Step 2 Advise All Smokers to Quit

All smokers should be advised to quit in a clear, strong, and personalized manner. At the same time, acknowledge that it is up to the patient to make the decision to quit. Ask the patient what their personal reasons for quitting might be. Look for reasons that are concrete, specific, and personal such as, I want to be able to keep up with my grandchildren when we go to the zoo. Theoretical, vague, and impersonal reasons may sound like the right answer (I want to quit for my health), however,...

The Role Of Insulin Resistance And Hyperuricemia

Insulin stimulates Ca-ATPase, Na-K-ATPase, and PI3K and decreases calcium influx into VSMC. Therefore, insulin resistance causes increased intracellular ionized calcium and reduced intracellular Mg ion concentration that has been associated with vasospasm, increased vascular reactivity, increased intracellular calcium concentration, the formation of pro-inflammatory agents, oxygen radicals, platelet aggregation, decreased cardiac bioenergetics, cardiac failure, lipoprotein oxidation,...

Diagnostic evaluation

High Monophasic Velocity Blood Cfa

The evaluation of a patient with lower extremity arterial occlusive disease starts with a detailed history and a complete physical examination 1 . A thorough pulse exam of both upper and lower extremities is of outmost importance. Absence of palpable pulses at any level indicates hemodynamically significant lesion s to the main artery proximal to that level. Thus, absence of palpable femoral pulses is suggestive of severe stenosis or occlusion of the ipsilateral iliac artery 2 . Hemodynamic...