Blood Vessel Disorders

Peripheral Arterial Disease (Thromboangitis Obliterates)

Also called Buerger Disease- this is an inflammatory arterial disorder that causes thrombus formation. This disorder affects medium sized arteries, usually the plantar and digital vessels in the foot and lower leg. This is characterized by the segmental, thrombosing, acute, and chronic inflammation. Although primarily an arterial disorder, the inflammatory process often extends to involve adjacent veins and nerves. Etiologies include: Cigarette smoking, chewing tobacco, and genetics. Clinical manifestations: Pain, peripheral pulses are absent, changes in color of extremities, and cyanosis. Diagnosis and treatment include: Life style changes (stop smoking), and focusing on methods that produce vasodilation.

Low density lipoprotein (LDL)

"Bad cholesterol" Made of 10% triglycerides, 50% cholesterol and protein. These lipoproteins are the main carriers of cholesterol in the blood

High Density lipoprotein (HDL)

"Good Cholesterol" Mostly made up of protein, and small amount of cholesterol. These are synthesized in the liver, and transport cholesterol from tissues, back to the liver.

Theory of development of an atherosclerotic plaque

1. Damaged endothelium and inflammation develops. 2. Monocytes are activated and move into arterial wall. 3. Monocytes become foam cells (metaplasia) and and start accumulation fatty marerial. 4. Smooth muscles cells begin to multiply and move into arterial lining. 5. There is fibrous plaque development (stable and unstable). 6. Connective, and elastic tissues, cellular debris, and calcium deposits accumulate in in plaque (atheroma), 7. The atheroma thickens and bulges into the blood vessel lumen, potentially narrowing or blocking an artery or potentially hemorrhaging. causing thrombosis, embolus, or aneurysm.

Different Types of Aneurysms

1.Fulsiform Aneurysm (narrow cylinder shaped) 2. Saccular Aneurysm (berry or sac shaped) 3. Dissecting(separation of the middle blood vessel layers) 4. False Aneurysm (Pulsating hematoma). 5. Abdominal Aortic Aneurysm (most common signs and symptoms include, back/flank pain, nausea, pulsating mass in abdomen.) , 6. Thoracic Aortic Aneurysm, 7. Cerebral aneurysm. 8. Aortic Dissecting Aneurysm ( sudden chest pain, feeling like something is being torn or ripped, SOB, weak pule in one arm, and loss of consciousness).

Vasculitis

An inflammation of the blood vessels that causes changes in the blood vessel walls. Vasculitis can cause vessel walls to thicken and narrow, cutting off vital blood supply to tissues and organs. Symptoms include fever, fatigue, weight loss, and muscle and joint pain. Some forms of vasculitis improve on their own. Others require medications. Vasulitis may result from direct injury to blood vessel, infectious agents, or immune processes, or may be secondary to other disease states such as systemic lupus.

Peripheral Arterial Disease

Arterial Disorders of the extremeties and cause vasculitis. These diseases include: 1.Acute Arterial Occlusion, 2. Atherosclerotic Occlusive disease, 3. Thromboangiitis, 4. Raynauds Disease.

Arterial Thrombus

Arterial thrombosis is a blood clot that develops in an artery. It's very dangerous, because it can obstruct the flow of blood to major organs. Depending on where the clot forms, arterial thrombosis can cause several serious conditions, including: heart attack - when blood flow to the heart is suddenly blocked.

Monckebergs Sclerosis (arterial circulation)

Calcium salts that accumulate in the muscle layer of small to medium sized arteries (tunica media) decreasing flexibility. Tends to attack the elderly.

Chylomicron

Chylomicrons are lipoprotein particles that consist of triglycerides, phospholipids, cholesterol, and proteins. They transport dietary lipids from the intestines to other locations in the body. Produced by small intestine.

Life Style Changes to help reduce HTN

Weight loss, exercise, reduced sodium intake, reduced alcohol intake, quitting smoking, reducing stress, and self-monitoring of BP.

Primary hypertension

Elevation in blood pressure as observed multiple times over a time range. This has multifactoral etiologies. and is a slow chronic process. A BP of 140/90 is considered to be hypertension. Some etiologies may include:genetics, age, race, diet, weight. Clinical manifestations: This is a largely asymptomatic condition. But some signs/symptoms may include: headaches, dizziness, confusion, blurry vision, anxiety, and edema. Complications of HTN include: cardiovascular disease, dissecting aneurysm, angina, MI, CVA, stroke, and renal disease.

