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of the heart and vascular system are part of training in many therapies, such as Massage, Aromatherapy, Shiatsu, and others. This page is intended as Revision Notes for Basic / First Level Courses in these therapies, and some ITEC Diplomas. Blood Clotting is one of three mechanisms that reduce the loss of blood from broken blood vessels. The three mechanisms are: Vascular Spasm - The smooth muscle in blood vessel walls contracts immediately the blood vessel is broken. This response reduces blood loss for some time, while the other hemostatic mechanisms become active. Platelet Plug Formation - When blood platelets encounter a damaged blood vessel they form a "platelet plug" to help to close the gap in the broken blood vessel. (The key stages of this process are called platelet adhesion, platelet release reaction, and platelet aggregation) Blood Clotting (Coagulation) - As described below:
Following damage to a blood vessel, vascular spasm occurs to reduce blood loss while other mechanisms also take effect: Blood platelets congregate at the site of damage and amass to form a platelet plug. This is the beginning of the process of the blood "breaking down" from is usual liquid form in such a way that its constituents play their own parts in processes to minimise blood loss. Blood normally remains in its liquid state while it is within the blood vessels but when it leaves them the blood may thicken and form a gel (coagulation). Blood clotting (technically "blood coagulation") is the process by which (liquid) blood is transformed into a solid state. This blood clotting is a complex process involving many clotting factors (incl. calcium ions, enzymes, platelets, damaged tissues) activating each other. The three stages of this process are: 1. Formation of Prothrombinase Prothrombinase can be formed in two ways, depending of which of two "systems" or "pathways" apply. These are Intrinsic This is initiated by liquid blood making contact with a foreign System surface, i.e. something that is not part of the body; or Extrinsic This is initiated by liquid blood making contact with damaged System tissue. Both the intrinsic and the extrinsic systems involve interactions between coagulation factors. These coagulation factors have individual names but are often referred to by a standardised set of Roman Numerals, e.g. Factor VIII (antihaemophilic factor), Factor IX (Christmas factor).
Prothrombin converted into the enzyme Thrombin
The Structure and Functions of Blood Note: Knowledge of the structure and function of blood and aspects of the heart and vascular system are part of training in various therapies. This page is divided into the following sections: 1. which is dangerous and can lead to strokes or heart-attacks.). The Composition of Blood (incl. Fibrinogen (soluble) converted to Fibrin (insoluble) In turn.as opposed to the functions of particular components of blood). Aromatherapy. In this case much blood may be lost from the blood vessels. Massage. (incl. Consequences of Blood Clotting Problems: If blood clots too quickly/easily then thrombosis may occur. Acupuncture. Types of Leucocytes (White Blood Cells) Page 2 . if blood takes too long to clot hemorrhage may occur.3. e.) converts prothrombin. thrombin converts fibrinogen (which is also a plasma protein synthesized in the liver) into fibrin. The hereditary disorder haemophilia is a condition in which certain coagulation factors are missing from the blood. which is a plasma protein that is formed in the liver. the different types of blood cells and their properties and functions). etc. Conversely. into the enzyme thrombin. 3. This is blood clotting in an unbroken blood vessel. Fibrin is insoluble and forms the threads that bind the clot. as a result of which the blood cannot form clots (without medical intervention). 2. This page is intended to include detail suitable for introductory courses. Shiatsu. Process of Oxygenation of Tissues due to Circulation of Blood 4. which is also dangerous.g. Prothrombinase (formed in stage 1. The Functions of Blood (generally . and some ITEC Diplomas.
glycerol). white blood cells 'leucocytes'.e. i. Page 3 . 3. Of these. 8 pints). Plasma proteins (associated with defence. Maintains Body Temperature Controls pH The pH of blood must remain in the range 6. 5. Toxins removed from the blood by the kidneys leave the body in the urine.4. Enzymes. micro-nutrients (vitamins & minerals). Hormones. 4. Functions of Blood 1. and described in further detail below. Blood cells (incl. and red blood cells 'erythrocytes'). 36 times every 24 hours. Waste products of metabolism (e. otherwise it begins to damage cells.8 to 7.g. such as blood-clotting and antibodies). Transports: Dissolved gases (e. carbon dioxide). oxygen. which may contain around 10g salt per day (such as in the cases of people on western diets containing more salt than the body requires). Nutrients (such as glucose. 99% are erythrocytes (red blood cells) and 1% are leucocytes (white blood cells) and thrombocytes (blood platelets). fatty acids. Removes toxins from the body The kidneys filter all of the blood in the body (approx.1. (Toxins also leave the body in the form of sweat. This is summarised in the following diagram. These include: 55%Plasma 45%Components. 2. 'Blood Cells'.g. urea). water.) Regulation of Body Fluid Electrolytes Excess salt is removed from the body in urine. amino acids. Composition of Blood Blood consists of many components (constituents). 2.
