CH.24 Alterations of cardiovascular function Flashcards by areanna burnett

vein which blood has pooled. Distended, tortuous, and palpable veins

Varicose veins

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What causes varicose veins?

Trauma or gradual venous distention

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When veins and valves become incompetent, backward leaking of blood with pooling occurs. This increases what?

Hydrostatic pressure with second-spacing fluid

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Risk factors for varicose veins?

Age, female, family history, obesity, pregnancy, deep vein thrombosis

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Tx of varicose veins?

Compression stockings
Sclerotherapy
Laser therapy
Vein ligation and stripping

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Inadequate venous return over a long period of time due to varicose veins or valvular incompetence causes what?

Chronic venous insufficiency

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Venous congestion.
Increased venous pressure
Tissue hypoxia
inflammation
Fibrosclerotic remodeling

Chronic venous insufficiency

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Thrombi obstruct venous flow leading to increased venous pressure

Venous thrombi (clots)

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What are contributing factors to venous thrombi?

Venous stasis
Venous endothelial damage
Hypercoagulable
Other (cancer, orthopedic surgery/trauma, heart failure)

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Most clots originate from veins in the ____ _____ (think DVT)

Lower extremities

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How to prevent venous thrombi?

VTE prophylaxis using anticoagulants for high-risk patients

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How do you diagnose venous thrombi?

Serum D-dimer test and doppler ultrasonography

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Treatment for venous thrombi?

Anticoagulants.
Thrombolytics
Inferior vena cava filter

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Pulmonary _____ is a potential complication from venous thrombi

emboli

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What is superior vena cava syndrome?

Progressive occlusion of the superior vena cava

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What typically causes superior vena cava syndrome?

Cancers or thrombosis of CVC’s

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Vena caval occlusion leads to _____ ____ of upper extremities and head

venous distention

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Symptoms of SVCS

Headache, decreased consciousness, feeling of “fullness” in the head, and tight collars

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Is superior vena cava an oncologic emergency?

Yes

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What would a patient with superior VC syndrome look like?

presents as neck or facial swelling

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How do you diagnose superior VC syndrome

Chest x-ray and venous doppler

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Tx for superior VC syndrome

diuretics, anticoagulants, cancer tx, senting, or bypassing the occlusion

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Venous stasis
Venous endothelial damage
Hypercoagulable
Other (cancer, orthopedic surgery/trauma, heart failure)
These factors contribute to?

Venous thrombi

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Patient presents with a swollen neck and is complaining of a constant headache that feels “full”. A diagnosis is made after performing chest x-rays and using the venous doppler. The patient receives diuretics and anticoagulants. What does the patient likely have?

Superior Vena Cava syndrome

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What indicates hypertension (HTN)

Sustained bp of 140 over 90

Progressive occlusion of the superior vena cava is....

superior vena cava syndrome

How many US adults have HTN

1/3

1. Anticoagulants. 2. Thrombolytics 3. Inferior vena cava filter There are treatments for...

Venous thrombi

_______ is the consistent elevation of systemic arterial blood pressure

hypertension

Of the 1/3 of adults with hypertension, how many are older than 60 years old?

2/3

Headache, decreased consciousness, feeling of "fullness" in the head, and tight collars. These are symptoms of

Superior Vena Cava syndrome

How do you classify HTN? two main classes.

1. Primary vs secondary | 2. Complicated and malignant

What are other names for primary hypertension

Essential or idiopathic

What % of people with HTN have primary HTN?

92%-95% of individuals

Which HTN has increased rates among african americans?

Primary

Primary HTN can be caused by high ______ intake

sodium

Primary HTN can be caused by _____ _____ abnormalities

natriuretic peptide

Primary HTN can be caused by ______ (swelling)

inflammation

Which HTN has polygenic origins and is associated with epigenetic changes, diet, and lifestyle?

