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HLSC 222 - Midterterm 2 > Cardiac - Class 2 - vessels > Flashcards

Cardiac - Class 2 - vessels Flashcards

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1
Q

What can happen if a thrombus forms over the atherosclerotic lesion in PAD? What does it cause?

A

Complete obstruction of blood flow can occur acutely, causing severe pain, loss of pulses, and skin colour changes in the affected extremity

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2
Q

What does hypertension result from?

A

It results from a sustained increase in peripheral resistance, an increase in blood volume, or both

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3
Q

Primary Hypertension Vs Secondary Hypertension?

A

Primary Hypertension – 92-95% of population – primary disease – disease is hypertension – no known cause

Secondary Hypertension – 5-8% of population – caused by underlying disease – underlying disease – possibly renal – causing hypertension

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4
Q

Causes of vascular diseases?

A

o Obstruction (Tend to create turbulence):
 Thrombus - formation (blood clot attached to vessel wall)
 Embolus - clot or foreign mass floating in circulation.
 Compression by external forces such as tourniquet, cast, circular dressings, tumours, sustained pressure especially over bony prominences

 Structural changes to the vessel
o Aneurysms
o Impaired venous valves
o Atherosclerosis (fatty deposits on the walls of the vessel
o Vasospasm - smooth muscle constricts due to local or neurally mediated reflex or disruption of other regulation mechanisms

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5
Q

Where do aneurysms commonly occur? Why?

A

Most commonly occur In the thoracic or abdominal aorta

The aortic is susceptible to aneurysm formation because of constant stress on the vessel wall and the absence of penetrating vasa vasorum in the media layer

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6
Q

vasospastic attacks – change in skin colour & sensation – causes pallor, numbness, sensation of coldness are symptoms of?

A

Raynaurd Phenomenon

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7
Q

What is Raynaud Phenomenon?

A

Attacks of vasospasm in the small arteries and arterioles of fingers (less common toes), circulation cut off until you get away from stimulus, warm hands up

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8
Q

What can complicated primary hypertension occur with?

A

Can occur with:
Chronic hypertension - normally controlled by medication – acute exacerbation that can no longer be controlled by medication,
Pregnancy
adrenal tumours

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9
Q

What causes Chronic venous insufficiency?

A

Valvular incompetence

Obesity

Inadequate venous return over a long period

Venous hypertension,

circulatory stasis,

and tissue hypoxia = remodeling of the skin – then ulceration

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10
Q

What is white coat syndrome?

A

This condition occurs when blood pressure readings at a health care provider’s office are higher than they are in other settings, such as at home. It’s called white coat hypertension because people who measure blood pressure sometimes wear white coats.

White coat syndrome – keep in mind patient anxiety – having them take their blood pressure at home or on an automated BP without a physician present

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11
Q

SNS- development and sustaining HTN?

A

SNS – development and sustaining HTN:
-Stress/Flight/Fight
1.)Epinephrine/Norepinephrine

2.)Beta 1 = increased heart rate and contraction force =increased BP

3.) Alpha 1 = peripheral vasoconstriction = increased BP

4.) Increased ADH= kidneys release less water = increased BP

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12
Q

Risk factors for Atherosclerosis?

A

smoking, hypertension, diabetes, increased levels of LDL – low density lipoprotein and decreased levels of HDL – high density lipoprotein,

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13
Q

What do aneurysms have the potential for?

A

Potential for aortic dissection, rupture, hemorrhage

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14
Q

Infarction and subsequent necrosis of a central organ are life threatening in?

A

Embolisms

Ischemia or infarction in tissue distal to obstruction – organ dysfunction and pain
Life threatening – coronary – cause MI
- cerebral artery – Stroke

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15
Q

What is Venous Stasis?

A

1/3 DVT risk factors

  • Bed rest
  • *Immobility
  • Spinal cord injury
  • Heart failure
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16
Q

What is Chronic venous insufficiency (CVI)?

A

Is inadequate Venus return over a long period of time

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17
Q

Main manifestations of PAD?

A

-Pain worse when elevating legs, improves with dangling

-Sores that do not heal

-Shiny, hairless skin

-Ulceration can occur from a slight injury and in most severe stages gangrene can occur

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18
Q

What are the two kinds of True aneurysms?

