections, and perspective of the author, Mike Davis.
This is a personal recollection on the Move fire on May 13, 1985
| Intermittent claudication | |
|---|---|
| Other names | Vascular claudication, claudicatio intermittens |
| Specialty | Cardiology, vascular surgery  |
Intermittent claudication, also known as vascular claudication, is a symptom that describes muscle pain on mild exertion (ache, cramp, numbness or sense of fatigue),[1] classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest. It is classically associated with early-stage peripheral artery disease, and can progress to critical limb ischemia unless treated or risk factors are modified and maintained.
Claudication derives from Latin claudicare 'to limp'.
One of the hallmarks of arterial claudication is that it occurs intermittently. It disappears after a very brief rest and the patient can start walking again until the pain recurs. The following signs are general signs of atherosclerosis of the lower extremity arteries:[2]
The six "P"s of ischemia[3]
Most commonly, intermittent (or vascular or arterial) claudication is due to peripheral arterial disease which implies significant atherosclerotic blockages resulting in arterial insufficiency. Other uncommon causes are coarctation of the aorta,[4] Trousseau disease[medical citation needed] and Buerger's disease (thromboangiitis obliterans),[5] in which vasculitis occurs.
Raynaud's phenomenon functional vasospasm.[clarification needed] It is distinct from neurogenic claudication, which is associated with lumbar spinal stenosis. It is strongly associated with smoking, hypertension, and diabetes.[6]
Intermittent claudication is a symptom and is by definition diagnosed by a patient reporting a history of leg pain with walking relieved by rest. However, as other conditions such as sciatica can mimic intermittent claudication, testing is often performed to confirm the diagnosis of peripheral artery disease. [citation needed]
Magnetic resonance angiography and duplex ultrasonography appear to be slightly more cost-effective in diagnosing peripheral artery disease among people with intermittent claudication than projectional angiography.[7]
Exercise can improve symptoms, as can revascularization. Both together may be better than one intervention of its own.[8]
Supervised exercise improves maximum walking distance and pain-free walking distance more than home based exercise. Although when monitoring is included in home based exercise programmes similar changes in pain-free walking distance are observed in both supervised and home based exercise.[9]
In people with stable leg pain, exercise, such as strength training, pole-striding and upper or lower limb exercises, compared to usual care or placebo improves maximum walking time, pain-free walking distance and maximum walking distance.[10] Alternative exercise modes, such as cycling, strength training and upper-arm ergometry compared to supervised walking programmes showed no difference in maximum walking distance or pain-free walking distance for people with intermittent claudication.[11]
Pharmacological options exist, as well. Medicines that control lipid profile, diabetes, and hypertension may increase blood flow to the affected muscles and allow for increased activity levels. Angiotensin converting enzyme inhibitors, adrenergic agents such as alpha-1 blockers and beta-blockers and alpha-2 agonists, antiplatelet agents (aspirin and clopidogrel), naftidrofuryl, pentoxifylline, and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication.[12] However, medications will not remove the blockages from the body. Instead, they simply improve blood flow to the affected area.[13]
Catheter-based intervention is also an option. Atherectomy, stenting, and angioplasty to remove or push aside the arterial blockages are the most common procedures for catheter-based intervention. These procedures can be performed by interventional radiologists, interventional cardiologists, vascular surgeons, and thoracic surgeons, among others.[citation needed]
Surgery is the last resort; vascular surgeons can perform either endarterectomies on arterial blockages or perform an arterial bypass. However, open surgery poses a host of risks not present with catheter-based interventions.[citation needed]
Atherosclerosis affects up to 10% of the Western population older than 65 years and for intermittent claudication this number is around 5%. Intermittent claudication most commonly manifests in men older than 50 years.[citation needed]
One in five of the middle-aged (65–75 years) population of the United Kingdom have evidence of peripheral arterial disease on clinical examination, although only a quarter of them have symptoms. The most common symptom is muscle pain in the lower limbs on exercise—intermittent claudication.[14]
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Source: Wikipedia. Article content is retrieved live through the MediaWiki API.
Intermittent claudication, also known as vascular claudication, is a symptom that describes muscle pain on mild exertion (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest. It is classically associated with early-stage peripheral artery disease, and can progress to critical limb ischemia unless treated or risk factors are modified and maintained. Claudication derives from Latin claudicare 'to limp'.
