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Pathophysiology > Ch 12 cardio > Flashcards

Ch 12 cardio Flashcards

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1
Q

Where is the heat located

A

Mediastinum between lungs

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2
Q

Located in the floor of the right atrium

A

Atrioventricular node

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3
Q

Consists of the right and left branches

A

Bundle of his also known as AV bundle

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4
Q

What are the terminal fibers

A

Perkins fibers

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5
Q

What consists of the sinus rhythm and pacemaker

A

Sing atrial node

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6
Q

What are the parts of a ECG

A

P wave
QRS waves
T wave

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7
Q

What wave of an ECG

Atrial depolarization

A

P wave

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8
Q

What wave of an ECG

Ventricular depolarization

A

QRS wave

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9
Q

What wave of ECG

Ventricular depolarization

A

T wave

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10
Q

What controls heart rate and contraction force

A

Medulla

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11
Q

Detect changes in blood pressure

A

Bark receptors

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12
Q

Where is the baroreceptors located

A

In the aorta and internal carotid arteries

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13
Q

Increases heart rate

A

Sympathetic stimulation

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14
Q

What is another name for the sympathetic stimulation

A

Cardiac accelerator nerve

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15
Q

Decreases heart rate

A

Parasympathetic stimulation

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16
Q

What is another name for the parasympathetic stimulation

A

Vagus nerve

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17
Q

Important site of action for some drugs

A

Sympathetic or beta1 adrenergic receptors

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18
Q

What are the eight factors that increase heart rate

A 
Increased thyroid hormones or epinephrine
Elevated body temperature or infection
Increased environmental temperature
Exertion or exercise
Smoking
Pregnancy
Pain
Stress response
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19
Q

Part of the systemic circulation

Branch of aorta immediately distal to the aortic valve

A

Right and left coronary arteries

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20
Q

Functions as pump for circulating blood

A

Heart

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21
Q

what two things does the left coronary artery divide into

A

left anterior descending or interventricular artery

left circumflex artery

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22
Q

what two things does the right coronary artery branch into

A

right marginal artery

posterior interventricular artery

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23
Q

blood flow through the myocardium is greatest during what and is reduced during what

A

diastole (relaxation)

systole (contraction)

