Smoking and Vascular Disease
Just when you thought the list couldn't get any longer, more links between cigarette smoking and disease pop up. It is no secret that smoking is intrinsically linked to heart attacks. It is also a trigger or exacerbating factor in many other vascular diseases besides heart attacks. Exposure to nicotine causes blood vessels to narrow temporarily and then over time, permanently. Smoking also makes the likelihood of developing blood clots very high.
Smoking has been found to aggravate or initiate Raynaud phenomenon, also called Raynaud's syndrome. Raynaud phenomenon occurs when there is an episode of reduction in the blood supply to the fingers and/or toes as the arteries that supply the blood go into spasm, causing the blood flow to be cut off. During an attack of Raynaud phenomenon, the skin changes color from normal to white, then to blue and finally back to red as it warms up again. Since smoking causes blood vessels to narrow and constrict, it is easy to see how it is implicated in this disease.
Secondary Raynaud phenomenon occurs when there is an associated condition or disorder that causes blood vessel spasm or obstruction. Sometimes it is a sign of systemic sclerosis, an autoimmune disorder that results in widespread scarring (fibrosis) and ultimately vascular disease. Raynaud phenomenon is one of the first symptoms that lead to ulceration of the fingers and toes where blood supply is inadequate. Smoking, a major risk factor for vascular disease also increases the risk of developing these ulcers.
Cigarette smoking can also be blamed for Buerger disease (thromboangiitis obliterans) wherein blood clots appear in small blood vessels. It is a cause for many cases of cholesterol emboli which is associated with atherosclerosis (hardening of the arteries). Cholesterol emboli are small deposits of sterol - a combination of steroid and alcohol. It is a fatty, waxy substance found in the membrane that surrounds every cell in the body. When these deposits of cholesterol become lodged inside the blood vessels of the skin or other internal organs they lead to a blockage of the flow of blood through small arteries causing malfunction or death.
Thromboangiitis obliterans occurs almost exclusively in smokers between the ages of 20 to 45, primarily those who roll their own cigarettes. It also has a long term effect on marijuana smokers. The affected areas are most commonly the hands and feet, similar to Raynaud phenomenon. While not fully understood, it is probable that the smoking triggers thrombosis in the blood vessels which leads to a lack of oxygen and nutrients to the affected tissues.
Common Symptoms of Buerger Disease
The most common symptoms of Buerger Disease is purple and/or blue areas on the fingers and toes, usually on one side or on isolated fingers or toes. The pain worsens with exercise, cold, and at night. Over time areas affected may become ulcerated and eventually gangrene sets in. If the person continues to smoke he or she may lose fingers, toes, or limbs. In the early stages the pulse is lost, indicating no blood flow to the area. Other problems associated with Buerger Disease include venous thrombosis of the superficial or deep veins. Erythema nodosum, a skin condition where red lumps form on the shins, thighs and forearms is another problem that accompanies Buerger Disease. Very rarely, the blood supply to major organs like the kidneys, heart, and brain are also affected.
No Definitive Treatment
Although there is no definitive treatment for thromboangiitis obliterans, there are some things that are mandatory if it is to be treated. It is, first of all, essential to stop smoking. In order to protect the hands and feet from trauma and infection they should be kept warm. A consideration is an intravenous infusion of a medication that helps the blood vessel walls relax and reduces clotting. Ablation of the nerves causing blood vessel constriction is another type of treatment. Removal of gangrenous tissue may be necessary.