Red portion of heart and red blood vessels carry oxygen-rich blood.

Blue portion of heart and blue blood vessels carry oxygen-poor

In the pulmonary system, unoxygenated blood is carried by the pulmonary arteries and oxygenated blood is carried by pulmonary veins. In the systemic system, arteries carry oxygenated blood and veins carry unoxygenated blood.

Triglycerides – combinations of 3 fatty acids condensed with a single glycerol molecule; used in energy metabolism  Phospholipids – contains phosphate group; essential in structural constituents, especially in cell membrane  Cholesterol – synthesized from fatty acids thus with similar chemical activity to other lipids.

Total serum cholesterol level <200mg/dL – considered desirable  Levels of 200-209mg/dL – borderline high  LDL cholesterol levels <100mg/dL – considered optimal  LDL 100-129 mg/dL – near or above optimal  LDL 130-159 mg/dL – borderline high  LDL 160-189 mg/dL – high  LDL > or = 190 mg/dL – very high  HDL <40 mg/dL – considered low; levels > or=60 mg/dL are high

Reduce LDL  Dietary and lifestyle modification  4 types of medications available for treating hypercholesterolemia:

Bile-acid binding resins niacin and its congeners HMG-CoA reductase inhibitors(statins) Fibric acid agents

Atherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol. t is a syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, in large part due to the accumulation of macrophage white blood cells and promoted by low density (especially small particle) lipoproteins (plasma proteins that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol from the macrophages by functional high density lipoproteins (HDL). It is commonly referred to as a hardening or furring of the arteries. It is caused by the formation of multiple plaques within the arteries.

Hyperlipidemia, hypertension and cigarette smoking together increases the risk seven times.  Factors add to each other multiplicatively, with two factors increasing the risk of atherosclerosis fourfold.

Atherosclerosis develops from low-density lipoprotein molecules (LDL) becoming oxidized (ldl-ox) by free radicals, particularly oxygen free radicals (ROS). Blood in arteries contains plenty of oxygen and is where atherosclerosis develops. Blood in veins contains little oxygen where atherosclerosis rarely develops. When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL. The LDL molecule is globular shaped with a hollow core to carry cholesterol throughout the body to generate brain tissues, vitamin D, and so on. Cholesterol does not dissolve in water. Blood is 70% water. Cholesterol can move in the bloodstream only by being transported by LDL.

If atherosclerosis leads to symptoms, some symptoms such as angina pectoris can be treated. Non-pharmaceutical means are usually the first method of treatment, such as cessation of smoking and practicing regular exercise. If these methods do not work, medicines are usually the next step in treating cardiovascular diseases, and, with improvements, have increasingly become the most effective method over the long term. However, medicines are criticized for their expense, patented control and occasional undesired effects.

Refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels.  Solitary inflammation of veins (phlebitis) or arteries (arteritis), although both occur in  vasculitis, on their own are separate entities.  Vasculitis affects both arteries and veins.  Vasculitis is primarily due to leukocyte migration and resultant damage.

Polyarteritis nodosa (or periarteritis nodosa) is a vasculitis of medium-sized arteries, which become swollen and damaged from attack by rogue immune cells.  Polyarteritis nodosa is also called Kussmaul disease or Kussmaul-Maier disease.

Polyarteritis nodosa is a disease of unknown cause that affects arteries, the blood vessels that carry oxygenated blood to organs and tissues.  It occurs when certain immune cells attack the affected arteries.

The onset of polyarteritis nodosa usually is abrupt, with complaint of anorexia, weight loss, fever, and fatigue often accompanied by sign of organ involvement.  Hypertenion is a common manifestation of the disorder.  Gastrointestenal involvement may manifest as abdominal pain, nausea, vomiting, or diarrhea.

Treatment involves medications to suppress the immune system, including prednisone and cyclophosphamide.  Therapy results in remissions or cures in 90% of cases. Untreated, the disease is fatal in most cases. The most serious associated conditions generally involve the kidneys and gastrointestinal tract. Without treatment, the outlook is poor.

