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

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

In the pulmonary system un-oxygenated 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 un-oxygenated blood

Triglycerides ndash combinations of 3 fatty acids condensed with a single glycerol molecule used in energy metabolism

Phospholipids ndash contains phosphate group essential in structural constituents especially in cell membrane

Cholesterol ndash synthesized from fatty acids thus with similar chemical activity to other lipids

Total serum cholesterol level lt200mgdL ndash considered desirable

Levels of 200-209mgdL ndash borderline high LDL cholesterol levels lt100mgdL ndash

considered optimal LDL 100-129 mgdL ndash near or above optimal LDL 130-159 mgdL ndash borderline high LDL 160-189 mgdL ndash high LDL gt or = 190 mgdL ndash very high HDL lt40 mgdL ndash considered low

levels gt or=60 mgdL 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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

In the pulmonary system un-oxygenated 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 un-oxygenated blood

Triglycerides ndash combinations of 3 fatty acids condensed with a single glycerol molecule used in energy metabolism

Phospholipids ndash contains phosphate group essential in structural constituents especially in cell membrane

Cholesterol ndash synthesized from fatty acids thus with similar chemical activity to other lipids

Total serum cholesterol level lt200mgdL ndash considered desirable

Levels of 200-209mgdL ndash borderline high LDL cholesterol levels lt100mgdL ndash

considered optimal LDL 100-129 mgdL ndash near or above optimal LDL 130-159 mgdL ndash borderline high LDL 160-189 mgdL ndash high LDL gt or = 190 mgdL ndash very high HDL lt40 mgdL ndash considered low

levels gt or=60 mgdL 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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Triglycerides ndash combinations of 3 fatty acids condensed with a single glycerol molecule used in energy metabolism

Phospholipids ndash contains phosphate group essential in structural constituents especially in cell membrane

Cholesterol ndash synthesized from fatty acids thus with similar chemical activity to other lipids

Total serum cholesterol level lt200mgdL ndash considered desirable

Levels of 200-209mgdL ndash borderline high LDL cholesterol levels lt100mgdL ndash

considered optimal LDL 100-129 mgdL ndash near or above optimal LDL 130-159 mgdL ndash borderline high LDL 160-189 mgdL ndash high LDL gt or = 190 mgdL ndash very high HDL lt40 mgdL ndash considered low

levels gt or=60 mgdL 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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Total serum cholesterol level lt200mgdL ndash considered desirable

Levels of 200-209mgdL ndash borderline high LDL cholesterol levels lt100mgdL ndash

considered optimal LDL 100-129 mgdL ndash near or above optimal LDL 130-159 mgdL ndash borderline high LDL 160-189 mgdL ndash high LDL gt or = 190 mgdL ndash very high HDL lt40 mgdL ndash considered low

levels gt or=60 mgdL 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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 raynaudrsquos dieseas raynaudrsquos 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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 ldquohardening of the arteriesrdquo 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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Thrombolytics- attempts to open the artery may include use of clot dissolving medications

Anticoagulants - medications that prevent the blood from clotting eg 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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

SYMPTOMS Intermittent claudication Site of occlusion determines site of pain Occlusion of abdominal aorta andor 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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Diagnosis Treatment

An examination usually reveals a decrease or absence of pulses in the extremitiesBlood tests are usually normalAn 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

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Raynaudrsquos 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

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Common causes are

Diseases of the arteries such as atherosclerosis and buergers 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

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Symptoms 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 Raynauds 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 Raynauds 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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Atherosclerosis High blood pressure Smoking Deep wounds injuries or infections of

the blood vessels A congenital abnormality Inherited diseases

The following increase the risk of an aneurysm or an aortic

dissection

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Aortic aneurysms may cause

Aortic dissection may cause

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 bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Three common problems bullVaricose veins

bullVenous insufficiencybullVenous 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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

veins that have become enlarged and tortuous

leaflets of the valves no longer meet properly and the valves dont 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 ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Originate in the superficial saphenous veins ssx unsightly appearance aching edema treatment elastic support stockings

elevating the legs and exerciseSclerotherapySurgical 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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 ssx 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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

ssx 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

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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

Ssx some are asymptomatic because veins are not totally occludedwhen present most common ssx 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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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 ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Arterial Blood Pressure Systolic pressure ndash pressure exerted

on arterial walls during ventricular

contraction Diastolic pressure ndash lowest level of

arterialpressure during a ventricular cycle

Pulse pressure ndash the difference between

systolic and diastolic pressure EX 120-80= 40 (Pulse Pressure)

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Blood Pressure (BP) 1048708 Force per unit area exerted on the wall of a blood vessel by its contained blood 1048708Expressed in millimeters of mercury (mm Hg) 1048708Measured in reference to systemic arterial BP in large arteries near the heart 1048708 The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Measuring Blood Pressure 1048708 Systemic arterial BP is measured indirectly with the auscultatory method 1048708A sphygmomanometer is placed on the arm superior to the elbow 1048708Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery 1048708Pressure is released slowly and the examiner listens with a stethoscope

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Alterations in Blood Pressure 1048708 Hypotension ndash low BP in which systolic pressure is below 100 mm Hg 1048708 Hypertension ndash condition of sustained elevated arterial pressure of 14090 or higher 1048708Transient elevations are normal and can be caused by fever physical exertion and emotional upset 1048708Chronic elevation is a major cause of heart failure vascular disease renal failure and

stroke

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Hypotension 1048708 Orthostatic hypotension ndash temporary low BP and dizziness when suddenly rising from a sitting or reclining position 1048708 Chronic hypotension ndash hint of poor nutrition and warning sign for Addisonrsquos disease 1048708 Acute hypotension ndash important sign of circulatory shock 1048708Threat to patients undergoing surgery and those in intensive care units

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

Hypertension 1048708 Hypertension maybe transient or persistent 1048708 Primary or essential hypertension ndash risk

factors in primary hypertension include diet obesity age race heredity stress and smoking 1048708 Secondary hypertension ndash due to identifiable disorders including renal disease arteriosclerosis hyperthyroidism obstruction of renal artery etc

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

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]

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

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]

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]

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

o Maintain arterial blood pressure below 14090 mm Hg

o Lifestyle modification Reducing salt intake Losing weight Regular exercise Quitting smokingo 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 HYPERTENTIONRenal 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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

Bp check regularly by using sphygmomanometer

X-ray and tissue examination Screening program provides an effective

means of early detection

o Maintain arterial blood pressure below 14090 mm Hg

o Lifestyle modification Reducing salt intake Losing weight Regular exercise Quitting smokingo 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 HYPERTENTIONRenal 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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

o Maintain arterial blood pressure below 14090 mm Hg

o Lifestyle modification Reducing salt intake Losing weight Regular exercise Quitting smokingo 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 HYPERTENTIONRenal 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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

Hypertension that results from an underlying identifiable often correctable cause 5-10

CAUSES OF SECONDARY HYPERTENTIONRenal 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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

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 ge140 mmHg or ge 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 gt 14090 mmHg) that occurs during the first 20 wks pregnancy and is accompanied by proteinuria(urinary excretion of 03 g in a 24 hr specimen)

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

Preeclampsia superimposed on chronic hypertension - Chronic hypertension( bp ge14090 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-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38

Obtain regular prenatal medical care Avoid alcohol and tobacco Talk to your doctor about any over-the-

counter medications you are taking or are thinking about taking

• Slide 32
• Slide 38