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Pathophysiology 212 > Disorders of blood flow and blood pressure > Flashcards

Disorders of blood flow and blood pressure Flashcards

1
Q

hyperlipidemia

A 
Cholesterol & triglycerides (dietary lipids) are insoluble in plasma as encapsulated by lipoproteins
5 types of lipoproteins
Chylomicrons
VLDL 
LDL 
IDL 
HDL
  • LDL is the main carrier of cholesterol but leaves some behind for uptake in arterial wall
  • HDL also carry cholesterol but remove it from tissues and take to liver for disposal.
  • Genetic defect of these proteins may accelerate atherosclerosis
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2
Q

hyperlipidemia causes/risks

A 
Lipid blood levels raised by
Nutrition
- High-calorie diet increases production of VLDL & it’s conversion to LDL
Genetics
Comorbid conditions/diseases
Medication
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3
Q

Atherosclerosis Risk Factors: non-modifiable

A

Risk Factors: non-modifiable

  • Age
  • Gender
  • Post-menopausal women
  • Family hx of premature CAD
  • Genetically determined alteration in lipoprotein and cholesterol metabolism.
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4
Q

Atherosclerosis Risk Factors: modifiable

A

Risk Factors: modifiable

  • Cigarette smoking
  • Obesity
  • Hypertension
  • Hyperlipidemia
  • Diabetes mellitus

C-reactive protein
Hyperhomocystinemia
Increased serum lipoprotein

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5
Q

Tobacco use

A
  • Increases blood lipid levels
  • Damages endothelium
  • Enhances thrombosis formation
  • Increases blood viscosity
  • Increases circulating catecholamines.
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6
Q

Arteriosclerosis, Arteriolosclerosis, & Atherosclerosis

A

Arteriosclerosis
Hardening of medium to large arteries

Arteriolosclerosis
Hardening of small arterioles

Atherosclerosis
Hardening d/t atheromatous plaque

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7
Q

Atherosclerosis plaques

A

Stable plaques

  • Thick fibrous caps
  • Partially block vessels
  • Don’t tend to form clots/emboli

Unstable plaques

  • Thin fibrous caps
  • May rupture causing clot formation
  • May completely block artery
  • Clot may break free
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8
Q

Sites of Atherosclerosis: Arteries

A
  • Abdominal aorta
  • Proximal coronary
  • Thoracic aorta
  • Femoral & popliteal
  • tend to form at branches*
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9
Q

Types of Atherosclerotic Lesions

A
  1. Fatty Streak
    - Found in all ages/geographic areas/race/lifestyle, etc.
  2. Fibrous Atheromatous Plaque
    - Lipids, smooth muscle, scar tissue
    - Predispose to thrombus formation
  3. Complicated Lesion- clots & lesions forming
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10
Q

Peripheral Artery Disease & Risk Factors

A
  • Atherosclerosis distal to the
    aortic arch

Risk Factors

  • Male
  • > 60 years old
  • Smokers
  • Diabetes Mellitus
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11
Q

Peripheral Artery Disease Manifestations

A
  • Intermittent claudication (pain in the legs when moving)
  • Thinning of skin & tissue
  • Gradual atrophy of muscles
  • Decreases blood supply, leads to: weak/absent pulses, cool extremities, brittle toenails, hair loss, pallor, dependent rubor.
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12
Q

Peripheral Artery Disease Complications

A

-Ulceration, gangrene

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13
Q

Peripheral Artery Disease Diagnosis

A
  • Blood pressure changes in leg
  • Pulse changes
  • Doppler Ultrasound
  • MRI Ateriography/Spiral CT arteriography
  • Contrast angiography.
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14
Q

Raynaud Phenomenon

A

Intense episodic vasospastic disorder of arteries and arterioles
- Usually fingers, less often toes

Primary: symmetrical

  • Secondary: non-symmetrical
  • Associated with pre-existing PAD
  • Frostbite, occupational trauma (vibrating tools, hot/cold environment)
  • Usually young women
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15
Q

Raynaud Phenomenon Manifestations

A

Precipitated by cold, strong emotions

Manifestations
Tingling/numbness/aching/throbbing pain
Pallor to cyanosis

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16
Q

Aneurysms

A

Abnormal localized dilation of blood vessel

  1. True
    - Berry (happens at a branch of an artery)
    - Saccular (pouches out)
    - Fusiform (all the way around the artery)
  2. False
    - Dissecting (layers of the wall separate b/c there is blood leaking)
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17
Q

Aortic Aneurysm

A

Often discovered during routine Xray
- ECG, Ultrasound, MRI, CT

Risk Factors

  • Atherosclerosis
  • Age+

Manifestations
- Dependent on size, location, stage

18
Q

Aneurysm: Thoracic

A

Substernal, back, neck pain

Pressure on:
Trachea = cough, stridor, dyspnea 
Laryngeal nerve = hoarseness
Esophagus = difficulty swallowing
Superior vena cava = facial/neck edema
19
Q

Aneurysm: Abdominal Aortic

A

“Triple A” – Most Common

  • Asymptomatic
  • Pulsating mass if >4cm often first sign
  • Mild to severe abdominal and back pain.
20
Q

Aneurysm: Complications

A

Thrombi

Compression

  • Vasculature
  • Nerves

Rupture

21
Q

Risk Factors for Aortic Aneurysm

A

Often occurs without atherosclerotic changes

Risk Factors

  • Hypertension
  • 40-60 year old men
  • Marfan’s syndrome
  • Pregnancy
  • Congenital defects of aortic valve
  • Aortic coarctation (band around the aorta which decreases bloodflow)
  • Blunt trauma.
22
Q

Dissecting AA Manifestations

A

> Excruciating pain anterior chest & back

> Blood pressure

  • Initially high
  • Later unobtainable in one or both arms

> Syncope
Lower extremity hemiplegia/paralysis
Heart failure if aortic valve involvement

23
Q

Determinants of Blood Pressure (review!)