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24
Q

Many small branches extend from the coronary arteries to supply what two things

A

myocardium

endocardium

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25
collateral circulation is what
extremely limited
26
relaxation of the myocardium required for filling chambers
diastole
27
contraction of myocardium provides increase in pressure to eject blood
systole
28
name the steps of the cardiac cycle
Atria relaxed (filling with blood) to the AV valves open to blood flows into ventricles to atria contract (remaining blood forced into ventricles) to atria relax to ventricles contract to AV valves close to semilunar valves open to blood into aorta and pulmonary artery to ventricles relax
29
diastole or systole atria fills, all valves close increased atrial pressure opens AV valves, ventricles fill ventricles empty, ventricles relax, aortic and pulmonary valves close
diastole
30
diastole or systole atria contract and empty, ventricles are full ventricles begin contraction, pressure closes AV valves, atria relax ventricles contract, increased pressure in ventricles, aortic and pulmonary valves open, blood ejected from aorta and pulmonary artery
systole
31
whats the sound? | closure of AV valves
Lubb
32
whats the sound? | closure of the semilunar valves
Dub
33
caused by incompetent valves
murmurs
34
indicates heart rate
pulse
35
difference in rate between apical and radial pulses
pulse deficit
36
what is the equation for cardiac output
CO=SV * HR SV stroke volume HR heart rate
37
blood ejected by a ventricle in one minute
cardiac output
38
volume of blood pumped out of ventricle-contraction
stroke volume
39
what varies with the stroke volume
sympathetic stimulation and venous return
40
ability of the heart to increase output in response to increased demand
cardiac reserve
41
amount of blood delivered to heart by venous return
preload
42
forced required to eject blood from ventricles
afterload
43
what is the afterload determined by
peripheral resistance in arteries
44
the number of contractions of the ventricles each minute
heart rate
45
exerted when blood is ejected from ventricles
systolic pressure
46
sustained pressure when ventricles relax
diastolic
47
blood pressure is altered by what
cardiac output blood volume peripheral resistance to blood flow
48
changes in blood pressure for sympathetic branch of ANS: increased and decreased
increased output: vasoconstriction and increased blood pressure decreased output: vasodilation and decreased blood pressure
49
blood pressure is directly proportional to what
blood volume
50
What does antidiuretic hormone do to blood pressure
increases
51
what does aldosterone do to blood pressure and blood volume
increase both
52
what does renin-angiotensin-aldosterone do to blood pressure and which type of vaso
increase | vasoconstriction
53
What is the equation for blood pressure
BP=CO * PR CO cardiac output PR peripheral resistance
54
blood pressure has no change (equation)
increase cardiac output and decrease peripheral resistance
55
blood pressure is elevated (equation)
cardiac output has no change and increase peripheral resistance
56
increased blood pressure (equation)
increase heart rate which increases cardiac output and systemic vasoconstriction which increases peripheral resistance
57
decreased blood pressure (equation)
decrease in stroke volume which decreases cardiac output and systemic vasodilation which decreases peripheral resistance
58
useful in the initial diagnosis and monitoring of dysrhythmias, myocardial infarction, infection , pericarditis
electrocardiography
59
what are the diagnostic tests for cardiovascular function
``` blood tests doppler studies arterial blood gas determination cardiac catheterization angiography exercise stress test chest x-rays nuclear imaging SPECT tomographic studies auscultation echocardiography electrocardiography ```
60
determination of valvular abnormalities or abnormal shunts of blood that cause murmurs
auscultation
61
how is auscultation detected
by listening through a stethoscope
62
used to record heart valve movements, blood flow, and cardiac output function
echocardiography
63
used to assess general cardiovascular
exercise stress test
64
what is used for an exercise stress test
bicycle, treadmill, or steps
65
used to show shape and size of the heart
chest x-rays
66
measures pressure and assesses valve and heart function
cardiac catheterization
67
determines central venous pressure and pulmonary capillary wedge pressure
cardiac catheterization
68
visualization of blood flow in the coronary arteries
angiography
69
checks the current oxygen level and acid-base balance
arterial blood gas determination
70
assess levels of serum triglycerides, cholesterol, sodium, potassium, calcium, and other electrolytes
blood test
71
assess blood flow in peripheral vessels
