Microangiopathy is a disease in the small blood vessels of the body, in contrast with another form of angiopathy, macroangiopathy, which involves the large blood vessels. There are a number of types of this condition and a range of reasons for people to develop it. It can be a serious cause of concern, as damage to the blood vessels can lead to consequences ranging from stroke to loss of a limb.
One of the most infamous forms can be found in patients with poorly controlled diabetes. In these patients, the walls of the blood vessels become damaged and start to leak proteins, and the flow of blood is impeded. Slowing the flow of blood can result in reduced oxygenation to the tissue supplied by the involved blood vessels. This, in turn, can result in necrosis. For example, the tissues in the foot may die and become damaged, potentially leading to amputation because once the tissue dies, it cannot be revived.
Microangiopathy can also occur in the central nervous system, leading to strokes. The brain especially is vulnerable to interruptions in its oxygen supply, and if the blood flow to the brain is disrupted or slowed, brain cells can die. Depending on the area of the brain involved, the patient can develop an array of symptoms. Some common hallmarks of a stroke include slurred speech, difficulty walking, confusion, and blurred vision.
In a condition known as microangiopathic hemolytic anemia (MAHA), the blood vessels become damaged, and this leads to destruction of red blood cells, creating anemia for the patient. A number of conditions can lead to the onset of MAHA if they are not identified in time or managed appropriately.
Certain patients are at higher risk for developing microangiopathy, and they are monitored closely for early signs of onset so that they can receive treatment in a timely fashion. Diabetics, for example, are routinely examined by their care providers so that early signs of complications can be quickly identified. Healthcare professionals can use a number of diagnostic techniques to observe the signs of microangiopathic processes in the body, such as using angiography to visualize the blood vessels in an area of interest to look for signs of problems such as slow movement of blood or leaking. The most appropriate treatment varies, depending on why the patient has developed the condition and how far the problem has progressed.
What Causes Microangiopathy?
One of the leading causes of microangiopathy is diabetes. The high blood sugar levels associated with individuals that have diabetes cause the cells that line the interior service of blood vessels to absorb more glucose than normal.
When this happens, the vessel walls grow weaker and thicker, causing the vessels to slow the blood flow throughout the body, bleed, and leak protein. Some parts of the body do not get enough oxygen and other nutrients when this happens, causing damage to organs, nerves, and neurons.
Microangiopathy affects different organs. Some organs have specific risk factors for developing this condition. For example, damage or diseased heart arteries cause microangiopathy of the heart. Usually, heart arteries become damaged because of high blood pressure, lack of exercise, high cholesterol levels, obesity, and smoking.
Many factors increase the risk of developing microangiopathy. Like heart microangiopathy, the leading causes for this condition in other organs include lack of exercise, high blood pressure, high cholesterol levels, obesity, and smoking. Insulin resistance, unhealthy diets, and polycystic ovary systems also create potential risks.
Unfortunately, some risk factors are unavoidable. For example, women are more likely than men to develop microangiopathy in their lifetime. Those who have a family history of the condition are also more likely to struggle with the condition. Age plays a factor in developing certain types of microangiopathy as well.
What Causes Chronic Microangiopathy?
Medical conditions that last for a year or more, impact daily living and require consistent medical treatment are considered chronic illnesses. As such, microangiopathy is usually considered a chronic condition. Most medical treatments for this disease involve controlling symptoms or addressing underlying medical conditions rather than microangiopathy itself.
For example, patients with chronic heart microangiopathy may be prescribed nitroglycerin tablets, sprays, or patches. These tables ease chest pain and improve blood flow. Other medications such as beta-blockers slow the heart rate and decrease blood pressure. Ranolazine alters calcium and sodium levels, thus relieving chest pain. Doctors prescribe medications such as metformin to those who suffer from microangiopathy and diabetes. Metformin lowers blood sugar in people with diabetes and improves blood vessel health.
Common medications like aspirin relieve microangiopathy by reducing inflammation and preventing blood clots. Additionally, calcium channel blockers relax the muscles and open blood vessels, increasing blood flow. Calcium channel blockers also help control the small blood vessel spasms associated with high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) also help open blood vessels and lower blood pressure.
Medical professionals even prescribe statins to treat microangiopathy. Statins control cholesterol, as cholesterol levels contribute to the narrowing of small blood vessels. Statins relax blood vessels and help treat blood vessel damage.
