arterial and venous, Alterations in cardiovascular system

Disorders of arterial circulation:

• ALL related to a decrease in blood flow to tissues 

  • Causes: narrowing or occlusion of blood vessels or a weak vessel wall  

  • Ischemia : tissue injury related to decreased oxygen supply 

  • Infarction tissue death related to no oxygen supply 

• Hyperlipidemia

• lipoproteins

• hypercholesterolemia

• atherosclerosis

What is a tissue injury related to decreased oxygen supply 

ischemia

What is tissue death related to no oxygen supply 

infarction

What is beind described?

• Increase in lipid, triglyceride, and cholesterol levels 

• Lipids are insoluble in plasma – transported by lipoproteins(fat carrying proteins) 

• #1 cause of atherosclerosis (primary culprit associated with myocardial infarction & brain attack) 

hyperlipidemia

What are lipoproteins?

• Fat-carrying proteins that assist in carrying cholesterol & triglycerides in the blood 

• High-density lipoproteins (HDL)

• Low-density lipoproteins (LDL)

What ..

• Transports cholesterol to the liver to be metabolized and excreted 

• Goal: >60

High-density lipoproteins (HDL)       “happy” 

What is the goal for High-density lipoproteins (HDL)       “happy” 

>60

What…

• Transports cholesterol throughout bloodstream contributing to cholesterol buildup on vessel walls (atherosclerosis) 

• Goal: <100

Low-density lipoproteins (LDL)         “lousy” 

What is cholesterol buildup on vessel walls

atherosclerosis

What is the goal for Low-density lipoproteins (LDL)         “lousy” 

<100

Triglycerides 

• Primary form of stored energy in the body; type of fat 

• Goal <150 

What is Hypercholesterolemia 

• Serum Cholesterol levels: Goal:_<200 mg/dl

• Causes: genetics, nutrition, metabolic disease 

• Xanthomas:   Cholesterol deposits that develop along tendons secondary to familial hypercholesterolemia 

What is the goal for Hypercholesterolemia 

<200

What are Cholesterol deposits that develop along tendons secondary to familial hypercholesterolemia 

Xanthomas

What is Atherosclerosis?

Deposits of fats in the intimal lining of arteries

Risk factors: Atherosclerosis

• ↑ LDL [Hypercholesterolemia] 

• Age 

• Diabetes mellitus (2x risk for CAD) 

• Family history 

• Hypertension (2x risk for CAD) 

• Male gender 

• Obesity 

• Postmenopausal women 

• Smoking: damage to endothelial lining  

Athereosclerosis complications:

• Ischemic Heart Disease 

• Stroke 

• Peripheral vascular disease 

Atherosclerosis Pathophysiology

Lesion Types:

• Fatty streak

• Fibrous Atheromatous Plaque 

• Complicated Lesion 

What are..

• Deposits of lipids with macrophages/muscle cells (foam cell); progressively enlarge by becoming thicker and more elevated 

• Form yellow discolorations 

fatty streak

What is ..

• Additional accumulation of lipids after endothelium is damaged 

• Scarring and calcifications form 

• Pearly white – gray color 

• As plaque accumulates – vessel lumen narrows – sets stage for thrombus formation  

Fibrous Atheromatous Plaque 

What is a complicated lesion?

• Thrombosis or ulceration of vessel 

• May have scar tissue deposits 

Development of Atherosclerotic Lesions 

1. Endothelial (intimal) lining injury 

2. Inflammatory response 

3. WBC (cellular stage): macrophages and monocytes 

4. Platelet aggregation and adhesion 

5. Muscle cells proliferate 

6. Rupture, ulceration, or erosion of fibrous plaque 

7. May lead to hemorrhage or thrombosis  

 

Atherosclerosis clinical manefestations

• Depends upon vessels involved and the extend of obstruction; (majority in femoral or popliteal artery) 

• Slow progression that may take over 20-40 years; slow progression may cause collateral circulation(making new vessels) 

May result in: 

•      Ischemia    : inadequate blood supply  

•      Thrombus     : stationary clot 

•      Emboli   :  traveling clot  

•    Aneurysm    : weakening of the blood vessel 

What is inadequate blood supply  

ischemia

What is a stationary clot?

thrombus

What is a traveling clot?

emboli

What is weakening of the blood vessel?

aneurysm

ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS]

• Acute Arterial Occlusion: EMERGENCY 

• Atherosclerotic Occlusive Disease 

• Thromboangiitis Obliterans (Buerger’s Disease) 

• Raynaud’s Disease or Phenomenon 

• ANEURYSMS 

• Aortic Aneurysms 

• Dissecting Aortic Aneurysm 

What is the..

