1. ARTERIAL VENOUSSYMMETRY One or both extremities Affected leg largerCOLORDependent rubor, pallor Cyanosis, brown on elevationpigment, scalingPAIN Claudication c exercise, Dull ache, heaviness, relieved c dependency relieved c elevationEDEMA-+PULSES Decreased or absent+TEMP Cool WarmULCERS 20%75% Pressure points, tips of Around ankle c irreg. toes, circular & dry border, moist

2. Varicose Veins Dilated, tortuous veins of lower extremities no valves in inferior vena cava common iliac veins superficial saphenous vein only covered by fat & skin (no muscles) Predisposing factors Heredity Standing High intraabdominal pressures (pregnancy) 3. Deep Vein Thrombosis (DVT) Risk Factors Prolonged immobility Varicose veins bed rest Deficiencies of naturally hip fractureoccurring Economy classanticoagulants syndrome Antithrombin III Dehydration Protein C Smoking Protein S Oral contraceptives Postpartum period increased coagulationfactors 4. Clot from vein travels through RIGHTheart 5. Artery (arterio) Arteriosclerosis Atherosclerosis Elderly, diabetics Atheromas plaques Loss of vessel elasticity fat & fibrin (Cholesterol) Thick & hardhardening of arteries narrows 6. Fibrous Athermatous Plaque Patho Intra/extra cellular lipid accumulation smooth muscle cells proliferation scar tissue formation vessel intima thickening lead to Platelet aggregation Occlusion Aneurysm 7. Atherosclerosis/CADRisk FactorsModifiableUnmodifiable Cigarette smoking Heredity HTN Gender DM > risk males- until women Hyperlipidemiahit menopause Upper body obesity = incidence by 70-80 Sedentary lifestyle Age Stress/Type A personality CRP 8. Normal Lipid Panel Cholesterol < 200 mg/dl LDL < 100 mg/dl HDL > 60 mg/dl Triglycerides < 165mg/dl 9. Familial Hypercholesterolemia Autosomal dominant disorder Homozygotes xanthomas & arteriosclerosis in childhood many die of MI by 20 Heterozygotes 1 in 500 cholesterol elevated from birth 2 to 3 fold serum cholesterol increase xanthomas & arteriosclerosis in adulthood