Francis Kim, MD Learning Objectives: -State why endothelial function is important for cardiologists -Describe how endothelial function is measured -Describe mechanisms of endothelial dysfunction
An additional mechanism? (an informed hypothesis) Blood sugar spikes (among other factors) wash out the vascular endothelial glycocalyx. This is a structure that is not shown in medical textbook illustrations. It is only recently that it has been visualized in vivo. The glycocalyx acts as a shield for the endothelial layer. It is also a 'flow sensor' and controls the release of Nitrous Oxide (NO) for BP control (vasodilation). It takes the glycocalyx multiple hours to recover. With the shields down, the endothelial layer is exposed to toxins, oxidized products and LDL remnants. Continuous consumption of carbohydrates never allows the glycocalyx to fully recover. It is a one-two punch, a binary explosive. Excess inflammatory factors *WHILE* the shields are down. If you study just one factor, you might miss it (as you clearly stated). Why would we have such a fragile structure for these mechanisms that protect us? The flight-or-fight response. "Adrenaline (later, cortisol continues the response) is released which triggers the release of blood sugar (glucose) and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body. The glycocalyx is washed out, preventing the release of NO and causing blood pressure to rise as heart rate and blood flow increase. That gets the energy and hormones to every nook and cranny of every capillary. This does increase our exposure to the {toxins}, but _Desperate Times Call for Desperate Measures._ Being in that state chronically (for one example, sleep apnea) is deadly.
The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of heart attack, stroke, heart failure and other complications.
It's very important to get enough sleep. Apparently lack of sleep leads to deficiencies in key micro RNAs which regulate inflammation. So that's why if you've been sleep deprived for 3 days, (less than 6 hours each night) everything hurts.
why isn't the endothelial glycocalyx talked about? The clear thin coat that sits directly inside and ontop of the endothelial cell...ever wonder why blood cells don't come in contact with the endothelial cell...it's because of that very important lining.
You talked about different diseases that could cause this. What causes the diseases like lupus RA etc.Id would school the masses on that....just saying.Lets get to the root cause.Lyme maybe.
Thank you for this video, I was diagnosed with Microvascular and Epicardial ED in August. Currently being diagnosed with Hypoxia as well. Have you studied the connection between Hypoxia and Endothelial Dysfunction?
An additional mechanism? (an informed hypothesis) Blood sugar spikes (among other factors) wash out the vascular endothelial glycocalyx. This is a structure that is not shown in medical textbook illustrations. It is only recently that it has been visualized in vivo. The glycocalyx acts as a shield for the endothelial layer. It is also a 'flow sensor' and controls the release of Nitrous Oxide (NO) for BP control (vasodilation). It takes the glycocalyx multiple hours to recover. With the shields down, the endothelial layer is exposed to toxins, oxidized products and LDL remnants. Continuous consumption of carbohydrates never allows the glycocalyx to fully recover. It is a one-two punch, a binary explosive. Excess inflammatory factors *WHILE* the shields are down. If you study just one factor, you might miss it. Why would we have such a fragile structure for these mechanisms that protect us? The flight-or-fight response. "Adrenaline (later, cortisol continues the response) is released which triggers the release of blood sugar (glucose) and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body." The glycocalyx is washed out, preventing the release of NO and causing blood pressure to rise as heart rate and blood flow increase. That gets the energy and hormones to every nook and cranny of every capillary. This does increase our exposure to the {toxins}, but _Desperate Times Call for Desperate Measures._ Being in that state chronically (for one example, sleep apnea) is deadly.
An additional mechanism? (an informed hypothesis) Blood sugar spikes (among other factors) wash out the vascular endothelial glycocalyx. This is a structure that is not shown in medical textbook illustrations. It is only recently that it has been visualized in vivo. The glycocalyx acts as a shield for the endothelial layer. It is also a 'flow sensor' and controls the release of Nitrous Oxide (NO) for BP control (vasodilation). It takes the glycocalyx multiple hours to recover. With the shields down, the endothelial layer is exposed to toxins, oxidized products and LDL remnants. Continuous consumption of carbohydrates never allows the glycocalyx to fully recover. It is a one-two punch, a binary explosive. Excess inflammatory factors *WHILE* the shields are down. If you study just one factor, you might miss it (as you clearly stated). Why would we have such a fragile structure for these mechanisms that protect us? The flight-or-fight response. "Adrenaline (later, cortisol continues the response) is released which triggers the release of blood sugar (glucose) and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body." The glycocalyx is washed out, preventing the release of NO and causing blood pressure to rise as heart rate and blood flow increase. That gets the energy and hormones to every nook and cranny of every capillary. This does increase our exposure to the {toxins}, but _Desperate Times Call for Desperate Measures._ Being in that state chronically (for one example, sleep apnea) is deadly.
