>10 mm Hg between the arms. 1. Peripheral pulses may not be felt. 2. Arterial bruits over any large artery and bruit of aortic regurgitation. 3. High BP in 50% Diagnosis: For diagnosis the patient should fulfill 3 or more of the criteria listed: 1. Onset of disease ≤ 40 years 2. Claudication of an extremity - caused by narrowed blood vessels 3. Reduced brachial artery pulsation 4. Difference in systolic blood pressure >10 mmHg between the arms 5. Aortic or sub-clavian artery bruit 6. Angiographic abnormality The medical examination most often detects reduced or absent pulses in the arms and less often in the legs. Using a stethoscope, bruits may be heard, over the neck, chest or kidneys indicating narrowed arteries The raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) indicate inflammation. Angiography is the main diagnostic test. It appraises the arterial lumen only The obligatory criterion is angiography (conventional, CT or MRI) of the aorta or its main branches and pulmonary arteries indicating aneurysm or dilatation, narrowing, occlusion or thickened arterial wall Treatment: The treatment is directed at improving symptoms and avoiding scarring to the blood vessels. When there is active arterial inflammation, the treatment is first treated with high doses of steroids. Immunosuppressive drugs (azathioprine, mycophenolate, methotrexate or leflunomide) are often added. For refractory disease, biological therapies, such as tumor necrosis factor inhibitors (etanercept and infliximab) have been used effectively Medicines to lower blood pressure are often advised. Statins are often given to reduce cholesterol Surgery: 1. Revascularisation to bypass a blocked artery 2. Percutaneous transluminal angioplasty to open a narrow artery Aortic valve replacement may be done. TABLE OF CONTENT Introduction Chapter 1 Pulseless Dis...
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