Red portion of heart and red blood vessels carry oxygen-rich

blood.
Blue portion of heart and blue blood vessels carry oxygen-poor
 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 – combinations of 3 fatty acids
condensed with a single glycerol molecule;
used in energy metabolism
 Phospholipids – contains phosphate group;

essential in structural constituents,

especially in cell membrane
 Cholesterol – synthesized from fatty acids

thus with similar chemical activity to other

lipids.
 Total serum cholesterol level <200mg/dL –
considered desirable
 Levels of 200-209mg/dL – borderline high
 LDL cholesterol levels <100mg/dL –

considered optimal
 LDL 100-129 mg/dL – near or above optimal
 LDL 130-159 mg/dL – borderline high
 LDL 160-189 mg/dL – high
 LDL > or = 190 mg/dL – very high
 HDL <40 mg/dL – considered low;

levels > or=60 mg/dL 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
* raynaud’s dieseas
*raynaud’s 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 “hardening of the
arteries.” 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 .e.g.

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 and/or 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
extremities. The main treatment is
Blood tests are usually
normal. to STOP SMOKING
An angiogram (in which immediately. 
a dye is injected into
the blood vessel and
then X-Rays taken) may
help with the diagnosis,
and may rule out other
causes
 Raynaud’s 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

buerger's 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 Raynaud's 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 Raynaud's 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.
 The following increase the risk of
an aneurysm or an aortic
dissection
 Atherosclerosis
 High blood pressure
 Smoking.
 Deep wounds, injuries, or infections of

the blood vessels.

 A congenital abnormality
 Inherited diseases.
 Aortic aneurysms
may cause: Aortic dissection may
cause:

 shortness of breath,  severe pain

 a croaky or raspy  stomach pain
voice,  lower back pain, or
 backache, flu
 pain in your left
shoulder or
between your
shoulder blades.
Three common problems:
•Varicose veins
•Venous insufficiency
•Venous 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 don't 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.
 s/sx: unsightly appearance, aching, edema
 treatment: elastic support stockings,

elevating the legs, and exercise.

Sclerotherapy
Surgical 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
 s/sx: 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.
 s/sx:
 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.
 S/sx: some are asymptomatic because veins
are not totally occluded.
when present most common s/sx 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 – pressure exerted

on
 arterial walls during ventricular

contraction
 Diastolic pressure – lowest level of

arterialpressure during a ventricular

cycle
 Pulse pressure – the difference

between
systolic and diastolic pressure
 EX: 120-80= 40 (Pulse Pressure)
 Blood Pressure (BP)
 Force per unit area exerted on the wall of a
 blood vessel by its contained blood
 Expressed in millimeters of mercury (mm
 Hg)
 Measured in reference to systemic arterial
 BP in large arteries near the heart
 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
 Systemic arterial BP is measured indirectly
 with the auscultatory method
 A sphygmomanometer is placed on the arm
 superior to the elbow
 Pressure is increased in the cuff until it is
 greater than systolic pressure in the brachial
 artery
 Pressure is released slowly and the
 examiner listens with a stethoscope
 Measuring Blood Pressure
 Systemic arterial BP is measured
indirectly
 with the auscultatory method
 A sphygmomanometer is placed on the

arm
 superior to the elbow
 Pressure is increased in the cuff until it is
 greater than systolic pressure in the

brachial
 artery
 Pressure is released slowly and the
 Alterations in Blood Pressure
 Hypotension – low BP in which systolic
 pressure is below 100 mm Hg
 Hypertension – condition of sustained
 elevated arterial pressure of 140/90 or

higher
 Transient elevations are normal and can

be
 caused by fever, physical exertion, and
 emotional upset
 Chronic elevation is a major cause of heart
 failure, vascular disease, renal failure and
 Hypotension
 Orthostatic hypotension – temporary low
BP
 and dizziness when suddenly rising from a
 sitting or reclining position
 Chronic hypotension – hint of poor
nutrition
 and warning sign for Addison’s disease
 Acute hypotension – important sign of
 circulatory shock
 Threat to patients undergoing surgery and
 those in intensive care units
 Hypertension
 Hypertension maybe transient or
persistent
 Primary or essential hypertension – risk
factors
 in primary hypertension include diet,

obesity,
 age, race, heredity, stress, and smoking
 Secondary hypertension – due to
identifiable
 disorders, including renal disease,
 arteriosclerosis, hyperthyroidism,
 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 140/90
mm Hg
o Lifestyle modification
Reducing salt intake
Losing weight
Regular exercise
Quitting smoking
o 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 HYPERTENTION

Renal 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 ≥140
mmHg or ≥ 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 > 140/90
mmHg) that occurs during the first 20 wks
pregnancy and is accompanied by
proteinuria(urinary excretion of 0.3 g in a 24 hr
specimen).
 Preeclampsia superimposed on chronic
hypertension - Chronic hypertension( bp
≥140/90 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.