Doppler studies
72
record sounds of blood flow or obstruction
Doppler studies
73
general treatment measures for cardiac disorders
``` diuretics anticoagulants cholesterol-lowering drugs digoxin antihypertensive drugs adrenergic blocking drugs angiotensin-converting enzyme inhibitors vasodilators beta blockers calcium channel blockers dietary modifications regular exercise program cessation of smoking ```
74
what would dietary modifications for cardiac disorders do for the body
to decrease total fat intake general weight reduction reduce salt intake
75
what would regular exercise program for cardiac disorders do for the body
increases high-density lipoprotein levels lowers serum lipid levels reduces stress levels
76
what would cessation of smoking for cardiac disorders do for the body
decreases risk of coronary disease
77
what would vasodilators for cardiac disorders do for the body
reduction of peripheral resistance
78
what would beta blockers for cardiac disorders do for the body
treatment of hypertension and dysrhythmias | reduction of angina attack
79
what would calcium channel blockers for cardiac disorders do for the body
decrease cardiac contractility prophylactic against angina antihypertensives and vasodilators
80
what would digoxin for cardiac disorders do for the body
treatment for heart failure | antidysrhythmic drug for atrial dysrhythmias
81
what would antihypertensive drugs for cardiac disorders do for the body
used to lower blood pressure
82
what would adrenergic blocking drugs for cardiac disorders do for the body
act on SNS centrally or on the periphery
83
what would angiotensin-converting enzyme inhibitors for cardiac disorders do for the body
block conversion of angiotensin I to angiotensin II
84
what would diuretics for cardiac disorders do for the body
remove excess sodium and/or water | treat high blood pressure and congestive heart failure
85
what would anticoagulants for cardiac disorders do for the body
reduce risk of blood clot formation
86
what would cholesterol-lowering drugs for cardiac disorders do for the body
reduce low-density lipoprotein and cholesterol levels
87
what is nitroglycerin used for
angina attacks and prophylaxis
88
what is nitroglycerin's action
reduces cardiac workload | peripheral and coronary vasodilator
89
what are the adverse effects of nitroglycerin
dizziness | headache
90
what are the adverse effects of metoprolol
dizziness | fatigue
91
what is the use of metoprolol
hypertension angina antiarrhythmic
92
what is the action of metoprolol
blocks beta-adrenergic receptors | slows heart rate
93
what is the use of nifedipine
angina hypertension peripheral vasodilator antiarrhythmic
94
what is the action of nifedipine
calcium blockers | vasodilator
95
what is the adverse effects of nifedipine
dizziness fainting headache
96
what is the adverse effects of digoxin
nausea fatigue headache weakness
97
what is the use of digoxin
congestive heart failure and atrial arrhythmias
98
what is the action of digoxin
slows conduction through AV node and increases force of contraction to increase efficiency
99
what is another name for digoxin
lanoxin
100
what is another name for nifedipine
adalat
101
what is another name for metoprolol
lopressor
102
what is another name for enalapril
vasotec
103
what is the use of enalapril
hypertension
104
what is the action of enalapril
ACE inhibitor | blocks formation of angiotensin II and aldosterone
105
what are the adverse effects of enalapril
headache dizziness hypotension
106
what are the adverse effect of furosermide
nausea diarrhea dizziness
107
what are the adverse effects of simvastatin
digestive discomfort
108
what are the adverse effects of warfarin
excessive bleeding | needs more Vitamin K
109
what are the adverse effects of ASA
gastric irritation | allergy
110
What is another name for furosemide
lasix
111
what is another name for simvastatin
zocor
112
what is another name for warfarin
coumadin
113
what is another name for ASA
aspirin
114
what is the use of furosemide
edema with CHF | hypertension
115
what is the action of furosemide
diuretic increases excretion of water and sodium
116
what is the use of simvastatin
hypercholesteremia
117
what is the action of simvastatin
decreases cholesterol and LDL
118
what is the use of warfarin
prophylaxis and treatment of thromboemboli
119
what is the action of warfarin
anticoagulant interferes with Vitamin K in synthesis of clotting
120
what is the use of ASA
prophylaxis of thromboemboli
121
what s the action of ASA
prevents platelet adhesion | antiinflammatory
122
what is CAD
coronary artery disease
123
what is IHD
ischemic heart disease
124
what is ACS
acute coronary syndrome
125
presence of atheromas in large arteries
artherosclerosis
126
general term for all types of arterial changes
arteriosclerosis
127