Diagnosis requires ongoing treatment on behalf of the patient and lifestyle changes. Doctors advise patients to quit smoking, introduce healthier diets into their lives, and increase activity levels. Sometimes, chronic microangiopathy results from other chronic conditions such as diabetes.
Overall, microangiopathy is a disease of small blood vessels. Some damage to small blood vessels cannot be reversed and require ongoing treatments. There are no causal treatments for some forms of this disease such as cerebral microangiopathy. However, if caught early enough, cerebral microangiopathy may resolve. Usually, it progressively gets worse over time.
What is Cerebral Microangiopathy?
Cerebral refers to the cerebrum, the largest portion of the brain located in the front of the skull. Simply put, cerebral microangiopathy refers to microangiopathy of the brain.
More specifically, cerebral microangiopathy consists of a broad array of issues associated with abnormalities of small blood vessels in the brain. Like other organs affected by the condition, small blood vessels are damaged and cause medical issues in the brain. Due to the complicated nature and prevalence of cerebral microangiopathy, it is hard to attribute factors to the disease.
Generally, it is believed that plaque develops in the small blood vessels in the brain, leading to blockage of blood flow. The blockage causes the brain to become oxygen-starved, leak, or hemorrhage.
Cerebral microangiopathy causes strokes, depression, cognitive impairment, and dementia. Additionally, it can create problems with mobility, such as walking and balance. Sometimes, older adults that have this disease have no symptoms. Usually, in these cases, the condition is mild.
Cerebral microangiopathy is a broad condition that involves all damage to small arteries in the brain, making it hard to pinpoint one direct cause. Usually, microangiopathy of the brain evolves with age. Like other organs affected by microangiopathy, high cholesterol, hypertension, and smoking are common risk factors for the disease.
Types of microangiopathy
Since microangiopathy, also called small vessel disease (SVD), microvascular disease, or microvascular dysfunction, affects the small blood vessels of the body it can occur anywhere in the body those vessels exist, which is basically everywhere. Some of the most common types include:
- cerebral SVD/ cerebral microangiopathy (possibly related to white matter disease)
- coronary SVD/ microvascular angina/ microvascular dysfunction
- diabetic microangiopathy (often renal microangiopathy specifically)
- skeletal microvascular disease
- thrombotic microangiopathy
- microangiopathic hemolytic anemia
Each different type has different indications and all of them can pose serious health risks and should be swiftly addressed by a medical professional.
Symptoms of microangiopathy
The specific symptoms exhibited vary based on the specific type of microangiopathy involved. It is also possible for an individual to have multiple types of microangiopathy and thus exhibit symptoms of multiple versions. Additionally, many of the symptoms of microangiopathy are symptoms of other conditions and diseases as well. Some of the most common symptoms of prevalent types of microangiopathy include:
- gait apraxia (difficulty walking or sudden loss of the ability to start walking)
- urinary incontinence
- transient ischemic attacks (TIAs)
- memory issues (dementia)
- chest pain
- shortness of breath
- frequent bruising/bleeding issues
The above list is not an exhaustive list of signs and symptoms of microangiopathy by any means. Having any of the above symptoms is not a definitive indication of this condition either. To truly determine if microangiopathy is the problem, a doctor must conduct a thorough series of tests and scans. It is always best to consult a medical professional as soon as possible, if anything seems wrong, new, or unusual when it comes to the human body.
One specific type of microangiopathy is thrombotic microangiopathy or TMA. The term thrombotic indicates that a thrombus or a blood clot is present. Blood clots can appear in both the veins and the arteries of the body and can develop into serious complications. Essentially, TMA occurs anytime the small or damaged microvessels in the body develop a blood clot that severely diminishes or completely cuts off blood flow through that vessel. TMA can also occur anywhere in the body, but it is especially prevalent in the kidneys and the brain.
TMA in the kidneys occurs when the small blood vessels known as capillaries develop a clot. This clot, or sometimes multiple clots, significantly reduces or completely discontinues the necessary blood flow through the kidney. Kidneys filter through the blood and remove the waste and excess fluid from it before sending it back through the body. Clots can cause parts of the kidney to die off, thereby reducing the presence of clean, healthy red blood cells in the rest of the body.
TMA in the brain causes a similar issue, in that the clot causes restricted blood flow to the brain. This event is more commonly referred to as a stroke. Strokes often have serious consequences and can even be fatal. One must watch for and treat microangiopathy early on before it develops into TMA and becomes more serious.