Blood Vessel Disorders

Transcription

1 Blood Vessel Disorders Objectives: Hyperlipidemia Arterioschlerosis Disorders associated with arteries Disorders associated with veins Hypertension and hypotension Part 1: Diseases Associated with Arterial Circulation 1

2 Diseases of Arterial Circulation: Hyperlipidemia: elevated blood lipids Chlylomicrons: largest of lipoproteins, produced by small intestine. VLDL: (very low density lipoproteins) LDL: (low density lipoprotein) HDL: (high density lipoprotein) 2

3 Hyperlipidemia: elevated blood lipids Etiologies: genetic and/or disease Significant risk factor for the development of atherosclerosis Treatment: life style changes (exercise, diet, quit smoking/drinking, lose weight), lipidlowering medications (statins). Arteriosclerosis: general term for hardening of the arteries. Monckeberg s Sclerosis: calcium salts accumulate in the muscle layer of small to medium sized arteries decreasing flexibility. Atherosclerosis: hard cholesterol plaques develop in arteries, may block flow of blood in a blood vessel or clot may travel elsewhere. Etiologies: (multifactorial) Genetics High serum cholesterol, triglycerides, glucose High serum homocysteine Low estrogen Obesity, sedentary lifestyle, smoking Stress Hypertension Chlamydia pneumoniae Inflammation 3

4 Diagnosis: Blood Profile High C-reactive protein High ESR Electrocardiogram (ECG) Imaging: Chest X-ray, echocardiogram, ultrasound, CT scan Stress test Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the systolic pressure at the arm. Development of atherosclerosis: 1. Damaged endothelium, inflammation develops. 2. Monocytes are activated and move into arterial wall. 3. Monocytes become foam cells and start accumulating fatty materials. 4. Smooth muscle cells begin to multiply and move into the arterial lining. 5. There is fibrous plaque development. 6. Connective tissue, elastic tissue, cellular debris, calcium deposits accumulate in plaque. (atheroma) 7. The atheroma thickens and bulges into the blood vessel lumen potentially narrowing or blocking an artery or potentially causing a hemorrhage, thrombosis, embolus or aneurysm. Atherosclerotic Plaque CAP CORE 4

5 Stable Plaques Have thick fibrous caps Partially block vessels Do not tend to form clots or emboli Unstable Plaques Have thin fibrous caps Plaque can rupture and cause a clot to form May completely block the artery The clot may break free and become an embolus 5

6 Thrombosis: formation of a blood clot that is attached to a blood vessel wall. Embolism: obstruction of a vessel by embolus which is a detached, traveling mass Thromboembolism Cholesterol embolism Tissue embolism Fat embolism Air embolism Amniotic fluid embolism Vasculitides: a group of blood vessel disorders characterized by inflammation and necrosis of blood vessel walls (vasculitis) Peripheral Arterial Disease: arterial disorders of the extremities. Acute Arterial Occlusion Atherosclerotic Occlusive Disease Thromboangiitis Obliterans Raynaud Disease 6

7 Acute Arterial Occlusion: sudden interruption of arterial blood flow to organs/tissues. Etiologies: thrombi or emboli, trauma, aortic dissection, arterial spasm, acute compartment syndrome Manifestations: (The P s) Pistol shot (acute onset) Pallor (loss of color) Polar (cold) Pulselessness Pain Paresthesia Paralysis Acute Arterial Occlusion: Diagnosis: Visual assessment Palpation of pulses Imaging Treatment: Embolectomy Thrombolytic and anticoagulant therapy Atherosclerotic Occlusive Disease: Usually seen in the lower extremities Smoking, diabetes and age are risk factors Manifestations: Intermittent claudication (pain with walking) or generalized pain Thinning of skin and subcutaneous tissues of the lower leg Coolness 7

8 Thromboangiitis Obliterans (Buerger Disease): vasculitis and vasospasm of arteries which leads to thrombosis in feet, lower legs and/or hands. Affects men more than women, strong correlation with tobacco use Manifestations: pain, shiny & thin skin, increased sensitivity to cold, deformed nails, could potentially lead to ulceration and gangrene 8