Primary

Primary HTN can be caused by ______ and ______ resistance

obesity and insulin

Primary HTN can be caused by ______ and heavy use of ______

tobacco and alcohol

The sympathetic nervous system and Renin-angiotensin-aldosterone system are pathophysiologic mechanisms of what?

Primary HTN

High sodium intake, natriuretic peptide abnormalities, inflammation, obesity and insulin resistance, and tobacco+alcohol use. THese are risk factors for

Primary HTN

_____ hypertension is caused by a systemic disease process that raises peripheral vascular resistance or cardiac output

Secondary

Renal vascular or parenchymal disease: increased renin secretion. This is associated with which HTN?

secondary

Adrenocortical tumors: aldosterone secretion. Associated with _____ HTN

secondary

Adrenomedullary tumors: catecholamine secretion. Associated with ______ HTN

secondary

Which drugs can cause secondary HTN?

Oral contraceptives, corticosteroids, and antihistamines

Treatment of HTN is to reduce the numbers to

less than 130 over 80 in most populations

Tx of HTN?

Lifestyle modifications and antihypertensive medications

92%-95% of individuals have this type of HTN

primary

Clinical manifestations of HTN?

- Asymptomatic | - Elevated BP

Diagnosis of HTN

Serial BP measurement and investigation for causative conditions

Chronic hypertensive damage to blood vessels and tissues is indicative of _____ hypertension

complicated

_____ HTN leads to target organ damage in the heart, kidney, brain, and eyes

complicated

_____ HTN causes left ventricular hypertrophy due to pumping against higher pressure which increases myocardial oxygen demand (risk for MI and HF)

Complicated

Which hypertension is a risk for myocardial infarction and heart failure

complicated HTN

_____ hypertension is rrapidly prorgressive

Malignant

With _____ HTN, the diastolic pressure is usually > 140

Malignant

Tx of Malignant HTN?

Antihypertesives

Patient has been in the hospital with an in range BP for a week. Suddenly her BP is 160/90 and she has cerebral edema. The nurse understands she has which type of HTN

Malignant

Decrease in both systolic and diastolic blood pressure upon standing within 3 minutes

Orthostatic (postural) HYPO tension

What is the pathophysiologic mechanism of postural hypotension?

Lack of normal blood pressure compensation in response to gravitational changes on the circulation

- Reflex vasoconstriction mediated by baroreceptors, increased heart rate. - Impact of venous valves, leg muscle contraction, decreased intrathoracic pressure

Orthostatic (postural) hypotension

Four main causes of orthostatic hypotension?

1. medications 2. Dehydration 3. Immobility 4. Venous pooling of blood

Chronic orthostatic hypotension is due to...

chronic diseases

Tx of _____ ____: compression stockings, increase fluid and Na+. These treatments are for primary or secondary?

Orthostatic hypotension; primary

What is the tx for secondary hypotension?

Treat the cause. ex: adrenal insufficiency

Which vessel or cardiac chamber is most susceptible to aneurysms?

Aortic: especially abdominal

What is the most common causes of aortic aneurysms?

Atherosclerosis and hypertension.

What do aneurysms lead to?

Aortic dissection or rupture

____ _____: all arterial wall layers. Fusiform aneurysms, circumferential, and saccular

True aneurysms

____ _____: extravascular hematoma

False aneurysms

Are aneurysms asymptomatic before rupture?

Yes

Are patients hypertensive or hypotensive when an aneurysm ruptures?

Hypotensive

Dx of aneurysm

Imaging studies

Tx of aneurysm

Clipping, coiling, and grafting

____ _____: blood clot that remains attached to the arterial wall

arterial thrombi

Risk factors for arterial thrombi?

Damage to intima (during surgery, trauma), infection, hypotension, aneurysm, and endocarditis(damaged valves)

If a patient gets an arterial thrombi caused by hypotension...what is worst case scenario with that?

From septic shock with Systemic Inflammatory Response Syndrome (SIRS)

What is a potential complication from arterial thrombi?