Erythrocytes (Red blood cells) Immature erythrocytes have a nucleus but mature erythrocytes have no nucleus. . Helps to maintain optimum body temperature throughout the organism. This is the straw-coloured fluid in which the blood cells are suspended. maintaining this within a range at which the cells can thrive. Hormones. and consists of: Dissolved substances including electrolytes such as sodium. globulin. manganese. neutrophils and eosinophils. basophils.The summary chart above includes: erythrocytes (red blood cells). potassiun. Haem Erythrocytes have a "prosthetic Page 4 Plasma Carry oxygen (process described in more detail -below). The following table includes further general information about the constituents of blood. It also includes categories of leucocytes: agranulocytes and granulocytes (also known as polymorphonucleocytes). and calcium ions. Helps to maintain an ideal balance of electrolytes in the blood and tissues of the body. Functions The medium in which the blood cells are transported around the body (by the blood vessels) and are able to operate effectively. monocytes. Helps to control the pH of the blood and the body tissues. Blood plasma proteins (albumin. fibrinogen). Structure Normal blood plasma is 90-92 % water. which may also be sub-divided into lymphocytes. chlorine. thrombocytes (blood platelets) and leucocytes (white blood cells).
Monocytes. 120 days.10. Major part of the immune system. Page 5 . (Bile breaks down fats. and iron. Erythrocytes are eventually broken down by the spleen into the blood pigments bilinubin and bilviridin. Leucocytes (White blood cells) There are different types of leucocytes (described in more detail .in this case. Lymphocytes.000 leucocytes per micro-litre of blood.5. Basophils.8 million erythrocytes per microlitre of healthy blood (though there are variations between racial groups and men/women).. Haem relies on the presence of iron (Fe). Agranular (do not contain granules): e. There are approx.group" (meaning "in addition to" . Have a longevity of a few hours to a few days (but some can remain for many years).g.g. in addition to the cell). There are approx.5 . classified as: Granular: e. continued in section below. Haem combines with oxygen to form oxyhaemoglobin: . Eosinophils.000 . and the blood pigments form bile salts. 5. Neutrophils..below). The active component of this prosthetic group is Haem. These components are then transported by the blood to the liver where the iron is re-cycled for use by new erythrocytes. 4.) Have a longevity of approx.
The Oxygenation of Blood The oxygenation of blood is the function of the erythrocytes (red blood cells) and takes place in the lungs. and 2. the high concentration of carbon dioxide in the tissues diffuses into the blood. . They also contain waste products of the metabolism (such as carbon dioxide).. Disk-shaped..Trombocytes (Platelets) Blood platelets are cell fragments. Have a longevity of approx. Diameter 2-4 um (1 micro-metre = 1 um = 0. 3.000001m). Due to the high concentration of oxygen in the blood and the low concentration of oxygen in the tissues.000 platelets per micro-litre of blood. 5-9 days. To facilitate blood clotting .000 400.) Blood returns from the tissues back to the heart via the superior vena cava (from the upper-body) and the inferior vena cava (from the lower-body) Page 6 . (95% of this carbon dioxide dissolves in the blood plasma. The sequence of events of the blood becoming oxygenated (in the lungs) then oxygenating the tissues (in the body) is as follows: The Right Ventricle (of the heart) sends de-oxygenated blood to the lungs. 150. While in the lungs: 1.the purpose of which is to prevent loss of body fluids. There is a low concentration of oxygen in the body tissues. There are approx. Oxygen (breathed into the lungs) combines with haemoglobin in the blood as it passes through the lung capillaries. Have many granules but no nucleus. Oxyhaemoglobin returns to the heart via the pulmonary vein and then enters the systemic circulation via the aorta. Carbon Dioxide diffuses out of the blood into the lungs.
