Contributed by Kerry Grace Heckle, of Rex Healthcare
Keeping pace with a 3-year-old can be a tall order. For Penny Burke, a 65-year-old preschool teacher, her charge is 14 energetic 3-year olds. So if there was anyone who needs to be on her game at all times, it is Burke.
A self-described healthy individual, Burke, who works at Cary Presbyterian Church, was active, had regular checkups, kept her weight on par and had not experienced any other issues aside from her thyroid.
“During the summer I began having headaches and hot flashes. I thought it was the heat, exercise and chasing children, but that didn’t account for sudden high blood pressure,” explained Burke. “I’d recently had my thyroid medication changed, and thought that might have something to do with it, too. But, really, it was a mystery.”
Over the course of a year, Burke continued to see her family physician, monitored aggravating symptoms, had a few tests, put off a couple as well (she rationalized, are all these expensive tests really necessary?) and “dealt with it.”
When racing heart palpitations and hypertension started along with the unbearable flashes, that’s when things turned serious — Burke landed in the ER. After that, her primary care physician wanted to rule out an adrenal tumor. Additional tests and more negative results, Burke’s doctor then heard a bruit, indicating further testing was necessary and referred her to the Rex Peripheral Vascular Lab for a renal duplex exam to analyze the kidneys and their blood vessels
Of 50 million hypertensive patients, 1 to 6 percent have some component of renal artery stenosis, which is why the renal duplex made sense. The Rex PVL excels in diagnosis and treatment of RAS, the most common secondary cause of hypertension. Several diagnostic tests may be performed to determine RAS, such as spiral CT angiography, magnetic resonance angiography, arteriography and renal artery duplex ultrasound scanning.
“Renal duplex is an exam that requires both a highly trained vascular technologist and a highly accredited facility to administer,” said S. Wayne Smith, MD, medical director of the Rex Peripheral Vascular Lab and Rex Cardiac Rehab Program. “Rex Hospital is the preeminent comprehensive vascular center in Wake County. We offer patients the highest standard in vascular procedures and perform more than 10,000 non-invasive vascular procedures a year, rivaling that of referral centers such as the Cleveland Clinic.”
The PVL uses a combination of ultrasound and color flow Doppler to evaluate the complete vascular system, including kidney blood flow. These exams are completely non-invasive, involve no contrast and are essentially pain free.
“At the time, I figured this test wouldn’t reveal anything special,” admitted Burke. She was wrong.
“I knew something was immediately wrong when the vascular technologist said, ‘I’d like a doctor to see you; I’ll be right back.’”
It turns out that she had an 80 percent blockage in her renal artery consistent with fibromuscular dysplasia. People with FMD experience a narrowing of the walls (stenosis) of one or more arteries in the body as a result of abnormal cell development. Significant narrowing causes a decrease in renal blood flow, and it’s at that point the symptoms may result.
“Here was a woman who was doing all the right things. She was the picture of health,” recounted Dr. Smith. “FMD usually occurs in young white females, so for this to be the diagnosis is very unusual. Renovascular hypertension can be related to renoatherosclerosis or FMD.”
FMD is most often found in the arteries that supply the kidneys with blood (renal arteries).The second most common artery affected is the carotid artery (in the neck), which supplies the brain with blood.
Nearly 30 percent of people with FMD may also have another artery blockage — Burke is one of them. With a partial carotid blockage also, her care team tackled the renal artery first, and chose to monitor her carotid.
Many people with this kind of vascular disease do not have symptoms or findings during a routine physical examination. Their signs and/or symptoms depend on the affected arteries (commonly renal and/or carotid) and the degree of narrowing within them. Individuals with mild disease are often asymptomatic, and the disease often goes undetected. Since the disease is often not diagnosed, it is likely that FMD is more common than previously thought.
Treatment for FMD depends largely upon which arteries are affected and the presence and severity of signs or symptoms. In some patients, an attempt should be made to improve the flow of blood through the vessel. For others, medication works. Burke is still working through her treatment plan; however it is highly likely she will undergo an angioplasty, where a physician extends a catheter into the affected artery and a small balloon is inflated that opens the narrow artery.
“Once you know that a blood pressure spike is from RAS, you can tailor blood pressure medication as treatment. The advantage to angioplasty is there’s a good chance the patient will not be on medication (indefinitely),” said Dr. Smith.
In angioplasty, patients receive a sedative before angioplasty, but remain awake during the procedure. It is much less stressful on the patient with little pain, and recovery is quick. Most people who undergo angioplasty leave the hospital same day
Continue to learn about Burke’s journey at www.carymagazine.com.
If you are in need of a physician, Rex can help. Call Rex HealthNet at (919) 784-4490 or visit rexhealth.com. S. Wayne Smith, MD, is a vascular physician with Rex Healthcare.