Thromboembolus

Bolus of matter that is circulating in the blood steam

Arterial embolism

Complication of arterial embolism

Arterial occlusion with subsequent ischemia and tissue hypoxia

Tx of arterial thrombi and embolus

- Anticoagulants - Thrombolytics - Manual extraction with catheter

Autoimmune, inflammatory disease of the peripheral arteries

PVD--thromboangiitis obliterans (buerger disease)

Which disease is strongly associated with smoking?

Buerger disease (thrombo obliterans)

Characterized by the formation of thrombi filled with inflammatory and immune cells

PVD (buerger disease)

Thrombi become organized and fibrotic--result in permanent occlusion and obliteration of portions of small and medium sized arteries in feet and sometimes hands

PVD--Buerger disease

Manifestations include pain and tenderness in the affected area. Symptoms are caused by slow, sluggish blood flow.

PVD- thromboangitis obliterans

What does PVD often lead to?

Gangrenous lesions and amputations?

Tx of PVD?

Stop smoking. Vasodilators.

Patient presents with episodic vasospams in her fingers. This is

PVD...the raynaud phenomenon

What causes raynaud phenomenon

Imbalance between endothelium-derived vasodilators and vasoconstrictors

Primary PVD- R. phenomenon

Vasoplastic disorder of unknown origin

Secondary PVD--raynaud phenomenon

Secondary to other systemic diseases or conditions. - Collagen vascular disease - Smoking - Pulmonary hypertension - Myxedema - cold env. vib. stress.

Pallor, cyanosis, cold to the touch, and pain

Raynaud phenomenon

Tx of Raynaud

Avoid triggers. Vasodilators

Chronic disease of the arterial system--abnormal thickening and hardening of the vessel walls

Arteriosclerosis

Causes of arteriosclerosis

Loss of elastin with aging and chronic hypertension that results in arterial damage

A form of arteriosclerosis. Thickening and hardening caused . by accumulation of . lipid-laden macrophages

Atherosclerosis

Modifiable risk factors of atheroslerosis

Smoking, diabetes, hypertension, and hyperlipidemia/dys

Progression of ______: inflammation of endothelium, cellular proliferation, LDL oxidation, and fatty streak

Atherosclerosis

Dx of atherosclerosis

Blood tests, scans, and angiography

Tx of atherosclerosis

Eliminate or manage modifiable risk factors. Manage HTN, DM

Complications of atherosclerosis

Stroke, MI (due to inadequate perfusion, ischemia...ultimately leads to infarction

Complications of atherosclerosis

Stroke and MI

PAD stands for

Peripheral Artery Disease

Atherosclerotic disease of arteries that perfuse extremities

PAD

Clinical signs of PAD

Intermittent claudication--pain with ambulation

Dx of PAD

Venous doppler

PAD has an increased risk with what two factors?

Age and smoking

Tx of PAD

Antithrombotic drugs, vasodilators

Any vascular disorder that narrows or occludes the coronary arteries

Coronary Artery Disease

Risk of CAD

Myocardial ischemia, injury, and infarction

Most common cause of CAD?

Atherosclerosis

List some non-modifiable risk factors of CAD

- Increased age - Family history - Gender - post menopause

List some modifiable factors of CAD

- Dyslipidemia - Hypertension - Smoking - Diabetes Mell. - Obesity/inactive lifestyle - Atherogenic diet

First sign of CAD?