Tretments of HTN

For stage 1-1 type of Diuretics, and using ACE inhibitors, angiotensin II receptor beta blockers, alpha blockers, calcium channel blockers, and vasodilator drugs. For stage 2 and over- 2 types of diuretics, ACE inhibitors, angiotensin II receptor blockers, beta blockers, alpha blockers, calcium channel blockers, and vasodilator drugs.

Thrombosis

Formation of a clot that is attached to the wall of a blood vessel.

Arteriosclerosis

General term for hardening of the arteries. Chronic disease which results in impaired blood circulation. Can occur in veins as well. This is the build-up of fats, cholesterol, and other substances in and on the artery walls. Can cause atherosclerosis and monckebergs sclerosis.

Artherosclerosis (arterial circulation)

Hardening cholesterol plaques that develop in arteries that may block blood flow in a blood vessel or clot that may travel elsewhere. Etiologies include: genetics, high serum cholesterol, trigycerides, and glucose, stress, hypertension, high serum homocysteine (amino acid found in red meat), low estrogen, obesity, and sedentary lifestyle, smoking, chlamydia penumoniae, and inflammation. Dignosis is done with blood profile(checking cholesterol), High C-Reactive protein, High ESR (erythrocyte sedementation rate) ECG, imaging (CT scan, XR, echo, ultrasound) , stress tests, and Ankle brachial Index (ABI)- this is the systolic pressure at ankle, divided by the systolic pressure at the arm.

Chronic Venous Insufficiency

Improper functioning of the vein valves in the leg, causing swelling and skin changes. This refers ti the physiologic consequences of DVT, valvular incompetence, or a combination of both conditions. Normally, the vein valves keep blood moving back toward the heart. Symptoms include varicose veins, swelling, or skin color changes on the affected leg. If the condition progresses, leg ulcers can form. Treatment includes compression stockings, elevating the legs, and moisturizing the skin to prevent cracks. In some cases, surgery may be needed to improve blood flow.

Very low density lipoprotein (VLDL)

Lipoproteins are made up of cholesterol, triglycerides, and proteins. They move cholesterol, triglycerides, and other lipids (fats) to around the body. VLDL is one of the three main types of lipoproteins. VLDL contains the highest amount of triglycerides

Vasculitides

These are a group of blood vessel disorders characterized by inflammation and necrosis of the blood vessel walls (vasculitis). These are commonly classified baed on etiology. pathologic findings, and prognosis. Classification system includes three groups: 1-Small vessel (arterioles, venules, and capillaries) 2- Medium sized vessels (medium/small sized arteries, and aterioles) 3- Large Vessels (the aorta and its major tributaries).

Hyperlipidemia (atertial circulation)

These are elevated blood lipids. Lipids are classified as triglycerides or neutral fat, phospholipids, and cholesterol. This can be classified into two categories; Primary or Secondary. Primary includes elevated cholesterol levels that develop independent of other health problems. or lifestyle, whereas secondary is associated with other health problems or lifestyle behaviors. Etiologies can include: genetics, nutrition, medications, and metabolic conditions. A patient is a significant risk for development of atherosclerosis, heart disease ,and stroke. Diagnosis includes: a series of blood tests, drawing cholesterol levels. Treatments include:life style changes (exercise, diet, quitting smoking/drinking, and losing weight) and medications (statins)

Varicose Veins

These are veins that are dilated(enlarged) , tortuous of the lower extremities. These are common and often lead to secondary problems of venous insufficiency. These can be described as being primary or secondary. Primary varicose veins originate in the superficial saphenous veins, while secondary varicose veins result from impaired blood flow in the deep venous channels. The incidence of varicose veins rises with age. There is also a high chance in obese people. Etiology includes: Prolonged standing, increased intra-abdominal pressure, age, and pregnancy. Manifestations include: Unsightly appearance (bulging), aching in the lower extremities, edema, color changes, and pain after sitting for a long time. Diagnosis:A dx can be made after a thorough hx and PE are done. Ultrasound may be done to assess the flow of the blood through the veins. Also a "Perthes" test may be performed-this is where a tourniquet is applied to the affected knee while the person is instructed to do 10 heel rises, and the leg is elevated. Treatments focus on improving venous flow and preventing tissue injury. Fitting compression stockings may be used to prevent distention. Sclerotherapy (injecting sclerosing agent into the collapsed superficial vein to produce fibrosis of the vessel lumen) , and surgical treatment may also be used.

Stable Plaques

These have thick fibrous caps, partially block blood vessels, and do not tend to form clots or emboli.

Unstable Plaques

These have thin fibrous connective tissue cap. Can potentially rupture and cause a clot to form. These may completely block the artery, and this clot may break free and become and embolus.