• Sudden onset occlusion of an artery from a thrombus or an embolus (EMERGENT) 

• The blood flow to the distal tissues is impaired 

• Results in tissue ischemia and then necrosis  

Acute Arterial Occlusion: EMERGENCY 

• ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS]

What are causes of Acute Arterial Occlusion: EMERGENCY 

• Air  

• Bone marrow fat 

• Cardiac dysrhythmias (e.g. atrial fibrillation) 

• Plaque 

• Valvular disease 

What are the manefestations of Acute Arterial Occlusion: EMERGENCY 

• Line of demarcation 

• 7 P’s 

  • Pistol shot: Sudden onset of pain 

  • Pale: to cyanosis/mottling 

  • Polar (cold)  

  • Pulselessness

  • Pain

  • Paresthesisa, numbeness or tingling (sensory disturbance) 

  • Paralysis

What are the 7 P’s of Acute Arterial Occlusion: EMERGENCY

• Pistol shot: Sudden onset of pain 

• Pale: to cyanosis/mottling 

• Polar (cold)  

• Pulselessness

• Pain

• Paresthesisa, numbeness or tingling (sensory disturbance) 

• Paralysis

ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS:

Atherosclerotic Occlusive Disease

• Also known as: Peripheral Arterial Disease (PAD) or Peripheral Vascular Disease (PVD) 

• Risk factors similar to atherosclerosis 

• Superficial femoral and popliteal arteries most affected 

 

Atherosclerotic Occlusive Disease is also known as?

• Peripheral Arterial Disease (PAD) or Peripheral Vascular Disease (PVD) 

Manifestations  of PAD/PVD– occur with >50% occlusion: 

• Intermittent claudication

  • pain when walking, usually in the calf  

• Pain at rest 

• Paresthesia: sensory distrubances 

• Cool 

• Thin, shiny skin without hair 

• Weak / absent pulses 

• Thick toenails 

• Discoloration 

• Extremity pale with elevation ( no gravity assitance with flow) 

• Extremity red when dependent 

• Skin breakdown – Arterial Ulcers(dry gangrene)- usually on tips of toes or heel or outer ankle  

What is being described?

• Inflammatory disease of the peripheral arteries accompanied by thrombi, inflammation_, and vasospasm of arterial segments 

• Affects men under 40 who SMOKE  

 

Thromboangiitis Obliterans (Buerger’s Disease) 

• ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS]

What is the pathophysiology of  

Thromboangiitis Obliterans (Buerger’s Disease) 

1. Inflammatory process within small & midsize arteries (hands & feet) 

2. Impaired blood flow 

3. Intermittent exacerbations(making something worse) & remission 

4. May have genetic component 

What are the clinical manefestations of  

Thromboangiitis Obliterans (Buerger’s Disease) 

• Pain: Intermittent claudication (early) or at rest (late) 

• Cold sensitivity 

• Diminished peripheral pulses 

• Pale, cyanotic, or red skin color 

• Skin is thin and shiny; hairless 

• Thick nail 

• May lead to arterial ulceration 

What is being described?

• Intense vasospasm in the small arteries and arterioles of the fingers and less commonly, toes 

• May be associated with previous frostbite 

Raynaud’s Disease or Phenomenon 

• ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS]

What is the pathophysiology of Raynaud’s Disease or Phenomenon 

• Arterial spasms inhibit arterial blood flow to the distal digits (fingers or toes) 

• Initially only 1 or 2 fingers may be involved – usually fingertips 

• As the disease progresses the entire finger and/or all the fingers may be affected 

• Young women are the most commonly affected – ages 20-40 

• Attacks may be triggered by exposure to cold or emotional stress 

 

What are the manfestations of  

Raynaud’s Disease or Phenomenon 

• Symptoms “come & go”; intermittent 

• Attacks tend to be bilateral 

• Thick/brittle nails 

• BLUE – due to vasospasm 

• WHITE – numbness and cold sensation – d/t decreased circulation  

• RED - - throbbing and paresthesia – d/t spasm resolves and circulation returns 

• Ischemia – ulceration & gangrene 

ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS:

What are aneurysms

• Abnormal dilation (ballooning) of a vessel wall 

• Veins or arteries – more common in aorta 

• Causes: congenital defects, trauma, infections, atherosclerosis 

ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS:

What are aortic aneurysms

• Involves any section of the thoracic/abdominal aorta 

• Causes: HTN, atherosclerosis, degeneration of vessel 

• Complications: rupture – increased risk if aneurysm is > 5cm in diameter 

Manefestations of aortic aneurysms

• Dependent upon size and location 

• Asymptomatic 

• Pulsation to upper abdomen region (>4cm) 

