6.4 (after 6.1): peripheral vascular disorders

ARTERIES

• Thick walled vessels that transport oxygen & blood from aorta → tissues

3 layers

• Intima

• Media-smooth muscle

• Externa

VEINS

• Thin walled vessels that carry back deoxygenated blood from capillaries to R atrium

• 3 layers

• Little smooth muscle and connective tissue

• More distensible

• Major veins in lower extremity

• One way valves

• Why are these important? ____

May be more prone to blood clots (blood flows much slower and under lower pressure (bc flowing against gravity) compared to arteries)

ARTERIAL DISORDERS

Arterioscloerosis 

• Loss of ___

• Hardening of ____

Pathophysiology 

• ___

• Less ___

ARTERIAL DISORDERS

Arterioscloerosis 

• Loss of elasticity (-sclerosis)

• Hardening of vessel walls (over time, & is normal in aging)

Pathophysiology 

• Calcium deposited into cytoplasm and lose elasticity

• Less stretch and less O2 blood flow delivered

ARTERIAL DISORDERS

Atherosclerosis 

-___ 

-Lumen of arteries fill with ___

-More modifiable to ___

Manifestations	• ___ stage of atherosclerosis no ___  • Legs: ____ • Coronary: ___ • Renal: ___ • CV event: Stroke, MI
Evaluation	• Risk factors: high cholesterol, menopause, age,   • Family history • Localized perfusion studies: Doppler, EKG, ECHO (ultrasound)
Treatment	• Blood pressure • Cholesterol • Anticoagulant

Atherosclerosis 

-Chronic inflammatory process that damages the artery over time 

-Lumen of arteries fill with fatty streaks and fibrous plaque, made up of cholesterol

-More modifiable to vascular diseases than arteriosclerosis

Manifestations	• Early stage of atherosclerosis no symptoms until worsening of the condition  • Legs: claudication/ pain in calves when walking (bc demanding more blood flow to that area but not successfully getting the blood to it) • Coronary: Reduced exercise tolerance • Renal: Hypertension (bc altering blood flow to kidney) • CV event: Stroke, MI
Evaluation	• Risk factors: high cholesterol, menopause, age,   • Family history • Localized perfusion studies: Doppler, EKG, ECHO (ultrasound)
Treatment	• Blood pressure • Cholesterol • Anticoagulant

PERIPHERAL VASCULAR DISORDERS: 

Peripheral Artery Disease

Decreased blood flow toward tissue	• Creating ___ • ___ • Changes in ___
How would the pulses be?	• ___
What type of pain would they feel?	• Sharp, stabbing • Intermittent ___, rest pain
What are the signs and symptoms?	• Loss of ___ • _____

PERIPHERAL VASCULAR DISORDERS: 

Peripheral Artery Disease

Decreased blood flow toward tissue	• Creating ischemia below occlusion • Ischemic Ulcers: from lack of blood flow • Changes in Skin
How would the pulses be?	• Diminished/ absent
What type of pain would they feel?	• Sharp, stabbing • Intermittent claudication, rest pain
What are the signs and symptoms?	• Loss of hair, dry scaly skin in that area • Cold, gray blue skin, elevational pallor

PERIPHERAL VENOUS DISORDERS

• what is it? ____

• ___

• ___

• ___ will develop

Clinical Manifestations

• Dull, constant, achy

• ___

• ____

• ____

Virchow’s Triad: 

• Stability

• Vascular damage

• Hypercoagable state

PERIPHERAL VENOUS DISORDERS

• Deoxygenated blood can’t get back to the heart

• Pooling in extremities

• demand for O2 is greater than the supply

• Areas of ischemia and necrosis will develop

Clinical Manifestations

• Dull, constant, achy

• Edema (blood pooling instead of going back to heart)

• Pulses diminished or absent (not returning blood to heart)

• Warm legs (bc of venous congestion & pooling. Blood hanging around will make it warm)

Virchow’s Triad: 

• Stability

• Vascular damage

• Hypercoagable state

Venous Thromboembolism - DVT

Clot in ____

Pathophysiology	• Damage to the ___ • Vasoconstriction, which ___ • Platelets adhere to ___ • Platelet Plug • Coagulation Cascade Activate • Clotting factors-proteins made by ___ • Fibrinogen → fibrin • Mesh around platelets • Creates clot, can become dislodged
DVT assessment	-Pain  -Swelling -Redness  -Warmth
Tx	-Thrombolytic Enzymes  -____ -Long term Prevention • Anticoagulants: warfarin, heparin • Low dose ASA -____ -Compression Stockings  -Calf exercises

Venous Thromboembolism - DVT

Clot in vein between muscles

Pathophysiology	• Damage to the endothelium • Vasoconstriction which limits blood flow • Platelets adhere to damaged wall • Platelet Plug • Coagulation Cascade Activate • Clotting factors-proteins made by liver • Fibrinogen → fibrin • Mesh around platelets • Creates clot, can become dislodged
DVT assessment	-Pain  -Swelling -Redness  -Warmth
Tx	-Thrombolytic Enzymes  -Thrombectomy (clot removal) -Long term Prevention • Anticoagulants: warfarin, heparin • Low dose ASA -IVC Filter (IV that keeps clots from traveling to lungs) -Compression Stockings  -Calf exercises