Diseases of arteries and veins
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Diseases of Arteries and Veins. Atherosclerosis Hypertension CAD: Stable and Unstable angina Dyslipidemia DVT, PE Clotting Medications Review. Hypertension. Primary Secondary Isolated Systolic hypertension (aortic sclerosis in elderly) Postural (orthostatic) Malignant (DBP > 120)

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Diseases of Arteries and Veins

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Diseases of arteries and veins

Diseases of Arteries and Veins

  • Atherosclerosis

  • Hypertension

  • CAD: Stable and Unstable angina

  • Dyslipidemia

  • DVT, PE

  • Clotting Medications Review


Hypertension

Hypertension

  • Primary

  • Secondary

  • Isolated Systolic hypertension (aortic sclerosis in elderly)

  • Postural (orthostatic)

  • Malignant (DBP > 120)

    • Causes encephalopathy

    • Associated with general anesthesia


Hypertension1

Drugs

Alpha-1 blockers

Beta blockers

ACE inhibitors

ARBs

Calcium channel blockers

Diuretics

Other

Hypertension

  • Pathophysiology

    • Vasoconstriction

    • Increased contract

    • Increased HR

    • Increased volume

    • Arterial & Heart remodeling

    • RAAS activation


Embolus

Embolus

  • Thromboembolism

  • Air Embolism (diving, trauma, injection)

  • Amniotic

  • Bacterial Embolism

  • Fat embolism

  • Foreign matter (usually from injection)

    • Drug precipitate, glass, linen fibers


Arteriosclerosis

Arteriosclerosis

  • Hardening of arteries

    • Fibrotic

    • Atherosclerotic

  • Shape

    • Eccentric

    • Concentric


Atherosclerosis

Atherosclerosis

  • Inflammatory disease

    • Endothelial injury

    • Fatty streak formation

    • Fibrotic plaque

    • Complicated lesion


Endothelial dysfunction

“Novel” Risk factors

CRP

Serum fibrinogen

Insulin resistance

Oxidative stress

Infection

Periodontal Disease

Endothelial Dysfunction

  • Risk factors

    • Smoking

    • High blood pressure

    • Cholesterol

    • Sedentary life

    • Homocysteine

    • Turbulent blood flow


Injured endothelium

Injured Endothelium

  • Inflamed

    • Produces less vasodilating hormones

    • Produces less antithrombotic hormones

    • Inflammatory molecules cause damage

    • Growth factors released (SMCs)

    • Macrophages adhere

      • Oxidation of LDL

      • Foam Cell formation


Atherosclerotic plaque

Atherosclerotic Plaque

  • Fatty streaks found in children as young as ten years old

  • Develops fibrous cap

    • Hard candy coating on the outside

    • Delicious liquid center

  • Complicated lesion

    • Fibrous cap breaks

    • Contents spill out

    • Thrombus forms

      • Partial or complete occlusion or embolus


Manifestations of athersclerosis

Manifestations of Athersclerosis

  • None until severe or event

    • Collateral circulation

  • Legs: Claudication

  • Coronary: Reduced exercise tolerance

  • Renal artery: hypertension

  • CV Event (complicated lesion)

    • Stroke, MI

    • Death


Collateral circulation

Collateral Circulation


Eval tx of atherosclerosis

Eval & Tx of Atherosclerosis

  • Risk factors risk factors

  • Family history

  • Endothelium function test

  • Localized perfusion studies

    • Doppler

    • ECG, Echo, Angiogram, Stress test

  • Tx:

    • Tx BP & cholesterol, anticoagulant

    • Life style

    • Treat localized ischemic lesions


Treatment of localized lesions

Treatment of Localized Lesions

  • Bypass surgery

    • Use another artery

    • Use a piece of vein

    • CABG, Fem-pop

  • Heart catheterization (PCI)

    • Percutaneous Transluminal Angioplasty- PCTA

    • Stent

    • Thrombolysis


Peripheral arterial disease

Peripheral Arterial Disease

  • Atherosclerotic

  • Thromboangitis obliterans (Buerger’s Disease)

  • Raynaud’s disease/phenomenon

    • Peripheral vasospasm

    • Treat with alpha-blockers

    • Raynaud’s phenomenon often accompanies other illnesses

      • E.g., SLE


Diseases of the veins

Diseases of the Veins

  • Varicose veins & Venous insufficiency

    • Enlarged tortuous veins

    • Failure of valve

    • May lead to insufficient venous return

      • Functional decrease in preload

      • Hyperpigmentation of feet

      • Edema

      • Sluggish circulation in lower extremities

      • Venous stasis ulcers


Diseases of arteries and veins

DVT

  • ~10-26% of hospitalized patients may develop

    • Highest risk for shock, stroke, MI, CHF, malignancy

  • ~100% risk in

    • Orthopedic trauma/surgery

    • Spinal cord injury

    • Some OB/gyn conditions

  • Patient with coagulation disorders


Diseases of arteries and veins

DVT

  • Factors that promote DVT

    • Venous stasis

      • Immobility, meds, posture

    • Venous endothelial damage

    • Hypercoagulable states

      • Inherited, malignancy, pregnancy, OCs, HRT

  • Manifestations & Eval

    • Pain, Swelling, Redness, +Homan’s sign

    • Doppler ultrasound

  • Tx: Prevention, Anticoagulation


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