degenerative changes in small arteries and arterioles loss of elasticity lumen gradually narrows and may become obstructed cause of increased blood pressure
arteriosclerosis
128
plaques consisting of lipids, calcium, and possible clots | related to diet, exercise, and stress
atherosclerosis
129
are transported in combination with proteins
lipids
130
transports cholesterol from liver to cells | major factor contributing to atheroma formation
low density lipoprotein (LDL)
131
transports cholesterol away from the peripheral cells to liver catabolism in liver and excretion
high density lipoprotein (HDL)
132
what type is good cholesterol
HDL
133
what type of cholesterol are bad cholesterol
LDL
134
what are the eight steps to development of an atheroma
dietary intake of cholesterol and triglycerides chylomicrons absorbed into blood and lymph lipid uptake by adipose and skeletal muscle cells remnants to liver liver synthesizes lipoproteins LDL transports cholesterol to cells LDL attaches to LDL receptor in smooth muscle and endothelial tissue HDL transports cholesterol from cells to liver
135
nonmodifiable risk factors for atherosclerosis
age (more common after 40) gender genetic or familial factors
136
modifiable risk factors for atherosclerosis
obesity sedentary lifestyle cigarette smoking diabetes mellitus poorly controlled hypertension combination of oral contraceptives and smoking combination of high cholesterol and high blood pressure
137
diagnostic tests of atherosclerosis
serum lipid levels
138
treatment of atherosclerosis
weight loss increase exercise lower total serum cholesterol and LDL levels by dietary modification reduce sodium intake control chronic disorders (hypertension and diabetes) cessation of smoking antilipidemic drugs surgical intervention, such as coronary artery bypass grafting
139
what does a total occlusion cause in the heart
myocardial infarction
140
what does a partial occlusion cause in the heart
angina pectoris
141
what does a partial occlusion cause in the brain
transient ischemic attack
142
what does a total occlusion cause in the brain
cerebrovascular accident
143
what causes an occlusion, rupture, and hemorrhage
aneurysm
144
what causes gangrene and amputation
peripheral vascular disease
145
occurs when there is a deficit of oxygen to meet myocardial needs
angina pectoris
146
what are the different patterns that chest pain may occur
classic or exertional angina variant angina unstable angina
147
what occurs in a variant angina
vasospasm occurs at rest
148
what occurs in an unstable angina
prolonged pain at rest and may precede myocardial infarction
149
decreased oxygen supply means what two things
decreased activity | pain
150
attacks vary in severity and duration but become more frequent and longer as disease progresses recurrent, intermittent brief episodes of substernal chest pain
angina pectoris
151
what triggers angina pectoris
physical or emotional stress
152
angina pectoris is relieved by what
rest and administration of coronary vasodilators
153
primarily acts by reducing systemic resistance, decreasing the demand for oxygen
nitroglycerin
154
what are the emergency treatments for angina
rest, stop activity patient seated in administer oxygenupright position administration of nitroglycerin check pulse and respiration
155
occurs when coronary artery is totally obstructed vasospasm is cause in a small percentage part of thrombus may break away, forming embolus
myocardial infarction
156
what is the most common cause of a myocardial infarction
atherosclerosis
157
what may obstruct the artery in a myocardial infarction
thrombus from atheroma
158
what determines the damage of a myocardial infarction
size and location of the infarct
159
what are the warning signs of a heart attack
feeling of pressure, heaviness, or burning in chest sudden shortness of breath, weakness, fatigue hypotension, rapid pulse nausea, indigestion anxiety and fear pain may occur and can be crushing, radiating, and substernal
160
what are the diagnostic tests of a myocardial infarction
changes in ECG serum enzyme and isoenzyme levels serum levels of myosin and cardiac troponin are elevated serum electrolyte levels may be abnormal leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate common arterial blood gas measurements may be altered in severe cases pulmonary artery pressure measurements
161
at what time are the serum levels high: CPK-MB, AST, and LDH-1
LDH-1: 72 hours AST: 48 hours CPK-MB: 24 hours
162
what are complications of myocardial infarction
``` sudden death cardiogenic shock CHF rupture of necrotic heart tissue (ventricular aneurysm) thromboembolism ```
163
What are the treatments of a myocardial infarction
``` reduce cardiac demand oxygen therapy analgesics anticoagulants thrombolytic agents may be used tissue plasminogen activator medication ```
164
what are the medications to treat myocardial infarction