Disorder of the circulation in the extremities often are referred to as peripheral vascular disease. This section focuses on: *acute arterial occlussion *atherosclerotic occlussive disease *thromboangitis obliterans * raynaud’s dieseas *raynaud’s phenomenon

In lower extremity arterial disease, the lining of the artery becomes rough and thickened by a build up of cholesterol and plaque. This is called atherosclerosis, or “hardening of the arteries.” When this happens, the arteries to the legs become narrowed or blocked, and blood flow decreases.

Risk Factors In the Development of Lower Extremity Arterial Disease

 Acute

Arterial Occlusion

is a sudden event that interrupts arterial flow to the affected tissues or organ. Embolus and thrombulos are the result of acute arterial occlusion . embolus- something that travels through the bloodstream, lodges in a blood vessel and blocks it. thrombulos- A blood clot in a blood vessels or within the heart.

Severe pain  Coldness  Paresthesias  Loss of sensation  Paleness in an extremity  Lack of pulse in an extremity  Blue skin in affect limb

Thrombolytics- attempts to open the artery may include use of clot dissolving medications  Anticoagulants - medications that prevent the blood from clotting .e.g. Coumadin.  Catheter - repaired or the blockage removed with a tube inserted into the artery.

An atherosclerotic occlusive disease (AOD) can be acute or chronic. There is obstruction or narrowing of the lumen of the aorta and its major branches causing interruption of blood flow, usually to feet and legs. Involved arteries. Occlusions cause ischemia, discomfort, skin ulceration and gangrene.

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SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta and/or iliac vessels produce claudication in the back, buttocks and hips Femoral obstruction causes pain in the calf The degree of occlusion determines the exercise tolerance and if severe enough produces pain at rest Pulses are diminished or absent The limb is cold and pale and typically develops dependent rubor Atrophic skin changes often result in shiny hairless skin

Thromboangiitis obliterans is a rare disease in which blood vessels of the hands and feet become obstructed. Symptoms    Hands or feet may be pale, red, or bluish Hands or feet may feel cold Pain in the legs, ankles, or feet when walking (intermittent claudication)

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Skin changes or ulcers on hands or feet

◦ Often located in the arch of the foot



An examination usually reveals a decrease or absence of pulses in the extremities. Blood tests are usually normal. An angiogram (in which a dye is injected into the blood vessel and then X-Rays taken) may help with the diagnosis, and may rule out other causes

The main treatment is to STOP SMOKING immediately. 

Raynaud’s phenomenon is a condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the fingers, toes, ears, and nose.

Common causes are:

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Diseases of the arteries, such as atherosclerosis and buerger's disease Drugs that cause narrowing of arteries, such as amphetamines, certain types of beta-blockers, some cancer drugs, ergot compounds, and methysergide Arthritis and autoimmune conditions, such as scleroderma, Sjogren syndrome, rheumatoid arthritis, and systemic lupus erythematosus Repeated injury, particularly from vibrations such as those caused by typing or playing the piano Smoking Frostbite Thoracic outlet syndrome


Strong emotions or exposure to the cold causes the fingers, toes, ears, or nose to become white, then turn blue. When blood flow returns, the area becomes red and then later returns to normal color. The attacks may last from minutes to hours. People with primary Raynaud's phenomenon (no other cause or condition) have problems in the same fingers on both sides, but they do not have very much pain. People with secondary Raynaud's phenomenon with other are more likely to have pain in different fingers. They often have pain and tingling.

An aneurysm (AN-u-rism) is a balloon-like bulge in an artery. Arteries are blood vessels that carry oxygen-rich blood from your heart to your body. Aortic dissection occurs when the layers of the wall of the aorta separate or are torn, allowing blood to flow between those layers and causing them to separate further. When the aortic wall separates, blood cannot flow freely, and the aortic wall may burst.