A

Saccular and Fusiform

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19
Q

Complicated hypertension as a hypertensive crisis

A

Hypertensive crisis – malignant hypertension – sustained over 180 (looking at it repeatedly)

Rapid progression of hypertension -
Increase arterial pressure = vascular fluid pushed into interstitial space – cerebral edema or encephalopathy – other systems involved – medical emergency

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20
Q

Where do pulmonary embolisms originate?

A

They originate on the venous side (mostly from DVT of the legs) of the systemic circulation or in the right heart

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21
Q

What is malignant hypertension?

A

It is a rapidly progressive hypertension in which diastolic pressure is usually greater than 140mm HG and is a hypertensive crisis /medical emergency

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22
Q

Causes of Atherosclerosis?

A

Consumption of high fat and cholesterol containing LDL foods
Hypertension, smoking and obesity (inhibits the oxidation of LDL
Diabetes, hyperlipidemia
Insulin resistance, infection and periodontal disease

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23
Q

What is a significant cause of venous thrombosis?

A

altered blood coagulation, stasis of blood, vessel wall injury

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24
Q

Patho process for DVT? what does it result in?

A

Accumulation of clotting factors and platelets – particularly close to valves lead to thrombus formation in a vein

Inflammation around thrombus – more platelets

After significant obstruction – increased pressure behind clot = edema in extremity

