Alterations of blood flow and pressure Flashcards
(158 cards)
1
Q
What are pathophysiological alterations to arteries and veins?
A
Conditions such as hypertension, atherosclerosis, and peripheral vascular disease
These conditions can lead to other cardiovascular diseases.
2
Q
What is hypertension?
A
A consistent elevation of systemic arterial blood pressure
It significantly increases the risk of coronary heart disease, heart failure, and stroke.
3
Q
What blood pressure measurements define hypertension?
A
Systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg
4
Q
What is pre-hypertension?
A
Blood pressure above normal but not meeting hypertension criteria
Individuals in the high-normal range are at risk of developing hypertension.
5
Q
What is the most significant factor in causing organ damage in hypertension?
A
Systolic hypertension
This can occur even without an increase in diastolic pressure.
6
Q
What are the grades of hypertension based on systolic and diastolic pressures?
A
Optimal: <120/<80
Normal: 120–129/80–84
High-normal: 130–139/85–89
Grade 1: 140–159/90–99
Grade 2: 160–179/100–109
Grade 3: ≥ 180/≥ 110
Isolated systolic: > 140/< 90
7
Q
What is primary hypertension?
A
Hypertension with no identifiable cause, accounting for 90–95% of cases
Also called essential or idiopathic hypertension.
8
Q
What is secondary hypertension?
A
Hypertension with an identifiable and potentially reversible cause
Examples include kidney disease and hormonal imbalances.
9
Q
What are common risk factors for primary hypertension?
A
- Family history
- Advancing age
- Cigarette smoking
- Obesity
- Heavy alcohol consumption
- High dietary sodium intake
- Low dietary intake of potassium, calcium, magnesium
- Insulin resistance
- Chronic stress, anxiety
10
Q
What role does the sympathetic nervous system play in hypertension?
A
It increases heart rate and systemic vasoconstriction, raising blood pressure
It also induces vascular remodeling and renal sodium retention.
11
Q
What is the renin-angiotensin-aldosterone system’s role in hypertension?
A
It regulates blood pressure by moderating vascular tone and influencing sodium and water retention
12
Q
What are natriuretic hormones?
A
Hormones that promote sodium excretion in urine
Examples include atrial natriuretic peptide and B-type natriuretic peptide.
13
Q
What is isolated systolic hypertension?
A
Sustained systolic BP > 140 mmHg and diastolic BP < 90 mmHg
Common in individuals older than 65 years.
14
Q
What are complications of complicated hypertension?
A
- Left ventricular hypertrophy
- Angina pectoris
- Heart failure
- Coronary heart disease
- Myocardial infarction
- Sudden death
15
Q
What is microalbuminuria?
A
Small amounts of albumin in urine
Recognized as an early sign of renal dysfunction and increased cardiovascular risk.
16
Q
What is the primary clinical manifestation of hypertension?
A
Elevated blood pressure
Hypertension is often called a silent disease due to lack of symptoms.
17
Q
At what age does the chance of developing primary hypertension increase?
A
With advancing age, especially from the 30s onward
18
Q
What is the relationship between obesity and hypertension?
A
Obesity is recognized as an important risk factor for hypertension
It contributes to increased peripheral resistance.
19
Q
What are the potential pathological effects of sustained primary hypertension on the heart?
A
- Left ventricular hypertrophy
- Myocardial ischaemia
- Heart failure
20
Q
What is the effect of chronic inflammation on hypertension?
A
Contributes to vascular remodeling and smooth muscle contraction
21
Q
What percentage of children under 13 years old are affected by hypertension?
A
Around 3%
Hypertension also occurs in up to 1 in 4 overweight children.
22
Q
In which decades of life does increased peripheral resistance and early hypertension typically develop?
A
Second, third, and fourth decades
Elevated blood pressure can accelerate tissue effects when individuals are 30–50 years old.
23
Q
What are the complications of hypertension that begin to appear during the fourth, fifth, and sixth decades of life?
A
Complications that damage organs and tissues outside the vascular system
These can include heart disease, renal insufficiency, and central nervous system dysfunction.
24
Q
What must be done to diagnose hypertension?
A
Measure blood pressure on at least two separate occasions
The individual should be seated and relaxed for accurate readings.
