1、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) Causes encephalopathy As

2、sociated with general anesthesia,Hypertension,Pathophysiology Vasoconstriction Increased contract Increased HR Increased volume Arterial & Heart remodeling RAAS activation,Drugs Alpha-1 blockers Beta blockers ACE inhibitors ARBs Calcium channel blockers Diuretics Other,Embolus,Thromboembolism Air Em

3、bolism (diving, trauma, injection) Amniotic Bacterial Embolism Fat embolism Foreign matter (usually from injection) Drug precipitate, glass, linen fibers,Arteriosclerosis,Hardening of arteries Fibrotic Atherosclerotic Shape Eccentric Concentric,Atherosclerosis,Inflammatory disease Endothelial injury

4、 Fatty streak formation Fibrotic plaque Complicated lesion,Endothelial Dysfunction,Risk factors Smoking High blood pressure Cholesterol Sedentary life Homocysteine Turbulent blood flow,“Novel” Risk factors CRP Serum fibrinogen Insulin resistance Oxidative stress Infection Periodontal Disease,Injured

5、 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,Fatty streaks found in children as young as ten years old

6、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,None until severe or event Collateral circulation Legs: Claudication Corona

7、ry: Reduced exercise tolerance Renal artery: hypertension CV Event (complicated lesion) Stroke, MI Death,Collateral Circulation,Eval & Tx of Atherosclerosis,Risk factors risk factors Family history Endothelium function test Localized perfusion studies Doppler ECG, Echo, Angiogram, Stress test Tx: Tx

8、 BP & cholesterol, anticoagulant Life style Treat localized ischemic 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,Ather

9、osclerotic Thromboangitis obliterans (Buergers Disease) Raynauds disease/phenomenon Peripheral vasospasm Treat with alpha-blockers Raynauds phenomenon often accompanies other illnesses E.g., SLE,Diseases of the Veins,Varicose veins & Venous insufficiency Enlarged tortuous veins Failure of valve May

10、lead to insufficient venous return Functional decrease in preload Hyperpigmentation of feet Edema Sluggish circulation in lower extremities Venous stasis ulcers,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,DVT,Factors that promote DVT Venous stasis Immobility, meds, posture Venous endothelial damage Hypercoagu