dysrhythmias hypertension CHF cardiac rehabilitation begins immediately
165
for monitoring the conduction system that detects abnormalities
electrocardiography
166
what are deviations from normal cardiac rate or rhythm caused by
electrolyte abnormalities, fever, hypoxia, stress, infection, drug toxicity
167
reduction of the efficiency of the heart's pumping cycle
cardiac dysrhythmias
168
pacemaker of the heart and rate can be altered
SA node
169
regular but slow heart rate
bradycardia
170
regular rapid heart rate
tachycardia
171
marked by altering bradycardia and tachycardia
sick sinus syndrome
172
often requires a mechanical pacemaker
sick sinus syndrome
173
what are the three atrial conduction abnormalities
atrial flutter atrial fibrillation premature atrial contractions
174
extra contraction or ectopic beats irritable atrial muscle cells outside conduction pathway palpitations
premature atrial contractions
175
atrial heart rate of 160 to 350 beats a minute | AV node delays conduction (ventricular rate slower)
atrial flutter
176
rate over 350 beats a minute causes pooling of blood in the atria thrombus formation is a risk
atrial fibrillation
177
what degree block: conduction delay between atrial and ventricular contractions
first
178
what degree block: every second to third atrial beat dropped at AV node
second
179
what degree block: no transmission from atria to ventricles | total blockage
third
180
conduction excessively delayed or stopped at AV node or Bundle of His
heart block
181
What are different ventricular conduction abnormalities
bundle branch block ventricular tachycardia ventricular fibrillation premature ventricular contractions
182
interference with conduction in one of the bundle branches
bundle branch block
183
likely to reduce cardiac output as reduced diastole occurs
ventricular tachycardia
184
muscle fibers contract independently and rapidly | cardiac standstill occurs if not treated immediately
ventricular fibrillation
185
additional beats from ventricular muscle cell or ectopic pacemaker may lead to ventricular fibrillation
premature ventricular contractions
186
what is the effect of bradycardia
stroke volume increased | possibly reduced cardiac output
187
what is the effect of tachycardia
possibly reduced cardiac output
188
what is the effect of atrial flutter
less filling time | often reduced cardiac output
189
what is the effect of fibrillation
no filling, no output- cardiac standstill
190
what is the effect of premature ventricular contractions
may induce fibrillation
191
what is the effect of bundle branch block
no effect
192
what is the effect of first heart block
no effect
193
what is the effect of second heart block
periodic decrease in output
194
what is the effect of a total heart block
marked decrease in output, causing syncope
195
what is used to treat cardiac dysrhythmias
antidysrhythmic drugs SA nodal problems or total heart block require pacemaker defibrillator may be implanted for conversion of ventricular fibrillation
196
asystole
cardiac arrest
197
cessation of all heart activity means
no conduction of impulses | flat EKG
198
what are reasons of cardiac arrest
``` excessive vagal nerve stimulation potassium imbalance cadiogenic shock drug toxicity insufficient oxygen respiratory arrest blow to heart ```
199
heart is unable to pump out sufficient blood to meet metabolic demands of the body
congestive heart failure
200
when heart cannot maintain pumping capability for CHF (2)
cardiac output or stroke volume decreases | backup and congestion develop as coronary demands for oxygen and glucose are not met
201
why does cardiac output or stroke volume decrease (4)
less blood reaches the various organs decreased cell function fatigue and lethargy mild acidosis develops
202
How does backup and congestion develop as coronary demands for oxygen and glucose are not met (2)
output from ventricle is less than the inflow of blood | congestion in venous circulation draining into the affected side of the heart
203
what are the effects of CHF left side
left ventricle weakens and cannot empty decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion high pressure in pulmonary capillaries leads to pulmonary congestion or edema
204
what are the effects of CHF right side
right ventricle weakens and cannot empty decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion increased venous pressure results in edema in legs and liver and abdominal organs very high venous pressure causes distended neck vein and cerebral edema
205
what are the three compensation mechanisms of CHF
tachycardia cutaneous and visceral vasoconstriction daytime oliguria
206
what are the four forward effects of CHF
decreased blood supply to tissues, general hypoxia fatigue and weakness dyspnea and shortness of breath exercise and cold intolerance
207
what is the first sign of CHF in children