24% of leucocytes are lymphocytes. and seratonin in allergic reactions. These produce anti-bodies and include: * T-Cells * B-Cells * Natural Killer Cells Approx. cells. histamine. Diameter 10-12 micro-metres. cell debris. Combat the effects of histamine in allergic reactions. Phagocytize antigen-antibody complexes. *Eosinophils: 0. Further notes about the types of leucocytes identified above: Lymphocytes: Phagocytosis: The term "antigen" refers to something that is not A phagocyte is a cell able to engulf and digest naturally present and 'should not be in the body'. * It is only possible to observe the differences between these by staining them. Phagocytes include many leucocytes gland. They combat microbes by the process of phagocytosis. Types of Leucocytes (White Blood Cells) Lymphocytes: Monocytes: Approx. 4% of leucocytes are monoocytes. Diameter 8-10 micro-metres. The 'B' indicates 'bone marrow' cells. Destroy some parasitic worms.which pl B Cells (lymphocytes) are activated by other major role in the body's defence system. Phagocytosis is the engulfment and digestion o Both T-cells and B-cells: bacteria and other anigens by phagocytes. *Basophils: 60-70% of leucocytes are basophils. intensifying inflammatory response. Liberate heparin. Phagocytosis.5-1% of leucocytes are eosinophils. lymphoid tissue. protozoa. These are also known as phagocytes. *Neutrophils: 2-4% of leucocytes are neutrophils. Diameter 10-12 micro-metres. Destruction of bacteria with lysozyme and strong oxidants. and other s T Cells (lymphocytes) are activated by the thymus particles. (white blood cells) and macrophages . Page 7 .4. bacteria.
such as lysozyme. Monocytes take longer to reach the site of infection than neutrophils . Eosinophils: An increased (higher than usual) percentage of eosinophils in the blood may indicate parasitic infection somewhere in the body. Neutrophils & Monocytes: Neutrophils are the first leucocytes to respond to bacterial invasion of the body. that destroy certain bacteria.(1) destroy antigens.but they eventually arrive in much larger numbers. This page is intended to include the detail required for most Basic / First Level Courses in these therapies. such as Massage (incl. Basophils: An increased (higher than usual) percentage of basophils in the blood may indicate an inflammatory condition somewhere in the body. "Swedish Massage". Monocytes also clear up cellular debris after an infection. They act by carrying out the process of phagocytosis (see opposite). "Indian Head Massage". "Acupressure Massage" etc. and some ITEC Diplomas Page 8 . Blood Vessel Introductory Note: Knowledge of the structure and function of blood vessels and other aspects of the heart and vascular system are parts of training in many therapies.Monocytes that migrate into infected tissues develop into cells called wandering macrophages that can phagocytize many more microbes than neutrophils are able to. and also be releasing enzymes . and others. Aromatherapy. This is illustrated below. and (2) produce 'memory cells' and anti-bodies. Shiatsu.).
Diagrams The following diagram summarises the sequence of blood flow through the heart. y Capillaries. arteries. arterioles. y Arterioles. veins. y Venules. then back to the heart: Page 9 . 1. capillaries. These are described and compared on this page. venules.The main types of blood vessels are: y Arteries. and y Veins.
Exchange of oxygen. and constrict and dialate. Transport blood from arteries to capillaries. Transport deoxygenated blood only (except in the case of the pulmonary vein). Veins include valves that aid the return of blood to the heart by preventing blood from flowing in the reverse direction. Arterioles are the main regulators of blood flow and pressure. CapillariesCapillaries are tiny (extremely narrow) blood vessels. between the blood and the surrounding body tissues. Drains blood from capillaries into veins. 3..000001metre) diameter. etc.2. the blood. for return to the heart Transport blood towards the heart. Transport oxygenated blood only (except in the case of the pulmonary artery). Structure and Functions of Blood Vessels Arteries Structure The walls (outer structure) of arteries contain smooth muscle fibre that contract and relax under the instructions of the sympathetic nervous system. There are networks of capillaries in most of the organs and tissues of the body. Comparison between Arteries and Veins Arteries Transport blood away from the heart. and also to remove waste from the surrounding cells . of approximately 5-20 micro-metres (one micro-metre = 0. Many venules unite to form a vein. as opposed to simply moving the blood around the body (in the case of other blood vessels). Veins Transport blood towards the heart. Functions Transport blood away from the heart.. and carried by. carbon dioxide. to regulate blood flow. Arterioles Arterioles are tiny branches of arteries that lead to capillaries. Capillary walls are only one cell thick (see diagram). These are also under the control of the sympathetic nervous system.. Function is to supply tissues with components of. which permits exchanges of material between the contents of the capillary and the surrounding tissue. Veins The walls (outer structure) of veins consist of three layers of tissues that are thinner and less elastic than the corresponding layers of aerteries. Venules Venules are minute vessels that drain blood from capillaries and into veins. These capillaries are supplied with blood by arterioles and drained by venules. Page 10 . salts. water.