The following increase the risk of an aneurysm or an aortic dissection Atherosclerosis  High blood pressure  Smoking.  Deep wounds, injuries, or infections of the blood vessels.  A congenital abnormality  Inherited diseases.

Aortic aneurysms may cause:
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Aortic dissection may cause:
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shortness of breath, a croaky or raspy voice, backache, pain in your left shoulder or between your shoulder blades.

severe pain stomach pain lower back pain, or flu

Three common problems: •Varicose veins •Venous insufficiency •Venous thrombosis

veins (from the Latin vena) are blood vessel that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood.

Venous system in the legs:  Superficial veins- saphenous veins and its tributaries.  Deep Venous Channels Communicating veins (perforators) connects these two systems.

Superficial veins are those whose course is close to the surface of the body, and have no corresponding arteries. Deep veins are deeper in the body and have corresponding arteries.

Blood flow in the major veins of the lower extremity depends, in part, on the pumping action produced by leg muscle contractions. Retrograde flow is prevented by venous valves.

veins that have become enlarged and tortuous  leaflets of the valves no longer meet properly, and the valves don't work.  allows blood to flow backwards and they enlarge even more.  most common in the superficial veins of the legs, which are subject to high pressure when standing.

Originate in the superficial saphenous veins.  s/sx: unsightly appearance, aching, edema  treatment: elastic support stockings, elevating the legs, and exercise. Sclerotherapy Surgical Treatment

Becomes inevitable when flow in these deep channels is impaired or blocked.  DVT(Deep Vein Thrombosis)  is the formation of a blood clot("thrombus") in a deep vein.  it is a form of thrombophlebitis  s/sx: some DVT can occur without symptom.  But many cases painful, swollen, red, warm and the superficial veins may be engorged.

Causes deformity of the vavle leaflet, rendering them incapable of closure  Muscle pumps are ineffective  Secondary failure of the communicating and superficial veins subjects the subcutaneous tissues to high pressures

venous reflux, is the impaired return of venous blood from the legs and feet,.  reflux is caused by the over dilation of the vessel wall(prevents the valve cusps from closing properly resulting in reflux. )and damaged or absent valves.

s/sx:  Edema-exacerbated by long standing  Necrosis of subcutaneous fat deposits followed by skin atrophy  Brown pigmentation Impaired tissue nutrition causes statis dermatitis and venous ulcers. Statis Dermatitis- presence of thin, shiny, bluish-brown, irregularly pigmented desquamative skin.

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thrombophlebitis a blood clot that forms within a vein. Superficial venous thromboses can cause discomfort but generally do not cause serious consequences, unlike the deep venous thrombases(DVTs) that form in the deep veins of the legs or in the pelvic veins. Caused by: prolong bed rest or immobility, ventilatory support and spinal cord injury. S/sx: some are asymptomatic because veins are not totally occluded. when present most common s/sx are: pain, swelling, and deep muscle tenderness.

Alterations in blood pressure

 Arterial

Blood Pressure

Arterial BP reflects two factors of the arteries close to the heart  Their elasticity (compliance or distensibility)  The amount of blood forced into them at any given time  Blood pressure in elastic arteries near the heart is pulsatile (BP rises and falls)

Arterial Blood Pressure

Systolic pressure – pressure exerted on  arterial walls during ventricular contraction  Diastolic pressure – lowest level of arterialpressure during a ventricular cycle  Pulse pressure – the difference between systolic and diastolic pressure  EX: 120-80= 40 (Pulse Pressure)

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Blood Pressure (BP) Force per unit area exerted on the wall of a blood vessel by its contained blood Expressed in millimeters of mercury (mm Hg) Measured in reference to systemic arterial BP in large arteries near the heart The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