feeding difficulties | failure to gain weight or meet developmental guidelines
208
what are four signs of CHF in children
short sleep periods tripod position to play cough, rapid grunting respirations, flared nostrils, wheezing often a third heart sound is present
209
radiographs for CHF in children shows what
cardiomegaly and presence of absence of fluid in lungs
210
arterial blood gases are used to measure what in CHF in children
hypoxia
211
structural defects in the heart that develop during the first eight weeks of embryonic life
cardiac anomalies
212
septal defects valvular defects detected by the presence of heart murmurs
congenital heart disease
213
depending on the direction of shunting in congenital heart defects can be
acyanotic or cyanotic
214
what are the seven signs and symptoms of large congenital heart defects
``` pallor tachycardia dyspnea on exertion squatting position clubbed fingers intolerance for exercise and exposure to cold weather delayed growth and development ```
215
signs of congenital heart defects what does a squatting position do
appears to modify blood flow
216
True or false severe defects are often diagnosed at birth and others may not be detected for some time
true
217
what are the five different examination techniques of congenital heart defects
``` radiography diagnostic imaging cardiac catheterization echocardiography electrocardiography ```
218
what is the most common congenital heart defect
ventricular septal defect
219
congenital heart defect hole in the heart; opening in the interventricular septum
ventricular septal defect
220
what are the three things that happen with untreated ventricular septal defects
pressure usually higher in left ventricle shunt from left to right acyanotic condition unless respiratory condition increases pressure in right ventricle
221
usually affect aortic and pulmonary valves may be classified as stenosis or valvular incompetence mitral valve prolapse
ventricular septal defect
222
abnormally enlarged and floppy valve leaflets
mitral valve prolapse
223
failure of valve to close completely | blood regurgitates or leaks backward
stenosis or valvular incompetence
224
surgical repair of ventricular septal defect
mechanical or animal tissue
225
occurs because shunt bypasses the pulmonary circulation
cyanosis
226
most common cyanotic congenital heart condition | alters pressures in heart and alters blood flow
tetralogy of fallot
227
what are the four abnormalities of tetralogy of fallot
involves heart as well as joints VSD dextroposition of the aorta right ventricular hypertrophy
228
acute systemic inflammatory condition may result from an abnormal immune reaction can occur a few weeks after an untreated infection involves heart as well as joints usually occurs in children ages 5 to 15 years old
rheumatic fever
229
rheumatic fever may be complicated by what
infective endocarditis and heart failure in older adults
230
what untreated infections could cause rheumatic fever
group A beta hemolytic streptococcus
231
acute stage of rheumatic fever
inflammation of the heart myocarditis pericarditis endocarditis and incompetent heart valves
232
other sites of inflammation that have to do with rheumatic fever
large joints erythema marginatum nontender subcutaneous nodules involuntary jerky movement of the face, arms, legs
233
signs and symptoms of rheumatic fever
low-grade fever, leukocytosis, malaise, anorexia, fatigue, tachycardia, heart murmur, abdominal pain
234
what diagnostic tests are used for rheumatic fever
heart function test electrocardiography ASO titer
235
what treatments are used for rheumatic fever
prophylactic antibacterial agents | anti-inflammatory agents
236
subacute infective endocarditis
streptococcus viridans | may interfere with opening and closing of valves
237
acute infective endocarditis
staphylococcus aureus
238
factors that predispose to endocarditis infection
bactermia reduced host defenses presence of abnormal valves in heart
239
increasing fatigue, anorexia, cough, and dyspnea
insidious onset
240
subacute endocarditis has what onset
insidious
241
how is endocarditis treated
antimicrobial drugs for several weeks often IV
242
sudden, marked onset, spiking fever, chills, drowsiness, heart valves badly damaged
acute endocarditis
243
signs of infective endocarditis
new heart murmurs, low grade fever or fatigue, anorexia, splenomegaly, congestive heart failure in severe cases
244
simple inflammation of the pericardium chest pain effusion may develop can be secondary
acute pericarditis
245
pericarditis may be secondary to
open heart surgery, myocardial infarction, rheumatic fever, systemic lupus erythematosus, cancer, renal failure, trauma, viral infection
246
what does it mean for effusion in pericarditis
large volume of fluid accumulates in pericardial sac | leads to distended neck veins, faint heart sounds, pulsus paradoxus
