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Fibromuscular Dysplasia (FMD): Causes, Symptoms, Treatment
Here are 10 facts about 10 Fibromuscular Dysplasia (or FMD).
1. Definition: Fibromuscular Dysplasia is a rare medical condition characterised by abnormal cell growth in the walls of medium-sized arteries, leading to narrowing (stenoses), beading, aneurysms, or tears (called dissections). It can affect any artery but commonly impacts renal and carotid arteries.
Less commonly, FMD affects the arteries in the abdomen (supplying the liver, spleen and intestines) and extremities (legs and arms). In more than one-half of people with this disease, there will be evidence of FMD in more than one artery.
If narrowing or a tear causes a decrease in blood flow through the artery, symptoms may result.
2. Causes: The exact cause of FMD remains unknown, but genetic and hormonal factors may play a role. Some cases have been linked to repeated blood vessel stretching.
3. Risk Factors: FMD primarily affects women, especially those between 40 and 70 years old. Other potential risk factors include smoking, which can worsen the condition.
4. Symptoms: Symptoms vary depending on the affected arteries and can include:
- Cardiovascular: Heart attack (rarely)
- Neurological: Pulsatile tinnitus, visual problems, and stroke; headaches, dizziness, and neck pain
- Renal: High blood pressure (can be very high); occasionally acute kidney injury (AKI)
- Other: Abdominal pain, claudication.
Note. Many people with FMD do not have any symptoms, or abnormalities on physical examination; and are diagnosed by accident during a radiology scan for another problem.
5. Diagnosis: Diagnosis often involves imaging tests such as:
Characteristic beading in the renal (kidney) artery (angiogram)
- Angiogram: The gold standard for diagnosing FMD
- CT Angiogram: A non-invasive alternative to a traditional angiogram
- MRI Angiogram: Another non-invasive option that uses magnetic fields to visualise arteries
- Ultrasound: Doppler ultrasound can detect blood flow abnormalities in affected arteries.
6. Treatment: Treatment focuses on managing symptoms and preventing complications, and may include:
- Medications: Blood pressure medication, antiplatelet drugs, and statins
- Angioplasty: A procedure to open narrowed arteries
- Stenting: Inserting a stent to keep an artery open
- Surgery: Repairing or bypassing affected arteries in severe cases.
7. Complications: FMD can lead to serious complications, including:
- Aneurysm: Weakened artery walls that can rupture, and cause bleeding
- Artery Dissection: Tears in the artery walls, and cause bleeding
- Stroke and Heart Attack: Reduced blood flow to the brain, and heart.
8. Prognosis: Many people with FMD have a normal life expectancy, but regular monitoring and treatment are crucial to prevent complications.
9. Prevention: Since the exact cause of FMD is unknown, prevention strategies are limited. However, lifestyle changes such as quitting smoking, exercising regularly, and managing stress can help manage the condition.
10. Referral: If you suspect a patient has FMD, refer them to a vascular surgeon, cardiologist, neurologist or nephrologist (depending on which system is involved) for further evaluation and treatment. Regular follow-ups with that senior doctor are essential to
monitor the condition and adjust treatment as needed.
- The vascular sub type of Ehlers-Danlos syndrome (type IV) has been associated with the most common type of fibromuscular dysplasia, known as medial fibroplasia.
- This syndrome should be suspected in patients with multiple aneurysms and/or tears (dissections) in arteries in addition to the typical angiographic findings of FMD.
- There have been isolated reports of FMD associated with other disorders, including Alport’s syndrome, pheochromocytoma, Marfan’s syndrome, and Moyamoya disease.
- Other diseases which may be confused with FMD include vasculitis, Takayasu’s arteritis, and giant cell arteritis.