25
What factors should be considered during blood pressure measurement?
Seated position, relaxed state, supported arm, free of clothing
## Footnote
Measurements should be taken in a quiet room.
26
What is the maximum acceptable systolic and diastolic blood pressure difference when averaging readings?
Less than 10 mmHg for systolic and less than 6 mmHg for diastolic
## Footnote
This helps ensure accurate blood pressure assessment.
27
What investigations may be included in the physical examination for hypertension?
24-hour blood pressure monitoring, blood analysis, urinalysis, ECG
## Footnote
Blood analysis tests for sodium, potassium, creatinine, glucose, and cholesterol levels.
28
What is assumed about individuals with elevated blood pressure in the absence of other indicators?
They have primary hypertension
## Footnote
This assumption holds unless history or examinations indicate secondary hypertension.
29
What is an important lifestyle modification for preventing hypertension?
Increasing exercise levels
## Footnote
Other modifications include dietary changes, ceasing smoking, and limiting alcohol intake.
30
When are pharmacological interventions required for hypertension?
When lifestyle modifications and blood pressures are not controlled
## Footnote
The decision is based on severity and extent of end-organ damage.
31
How do angiotensin-converting enzyme (ACE) inhibitors help in hypertension?
They decrease the release of aldosterone
## Footnote
This reduces sodium and water reabsorption, lowering blood volume and pressure.
32
Fill in the blank: A single elevated blood pressure reading ______ hypertension.
does not indicate
## Footnote
Diagnosis requires multiple measurements.
33
What is orthostatic hypotension?
A decrease in both systolic and diastolic arterial blood pressure on standing
## Footnote
Also known as postural hypotension.
34
What mechanisms normally compensate for gravitational changes when standing?
Reflex arteriolar and venous constriction, increased heart rate, mechanical factors
## Footnote
Includes closure of valves in veins, pumping of leg muscles, and decrease in intrathoracic pressure.
35
What symptoms often accompany orthostatic hypotension?
Dizziness, blurring or loss of vision, syncope
## Footnote
Caused by insufficient vascular compensation and reduction of blood flow through the brain.
36
What are the causes of acute orthostatic hypotension?
Altered body chemistry, drug action, prolonged immobility, starvation, physical exhaustion, decreased blood volume, venous pooling
## Footnote
Examples: dehydration, diuresis, pregnancy.
37
What distinguishes chronic orthostatic hypotension from acute?
Chronic may be secondary to a specific disease or idiopathic
## Footnote
Secondary causes include endocrine disorders, metabolic disorders, and diseases of the nervous system.
38
What is arteriosclerosis?
A chronic disease of the arterial system characterized by abnormal thickening and hardening of vessel walls
## Footnote
Involves migration of smooth muscle cells and collagen fibres into the tunica intima.
39
What is atherosclerosis?
The most common form of arteriosclerosis characterized by soft deposits of intra-arterial fat and fibrin that harden over time
## Footnote
A pathological process affecting blood vessels throughout the body.
40
What role does inflammation play in atherosclerosis?
Mediates the steps in the initiation and progression of atherosclerosis formation
## Footnote
Begins with injury to endothelial cells, leading to inflammatory responses.
41
What are common risk factors for endothelial injury in atherosclerosis?
Smoking, hypertension, diabetes, elevated LDL, decreased HDL, elevated CRP, insulin resistance, oxidative stress
## Footnote
Other factors include infection and periodontal disease.
42
What are foam cells in the context of atherosclerosis?
Lipid-laden macrophages that accumulate and form lesions called fatty streaks
## Footnote
Result from the oxidation of LDL and the inflammatory process.
43
What is the consequence of complicated plaques in atherosclerosis?
They are prone to rupture, leading to platelet adhesion and thrombus formation
## Footnote
May result in acute ischaemia and infarction.
44
What are the clinical manifestations of atherosclerosis?
Symptoms due to inadequate perfusion of tissues, transient ischaemic events, tissue infarction
## Footnote
Major cause of coronary heart disease and strokes.
45
What is the primary goal in managing atherosclerosis?
Restore adequate blood flow to affected tissues
## Footnote
Management may include lifestyle modifications and medications.