247
what are the five effects of pericardial effusion
``` fluid around heart compresses heart wall heart cannot expand to fill backup into systemic circulation decreased blood flow to lungs decreased output to body ```
248
Results in formation of adhesions between the pericardial membranes Fibrous tissue ten results from tuberculosis or radiation to the mediastinum Limiting movement of the heart during diastole and systole reduced cardiac output Inflammation or infection may develop from adjacent structures Causes fatigue, weakness, abdominal discomfort
Chronic pericarditis
249
Cause by systemic venous congestion
Chronic pericarditis
250
Arrhythmias has to do with
Myocarditis
251
Valve damage has to do with
Endocarditis
252
Effusion has to do with
Pericarditis
253
High blood pressure Often undiagnosed Sometimes classified as systolic and diastolic
Hypertension
254
What age group may hypertension occur
Any age group
255
Hypertension is what type of disease
Arterial disease
256
What individuals are more common to have hypertension
African ancestry
257
Essential hypertension Idiopathic Increase in arteriolar vasoconstriction Over long period of time there is damage to arterial walls
Primary hypertension
258
What is the blood pressure for primary hypertension
Consistently above 140/90
259
How does primary hypertension damage arterial walls
Blood supply to involved area is reduced | Ischemia and necrosis of tissues with loss of function
260
Results from renal or endocrine disease, pheochromocytoma, or SNS chain of ganglia Underlying problem must be treated to reduce blood pressure
Secondary hypertension
261
Benign tumor of the adrenal medulla
Pheochromocytoma
262
Uncontrollable, severe, and rapidly progressive form with many complications Diastolic pressure is extremely high
Malignant or resistant hypertension
263
What are the areas most frequently damaged by hypertension
Kidneys Heart Brain Retina
264
What are the five predisposing factors of hypertension
Incidence increases with age Men affected more frequently and more severely incidence in women increases after middle age Genetic factors Sodium intake, excessive alcohol intake, obesity, smoking, prolonged or recurrent stress
265
What are the initial signs of hypertension
Fatigue, malaise, sometimes morning occipital headache
266
What are the five steps to treat essential hypertension
``` Lifestyle changes Reduction of sodium intake Weight reduction Reduction of stress Drugs like diuretics, ACE inhibitors, drug combinations ```
267
Hypertension is frequently what in early stages
A symptomatic
268
Disease in arteries outside the heart | Increased incidence with diabetes
Peripheral vascular disease and atherosclerosis
269
Diagnostic tests for peripheral vascular disease and atherosclerosis
Blood flow assessed by Doppler studies and arteriography | Plethysmograph you measures the size of limbs and blood volume in organs or tissues
270
Most common sites of peripheral vascular disease and atherosclerosis
Abdominal aorta Carotid arteries Femoral and iliac arteries
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Signs and symptoms of peripheral vascular disease atherosclerosis
Increasing fatigue and weakness in the legs Intermittent claudication (leg pain) associated with exercise caused by muscle ischemia Sensory impairment like tingling, burning, numbness Peripheral pulses distal to occlusion become weak Appearance of skin of the feet and legs change; marked by pallor or cyanosis, skin dry and hairless, toenails thick and hard
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Treatment of peripheral vascular disease atherosclerosis
Maintain control of blood glucose level Reduce body mass index Reduce serum cholesterol level Platelet inhibitors or anticoagulant medication Cessation of smoking Increase activity and exercise Maintain dependent position for legs-improves arterial perfusion Peripheral vasodilators Observe skin for breakdown and treat promptly If gangrene develops, amputation is required
273
Localized dilation and weakening of arterial wall Develops from a defect in the medial layer Has three different shapes
Aortic aneurysm
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Aortic aneurysm | Bulging wall on the side
Saccule
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Aortic aneurysm | Circumferential dilation along a section of artery
Fuss form
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Aortic aneurysm | Develops when there is a tear in the intima of the wall and blood continues to dissect or separate tissues
Dissecting aneurysm
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Causes of aortic aneurysm
Atherosclerosis Trauma Syphilis and other infections Congenital defects
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Signs and symptoms of aortic aneurysm