Transient myocardial ischemia

Angina, ischemic chest pain: substernal pain or pressure...may radiate. Stable angina relieved by rest and nitrate medications

First symptoms of CAD

Prinzmetal angina--a variant angina, due to coronary vasospasm w/ or with out atherosclerosis

First sign of CAD

Management of stable angina

Dx by patient report. - ECG - Blood tests for cardiac enzymes - Angiograms

Tx of stable angina if no MI

- Medications (VasoD) - Lifestyle modifications - PCI (percutaneous coronary intervention)

____ angina: symptom of complicated atherosclerotic plaque

unstable

Causes ischemia, which is reversible and if reversed in time will prevent myocardial death

Unstable angina

Temporary loss of contractile ability

Myocardial stunning

Adaptation to decreased O2 supply

Hibernating myocardium

Mycocyte hypertrophy, widespread loss of contractibility

Myocardial remodeling

Manifestations of MI

- Sudden severe chest pain - Nausea, vomiting - Diaphoresis - Dyspnea

Complications of MI

Sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability

Dx of MI

ECG, blood tests, angiogram

Tx of MI

Reperfusion: thrombolytics, emergent PCI with angioplasty, stenting, and revascularization (CABG)

If you suspect a patient is experiencing chest pain or MI, what do you order first?

Oxygen

Clinical signs of pericarditis

Low grade fever, severe chest pain, friction rub on auscultation, ECG changes

Scarred pericardial layers adher

Constrictive pericarditis

What causes constrictive peri.

can be idiopathic, viral infections, and seen with patients with TB (immunocompromised population)

Tx of pericarditis

Anti-inflammatory drugs

Complication of pericarditis

Pericardial effusion

If fluid volume large enough, can cause tamponade

Pericardial effusion

- Distant heart sounds - Dyspnea on exertion - Dull chest pain

Signs of effusion

Key clinical sign of tamponade?

Pulsus paradoxus

Dx of pericardial effusion

echocardiogram

Tx of pericardial effusion

Pericardiocentesis

Diseases in which the myocardium itself is diseased or damaged

Cardiomyopathies

Name three types of causes for Cardio myop.

Genetic, non genetic, and mixed

CMYO non genetic causes include...

Secondary to HTN, ischemia, infection, myocarditis

CMYO genetic causes...

Hypertrophic cardiomyopathy (autosomal dominant)

Tests show dilation and thinning of myocardial wall (left V) Structural change with perivascular fibrosis

Dilated Cardiomyopathy

Systolic function is decreased, progressive heart failure, with clinical manifestations such as dyspnea, fatigue, and edema

Dilated CAMY

What is the most common cardiomyopathy?

Hypertrophic cardiomyopathy

Myocyte function disarray, fibrosis, altered sacromere function. Hypertrophy of the LV

Hypertrophic CAMY

Rigidity and noncompliance of myocardial wall (rare)

Restrictive CAMY

What do you see with restrictive CAMY?

Impaired V filling, decreased cardiac output

Dx of CAMY

chest x-ray, echocardiogram, ECG, treadmill test

Tx (depending n cause)

- Drug support - Myectomy (hypertrophic) - Pacemaker - Implant device - heart transplant

Valves are continuous with the _____

endocardium

Opening is constricted(valves)

Valvular stenosis

____ ____ results in resistance to forward blood flow

Valvular stenosis

Causes of VS

Congenital with aging. | Secondary to inflammation, trauma, ischemia, infection

Complications of VS

cardiomyopathy, MI, HF, dysrhythmias

Most commonVS

Aortic

____ stenosis: negative impact on left ventricle, causing hypertrophy which increases oxygen demand

aortic

_____ stenosis: common form of rheumatic heart disease

Mitral

____ stenosis: negative impact on left atrium, causing atrial dilation and/or hypertrophy

mitral

Patients with mitral stenosis run a risk of

increased risk of atrial fibrillation

Along with congenital, aging, and HTN, what else causes valve regurge?

rheumatic heart disease, endocarditis, and marfan syndrome

Examples of different valve regurges make sense if you know the anatomy Aorotic overflows the ___

If the tricuspid valve is regurging, what will overload?

THe right ventricle

Clinical sign of regurge?

Dyspnea and fatigue

Percent of people with MVP

MVP, the valve prolapses _____

backward

Systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by rhe group A-B hemolytic strep

Rheumatic fever

____ ______: inflammation of the joints, skin, nervous system, and heart

Febrile illness

If left untreated, rheumatic fever causes

rheumatic heart disease.