Most thrombi dissolve without treatment

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25
What is Atherosclerosis?
It is a* form of arteriosclerosis* that is caused by the accumulation of lipid-laden macrophages within the arterial wall, which leads to the formation of a lesion called a PLAQUE
26
Manifestations of aneurysms?
Manifestations depend on location: Can be asymptomatic until they rupture – then severe pain and hypotension Thoracic – dysphagia, dyspnea – bulge affects surrounding tissue Femoral aneurysm – if it affects circulation - Ischemia to lower limbs Cerebral – circle of Willis – to be studied in neuro – increased ICP – signs of stroke – leaking cerebral aneurysm
27
What is an aneurism?
It is a localized dilation or outputting of a vessel wall or cardiac chamber
28
What is secondary hypertension? what does it frequently involve?
Occurs with another underlying disease – frequently involves kidneys (there is a cause) Medications can cause hypertension, pregnant, tumour… Fix the disease, BP will resolve An underlying disease process or medication that rises peripheral vascular resistance or cardiac output can cause secondary hypertension
29
What happens if there is permanent occlusion of the peripheral writers in Buerger's disease?
Permanent occlusion – collateral vessels develop but are inadequate – not quick enough, lower blood volume
30
What is Buerger's disease?
-It is a peripheral vascular disease (peripheral partiers are occluded) -It is an inflammatory disease of the peripheral arteries and is associated with smoking Formation of thrombi in peripheral arteries – overtime thrombi organized and fibrotic (eventually become necrotic if not watching it)
31
How are embolisms introduced to the body?
Bolus of Air – IV lines, chest trauma Amniotic fluid – intraabdominal pressure during delivery – amniotic fluid forced into blood stream Fat – trauma of the long bones (car accident) Bacteria – subacute bacterial endocarditis or abscess (cancer cells) Foreign body – introduced through IV or arterial lines
32
What is Atherosclerosis Vs Arteriosclerosis
Arteriosclerosis – thickening and hardening of vessel/artery walls Atherosclerosis – build up of plaques of lipid material on artery walls, clot off coronary arteries
33
Veins Vs Arteries?
Arteries: Away from heart Thicker Elastic More susceptible to spasms Deeper in the body Veins: Back to heart Valves
34
What does orthostatic hypotension refer to?
* Refers to ↓systolic BP of 20mmHg or ↓diastolic BP of 10mmHg within 3min of standing
35
What is a dissecting aneurysm?
Dissecting aneurysm - splits the vessel wall along the length of the vessel, not going outside the outer layer, can be dangerous or fix themselves, can clot it off, no blood loss
36
What is the major risk associated with untreated DVT?
High risk of embolization
37
What happens with fluid IN PAD? Venous ulcer Vs arteriole ulcer?
Fluid can get down but it can’t get up— swelling, sloughing skin, oozing (venous ulcer) Pale, shiny, hairless skin, no edema, pin point, dry—cannot get fluid down there (arteriole ulcer)
38
What is Peripheral Artery Disease (PAD)? What does it describe?
* Atherosclerotic disease of arteries that perfuse lower limbs * Describes any condition that cause partial/complete obstruction of the flow of blood
39
What are most clinical manifestations of hypertension caused by?
They are caused by complications that damage organs and tissues outside the vascular system
40
DVT Risk factors?
Immobile for a while Injuries Flights (long) Elderly who have fallen Heart failure Hyper-coagulable Oral contraceptives Hormone therapies
41
What is Raynaud Phenomenon?
Attacks of vasospasm in the small arteries and arterioles of fingers (less common toes), circulation cut off until you get away from stimulus, warm hands up
42
What does a ruptured aneurysm present with?
Ruptured aneurysm presents with hypotension and severe back pain – large amount of bleeding internally, moves into lower extremities due to gravity
43
Patho process for DVT?
Accumulation of clotting factors and platelets – particularly close to valves lead to thrombus formation in a vein Inflammation around thrombus – more platelets After significant obstruction – increased pressure behind clot = edema in extremity Most thrombi dissolve without treatment
44
What kind of cerebrovascular issues can we have with complicated primary hypertension?
Cerebrovascular – transient ischemia, stroke, cerebral thrombosis, aneurysm, hemorrhage, & dementia – too much volume is pumped through vessels
45
Where do arterial embolisms originate? what are they commonly associated with?
Commonly originate in the left ventricle and are associated with thrombi after MI, vascular disease, left ventricular failure, endocarditis, and dysrhythmias
46
What is Venous endothelial damage?
damage occurs to the vascular endothelium, the thin layer of cells that lines blood vessel 1/3 DVT risk factors * Trauma (surgical intervention, infection, inflammation of vessel wall * Hip surgery and total hip replacement due to trauma of femoral and iliac veins * Thermal damage from heat generated during the procedure (cementing new joint ) * Venous catheters * Smoking
47
Causes of primary hypertension?
Genetic predisposition, low physical activity Stress, increased alcohol intake Diabetes, sodium and water retention— increase in our fluid
48
Examples of normal compensation for position changes in orthostatic hypotension?
-baroreceptor-mediated reflex – increase heart rate -Closure of valves in venous system Contraction of leg muscles -Decrease in intrathoracic pressure -Heart rate is increased with constriction of system arterioles
49
What is Bruit?
turbulent blood flow (on PAD slides)
50
What are some possible symptoms of hypertension?
Heart disease , MI, CVA, kidney failure, vision loss Headaches, epitaxies, confusion, dyspnea
51
Risk facts for peripheral artery disease (PAD)?
o Same as those for atherosclerosis high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.
52
What insufficiency causes this? "venous hypertension, circulatory stasis, and tissue hypoxia cause can inflammatory reaction in vessels and skin ulcerations?