Bruit may be heard on auscultation Pulse may be felt on palpation of abdomen Frequently asymptomatic until they become large or rupture
279
A rupture in aortic aneurysm may lead to what
Moderate bleeding but usually causes severe hemorrhage and death
280
Diagnostic tests of aortic aneurysm
Radiography Ultrasound Cut scanning Mir
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What is the treatment of aortic aneurysm
Maintain blood pressure at normal level Prevent sudden elevations caused by exertion Prevent stress, coughing, constipation Surgical repair
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Irregular, dilated, tortuous areas of superficial veins Familial tendency Increased body mass index, parity, and weight lifting are risks
Varicose veins
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In the legs varicose veins do what and appear as
May develop from defect or weakness In Vein walls or valves | Appear as irregular, purplish, bulging structures
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Treatment of varicose veins
Keep legs elevated, support stockings | Restricted clothing, crossing legs to be avoided
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Thrombus development in inflamed vein
Thrombophlebitis
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Thrombus forms spontaneously without prior inflammation; attached loosely
Phlebothrombosis
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What are the factors for thrombus development
Stasis of blood or sluggish blood flow Endothelial injury Increased blood coagulant lite
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Signs and symptoms of thrombophlebitis and phlebothrombosis
Often unnoticed Aching, burning, tenderness in affected legs Systemic signs like fever, malaise, leukocyte sis
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What is a complication of thrombophlebitis and phlebothrombosis
Pulmonary embolism
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What is the treatment of thrombophlebitis and phlebothrombosis
Preventive measures like exercise and elevating legs Anticoagulant therapy Surgical intervention
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Loss of circulating blood volume
Hypovolemic shock
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Inability of heart to maintain cardiac output to circulation
Cardiogenic shock
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Changes in peripheral resistance leading to pooling of blood in the periphery
Distributive, vasogenic, neurogenic, septic, anaphylactic shock
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Vasodilation owing to severe infection, often with gram-negative bacteria
Septic or endotoxins
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Loss of blood or plasma
Hypovolemic
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Decreased pumping capability of the heart
Cardio genie
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Vasodilation owing to loss of sympathetic and vasomotor tone
Vasogenic | Neurogenic or distributive
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Systemic vasodilation and increased permeability owing to severe allergic reaction
Anaphylactic
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Early manifestations of shock
``` Anxiety Tachycardia Pallor Light-headedness Syncope Sweating Oliguria ```
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Compensation mechanisms of shock
SNS and adrenal medulla stimulated- increase heart rate, force of contraction, systemic vasoconstriction Renin secretion increases Increased ADH secretion Secretion of glucocorticoids Acidosis stimulates increased respiration
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With prolonged shock what happens
Cell metabolism is diminished, waste not removed and leads to lower pH
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Complications of shock
Acute renal failure Shock lung, or adult respiratory distress syndrome Hepatic failure Paralytic ileum, stress or hemorrhagic ulcers Infection or septicemia Disseminated intravascular coagulation Depression of cardiac function
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Compensation manifestations in shock
``` Tachycardia Cool, pale, moist skin Oliguria Thirst Rapid respiration so ```
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Progressive manifestations of shock
Lethargy, weakness, faintness | Metabolic acidosis secretion
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Emergency treatment for shock
``` Place patient in a supine position Cover and keep warm Call for assistance Administer oxygen if possible Determine underlying cause and treat if possible such as using an epipen for anaphylaxis or applying pressure for bleeding ```

Pathophysiology (4 decks)

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