Which bacteria causes rheumatic fever

Group A beta hemolytic streptococci

Damage/scarring of valve leaflets, myocarditis, pericardial inflammation, cardiomegaly, left HF...results from untreated

Rheumatic fever

Patient presents with fever, nausea vomiting, tachycardia, abdominal pain, and arthalgia

Rheumatic fever--common signs

Patient presents with carditis, polyarthritis, chorea, and subcutaneous nodules

Major clinical manifestations of rheumatic fever

Tx of rheumatic fever

Antibiotics; anti-inflammatory drugs

Inflammation of the endocardium due to infection

Infective endocarditis

Rickettsiae and parasites can cause

Endocarditis

Patient presents with fever, new or changed cardiac murmur, and has petechial lesions of the skin, and oral mucosa.

Infective endocarditis

Patient presents with osler nodes and janeway lesions.

Endocarditis

Nonpainful hemorrhagic lesions on hte palms and soles

Janeway lesions seen with infective endoCard

Painful erythematous nodules on pads of fingers and toes

Osler nodes seen in patients with Infective endocarditits

Other manifestations of infective endocarditis?

Weight loss, back pain, night sweats, heart failure

Tx of infective endocarditis

Antibiotics

People with prosthetic valves and transplants are given what to prevent I.E

ABX prophylaxis

Cardiac complications of aids

- Myo, endo, and peri carditis. -Left heart failure - Cardiomyopathy - Pericardial effusion - Pulmonary HTN - Cardiotoxicity from viral drugs

Abnormal impulses can originate from Sinus node, AV node, and....

rogue pacemaker cells in atrial and ventricles

Abnormal conduction is often _____ or ____ conductions

Delayed or slowed

_____ can range from occasional, to rapid, to "blocks" of conduction

Dysrhythmias

Name the two more serious abnormal rhythms that impair the hearts pumping ability

Ventricular tachycardia and ventricular fibrillation

Rapid rhythms. E.G _____

tachycardias

Dx of Dysrhythmias

ECG

Tx of Dysrhythmias

Anti-dysrhythmic medications, radiofrequency ablation, and pacemaker

Prevalence of HF

adults > 65 yrs

Which chamber predominates others when it comes to HF

Left ventricle

Risk factors for HF

-HTN, Ischemic heart disease, valve disease, and cardiomyopathy

____ is the volume in the chamber

preload

_____ is the force of contraction

Contractility

_____ is the peripheral resistance

Afterload

Patient presents with frothy sputum, fatigue, and edema. Physical examination shows pulmonary edema and an S3 gallop. Patient has

Left heart failure

Management of Left HF?

Reduce preload and afterload...typically with drugs

Impaired perfusion of lungs by right ventricle

Right heart failure

Most commonly caused by a diffuse hypoxic pulmonary disease

Right heart failure

Hepatosplenomegaly is a manifestation of

Right heart failure

Inability of the heart to supply the body with blood-borne nutrients despite adequate blood volume and normal or elevated myocardial contractility

High-output failure

What causes high output failure?

Anemia, hyperthyroidism, septicemia, and beriberi

______: cardiovascular system fails to perfuse the tissues adequately

Shock

Shock leads to impaired _____ metabolism

cellular

shock leads to impaired ____ and ____ use

oxygen and suggaaaaa

Manifestations vary based on stage but often include hypOtension, tachycardia, increased RR

Shock

How to manage shock

Fluid resuscitation, vasopressors, and supplemental oxygen. Also, find and treat the cause

Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury

Multiple organ dysfunction syndrome

What causes MODS

sepsis, septic shock, and trauma (burns, major surgery)

Tx of MODS

Treat cause, control infection, restore oxygen and perfusion.

CH.24 Alterations of cardiovascular function Flashcards

(216 cards)