Secondary Hypertension

This describes an elevation in BP due to another disease condition. Unlike primary htn many of the conditions causing secondary htn can be corrected or cured by surgery or specific medical treatment. This type of htn tends to be seen in people younger than 30, and older than 50. Among the most common causes of secondary htn, renal disease is one of them.

Venous Thrombus

This describes the presence of a thrombus in a vein and the accompanying inflammatory response in the vessel wall (A blood clot in a deep vein, usually in the legs) These can develop in the superficial or deep veins. Most people experience no sx. This condition is serious because blood clots can loosen and lodge in the lungs. Leg pain or swelling may occur, but there may be no symptoms. Treatments include medications and use of compression stockings.

Raynaud Disease

This is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers, and less often the toes. This is a common disoder affecting 3-5% of the population, and is more common in women. Etiology: Exposure to cold, or strong emotions. Can be associated with previous vessel injury, such as frostbite, occupational trauma, and chronic arterial disorders. Clinical manifestations: Changes in color of skin, numbness and tingling in fingers, a period of hyperemia with intense redness, throbbing, and parasthesias. Diagnosis and treatment: Dx is based on history, or initiating an attack by putting hand in cold water. Treatment measures are directed toward eliminating factors that cause vasospasm and protecting digits from trauma during an ischemic episode Protecting the body from cold (not just the extremities), avoidance of emotional stress. Treatments with vasodilator meds may be used.

Acute Arterial Occlusion (Embolus)

This is a sudden event that interrupts arterial flow to the affected tissues or organ. Most are the result of an embolus or thrombus. Etiology: Caused by conditions that cause blood clots to develop on the wall of a heart chamber or valve surface. These are usually a complication of heart disease: ischemic heart disease with or without infarction, a fib, or rheumatic heart disease. Clinical Manifestations: The seven "Ps" -1. Pistol Shot (acute onset)2. Pallor. 3. Polar(cold). 4. Pulselessness 5. Pain. 6. Paraesthesia. 7. Paralysis. Dx and treatment: Dx is based of impaired blood flow. It uses visual assessment, palpation, of pulses, and methods to asses blood flow. Treatment is aimed at restoring blood flow. An embolectomy, is the optimal therapy when a large artery is occluded. Thrombolytic Therapy and anticogulants may also be used.

Orthostatic Hypotension

This is an abnormal drop in in BP when getting up to stand and dizziness, and syncope may occur. Etiologies of this may include: reduced blood volume, drugs, slow re fluxes with aging, prolonged immobilization, ANS dysfunction. (vasovagal syncope or neurocardio syncope)

Aneurysm

This is an abnormal localized dilation of a blood vessel. These can occur in arteries or veins, but they are most common in the aorta. There are two types of aneurysm:1- True aneurysm (one in which the aneurysm is bounded by a complete vessel wall.) and false aneurysm (localized dissection or tear in the inner wall of the artery with formation of an extra vascular hemotoma that causes vessel enlargement.)Etiologies Include: Genetics, wear and tear with age, atherosclerosis. Risk factors include: Diabetes, hypertension, smoking, alcoholism, copper deficiency. Some effects of aneurysms include: Thombus/embolus, pressure on other structures, sloe leakage of blood, and rupture. Specific manifestations depend on the location of the aneurysm. The severity depends on size and location. The risk factor of rupturing increased with the size of the aneurysm. Some common manifestations may include: edema, anemia, and pain. Treatment options include: surgery, angioplasty, life-style changes, treatment of hypertension, and pain management.

HTN during pregnancy

This is called Pre-Eclampsia-this is elevated blood pressure, proteinuria, elevated liver enzymes, persistent headaches, vision difficulties, and epigastric pain. If pre-eclampsia can lead to eclampsia that causes seizures. There is gestational hypertension that is not associated with proteinuria, and also women who have chronic HTN going into pregnancy. HTN can increase risk of early labor, impair fetal growth, and may cause placental abruption.

Intermittent Claudation

This is pain with walking. Generally seen in people with Atherosclerotic Occlusive Disease. Typlically people with this disorder complain of calf pain, because the gastrocnemius muscle has the highest oxygen consumption of any muscle group in the leg while walking.

Embolism

This is the obstruction of vessel by an embolus, which is a detached, traveling mass. Can be: Thromboembolism (traveling blood clot), cholesterol embolism, tissue embolism, fat embolism, air embolism, and amniotic fluid embolism.

Classification of Aortic Aneurysms

Type A-Refers to the association with the ascending aorta. Type B-these aneurysms occur elsewhere in the body along the aorta/descending aorta.