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Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Measurement of Blood Pressure01:17

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Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a...
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Antihypertensive Drugs: Vasodilators01:23

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Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
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Ischemic Heart Disease: Overview01:17

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Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
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Heart Failure Drugs: Inotropic Agents01:26

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Assessing Blood pressure using a doppler ultrasound01:19

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To obtain accurate blood pressure measurements in clinical settings, especially when traditional methods are insufficient, healthcare professionals utilize the Doppler ultrasound technique. This method uses high-frequency sound waves to detect blood flow within the arteries, which is crucial for patients with conditions that complicate circulatory system assessment.
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
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Related Experiment Video

Updated: Oct 22, 2025

Remote Limb Ischemic Preconditioning: A Neuroprotective Technique in Rodents
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Vasopressor-Induced Digital Ischemia.

Shruti Jesani1, Sherif Elkattawy1, Muhammad Atif Masood Noori1

  • 1Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA.

Cureus
|September 1, 2021
PubMed
Summary
This summary is machine-generated.

Critically ill patients requiring vasopressors like norepinephrine may develop digital ischemia, a severe complication causing decreased blood flow to digits. This case highlights the risk of digital necrosis, even amputation, from these essential medications.

Keywords:
digital ischemianeo-synephrinenorepinephrinevasopressinvasopressor

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Area of Science:

  • Critical Care Medicine
  • Vascular Surgery
  • Pharmacology

Background:

  • Vasopressors, such as norepinephrine, are crucial for managing circulatory shock in critically ill patients.
  • While effective in maintaining blood pressure, these potent vasoconstrictors can lead to serious complications.
  • Digital ischemia (DI) is an underreported side effect of vasopressor therapy, characterized by reduced blood flow to the extremities.

Observation:

  • This report details a female patient experiencing septic shock due to acute bowel ischemia.
  • The patient was treated with substantial dosages of norepinephrine to sustain blood pressure.
  • During treatment, she developed bilateral digital necrosis, a severe manifestation of digital ischemia.

Findings:

  • Norepinephrine, a commonly used vasopressor, was associated with the development of bilateral digital necrosis in this patient.
  • The severe vasoconstriction induced by norepinephrine therapy led to irreversible tissue damage in the digits.
  • This case underscores the potential for severe peripheral ischemic complications even with standard vasopressor use.

Implications:

  • Clinicians should maintain a high index of suspicion for digital ischemia in critically ill patients receiving vasopressors.
  • Early recognition and potential management strategies for vasopressor-induced digital ischemia are warranted.
  • This case emphasizes the need for careful monitoring of peripheral perfusion in patients on high-dose vasopressors to prevent limb-threatening complications like amputation.