46
Fill in the blank: Atherosclerosis is characterized by deposits of _______ in the vessel walls.
fat and fibrin
47
What does coronary heart disease refer to?
Conditions that affect the coronary blood vessels supplying the heart with nutrients and oxygen.
## Footnote
Also known as ischaemic heart disease, coronary artery disease, and heart disease.
48
What percentage of myocardial ischaemia cases result from coronary artery obstruction due to atherosclerosis?
More than 90%.
## Footnote
Atherosclerosis is the primary cause of obstruction in coronary arteries.
49
List three non-modifiable conventional risk factors for coronary heart disease.
* Advanced age
* Male or female after menopause
* Family history.
50
List five modifiable risk factors for coronary heart disease.
* Dyslipidaemia and atherosclerosis-promoting diet
* Hypertension
* Cigarette smoking
* Diabetes and insulin resistance
* Obesity and a sedentary lifestyle.
51
What does dyslipidaemia refer to?
Abnormal concentrations of blood lipoproteins.
52
What is considered a strong indicator of coronary risk?
Increased blood concentration of LDL.
53
What are the primary components of chylomicrons?
Triglyceride.
54
What is the role of HDL in the body?
Responsible for 'reverse cholesterol transport' and participates in endothelial repair.
55
True or False: High levels of HDL are protective against the development of atherosclerosis.
True.
56
What is the relationship between hypertension and atherosclerosis?
Hypertension is responsible for a two- to threefold increased risk of atherosclerosis.
57
How does cigarette smoking affect coronary heart disease risk?
Increases risk through mechanisms such as increased heart rate, vascular damage, and inflammation.
58
What are the effects of diabetes on the cardiovascular system?
* Endothelial damage
* Thickening of the vessel wall
* Increased inflammation
* Increased thrombosis
* Decreased production of vasodilators.
59
What is metabolic syndrome?
A combination of central obesity, abnormal glucose tolerance, raised triglycerides, decreased HDL, and elevated blood pressure.
60
What is the strongest link between obesity and coronary heart disease risk?
Abdominal obesity.
61
What is the effect of exercise on coronary heart disease risk?
Provides protection by improving cardioprotection mechanisms.
62
What is the significance of inflammatory markers in cardiovascular risk?
They help establish connections between inflammation and atherosclerosis.
63
What can cause myocardial ischaemia?
* Atherosclerotic plaques
* Coronary spasm
* Hypotension
* Arrhythmias
* Decreased oxygen-carrying capacity of blood.
64
What happens to cardiac muscle cells during prolonged ischaemia?
They lose the ability to contract and may undergo infarction if blood flow is not restored.
65
What is angina pectoris?
Recurrent predictable chest pain caused by myocardial ischaemia.
66
What is Prinzmetal’s angina?
Unpredictable chest pain resulting from abnormal vasospasm of coronary vessels.
67
What is silent ischaemia?
Myocardial ischaemia that does not cause obvious and detectable symptoms.
68
How long can cardiac muscle cells remain viable under ischaemic conditions?
Approximately 20 minutes.
69
What is silent ischaemia?
Silent ischaemia refers to myocardial ischaemia that occurs without detectable symptoms such as angina.
70
In which gender is silent ischaemia more prevalent?
Silent ischaemia is more prevalent in women.
71
What is angina?
Angina is chest pain caused by myocardial ischaemia, typically lasting 3–5 minutes.
72
What are common symptoms associated with angina?
* Substernal chest discomfort
* Radiating pain to neck, jaw, left arm, shoulder, or back
* Pallor
* Diaphoresis
* Dyspnoea
73
What causes the pain in angina?
Pain is caused by the build-up of lactic acid or abnormal stretching of the ischaemic myocardium.
74
What is stable angina?
Stable angina is caused by gradual luminal narrowing and hardening of arterial walls, preventing dilation during increased myocardial demand.
75
What is Prinzmetal's angina?
Prinzmetal's angina is chest pain due to transient ischaemia of the myocardium caused by vasospasm of coronary arteries.
76
What is the primary difference between stable angina and Prinzmetal's angina?
Stable angina is triggered by exertion, while Prinzmetal's angina often occurs unpredictably at rest.
77
What is the role of ECG in diagnosing myocardial ischaemia?
ECG is critical for diagnosing myocardial ischaemia, revealing transient ST segment depression and T wave inversion during ischaemia.
