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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
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
hypertension3
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
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
slide23
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
slide24
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