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Measuring Blood Pressure Systemic arterial BP is measured indirectly with the auscultatory method A sphygmomanometer is placed on the arm superior to the elbow Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure  Systemic arterial BP is measured indirectly  with the auscultatory method  A sphygmomanometer is placed on the arm  superior to the elbow  Pressure is increased in the cuff until it is  greater than systolic pressure in the brachial  artery  Pressure is released slowly and the

Alterations in Blood Pressure  Hypotension – low BP in which systolic  pressure is below 100 mm Hg  Hypertension – condition of sustained  elevated arterial pressure of 140/90 or higher  Transient elevations are normal and can be  caused by fever, physical exertion, and  emotional upset  Chronic elevation is a major cause of heart  failure, vascular disease, renal failure and

Hypotension  Orthostatic hypotension – temporary low BP  and dizziness when suddenly rising from a  sitting or reclining position  Chronic hypotension – hint of poor nutrition  and warning sign for Addison’s disease  Acute hypotension – important sign of  circulatory shock  Threat to patients undergoing surgery and  those in intensive care units

Hypertension  Hypertension maybe transient or persistent  Primary or essential hypertension – risk factors  in primary hypertension include diet, obesity,  age, race, heredity, stress, and smoking  Secondary hypertension – due to identifiable  disorders, including renal disease,  arteriosclerosis, hyperthyroidism,

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age over 60 male sex race heredity salt sensitivity obesity inactive lifestyle heavy alcohol consumption use of oral contraceptives

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reducing salt intake reducing fat intake losing weight getting regular exercise quitting smoking reducing alcohol consumption managing stress

is defined as an elevated systolic blood pressure.

manifestation  Systolic hypertension may be due to reduced compliance of the aorta with increasing age[3]. This increases the load on the ventricle and jeopardizes coronary blood flow, which can eventually result in left ventricular hypertrophy, coronary ischemia, and heart failure. [4]

Physical activity  Stressful situation

primary or essential hypertension - hypertension without known  Secondary hypertension -When a person has hypertension caused by  another medical condition

Bp check regularly by using sphygmomanometer  X-ray and tissue examination  Screening program provides an effective means of early detection.

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Maintain arterial blood pressure below 140/90 mm Hg Lifestyle modification Reducing salt intake Losing weight Regular exercise Quitting smoking Guidelines for the use of pharmacologic agents Diuretics β-adrenergic blockers ACE inhibitors calcium channel receptor-blocking drugs

◦ Hypertension that results from an underlying, identifiable, often correctable cause 5-10% CAUSES OF SECONDARY HYPERTENTION Renal hypertension- refers to hypertension caused by reduced renal blood flow and activation of the renin-angiotensin-aldosterone. pheochromocytoma- is a tumor of chromaffin tissue, which contains symppathetic nerve cells that stain with chromium salts.  coartation of the aorta◦ Most often just distal to the origin of the left subclavian artery ◦ High incidence of premature death ◦ Decreased lower-extremity pulses with upper extremity hypertension

Characterized by sudden marked elevations in blood pressure, with diastolic values above 120 mm Hg complicated by evidenced of acute or rapidly progressive life-threatening organ dysfunction.

high blood pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension).

Gestational hypertension - Blood pressure elevation without proteinuria, that is detected for the first time during midpregnancy and returns to normal by 12 weeks postpartum. Chronic hypertension - Blood pressure ≥140 mmHg or ≥ 90 mmHg diastolic that is present and observable before the 20th of pregnancy. Hypertension that is diagnosed for the first time during pregnancy and does not resolve after pregnancy also is classified as chronic hypertension. Preeclampsia- eclampsia - Pregnancy-specific syndrome of blood pressure elevation (bp > 140/90 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 0.3 g in a 24 hr specimen).

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ≥140/90 mmHg prior to 20th wk of pregnancy) with superimposed proteinuria and with or without signs of the preeclampsia syndrome.

Obtain regular prenatal medical care.  Avoid alcohol and tobacco.  Talk to your doctor about any over-thecounter medications you are taking or are thinking about taking.

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