CVI - Chronic venous insufficiency
53
What is the BP value for hypertension?
140/90
54
Symptoms of hypotension?
atigue. lightheadedness. dizziness. nausea. clammy skin. depression. loss of consciousness. blurry vision.
55
What does hypertension put an individual at risk for?
Hypertension puts individual at risk for developing cardiac events, kidney disease, and stroke
56
Systolic BP Vs Diastolic BP?
Systolic BP: Pressure when ventricle is contracting Diastolic BP: Pressure when relaxing
57
What is the most common cause of arterial aneurysms?
Athersclerosis because plaque formation erodes the vessel wall and contributes to inflammation
58
Manifestations of atherosclerosis?
Partial vessel occlusion can result in transient ischemic events – when exercising or stress As lesion becomes complicated – thrombosis may result in tissue infarction Obstruction of peripheral arteries – significant pain and disability Systemic - Presentation in one area may indicate risk for complications elsewhere
59
Embolisms travel throughout the blood stream until?
until becomes lodged in a smaller vessel 0 till it reaches a vessel through which it cannot pass
60
Causes of hypotension?
HF Shock Hemorrhagic Dehydrated
61
What is complicated primary hypertension? Why is it the silent killer?
Complicated primary hypertension– uncontrolled hypertension – no other underlying disease – hypertension causes the problems -Silent killer because we don't know our BP unit it damages our organs It is also a Hypertensive crisis – rapidly progressive hypertension with diastolic BP > 140mmHg
62
What are varicose veins?
varicose vein is a distended, torturous, and palpable vessel that results from pooling of blood -Varicose veins (stretching out— increasing in size) we need the muscles massaging the veins back up to not get these, veins don’t reach/touch anymore
63
What is an embolism/embolus?
It is a bolus of matter circulating in the bloodstream (embolism) that can lead to an obstruction of a vessel
64
What kind of condition is Buerger's diseases?
It is an autoimmune condition that is characterized by the formation of thrombi filled with inflammatory and immune cells
65
In orthostatic hypotension the reflex mechanisms are?
Reflex mechanisms are dysfunctional or inadequate – individual stands – blood pools and normal arterial pressure cannot be maintained
66
Diagnosis od Rhaynaurd phenomenon?
Diagnosis – vasospastic attacks – change in skin colour & sensation – causes pallor, numbness, sensation of coldness
67
What is secondary Raynaud Phenomenon?
It is associated with systematic diseases (lupus), particularly collagen vascular disease
68
What happens in Raynaud phenomenon/disease?
Attacks of vasospasm in the small arteries and arterioles of fingers (less common toes), circulation cut off until you get away from stimulus, warm hands up
69
What has a 100% likelyhood of developing DVT without any preventative measures?
Orthopedic surgery/trauma, spinal cord injury, obs/gyne
70
What does atherosclerosis form? Where does it form?
o Forms a lesion in large and medium arteries called plaque:  Peripheral arteries  Coronary Arteries  Cerebral Arteries  Aorta
71
Symptoms of Buerger's disease?
Symptoms – pain and tenderness – sluggish blood flow – rubor (redness) of skin Due to dilated capillaries under skin – skin is thin and shiny & nails are thick and deformed
72
Why does thromboembolism occur more frequently in veins than arteries?
Due to lower flow pressure in the veins rather than arteries
73
Symptoms of chronic venous insufficiency?
Edema to lower extremities – can extend to knees, hyperpigmentation of skin – feet and ankles, brownness Cellular demand for oxygen and removal of metabolic waste – not fully met Any trauma or pressure – can lower oxygen supply and cause venous stasis ulcers – decreased circulation = increased infection risk
74
Primary Vs Secondary Raynaud phenomenon/disease?
Primary (disease)– vasospastic disorder with unknown origin Secondary (phenomenom)– associated with systemic diseases – Lupus,
75
True Vs False((Pseudoaneurysm) aneurysm?
True: Involves all 3 layers of the arterial wall and best described as a weakening of the vessel wall False: Is an extravascular hematoma - gone through all of the layers, outside the adventitia
76
What are the three causes of DVT?
Venous stasis – immobility, age, heart failure Venous endothelial damage – trauma, intravenous medications Hypercoagulable states – inherited disorders, pregnancy, oral contraceptives, hormone replacement therapy
77
What are hypercoaguable states?
1/3 DVT risk factors o Orthopedic trauma/surgery, spinal cord injury, OB/GYN conditions increase 100% chance of DVT o Inherited abnormalities  V Leiden mutation  Prothrombin mutations  Deficiencies of protein C, protein S, antithrombin o Asymptomatic and difficult to detect clinically
78
What causes varicose veins?
Trauma to the saphenous veins – damage to one or more valves blood is not being moved back up – gravity is pulling it back down
79
What kind of renal complication can we have with complicated primary hypertension?
Renal complications – arterial sclerosis, insufficiency or failure – thickening over time due to increased pressure – damage to endothelium
80
what must we always assume with hypertension?
Must always assume it is primary hypertension until we find a causative factor
81
Manifestations of DVT if there is any?
Leg pain – starts in calf – cramping Red or discolored skin on the leg Feeling of warmth on the leg
82
Acute hypotension causes?
-pregnancy, due to an increase in demand for blood from both mother and the growing fetus -large amounts of blood loss through injury impaired circulation caused by heart attacks or faulty heart valves weakness and a state of shock that sometimes accompanies dehydration -Anaphylactic - a severe form of allergic reaction infections of the bloodstream -endocrine disorders such as diabetes,adrenal insufficiency, and thyroid disease

HLSC 222 - Midterterm 2 (9 decks)

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