as this could (in theory) return waste materials to the tissues. Transports blood under lower pressure (than arteries). and others. such as Massage (in its many forms. These are to prevent blood flowing in the wrong direction.Carry Oxygenated Blood (except in the case of the Pulmonary Artery). Shiatsu. is an essential part of training in many therapies. This page is intended to include the detail required for most Basic / First Level Courses in these therapies. showing its physical appearance and labelling its major components and blood vessels. Acupuncture. "Swedish Massage". The simpler diagrams below it are line drawings including essential information in a form that is easier to reproduce in exams. Page 11 . Aromatherapy. Transports blood under higher pressure (than veins). Do not have valves (except for the semi-lunar valves of the pulmonary artery and the aorta). Carry De-oxygenated Blood (except in the case of the Pulmonary Vein). The first diagram (immediately below) is a cut-away section through the heart. and some ITEC Diplomas. "Acupressure Massage" etc. Have relatively narrow lumens (see diagram above). The Structure of the Heart Introductory Note: Knowledge of the structure and function of the heart and other aspects of the vascular system. Have relatively more muscle/elastic tissue. Have valves throughout the main veins of the body. Have relatively wide lumens (see diagram above). Have relatively less muscle/elastic tissue.). "Indian Head Massage".
forwards. Deoxygenated blood (from the body) is pumped through the right atrium and the right Page 12 . The basic structure of the heart (illustrated above) may be described as follows: The Heart is divided into separate right and left sections by theinterventricular septum. and pointing towards the left. Right Ventricle (Labelled "RV" in the diagrams on this page). and with its pointed end (called the apex) downwards. The main purpose of the heart is to pump blood around the body. respectively. Each of these (right and left) sections is also divided into upper and lower compartments known as atriaand ventricles. or "septum" when the context is clearly that of the heart.Illustration of the Physical Form of the Heart The heart is a muscular cone-shaped organ about the size of a clenched fist of the same person. Left Atrium (Labelled "LA" in the diagrams on this page). Left Ventricle (Labelled "LV" in the diagrams on this page). It is located in the upper body (chest area) between the lungs. The four main chambres of the heart are therefore the: Right Atrium (Labelled "RA" in the diagrams on this page).
Deoxygenated blood leaves the right ventricle by Pulmonary artery.). is part of training in many therapies. "Indian Head Massage". which takes blood to the body via its system of arteries. Page 13 . These may be labelled as "right pulmonary veins" and "left pulmonary veins". The Aortic valve separates the right ventricle from the ascending aorta. Major arteries leading from the heart (via the ascending aorta) include thebrachiocephalic artery. such as Massage (in its many forms. Line Drawings of the Basic Structure of the Heart Although Diagram (1) above is a clear illustration of the structure of the heart it may be difficult to reproduce quickly in examinations. while oxygenated blood (from the lungs) is pumped through the left atrium and the left ventricle (to the body). which takes blood to the lungs via the right and left brances of the pulmonary artery. Oxygenated blood enters the left atrium from the Pulmonary veins. The Mitral (also known as the Bicuspid) valve separates the left atrium from the left ventricle. Diagram (2)a is a simplification of Diagram (1). The following diagrams are less detailed and not as fully labelled (the same information as above applies so more labels could be added). This page is intended to include the detail required for most Basic / First Level Courses in these therapies. The Tricuspid valve separates the right atrium from the right ventricle. "Acupressure Massage" etc. and capillaries. and others. The physical form and structure of the heart is described and illustrated on the separate page: The Structure of the Heart The following diagrams are simple summaries of the main parts of the heart.ventricle (to the lungs). Acupuncture. Oxygenated blood leaves the left ventricle by Ascending aorta. Aromatherapy. It is essential that blood flows in the correct direction through the heart so the structure of the heart includes a series of valves. These are just a few of the main arteries of the body. Deoxygenated blood enters the right atrium from the Superior vena cava and the Inferior vena cava. Diagram 2(b) includes additional information about structures concerned with the system of electical conduction operating in the heart (which is described on the page about The Functions of the Heart). The Pulmonic / Pulmonary valve separates the right ventricle from the pulmonary artery. and some ITEC Diplomas. arterioles. Shiatsu. the left common carotid artery. the functions of which are described below. "Swedish Massage". The Functions of the Heart Introductory Note: Knowledge of the structure and function of the heart and other aspects of the vascular system. and the left subclavian artery (illustrated above). but may be more convenient to sketch rapidly if required to do so.
