1. Vascular Disorders Dr Ali Abdel-WAHAB

2. Classify the vascular disorders Define degenerative arterial diseases Classify hypertension Enumerate risk factors for systemic hypertension Predict the complications of systemic hypertensive Define atherosclerosis Enumerate risk factors for atherosclerosis Predict the complications of atherosclerosis At the end of the module the student should be able to

3. Diseases of blood vessels Arteritis; Temporal (giant cell) arteritis Phlebitis; Vasculitis Arteriolosclerosis Monkeberg’s medial calcification Atherosclerosis Degeneration, localized dilatation of artery Aneurysms; Dilated, elongated & tortious vein Varicose veins; Hemangioma Angiosarcoma Tumor & tumor-like

4. Degenerative diseases of arteries Arteriosclerosis It includes: Arteriolosclerosis; Hypertension Diabetes mellitus. Senility Monkeberg’s medial calcification Atherosclerosis Hardening of the arteries; Arterial wall thickening and loss of elasticity

5. Hypertension Portal.Pulmonary.Systemic.

6. Systemic Hypertension (HTN) A chronic medical condition in which the systemic arterial blood pressure is persistently elevated above normal.

7. Etiologic classification Primary (essential) hypertension Secondary hypertension It may be

8. Secondary hypertension Renal disorders; Chronic glomerulonephritis Renal artery stenosis. Endocrine Hyperthyroidism Pheochromocytoma. Cardiovascular, PAN Neurologic; Increased ICT. Others; Toxaemia of pregnancy; preeclampsia, eclampsia syndrome.

9. Etiologic classification Primary (essential) hypertension Secondary hypertension It may be

10. Primary or Essential hypertension It is more common in adults Above 40 year old Multiple risk factors; Genetic factors, familial (multifactorial) or single gene disorder Environmental factors

11. Genetic factors Strong genetic component: in twins, and familial hypertension Single-gene disorders is rare; eg renal sodium reabsorption. Allelic variations in the genes encoding components of the renin- angiotensin system. Polymorphisms in angiotensinogen locus and the angiotensin II type I receptor locus.

12. Environmental factors StressObesitySmoking Physical inactivity Diet Heavy consumption of salt Lack of fruits High fat products Alcohol intake. Insulin resistance Early life (low birth weight, maternal smoking and lack of breast feeding) Hypertension

13. Epidemiology of hypertension About 25% of the adult population of the world had hypertension. The prevalence of hypertension is increasing The rates increase with age More prevalent in men

14. Pathological Vascular effects Arteriosclerosis Hyaline Arteriolosclerosis. Hyperplastic Arteriolosclerosis Fibrinoid necrosis in rapid sever hypertension Atherosclerosis

15. Arteriolosclerosis Hyaline Arteriolosclerosis Hemodynamic stress of hypertension leads to Thick hyaline arteriole wall with narrow lumen Hyperplastic Arteriolosclerosis More acute or severe hypertension Onion-skin; concentric, laminated thickening of the walls with narrowing of lumen Fibrinoid necrosis

16. Complications Heart disease, Left ventricular hypertrophy Left sided heart failure. Ischemic heart diseases Peripheral vascular Atherosclerosis, & Ischemia e.g. Lower limb. Heart CNS RetinopathyRenal, Nephrosclerosis Cerebral Aneurysm, Strokes Infarcts, Hemorhage

17. Summary Essential hypertension 90% to 95% of cases of hypertension, multifactorial disorder, mutations or polymorphisms at several gene loci in association with a variety of environmental influences. Secondary hypertension is caused by diseases of the kidneys or endocrine glands. Hypertension leads to arteriosclerosis, atherosclerosis with subsequent renal, cerebral and retinal complications

18. Atherosclerosis From Greek root words for "gruel" and "hardening," is the most frequent and clinically important pattern

19. Pathogenesis of Atherosclerosis It is characterized by intimal lesions called Atheroma: is a raised lesion formed of A core of lipid (cholesterol and cholesterol esters) Covered by a firm, fibrous cap. Weaken the underlying media may leads to aneurysm Atheroma may rupture, or cause thrombosis.

20. Epidemiology Geographical; Developed nations AgeSexFamily historyLifestyleDiet Special habits; smoking and alcohol

21. Risk factors for atherosclerosis Multiple risk factors have a multiplicative effect: Two risk factors increase the risk fourfold. Three risk factors; the risk increased seven times. Major risk factors Lesser risk factors

22. Major risk factor Conditional (Uncontrolabe) : AgeSexFamilialGenetic Potential controlabe Hyperlipidemia Exercise, polyunsaturated fatty acid, omeg-3-fatty acid, statin Hydrogenation of polyunsaturated FA, saturated FA HypertensionSmokingDMC-reactive protein

23. Lesser risk factors Obesity Physical inactivity Stress Postmenopausal estrogen therapy High carbohydrate Hydrogenated polyunsaturated FA Lipoprotein a Hemostasis

24. Complications of atherosclerosis Ischemia –Chronic or acute (compicated atheroma by thrombus, rupture, and hemorrhage) –Infarction (heart, brain) ganfgerene (ower imb) –Atrophy, brain Aneurysm Aortic dissection Hemorrhage

25. Summary Atherosclerosis is a degenerative disease and considered as one of the most serious vascular disorder Its event incidence is progressively increasing allover the world Atheroma is the lesion of atherosclerosis Its important preventable risk factors include hypertension, DM, smoking, hyperlipidemia

26. Effects of smoking Immediate –Raises blood pressure and heart rate. –Decreases blood flow to body extremities (fingers and toes). –The brain and the nervous system is stimulated for a short time and then reduced. –Dizziness. –Nausea. –Watery eyes. –Hyperacidity. –Weakened sense of taste and smell. –Loss of appetite.

27. Delayed effects of smoking Respiratory –COPD; emphysema, chronic bronchitis –Bronchial Asthma –Chest infection CVS –Ischemic heart diseases –Burger’s disease –Gangrene of lower limb Genital –Impotence for men –Infertility for women. Peptic ulcers General –Reduced fitness. –Yellowish stain on the smoker's fingers and teeth. –Difficulty recovering from minor illnesses. –Facial wrinkles

28. Withdrawal symptoms Increased nervousness and tension Agitation loss of concentration Change in sleep patterns Headache

29. Smoking & Cancers Cancer of oral cavity Larynx Lungs Esophagus Stomach Cancer bladder Hypernephroma kidney Pancreas Cervix