Vascular Disorders

VASCULAR DISORDERS

Depends on the pump of the heart

Responsiveness of blood vessels

Adequate circulating blood volume

High viscosity blood equals high RBC, high sugar

Vasa vasorum equals blood supplying the blood vessels

Hemoglobin F is what is normally present

In sickle cell, an autosomal recessive disorder, hemophilia, sex-linked

In sickle cell it could cause clumping in capillaries

Albumin equals oncotic pressure for water reabsorption

If not from albumin, lymphatic system will reabsorb it back to vena cava

Veins equals Valves, not found in artery, for pushing blood back

Valves are activated by contraction of skeletal muscles

Lymphatic system drains excess water and for immunity, spleen equals filtering microorganism, thymus equals differentiate T cells, lymph nodes equals filtering lymphs

Artery equals higher pressure, Vein equals lower pressure

If not equals affected tissue perfusion

Flow equals gradient pressure divided by Resistance

Laminar equals pressure in the middle of the artery

Turbulent equals happens with high blood flow, constriction

Lactic acid equals fail, toxic equals pain

Arterial insufficiency due to obstruction equals intermittent obstructions, increase demand and decrease supply aka ischemia

Pain is dull, boring, cramping, aching

Ask how far and how severe before the pain appears to estimate the obstruction

Rest pain: critical limb ischemia, one hundred percent, surgical emergency, tissue necrosis, amputation

At night due to temperature, Raynaud's phenomenon, vasoconstriction

Pain is felt if extremities is elevated, Calf equals femoral, popliteal, Hip, Buttock equals aorta, iliac arteries, Cyanotic, hair loss, arterial ulcerations equals severe arterial insufficiency

Gangrene equals necrosis

Edema equals Venous

Palpate pulse for rate, rhythm, quality, zero to four

Palpate simultaneously, EXPECT carotid

Femoral, popliteal, tibial, dorsalis

Twenty to thirty higher systolic

Duplex Ultrasound: determines blood flow and image of blood vessel

Stenosis narrowing versus atherosclerosis, severity and chronicity, determine the appropriate treatment

For abdominal aorta, NPO for six hours

Ankle-Brachial Index, A B I

Supine position Get the pressure of the highest Use doppler, Ankle B P divided by Brachial B P equals A B I, one point zero to one point three is NORMAL, less than zero point nine or LOWER equals P A D, greater than one point forty noncompressible arteries, calcification, one point zero zero to one point forty Normal, zero point fifty to zero point ninety Claudication, less than zero point fifty Ischemic rest pain, less than zero point forty Ischemic critical limb

<0.50 Ischemic rest pain

No alcohol, smoking

No alcohol, smoking

Exercise Testing

Five minutes; AFTER get B P in lower extremities

Normal: minimal B P changes; Arterial disease: ankle B P drops post-exercise

Visualization of blood vessels equals Angiography

C T scan or M R I

Atherosclerosis

H T N and increase blood viscosity

Reduce B P, sugar, Lipid, weight

Fibric acid inhibitor ALTERNATIVE to statin

Collateral circulation equals at rest

Pain DISTAL to obstruction

Intermittent claudication - persistent and pain relievers not working

Cool skin, pale

Bruits auscultated

Atrophy with chronic ischemia

Cilostazol: vasodilator plus antiplatelet

CONTRAINDICATED in Heart Failure

DUAT

Ballon equals Stent equals Atherectomy

Thru cardiac catheterization

Manage bleeding, flat position, direct pressure

Drag elupting stent is preferred

Endarterectomy equals cutting vessel open to remove clot

Bypass grafting

Aneurysm: localized dilation due to weakness of arterial wall elderly

Smoking, H T N, genetics

Pain radiating to back equals impending rupture

C T-A, Duplex Ultrasound

Aortic Dissection

SUDDEN onset

Chest to back to abdomen, LEFT HIGHER than ten in B P

VENOUS DISORDERS

Deep Vein Thrombosis, D V T

Thrombus formation

Virchow's triad: endothelial damage, venous stasis, hypercoagulable state

MAPAS: metabolic hypercoaguable state

Thrombophlebitis equals clot equals inflammation

Phlebothrombosis equals clot without inflammation

Femoral veins

Effort thrombosis due to repetitive movement equals

P I C C, Peripheral Inserted Central Catheter

Lower chance of infection

Cancer px is at RISK for D V T

Phlegmasia cerulea dolens

Swelling, pain, cyanosis

HIGH RISK of venous gangrene

Can lead to Pulmonary Embolism

Diagnostics: D-dimer, C B C, P T, a P T T, I N R, levels should go DOWN

Checks coagulation

Duplex ultrasound: incompressible vein, visible thrombus

Prevent D V T

Correct venous stasis, Passive leg exercise

Compression stocking, CONTRAINDICATED for arterial insufficiencies tho

Anticoagulants, heparin, warfarin, DOAC, saban

Clotting number ten for COMMON PATHWAY

Intrinsic factors, clotting number seven, clotting number twelve equals clotting number ten, fibrinogen

Thrombolytics equals dissolve clots, plase

Hemophilia, Heparin induced Thromobocythemia, bone marrow to many platelet, CONTRAINDICATED for anticoagulants

I V C filter ALTERNATIVE for anticoagulants

Taking anticoagulation

Maintain medication until advised

Check for bleeding

No contact sports

Follow I N R monitor for warfarin, avoid intake of Vitamin K

ELEVATE lower extremities