78
What does ST segment elevation indicate?
ST segment elevation indicates transmural ischaemia, often seen in Prinzmetal's angina and myocardial infarction.
79
What is the purpose of coronary angiography?
Coronary angiography determines the anatomical extent of coronary heart disease.
80
What is percutaneous coronary intervention (PCI)?
PCI is a treatment for myocardial ischaemia that includes angioplasty and stenting to restore blood flow.
81
What is percutaneous transluminal coronary angioplasty (PTCA)?
PTCA is a procedure that dilates narrowed coronary vessels using a balloon.
82
What is the main complication associated with PTCA?
Restenosis of the artery is the major complication of PTCA.
83
What is the function of stents in coronary procedures?
Stents are used to maintain vessel lumen after angioplasty and can be drug-eluting to reduce restenosis.
84
What is coronary artery bypass graft (CABG)?
CABG is a surgical procedure using grafts to restore blood flow to the myocardium in severe coronary heart disease.
85
What are the acute coronary syndromes?
Acute coronary syndromes are clinical conditions resulting from sudden myocardial tissue ischaemia, including unstable angina and myocardial infarction.
86
What differentiates STEMI from NSTEMI?
STEMI is characterized by ST segment elevation and elevated cardiac troponin, while NSTEMI has elevated troponin without ST elevation.
87
What is unstable angina?
Unstable angina results from reversible myocardial ischaemia and is a strong indicator of impending myocardial infarction.
88
What is the significance of increased dyspnoea and diaphoresis in unstable angina?
Increased dyspnoea and diaphoresis indicate worsening angina and potential progression to myocardial infarction.
89
What is the typical presentation of unstable angina?
Unstable angina may present as new-onset angina, angina at rest, or angina that is increasing in severity or frequency.
90
True or False: Women with coronary heart disease have a higher mortality rate than men after a primary event.
True
91
What are common symptoms of myocardial infarction in women?
* Chest pain or discomfort
* Shortness of breath
* Nausea or vomiting
* Upper back pressure or pain
* Jaw pain
92
What are the risk factors for women developing coronary heart disease?
* Diabetes
* Hypertension
* Hypercholesterolaemia
93
Fill in the blank: The primary aim of therapy for myocardial ischaemia is to reduce _______.
[myocardial oxygen consumption]
94
What medications are commonly used to treat myocardial ischaemia?
* Nitrates
* β-adrenergic blockers
* Calcium channel blockers
* ACE inhibitors
* Statins
* Antiplatelet agents
95
What is the relationship between atherosclerosis and acute coronary syndromes?
Atherosclerosis can lead to stable or unstable angina, and if ischaemia is sustained, it can result in myocardial infarction.
96
What is the role of inflammatory processes in atherosclerosis?
Inflammation can lead to plaque rupture, which is a precursor to thrombus formation and acute coronary syndromes.
97
What is unstable angina?
Angina occurring at rest or increasing in severity or frequency
## Footnote
Symptoms include increased dyspnoea, diaphoresis, and anxiety
98
What percentage of individuals with unstable angina progress to acute myocardial infarction or death?
Approximately 20%
## Footnote
Management usually requires antithrombotic therapy
99
What is the most common ECG finding during unstable angina?
ST segment depression and T wave inversion during pain
## Footnote
These changes resolve as the pain is relieved
100
What occurs when coronary blood flow is interrupted for an extended period?
Acute myocardial infarction occurs
## Footnote
This results in heart muscle cell death or necrosis
101
What are the two major types of myocardial infarction?
* Subendocardial infarction
* Transmural infarction
## Footnote
Both types relate to thrombus and coronary artery occlusion
102
What characterizes a transmural infarction?
The infarction extends through the myocardium from endocardium to pericardium
## Footnote
This results in severe cardiac dysfunction
103
What is a STEMI?
ST elevation myocardial infarction
## Footnote
Identified by marked elevations in ST segments on ECG
104
What is the time frame for cardiac muscle cells to withstand a lack of oxygen before cellular death?
About 20 minutes
## Footnote
After 30-60 seconds of hypoxia, ECG changes are visible
105
What happens after 8-10 seconds of decreased blood flow to the myocardium?
