动脉和静脉疾病.pptVIP

* * * * * * * * * * * * * * * * * Diseases of Arteries and Veins Atherosclerosis Hypertension CAD: Stable and Unstable angina Dyslipidemia DVT, PE Clotting Medications Review Hypertension Primary Secondary Isolated Systolic hypertension (aortic sclerosis in elderly) Postural (orthostatic) Malignant (DBP 120) Causes encephalopathy Associated with general anesthesia Hypertension Pathophysiology Vasoconstriction Increased contract Increased HR Increased volume Arterial Heart remodeling RAAS activation Drugs Alpha-1 blockers Beta blockers ACE inhibitors ARBs Calcium channel blockers Diuretics Other Embolus Thromboembolism Air Embolism (diving, trauma, injection) Amniotic Bacterial Embolism Fat embolism Foreign matter (usually from injection) Drug precipitate, glass, linen fibers Arteriosclerosis Hardening of arteries Fibrotic Atherosclerotic Shape Eccentric Concentric Atherosclerosis Inflammatory disease Endothelial injury Fatty streak formation Fibrotic plaque Complicated lesion Endothelial Dysfunction Risk factors Smoking High blood pressure Cholesterol Sedentary life Homocysteine Turbulent blood flow “Novel” Risk factors CRP Serum fibrinogen Insulin resistance Oxidative stress Infection Periodontal Disease Injured Endothelium Inflamed Produces less vasodilating hormones Produces less antithrombotic hormones Inflammatory molecules cause damage Growth factors released (SMCs) Macrophages adhere Oxidation of LDL Foam Cell formation Atherosclerotic Plaque Fatty streaks found in children as young as ten years old Develops fibrous cap Hard candy coating on the outside Delicious liquid center Complicated lesion Fibrous cap breaks Contents spill out Thrombus forms Partial or complete occlusion or embolus Manifestations of Athersclerosis None until severe or event Collateral circulation Legs: Claudication Coronary: Reduced exercise tolerance Renal artery: hypertension CV Event (complicated lesion) Stroke, MI Death Collateral Circulation Eval Tx of Atherosclerosis Risk fa