9 Raynaud Disease: disorder in which arteries/arterioles undergo vasospasm causing pain, discoloration and hypoxia of extremities Etiologies: largely idiopathic, hypersensitivity of the sympathetic nervous system, secondary to disease states, frostbite Common in women Ischemia could result in ulceration and gangrene Treatment Eliminate factors causing vasospasm and protect digits Vasodilator drugs Aneurysms: localized, blood-filled dilation of a blood vessel. Etiologies: Genetics Wear and tear with age Atherosclerosis Risk Factors: Diabetes, hypertension, smoking, alcoholism, copper deficiency 9

10 Aneurysms: Types: Fusiform (a narrow cylinder shape) Saccular (berry or sac shaped) Dissecting (separation of the middle blood vessel layers) False aneurysm (pulsating hematoma) Aneurysms: Effects: Thrombus/embolus Pressure on other structures Slow leakage of blood Rupture 10

11 Aneurysms (according to location) Abdominal aortic aneurysms Thoracic aortic dissection (type A and Type B) Cerebral aneurysm 11

12 Aneurysms Manifestations: Specific manifestations depending on location Severity dependent on size and location Risk of rupture rises with increased size Edema Anemia Pain 12

13 Aneurysms Treatment: Surgery Endovascular techniques (angioplasty with a stent) Life-style modifications (quit smoking, diet, exercise) Treatment of hypertension Pain management Part 2: Hypertension and Hypotension 13

14 Hypertension (HTN): elevation in blood pressure as observed multiple times over a time range. Essential or primary hypertension (multifactorial) benign essential HTN (slow chronic process) malignant essential HTN (rapid process leading to out of control Bp, may follow years of benign HTN) Non-essential or secondary hypertension Manifestations of Hypertension: Largely asymptomatic (known as the silent killer) Occipital headaches Dizziness, confusion, fatigue Blurry vision Edema Anxiety Manifestations associated with disease (if secondary) 14

15 Complications of Hypertension: Cardiovascular Disease (peripheral and/or coronary artery disease) Dissecting Aneurysm Angina/Myocardial Infarction/Heart Arrhythmias/Heart Failure/Sudden Cardiac Death Cerebrovascular Accident (CVA or stroke), transient ischemic attacks (TIAs) Renal Disease (nephrosclerosis/chronic kidney disease/renal failure) Retinopathy Treatment: Life-style modifications (weight loss, exercise, reduced sodium intake, reduced alcohol intake, quit smoking, stress reduction, self-monitoring of blood pressure) For Stage 1 (without complications): One type of diuretics Consider using ACE inhibitors, angiotensin II receptor blockers, beta-blockers, alpha-blockers, calcium channel blockers, vasodilator drugs 15

16 Treatment: For Stage 2 and over: Two different types of diuretics ACE inhibitors, angiotensin II receptor blockers, beta-blockers, alpha-blockers, calcium channel blockers, vasodilator drugs Pregnancy and High Blood Pressure: Pre-eclampsia: elevated blood pressure, proteinuria, elevated liver enzymes, persistent headache, vision difficulties, epigastric pain. Eclampsia: onset of seizures after preeclampsia Gestational hypertension Chronic hypertension Increases the risk of early labor and can impair fetal growth and may cause placental abruption. Orthostatic Hypotension: Abnormal drop in blood pressure when getting up to stand and dizziness and syncope may occur. Etiologies: Reduced blood volume Drugs Slowed reflexes with aging Prolonged immobilization Autonomic nervous system dysfunction (vasovagal syncope or neurocardio syncope) 16

17 Part 3: Diseases Associated with Venous Circulation Diseases of Venous Circulation: Varicose Veins: enlargement and inflammation of veins Can involve primary and secondary veins Etiologies: DVT, congenital, pregnancy, malignancies Manifestations: edema, achiness Treatment: support stockings, elevation of legs, weight loss, sclerotherapy Diseases of Venous Circulation: Chronic Venous Insufficiency: inadequate venous return over a long period of time, is a physiological consequence to DVT, incompetent valves, varicose veins. Manifestations: tissue congestion, edema, necrosis of subcutaneous tissues, skin atrophy and ulceration. 17

18 Diseases of Venous Circulation: Venous Thrombus (thrombophlebitis): inadequate venous return over a long period of time Thrombosis in veins can lead to occlusion, ischemia or embolism Manifestations: swelling, pain, redness, warmth, whitish/bluish coloration, leg cramps, asymptomatic Deep Venous Thrombosis (DVT) 18

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