Pathophysiology of microvascular dysfunction

Endothelial dysfunction is present when there is an inappropriate alteration with respect to perservation of organ function. Some of the clinical areas where endothelial function and dysfunction are important are ischemia-reperfusion injury, endotoxemia, diabetes, immuno-logical rejection and dyslipidaemia.

**Figure 10:** Patho-physiology of microvascular dysfunction in ischemia-reperfusion injury , endotoxemia, diabetes, immunological rejection and dsylipidaemia. External stimuli result in release of free radicals and endothelial and/or leucocyte activation with alterations in inflammatory mediators, cytokines and expression of integrins, selectins and members of the immuno-globulin super-family. This is manifest as endothelial dsyfunction (no-reflow phenomenum, increased leucocyte adhesion and migration and vasomotor dsyfunction).
$\begin{figure}\par\centering\par \includegraphics{microvascdysfunction} \par\index{Microvascular dysfunction}\par\end{figure}$

The core pathophysiology of microvascular and endothelial dysfunction in these conditions is outlined in figure 10. The pathophysiology is similar despite the stimulus so ischaemia reperfusion injury will be used to describe the process.