Page 14 .and lower-body via the Superior Vena Cava and the Inferior Vena Cava. This blood is then pumped under higher pressure from the right ventricle to the lungs via the pulmonary artery Left-Hand Side of the Heart The left-hand side of the heart receives oxygenated blood from the lungs (via the pulmonary veins) into the left atrium. This deoxygenated blood passes through the tricuspid valve into the right ventricle. It is then pumped to the aorta under greater pressure (as explained below). arteries. arterioles.What are the Functions of the Heart ? The main functions of the heart can be summarised as follows: Right-Hand Side of the Heart The right-hand side of the heart receives deoxygenated blood from the body tissues (from the upper. This higher pressure ensures that the oxygenated blood leaving the heart via the aorta is effectively delivered to other parts of the body via the vascular system of bllod vessels (incl. Hence. respectively) into the right atrium. How does the heart perform these functions ? The pump action performed by the heart is achieved by a sequence of alternating contraction and relaxation of the heart muscle (illustrated above). This oxygenated blood then passes through the bicuspid valve into the left ventricle. and capillaries). In this context the term "systole" refers to the contraction part of the sequence and the term "diastole" to the relaxation part of the sequence. the "systolic" and "diastolic" pressures may be measured and recorded separately when monitoring blood pressure.
After each of these contractions. so are also known as "Purkyne Fibres". One of the best ways to describe this system is using a diagram: Diagram summarising Systemic Circulation Page 15 . the pacemaker of the heart. The vagus nerve stimulates the sinoatrial node (SAN). "Swedish Massage". to all parts of the body. This/these are a bundle of modified cardiac muscle fibers that transmit impulses from the atra. and hence oxygen. and as the "Bundle of His". simultaneous contraction of both the right and left atria. The sinoatrial node (SAN) is a tiny area of specialised cardiac (meaning "heart") muscle in the upper wall of the right atrium. and the aorta taking blood to the body). This movement of the cardiac muscle pushes blood from the atria into the ventricles (via the tricuspid and bicuspid valves). The atrioventricular node is a mass of modified cardiac muscle located in the lower/central part of the right atrium of the heart. Shiatsu. This causes the . 2. This page is intended to include the detail required for most Basic / First Level Courses in these therapies. and others. The Purkinje fibres are referred to by various names in different textbooks. Aromatherapy. The contractions of the atria send impulses down the Purkinje fibers. such as Massage (in its many forms.. near the vena cava . to the ventricles. 3.as shown above. ventricles to contract. nerve impluses initiating each sequence. The whole series of actions that cause alternating contractions and relaxations may be summarised in five stages: 1. 4..This process is directed by the nervous system. 5. which pushes blood upwards into the arteries that take the blood away from the heart (the pulmonary artery taking blood to the lungs. . and some ITEC Diplomas. Systemic Circulation Introductory Note: Knowledge of systemic circulation and other aspects of the heart and vascular system are essential parts of training in many therapies. "Purkynje Fibres".as shown in the diagram on the right. Systemic Circulation is the system of blood vessels and associated tissues that supplies blood. The action potential from the impulse transmitted down the Purkinje fibers reaches the right and left branches of the Purkinje fibres ..). the impluse is dispersed across the atrial cardiac muscle. "Accupressure Massage" etc. The fibres of the SAN contract rhythmically approx. leading to .. ... which in turn stimulate the atrioventricular node (AVN).. "Indian Head Massage". Acupuncture. via the AVN.. 70 times each minute.
This diagram and systemic circulation itself may be summarised in words as follows: Page 16 .
