Carnitine in Peripheral Arterial Disease William R. Hiatt, MD William R. Hiatt, MD Professor of Medicine Professor of Medicine Section of Vascular Medicine Section of Vascular Medicine University of Colorado University of Colorado Conflicts: Consultant to Sigma Tau Pharmaceuticals
26
Embed
Carnitine in Peripheral Arterial Disease · Carnitine in Peripheral Arterial Disease William R. Hiatt, MD Professor of Medicine Section of Vascular Medicine University of Colorado
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Carnitine in Peripheral Arterial Disease
William R. Hiatt, MDWilliam R. Hiatt, MDProfessor of MedicineProfessor of Medicine
Section of Vascular MedicineSection of Vascular MedicineUniversity of ColoradoUniversity of Colorado
Conflicts: Consultant to Sigma Tau Pharmaceuticals
Atherothrombosis in PAD
MI ACSCVA / TIAAcute Leg IschemiaCV deathThrombosis
Atherosclerosis(Peripheral Artery)
Intermittent claudicationCritical Leg Ischemia
Stary HC. Circulation.1995;92:1355-1374.Fuster V et al. Vasc Med. 1998;3:231-239.
Arterioles
Arteries
Capillaries
PADPAD
Arterial stenosis/occlusion
Arterial stenosis/occlusion
↓ O2 supplyMuscle ischemia
Claudication
↓ Pressure & flow↓ Pressure & flow
Classic pathophysiology
Claudication PathophysiologyNOT Just Hemodynamics
Hemodynamics do not explain performance Microcirculatory changes
Endothelial injuryIncreased viscosity
Oxygen free radicalsMuscle fiber injuryMitochondrial DNA injury
Altered muscle metabolismAccumulation of acylcarnitinesImpairment in electron transport
J Cardiopulmonary Rehab 1988;12:525-532Vasc Med 2000;5:55-59
Pathophysiology of Intermittent Claudication
Reduced lower-extremity perfusion
Ischemia-Reperfusion injury-Denervation & muscle weakness-Impaired muscle metabolism-Reduced ATP production
Intermittent Claudication
Supply-Demand mismatchWith exercise
Functional impairmentWalking limitation
Creager M, ed. Management of Peripheral Arterial Disease. Medical, Surgical, and Interventional Aspects. 2000.