• Substernal, neck and back pain  

ARTERIAL DISEASES OF THE EXTREMITIES [PERIPHERAL VASCULAR DISORDERS:

What is a dissecting aortic aneurysm

• LIFE-THREATENING 

• Tearing of vessel wall; hemorrhage into the vessel wall with longitudinal tearing or separating = blood filled channel 

• Can occur anywhere along the length of the aorta 

• Causes: anything that weakens or causes degenerative changes to vessel – ex. HTN, congenital defects and degeneration of the medial layer of the vessel wall 

 

Manefestations of Dissecting aortic aneurysm

• Sudden onset of excruciating pain often described as ripping or tearing that may radiate to back and shoulder blades

• Hypertension initially  —>   Hypotension 

• Unilateral or bilateral unobtainable B/P, pulse due/to no arterial flow to arm(s) 

Disorders of the venous circulation

• Varicose veins

• Venous insuffciency

• VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT) 

What is..

• Irregular, distended, tortuous (twisting) veins with incompetent valves(for ex they go backwards or are stretched) 

• Can occur in any vein (i.e. hemorrhoids in the rectum) 

• Most common in lower extremities such as saphenous veins 

Varicose veins

Varicose veins pathophysiology

• Increased pressure on the venous walls stretches the vessel wall 

• Effects of gravity  

• Valves begin to close poorly and become incompetent 

• Results in pooling in the lower extremities (decreased venous return) which further stretch the venous walls and increases valvular incompetence 

Risk factors of varicose veins

• Age  

• Obesity (increased abdominal pressure) 

• Occupational (prolonged standing) 

• Pregnancy 

• White females 

What are these manefestations of?

• May be asymptomatic 

• Aching pain in the affected leg, especially after standing for long periods of time 

• Leg fatigue, heaviness 

• Warmth (too much blood not getting where it needs to go= warmth) 

• Visibly dilated veins 

Varicose veins

What is Inadequate venous return over a _prolonged_of time 

 

VENOUS INSUFFICIENCY 

What is the pathoophysiology of  

VENOUS INSUFFICIENCY 

• Varicose veins  

• Valvular Incompetence 

• Venous stasis 

• Tissue Congestion & edema 

• Poor oxygenation of extremities – ulcer 

What are these manfestations of?

• Same as varicose veins   AND 

• Tissue congestion, edema & impairment of tissue nutrition 

• Brown discoloration d/t skin atrophy and breakdown of RBC’s 

• Lymphatic insufficiency and sclerosis of lymph channels 

• Symptoms worsen with standing 

• Most common cause of leg ulcers: Venous stasis ulcers due to poor oxygenation of tissues in the legs – recurrent;  

• Usually occurs on medial or anterior aspect of ankle 

• Necrosis of subcutaneous tissues 

• Poor healing   

 

 

VENOUS INSUFFICIENCY 

What is the

• The formation of a blood clot on the wall of a vein. Inflammation and obstruction of venous flow often accompanying a venous thrombosis 

• Risk of breaking off (emboli) resulting in pulmonary emboli 

 

VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT) 

What is the Pathophysiology of VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT) 

• Virchow’s Triad 

1. Stasis of blood: immobility

2. vessel damage

3. increased blood coagubility

Vessel trauma – clotting cascade – platelet aggregation – initial clot – inflammatory response – tenderness – swelling – redness 

What is Virchow’s Triad, DVT patho

1. Stasis of blood: immobility

2. vessel damage

3. increased blood coagubility

Vessel trauma – clotting cascade – platelet aggregation – initial clot – inflammatory response – tenderness – swelling – redness 

Dangers of VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT,) (DVT)

BREAK LOOSE – TRAVELS THRU VENOUS SYSTEM – LODGES IN PULMONARY ARTERY 

Risk factors of VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT,) (DVT)

• Immobility 

• Pregnancy 

• Use of oral contraceptives 

• Surgery (esp. orthopedic & gynecologic) 

• Increased coagulability states (ex: dehydration) 

What are the manefestations of VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT,) (DVT)

• Asymptomatic 

• Dull ache - Pain 

• Redness 

• Warmth 

• Asymmetrical swelling 

Prevention of VENOUS THROMBOSIS (DEEP VEIN INVOLVEMENT,) (DVT)

• Identify high risk clients (ex: immobile people) 

• Medications (e.g. anticoagulants) 

• Early mobilization  

• Leg exercises 

• Intermittent compression devices / Compression hose (TED hose)