. Deoxygenated blood enters the lungs and is oxygenated before leaving the lungs (as oxygenated blood). Deoxygenated Blood Blood is deoxygenated when it leaves the tissues and organs it has supplied with oxygen and other nutrients. which returns the blood to the right ventricle of the heart. After re-entering the (right atrium of the) heart via the superior vena cava and the inferior vena cava. Blood returns from the liver via the hepatic vein. such as Massage. and also to the carotid artery that carries blood to the head. and so the cycle begins again . and blood supply to the lower-body.). ntroductory Note: Knowledge of the structure and functions of blood and other aspects of the heart and vascular system are part of training in many therapies. which is the major artery leaving the heart. the renal arteries that carry blood to the kidneys. deoxygenated blood is pumped into the right ventricle of the heart and then out of the heart to the lungs via the pulmonary artery. and the iliac arteries that carry blood to the legs (some of which eventually reaches the feet. Blood Supply to the Lower-Body: The aorta also leads to the hepatic artery that carries blood to the liver. and from the legs via the iliac veins.Oxygenated Blood Oxygenated blood leaves the lungs and enters the Left Atrium (LA) of the heart via the pulmonary veins. Blood Supply to the Upper-Body: The aorta leads to the subclavian arteries that take blood to the arms (some of which eventually reaches the hands). All of the blood in the major veins of the lower body flows into the inferior vena cava. and then out of the heart to the body tissues via the aorta. This can also be summarised for the upper-body and lower-body separately: Return of Blood from the Upper-Body: Blood returns from the head via the jugular veins. from the kidneys via the renal veins. This oxygenated blood is then pumped from the Left Atrium (LA) of the heart to the Left Ventricle (LV) of the heart. and from the arms via the subclavian veins. The aorta divides into other arteries that serve different parts of the body (as mentioned on the page about the structure of the heart).. to return back to the pulmonary circulatory system. All of the blood in the major veins of the upper body flows into the superior vena cava. Return of Blood from the Lower-Body: Blood returns from the small intestines by passing through the hepatic portal vein to the liver. Page 17 . the mesenteric artery that carries blood to the small intestines. These can be separated into two categories: blood supply to the upper-body. which returns the blood to the right ventricle of the heart.
The sounds start at the systolic pressure: (heart contraction => higher pressure) and finish at the diastolic pressure: (heart relaxation => lower pressure). Acupuncture. at the bend of the elbow. effects. and symptoms of both "High" and "Low" Blood Pressure: Page 18 .Aromatherapy. A column of mercury is linked to an inflatable cuff which is wound around the upper arm. Shiatsu. This page is intended as Revision Notes for Basic / First Level Courses in these therapies. The following table summaries key causes. Hence blood pressure is expressed as : "height of column of Hg at systolic pressure " "height of column of Hg at diastolic pressure". Normal Blood Pressure is about mm Hg. and some ITEC Diplomas. and others. A stethoscope is then used to listen to the sounds of the blood in the brachial artery. Measurement of Blood Pressure Blood pressure can be measured by an instrument called a sphygmomanometer.
Low Blood Pressure Temporary Hypotension : Simple faint (syncope) Light-headed Sweats Impaired conciousness Severe Hypotension : Peripheral circulatory failure (cardiogenic shock) Unrecordable blood pressure Weak pulses Suppression of urine production Page 19 . Hypertension is symptomless until the symptoms of its complications develop. orsymptomatic hypertension. More general contributory factors are : Stress. Allergic reactions. Obesity. Pulmonary embolism.g. Kidney failure. These include : Atherosclerosis Heart failure. an overdose of the drugs used to treat hypertension). Holes get blocked up by colesterol. Arrhythmias.g. including narrowing of the renal artery (renal hypertension) Or endocrine diseases (such as Cushing's disease or phaeochromocytoma) Or disease of the arteries (such as contraction of the aorta) which is known as secondary. Severe infections. and Drugs (e. Can occur following: Excessive fluid loss (e. burns or vomiting).Causes of Condition High Blood Pressure May be of unknown cause (essential hypertension. through diarrhoea. Social Class.g. Effects / Symptoms Damage to arteries & veins. Poor diet. Other causes may include: Myocardinal infarction. Age. Lack of exercise. Acute abdominal conditions (e. or hyperpiesia) May result from kidney disease. Cerebral haemorrage. Addisons disease. Severe blood loss (haemorrage) from any cause. Smoking. pancreatitits).
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