The affected myocardium becomes cyanotic
## Footnote
Myocardial oxygen reserves are quickly depleted
106
What are the consequences of anaerobic respiration in myocardial cells?
* Decreased glycogen stores
* Accumulation of lactic acid
* Reduced ATP production
## Footnote
Anaerobic respiration can only supply 65-70% of the total energy requirement
107
What is the role of catecholamines during myocardial ischaemia?
They mediate the release of glycogen, glucose, and stored fat
## Footnote
This leads to increased free fatty acids in the blood
108
What occurs after about 20 minutes of myocardial ischaemia?
Irreversible hypoxic injury causes cellular death and tissue necrosis
## Footnote
Damaged cells release intracellular enzymes into the bloodstream
109
What are the structural changes that occur in the myocardium after an infarction?
* Myocardial stunning
* Hibernating myocardium
* Myocardial remodelling
## Footnote
These changes affect the heart's contractile function
110
What is the ejection fraction percentage typically seen in healthy individuals?
55-70%
## Footnote
This percentage indicates the volume of blood ejected from the ventricles
111
What is the initial symptom of acute myocardial infarction?
Sudden, severe chest pain
## Footnote
The pain is more severe than angina and is not relieved by medication or rest
112
What cardiovascular changes can occur during a physical examination after myocardial infarction?
* Decreased blood pressure
* Increased heart rate
* Abnormal heart sounds
* Pulmonary congestion findings
## Footnote
These signs reflect left ventricular dysfunction
113
What cardiac biomarkers are used to confirm acute myocardial infarction?
* Troponin I (cTnI)
* Troponin T (cTnT)
* Creatine kinase-myocardial band (CK-MB)
## Footnote
Troponins are more specific indicators of heart muscle cell death
114
What can happen if thromboemboli break loose during acute myocardial infarction?
Transient ischaemic attacks or stroke
## Footnote
This occurs if clots form in cardiac chambers or on cardiac valves
115
What is the risk of sudden cardiac death related to?
* Ischaemia
* Left ventricular dysfunction
* Electrical instability
## Footnote
These factors increase the risk of death post-infarction
116
What are common complications from acute myocardial infarctions?
* Arrhythmias
* Left ventricular failure
* Pericarditis
* Rupture of heart structures
* Sudden death
## Footnote
Complications depend on the extent of necrosis and timely intervention
117
What is released into the blood after myocardial infarction?
Cardiac troponin
## Footnote
Cardiac troponin increases in the blood from 2–3 hours after myocardial infarction and reaches high levels after about 12 hours.
118
How long does it take for cardiac troponin to be removed from the blood after myocardial infarction?
More than 10 days
## Footnote
Cardiac troponin is removed from the blood by the liver and kidneys.
119
What are the anatomical locations where myocardial infarction can occur?
Anterior, inferior, posterior, lateral, subendocardial, transmural
## Footnote
These terms describe the region of the heart wall affected by infarction.
120
What diagnostic tool is used to localize the area affected by myocardial infarction?
Twelve-lead ECG
## Footnote
ECG identifies Q waves and changes in ST segments and T waves.
121
What surrounds the infarcted myocardium?
Zone of hypoxic injury
## Footnote
This zone may progress to necrosis or return to normal.
122
What is the term for myocardial infarction that presents with no elevation of the ST segment on ECG?
NSTEMI
## Footnote
NSTEMI stands for non-ST elevation myocardial infarction and is also known as NSTE-ACS.
123
What is the consequence of thrombus breaking up before complete distal tissue necrosis occurs?
Infarction involves only the myocardium directly beneath the endocardium
## Footnote
This typically results in NSTEMI.
124
What type of myocardial infarction results in significant ST segment elevation on ECG?
STEMI
## Footnote
STEMI is also referred to as ST elevation acute coronary syndrome (STE-ACS).
125
What occurs on the ECG some hours after a STEMI?
Characteristic Q wave development
## Footnote
This indicates progression of the infarction.
126
What is the first line of treatment for acute myocardial infarction?
Aspirin and sublingual glyceryl trinitrate
## Footnote
These are administered to relieve pain and promote coronary vasodilation.
127
Why is pain relief important in the management of myocardial infarction?
