alterations in blood flow in the systemic circulation-grp4
DESCRIPTION
a powerpoint presentation that we made for our psychopathophysiologyTRANSCRIPT
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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]
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
-
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
-
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
-