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Learning Objectives

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  1. Identify the lipid and nonlipid laboratory assays useful in the evaluation for cardiovascular risk and describe how they are used in conjunction with other information.

  2. Learn the names of the most commonly encountered or best characterized primary hyperlipidemias, their associated serum or plasma lipid abnormalities, and the defects responsible for the initiation of the disorders.

  3. Learn the correctable causes of hypertension that can be identified by laboratory tests.

  4. Understand the different forms of vasculitis and the role of antineutrophil cytoplasmic antibodies (ANCA) in their diagnosis.

  5. Learn the role of plasma D-dimer concentration and radiographic studies in the diagnosis of deep vein thrombosis.

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Introduction

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Because blood vessels are present in all organs and tissues, vascular disease is not restricted to a limited group of signs and symptoms. All organs and tissues are potential targets of injury in vascular disease, and most patients present with signs and symptoms indicative of injury to a specific organ or tissue, usually as a result of diminished blood flow. For example, if there is decreased blood flow to the heart, the patient presents with signs and symptoms related to cardiac dysfunction. The decrease in blood flow could be the result of a lesion that originates in the blood vessel wall, and therefore a vascular disease, or an obstruction by a blood clot inside the blood vessel. The disorders originating within the blood vessel wall include atherosclerotic vascular disease, hypertensive vascular disease, vasculitis, tumors, and aneurysms. Blood vessel disorders that may result from an abnormality that is not within the blood vessel wall include deep vein thrombosis (DVT), and what the DVT may generate if any of the clot moves to the lungs, pulmonary embolism (PE). DVT and PE are also discussed in this chapter. A first-time DVT or PE is nearly always the result of clot formation inside a normal vein. However, if an abnormality in vein anatomy exists, such as congenital atresia of the inferior vena cava, such defects within the blood vessels themselves can be highly contributory to the development of a DVT.

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  • Atherosclerotic vascular disease is one of the most predominant illnesses in the Western world. The goal of clinical laboratory testing is to identify the cause of atherosclerosis. This is usually related to excess dietary lipid or a disorder of lipid metabolism. This chapter provides information on disorders of lipid metabolism that lead to atherosclerosis.

  • Hypertensive vascular disease is also common. The role of clinical laboratory testing is to determine if there is a correctable cause for hypertension. Because more than 90% of hypertension cases are “essential,” there is currently no correctable cause. Treatment with antihypertensive medical therapy is important and beneficial, but it does not treat the underlying cause for hypertension in most cases. Some causes of hypertension, however, are identifiable and correctable, often surgically. An example of a surgically correctable form of hypertension is one in which a tumor secretes a ...

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