To reduce activation of the sympathetic nervous system
## Footnote
Pain relief often involves the use of intravenous morphine.
128
What is essential for monitoring during the first 24 hours after the onset of myocardial infarction symptoms?
Continuous monitoring of cardiac rhythms and enzymatic changes of cardiac biomarkers
## Footnote
This period is when the risk for sudden death is highest.
129
What treatments are frequently administered for both non-STEMI and STEMI?
Thrombolytics and percutaneous coronary intervention
## Footnote
Antithrombotics are also commonly used.
130
What may be included in further management of myocardial infarction depending on the haemodynamic state?
ACE inhibitors and β-blockers
## Footnote
These medications help manage blood pressure and heart function.
131
What is required for individuals in shock due to myocardial infarction?
Intravascular fluid management and possibly vasoactive or inotropic drugs
## Footnote
Emergency invasive procedures may also be necessary.
132
What laboratory data may indicate inflammation after myocardial infarction?
Leucocytosis, C-reactive protein (CRP), elevated sedimentation rate
## Footnote
These findings suggest an inflammatory response.
133
What is a common effect on blood glucose levels after myocardial infarction?
Usually elevated
## Footnote
Glucose tolerance may remain abnormal for several weeks.
134
Fill in the blank: The pattern of changes in the ECG resembles the time course of progression from _______ to injury, and finally infarction.
ischaemia
## Footnote
The progression is indicated by T wave inversion, ST elevation, and deep Q wave.
135
What is an aneurysm?
A localized dilation or outpouching of a vessel wall or cardiac chamber
136
What causes aneurysms to form in arteries?
Disruption of the wall of the blood vessel associated with changes in collagen and elastin
137
Which artery is particularly susceptible to aneurysm formation?
The aorta
138
What percentage of all aneurysms occur in the abdominal aorta?
75%
139
What is the most common cause of arterial aneurysms?
Atherosclerosis
140
How does hypertension contribute to aneurysm formation?
By increasing wall stress
141
What are common symptoms of a thoracic aneurysm?
Dysphagia and dyspnoea
142
What diagnostic methods are used to confirm an aneurysm?
Ultrasonography, CT scan, MRI, or angiography
143
What is the goal of medical treatment for aneurysms?
To maintain a low blood volume and low blood pressure
144
Indications for repair of abdominal aortic aneurysm include?
* Symptomatic aneurysm of any size
* Evidence of embolisation
* Frank rupture
* Asymptomatic aneurysm ≥ 5.5 cm in men and > 5.0 cm in women
* Rapidly expanding abdominal aortic aneurysm
* Abdominal aortic aneurysm associated with other arterial disease
* Infected abdominal aortic aneurysm
145
What conditions promote thrombus formation in arteries?
Activation of coagulation or stasis of blood flow
146
What are potential threats posed by arterial thrombi?
* Occlusion of the artery
* Dislodgement leading to thromboembolus
147
What is embolism?
The obstruction of a vessel by an embolus
148
What can an embolus consist of?
* Dislodged thrombus
* Air bubble
* Aggregate of amniotic fluid
* Aggregate of fat, bacteria, or cancer cells
* Foreign substance
149
Where do pulmonary emboli typically originate?
From the venous side, mostly from the deep veins of the legs
150
What is peripheral artery disease?
Atherosclerotic disease of the arteries that perfuse the limbs
151
What are the three factors that promote venous thrombosis?
* Venous stasis
* Venous endothelial damage
* Hypercoagulable states
152
What is deep vein thrombosis (DVT)?
Thrombus formation primarily in the lower extremities
153
What are common risk factors for DVT?
* Immobility
* Age
* Heart failure
* Trauma
* Medications
154
What is a varicose vein?
A vein in which blood has pooled, producing distended, tortuous vessels
155
What condition may develop in individuals with chronic venous insufficiency?
Venous stasis ulcers
156
What are some conservative treatments for varicose veins?
* Leg elevation
* Avoidance of long periods standing or sitting
* Wearing compression stockings
* Increased mobility or physical activity
157
True or False: Most thrombi eventually dissolve without treatment.
True
158
What treatment options are available for venous thromboembolism?
* Anticoagulants (heparin, warfarin, rivaroxaban)
* Mechanical devices (compression stockings)
* Early ambulation
