Welcome back ladies and gentlemen here we
take a look vascular diseases. Now, what we
are not covering is a vascular disease in
great detail because that is not what this lecture
series is about. In fact, it is about arrhythmias.
Under arrhythmias, we had two categories or
classifications. We had those that were dealing
with conduction system diseases and under
conducting system diseases and dysarrythmias,
we looked at those four major atrial issues
and SVTs and we looked at ventricular arrythmias.
We are now going to move into our vascular disease
portion where will take a look at in great detail
peripheral vascular diseases either due to
perhaps venous insufficiency, peripheral arterial
disease, and aortic dissection. That will
then complete the entire picture of arrythmias
Peripheral vascular disease in general terms.
Well, what if there is venous insufficiency? What
does that mean? Your valves, the one way valves
and which it allows the blood to be guaranteed
to move forward is not occurring. The valves
might be incompetent and if they are, remember,
for example, think about your leg and the
veins down there and how do you get them up
into the heart? How do you move it forward? Ambulation,
movement in between the muscles there is squeezing
ensuring that the blood is moving forward.
But what if the valves aren't working properly?
Resulting in venous insufficiency. What is
my topic? Peripheral vascular disease specifically
under the classification of arrythmia. Then
peripheral arterial disease. What may then
cause this? Well peripheral arterial disease, there
might be a disease within the artery which
is then causing it to narrow. Where? Down in
the periphery. How would you know, what kind
of tests that you need to conduct so that
you know for sure that you are dealing with
a peripheral arterial disease versus a coronary
arterial disease. We shall have a look when
the time is right. With venous insufficiency
the peripheral pooling
due to abnormal change of the LE stands for lower extremity
veins. Examples or etiology for this includes
obesity, diabetes mellitus type II, varicose
veins. What are these? Because medically perhaps
thought of by the patient as being unacceptable.
The superficial veins, think about the saphenous down in the legs, may
be the valves there aren't working properly
and so, therefore, resulting in varicose veins.
Lymphatic obstruction, what is my topic? Venous
insufficiency and these are various differentials.
Chronic lower extremity edema with brownish
discoloration of the skin mean to say that
with venous insufficiency at some point the
overlying skin is going to present with abnormalities
that you want to be extremely astute about.
Treat the underlying disease, for example,
we talked about in the previous discussion,
about diabetes, maybe obesity. Venous stripping
of the varicosities and by that we mean that
if the superficial veins are not properly
moving the blood forward and you have pooling
of it, you strip the varicosities.
Compression therapy, for example, hoisery
or bandages, especially if your patient that
has been sitting around postoperatively in
a bed for long periods of time, you want to
make sure that there is proper compression
therapy, so that you do not allow the blood
remaining for a long period of time, because
there is every possibility that the patient
may then develop a DVT and, more importantly,
prone to a PE or a pulmonary embolus.