A

Short-Term Regulation
Neural Mechanisms
Humoral Mechanisms

Long-Term Regulation
Kidneys retain or excrete water and sodium to regulate vascular volume (ECV)

24
Q

Neural Mechanisms: ANS

A

Medulla and lower pons (CV center)

Parasympathetic impulses via vagus nerve to heart = slows HR

Sympathetic impulses via spinal cord & peripheral sympathetic nerves to heart and blood vessels = increased HR & vasoconstriction (incr PVR)

25
Q

Neural Mechanisms con’t

A

Intrinsic reflexes
Baroreceptors/stretch receptors
- Carotid & aortic walls, heart

Chemoreceptors
- Carotid and aortic bifurcation

Extrinsic reflexes: diffuse reactions d/t pain, cold via hypothalamus/SNS pathways.

26
Q

Humoral Mechanisms

A

> Renin-Angiotension-Aldosterone System (renin released by JG cells in smooth muscle increases BP)
- Released in response to SNS activity, decreased volumes
- Converts angiotensin I to angiotension II
Vasopressin (ADH)
Epinephrine

27
Q

Primary/Essential Hypertension (Risk Factors)

A
  • Chronic/ Without evidence of other disease processes
    Risk Factors
  • Family history
  • Race
  • Older age
  • Lifestyle factors: high salt/caloric/fat intake, chronic excessive alcohol consumption, smoking, stress
28
Q

Secondary Hypertension

A
  • Results from another disorder

- Numerous risk factors

29
Q

Target Organ Damage

A

Hypertension is asymptomatic until long-term effects are seen in organs

Heart 
Brain
Kidney
Liver
Lungs
Eye
30
Q

Hypertensive Crisis

A

Elevated BP with impending target-organ damage
Severe: SBP >180 mmHg & DBP >110 mmHg
Emergency: DBP >120 mmHg

Vascular damage!
Symptoms!

31
Q

Orthostatic Hypotension

A

Sustained drop in BP d/t a change in body position (usually standing)

	Causes
Reduced blood volume
Pharmaceuticals 
Aging 
Bedrest/immobility
32
Q

Orthostatic Hypotension (cont) manifestations & diagnosis

A

Manifestations

  • Visual changes, dizziness, syncope
  • Drop in systole BP of 20 mmHg and –diastolic BP of 10 mmHg

Diagnosis

  • Lying/Standing Blood Pressure with 2-3 minute wait
  • Tilt Table
33
Q

Disorders of Venous Circulation

A
  • Skin
  • Subcutaneous tissues
  • Superficial veins
  • Deep veins
  • Heart

-Low Pressure System

34
Q

Varicose Veins

A

Dilated tortuous veins
Aching/edema (slower blood movement –> increased pressure)

25-30% of women; 10-20% of men

Risk Factors
Obesity
>50 years old.

35
Q

Varicose Veins: Primary & Secondary

A
  1. Primary
    - Originate in superficial saphenous veins
    - Caused by prolonged standing, pregnancy, abdominal pressure, prolonged heavy lifting
  2. Secondary
    - Impaired flow in deep veins d/t other disease
    - Caused by arteriovenous fistulas, venous malformations, tumor, pregnancy.
36
Q

Chronic Venous Insufficiency: Causes/Manifestations

A 
Causes/Manifestations
-Venous hypertension
-Dilation & stretching of vessel wall
-Impaired blood flow results in:
Edema, impaired issue nutrition
Ischemia, necrosis
Brown pigmentation 
Stasis dermatitis
Venous ulcers
37
Q

Deep Vein Thrombosis

A

Thrombus & Inflammation
Superficial or Deep Veins

Virchow’s Triad:

  • Venous stasis
  • Vascular trauma
38
Q

Risk Factors for DVT

A
  1. Venous stasis
    - Bedrest/immobility
    - SC injury
    - AMI/CHF/Shock
    - Venous obstruction
  2. Vascular trauma
    - Venous catheters
    - Surgery, especially orthopedic
    - Trauma/infection
    - # hip
39
Q

Risk Factors for DVT con’t

A 
Hypercoagulability
Genetics 
Stress/trauma
Pregnancy/Childbirth
Oral contraceptives/hormone replacement
Dehydration
Cancer
40
Q

DVT manifestations

A 
Often asymptomatic (50%)
Pain
Swelling
Deep muscle tenderness
Signs of inflammation
41
Q

DVT complications and treatment

A 
> Complication
-Pulmonary/cerebral embolus
> Treatment
-Prevention
-Anticoagulation
-Elevate limb
-Bedrest
-Gradual ambulation with elastic support
-Heat

Pathophysiology 212 (18 decks)

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