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in controlling hemorrhage and reducing acute blood loss. When blood vessels constrict, the flow of blood is restricted or decreased, thus retaining body heat or increasing vascular resistance. This makes the skin turn paler because less blood reaches the surface, reducing the radiation of heat. On a larger level, vasoconstriction is one mechanism by which the body regulates and maintains mean arterial pressure. Medications causing vasoconstriction, also known as vasoconstrictors, are one type of medicine used to raise blood pressure. Generalized vasoconstriction usually results in an increase in systemic blood pressure, but it may also occur in specific tissues, causing a localized reduction in blood flow. The extent of vasoconstriction may be slight or severe depending on the substance or circumstance. Many vasoconstrictors also cause pupil dilation. Medications that cause vasoconstriction include: antihistamines, decongestants, and stimulants. Severe vasoconstriction may result in symptoms of intermittent claudication.
Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain. PAD may happen in any blood vessel, but it is more common in the legs than the arms. When narrowing occurs in the heart, it is called coronary artery disease (CAD), and in the brain, it is called cerebrovascular disease. Peripheral artery disease in humans most commonly affects the legs, but other arteries also may be involved, such as those of the arms, neck, or kidneys. Peripheral artery disease (PAD) is a form of peripheral vascular disease. Vascular refers to the arteries and veins within the body. PAD differs from peripheral veinous disease. PAD means the arteries are narrowed or blocked—the vessels that carry oxygen-rich blood as it moves from the heart to other parts of the body. Peripheral veinous disease, on the other hand, refers to problems with veins—the vessels that bring the blood back to the heart. The classic symptom is leg pain when walking that resolves with rest and is known as intermittent claudication. Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg. Complications may include an infection or tissue death that may require amputation, coronary artery disease, or stroke. As many as 50% of people with PAD do not have symptoms. The greatest risk factor for PAD is cigarette smoking. Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol. PAD is primarily caused by the buildup of fatty plaque in the arteries that is called atherosclerosis, especially in individuals greater than 40 years of age. Additional risk factors include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis. PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm. Duplex ultrasonography and angiography also may be used to make a diagnosis. Angiography is more accurate and allows for treatment at the same time, however, it is associated with greater risks. It is unclear whether screening for peripheral artery disease in people without symptoms is useful, as it has not been properly studied. For those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy may improve outcomes. Medications, including statins, ACE inhibitors, and cilostazol, may also help. Aspirin, which helps with thinning the blood and thus improving blood flow, does not appear to help those with mild disease, but is usually recommended for those with more significant disease due to the increased risk of heart attacks. Anticoagulants (blood thinners) such as warfarin show no definitive scientific evidence of benefit in PAD. Surgical procedures used to treat PAD include bypass grafting, angioplasty, and atherectomy. In 2015, approximately 155 million people had PAD worldwide. It becomes more common with age. In the developed world, it affects about 5.3% of 45- to 50-year-olds and 18.6% of 85- to 90-year-olds. In the developing world, it affects 4.6% of people between the ages of 45 and 50 and 15% of people between the ages of 85 and 90. PAD in the developed world is equally common among men and women, although in the developing world, women are affected more commonly. In 2015, PAD resulted in about 52,500 deaths, which is an increase from the 16,000 deaths in 1990.
Cilostazol, sold under the brand name Pletal among others, is a medication used to help the symptoms of intermittent claudication in peripheral vascular disease. It may also be used to prevent stroke. It is taken by mouth. Common side effects include headache, diarrhea, dizziness, and cough. Serious side effects may include decreased survival in those with heart failure, low platelets, and low white blood cells. Cilostazol is a phosphodiesterase 3 inhibitor which works by inhibiting platelet aggregation and dilating arteries. Cilostazol was approved for medical use in the United States in 1999. It is available as a generic medication. In 2019, it was the 347th most commonly prescribed medication in the United States, with more than 800 thousand prescriptions.
Before the 1921 destruction of Tulsa’s Greenwood District, Black residents had created a remarkable center of business and community life. The district included stores, professional offices, entertainment venues and homes owned by Black citizens. Understanding Greenwood means learning what was built—not only what was burned.
MORE →Madam C.J. Walker