Overview

Fibromuscular dysplasia (FMD) is a rare condition involving abnormal growth of cells in the arteries that results in the narrowing of blood vessels. It can cause a variety of symptoms such as pain, dizziness, high blood pressure, headaches and serious complications such as aneurysm or stroke. This condition is more common in women than men.

Different tests are used to diagnose this condition. Patient education and self-management are crucial in managing fibromuscular hyperplasia. Knowledge of FMD helps patients recognise symptoms that might indicate complications or progression of the disease and helps them to adhere to treatment plans. Management involves taking medications regularly, monitoring blood pressure and following up on appointments. Management will help relieve symptoms and prevent complications.

What are common symptoms and complications?

Patients with FMD may experience various symptoms depending on which arteries are affected. However, many patients do not have any symptoms and are diagnosed accidentally when an imaging test of the arteries is conducted for unrelated reasons.

Some common symptoms and complications are:

• High blood pressure
• Whooshing sound in the abdomen or sides
• Renal artery aneurysm, known as a bulge or weakening of an artery
• Tear in an artery of the kidney

• Headaches (often migraines)
• Ringing in the ears
• Stroke 
• Neck pain
• Dizziness
• Brain aneurysm

• Abdominal pain after eating
• Weight loss
• Arm or leg pain with activity (upper or lower extremity FMD)¹

What are the commonly affected arteries?

Fibromuscular dysplasia (FMD) can cause blood vessels to narrow, bulge, or develop a beaded appearance. It can affect various arteries, including:

• Carotid arteries: Located in the neck, connecting your heart and brain
• Renal arteries: Carrying blood from your heart to the kidneys
• Coronary arteries: Supply blood to the heart
• Mesenteric arteries: Delivering blood to the intestines
• Other arteries: Including those that travel to the legs, arms, and other parts of the body

What are the causes of FMD?

The exact cause of FMD is not clear, but it can be due to a mix of genetic, environmental, and hormonal factors. Most people with FMD are women. However, men with FMD often have more severe problems, like aneurysms or tears in the arteries, occurring twice as often as in women. Smoking increases the risk of FMD. Smokers with FMD are more likely to develop aneurysms and serious issues like strokes or heart problems. They also have a higher chance of needing medical procedures. More research is needed to understand how smoking and other factors contribute to FMD.²

Importance of patient education and early detection

Recognising the signs of Fibromuscular Dysplasia (FMD) early can significantly improve health outcomes and lower the risk of serious complications. 

Prevents complications

Early detection of FMD is crucial as it can help prevent serious complications such as high blood pressure, strokes, and aneurysms. By identifying the condition at an early stage, healthcare providers can intervene before these severe issues develop, which can make a substantial difference in the patient’s overall health and quality of life.

Improves management

Detecting FMD early allows for more effective management of symptoms and closer monitoring of the disease's progression. When FMD is identified sooner, treatment plans can be tailored to address specific symptoms and adjust to any changes in the condition. This proactive approach can help manage symptoms more effectively and prevent the condition from worsening.

Support and awareness

Becoming involved with advocacy groups and support networks can benefit individuals with FMD. These groups connect patients with others who have the same condition, providing a platform for sharing experiences, advice, and emotional support. Additionally, participating in these groups can help raise awareness about FMD and support research efforts aimed at improving understanding and treatment of the condition.

Education and immediate attention

Education from your healthcare provider about FMD is vital. Your provider will inform you about the specific symptoms that require immediate medical attention, which can vary depending on the arteries affected. Understanding these symptoms is crucial for timely intervention and reducing the risk of severe outcomes.

Stroke awareness

People diagnosed with FMD need to be aware of the signs of a stroke. Recognising these signs early can be life-saving. Symptoms to watch for include sudden numbness or weakness on one side of the body, confusion, trouble speaking or understanding speech, vision problems in one or both eyes, dizziness, or a severe headache with no clear cause. Urgent medical attention is important if any of these symptoms occur.

By being aware of these signs, individuals with FMD can take proactive steps to manage their condition effectively, seek timely treatment, and connect with others for support and advocacy.

Approach to management 

Fibromuscular dysplasia (FMD) has no known cure, so management focuses on thorough evaluation, regular monitoring, lifestyle changes and treatment of symptoms. Some patients may need vascular procedures like angioplasty or aneurysm treatment. Since FMD symptoms vary widely, it’s recommended to consult a specialist experienced in FMD who works closely with an interdisciplinary team. This team may include experts such as a vascular medicine physician, cardiologist, nephrologist, neurologist, neurosurgeon, vascular surgeon, and vascular interventionalist (like an interventional cardiologist and radiologist).²

Medical management strategies 

Antiplatelet therapy is more frequently used in older patients. These patients were given antiplatelet medications, which is a common practice to prevent blood clots. Managing blood pressure is also crucial for FMD patients who have hypertension. For those with kidney artery involvement, using an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) has been recommended.²

Self-management strategies

There are different lifestyle strategies to manage symptoms of FMD:

• Regularly monitor your blood pressure to keep it under control
• Quit smoking and avoid using tobacco products, as they can worsen FMD
• Attend all follow-up appointments, including annual tests to monitor your arteries
• Follow treatment plans and take all medications as directed by your healthcare provider
• Consider joining advocacy organisations and support groups to connect with others, raise awareness, and support FMD research

Psychological support for FMD patients

A study has found that women with fibromuscular dysplasia (FMD) had a lower quality of life compared to the general population. This was mainly due to headaches, neck pain, and abdominal pain, making pain management very important. Living with a rare condition like FMD can also cause anxiety, especially since many healthcare providers may not be familiar with it. To help with this, it's important for patients experiencing significant distress to be referred to a psychologist or psychiatrist for support.³

Managing FMD: stroke risk and preventive education

Patients with fibromuscular dysplasia (FMD) who have had strokes need to be well-informed about their condition. They should be educated to recognise symptoms that might suggest worsening or complications of FMD. It’s also important to discuss other stroke preventive factors, such as giving up smoking, maintaining a healthy diet, and controlling blood sugar levels and to avoid neck trauma and intense neck movements.⁴

Summary

Fibromuscular dysplasia (FMD) is a rare condition that often shows up as high blood pressure or stroke. It affects medium-sized arteries and can present differently based on the patient’s age. Managing FMD effectively requires a team of specialists, including a radiologist and a cardiologist. Patients might need angioplasty, and regular follow-up is crucial due to the risk of recurrence. For those without symptoms, antiplatelet drugs are recommended, while blood pressure should be controlled with antihypertensives. Symptomatic patients might require angioplasty. Long-term follow-up is essential. There are many case reports of strokes, especially in younger people. Clear communication of the management plan is important to prevent complications.⁴ Patient education and self-management play a crucial role in detecting FMD early and can prevent serious complications.