Disorders of Blood Vessels Flashcards
(70 cards)
1
Q
Describe the sounds heard in BP
A
- First sound is systolic number
* After you stop hearing is diastolic
2
Q
Define hypertension
A
a systolic BP greater than 140 and/or diastolic blood pressure over 90
3
Q
What happens to BP as we age?
A
- As we age we are not as elastic- increase in stiffening in arteries- increases resistance and it naturally elevated
- 150/90 for older patients
4
Q
What are the 4 types of arteries?
A
- Elastic
- Muscular
- Small Arteries
- Arteriole
5
Q
Describe elastic arteries
A
- Large and include the aorta and initial branches, and the pulmonary artery
- Elastic and this makes them springy
6
Q
Describe muscular arteries
A
- Middle size and include the renal and coronary arteries
- Has encircling smooth muscle cells
- Regional flow and pressure are regulated by lumen size
- Contract to narrow the lumen (Vasoconstriction)
- Relax to enlarge it (Vasodilation)
- Vasoconstriction and vasodilation are controlled by the autonomic nervous system (hormones, local metabolic factors)
7
Q
Describe small arteries
A
- Less than 2 mm in diameter
- Retinal Arteries
8
Q
Describe Arterioles
A
- Tiny pre-capillary arteries
- Less than 0.1 mm
- Wrapped in a thin layer of smooth muscle
9
Q
Describe veins
A
- Carry low pressure, non-pulsing blood to the heart
- Larger diameter compared to arteries, larger lumen, and thinner wall
- Pliable and expand easily (to accommodate the changes in volume with little pressure change)
- 2/3 of blood is in the veins
- One way venous valves (prevent back flow)
10
Q
Describe capillaries
A
- Smallest of vessels, lie in tissues and join the arterial network to the venous network
- Composed of only endothelial cells resting on the basement membrane
- Promote free exchange of gases and fluids
- As blood flows down the arterial tree, the cross sectional area of each vessel becomes smaller, the total cross sectional area becomes larger
- Most numerous
- Flow rate is very slow
11
Q
What are the 3 layers of large vessels
A
o Adventura Supporting fibrous tissue o Media Composed of mainly smooth muscle o Intima A single layer of endothelial cells
12
Q
What are the 2 functions of endothelial cells?
A
o Control diffusion of substances across the wall to adjacent tissues
o In constant contact with blood and keep blood in a smooth, unclotted state
13
Q
What is the equation for BP?
A
• Blood pressure= Cardiac output * vascular resistance
14
Q
Define CO
A
the volume of blood per unit of time ejected from the left ventricle into the aorta
15
Q
What is the equation for CO
A
o Cardiac output= SV and HR
16
Q
Define vascular resistance
A
the resistance to the flow that must be overcome for blood to flow though the circulatory system
17
Q
What kind of relationship do resistance and flow have?
A
Inverse
18
Q
What regulates flow
A
Peripheral arterioles
19
Q
sense blood pressure and act to change peripheral resistance and blood volume
A
Kidneys
20
Q
What 2 things does the kidney do to regulate BP
A
o It decreases the amount of blood passing through the kidney
o Renin
21
Q
Describe the effect of vasoconstriction
A
o It decreases the amount of blood passing through the kidney
Lowers urine output
Preserves water
Increases blood volume
22
Q
Describe the effects of renin
A
Causes peripheral and renal vasoconstriction
Stimulates aldosterone
Expands blood volume
Increases CO and BP
23
Q
Lipids that are attached to plasma proteins
A
Lipoproteins
24
Q
plasma proteins that makes lipid soluble in the blood
A
Apoprotein
25
Describe High Density Lipoproteins
o Half protein, half lipid
o Lipid is phospholipid and cholesterol
o “Good Cholesterol”
o Like a garbage truck- it gets the bad stuff out
26
Normal values for HDL
o Normal levels Men- greater than 40, women above 50
27
This is associated with less risk of atherosclerosis
HDL
28
Describe LDL
o 22% protein
o Most of the lipid is cholesterol
o Smaller amounts of phospholipid and cholesterol
o “Bad” builds up in your arteries and is plaque
29
Normal values of low density lipoproteins
- Normal levels= less than 130
- If you are diabetic- less than 100
- Heart disease- less than 70
30
Characteristics of LDL
- High levels promote atherosclerosis
- Diet in saturated fat
- Trans fats
31
Describe VLDL
o Only 10% proteins
o “Very bad”- not really used in clinic
o Most of lipids are triglycerides
o Small amounts of phospholipid and cholesterol
32
Describe cohort score
o 10 year risk would be to have a cardiovascular event (stroke, MI)
o Helps guide treatment
33
When your score is ___ or mre, you should be put on a statin
7.5
34
What is the effect of a statin?
o Statins lower cholesterol and have an anti-inflammatory infect and reduce risk of cardiovascular event
35
What is includes in a cohort score?
```
Male or female
Age
Total cholesterol
• Bad and good collected together
• Less than 200 is normal
• Liver synthesizes this
• Need it in cells
HGL
BP (systolic)
Smoker
Diabetic
Treated for hypertension
```
36
Describe primary hypertension
o 95% of hypertension is unknown
| o Not associated with any identified cause
37
Describe secondary hypertension
o Where there is something causing the hypertension
| o Many causes and if you treat the problem the high BP will go away
38
Examples of things that cause secondary hypertension
- Renal Artery Stenosis
- Obstructive Sleep Apnea
- Pheochromacytoma
- Tumors of the Adrenal cortex
- Drugs
- Beta agonists
39
Describe the effects of Renal Artery Stenosis
* Narrowing of the renal arteries
* Decreased profusion
* Increase Renin
* Starts RAA system
* Seen in young patients with high blood pressure
* Most common cause of surgery correctible hypertension
40
Describe the effects of obstructive sleep apnea
* Uncontrolled sleep apnea can lead into hypertension
* Keeps airways open, body isn’t in stress mode, and your body goes back to normal
* Hypoxic mode and increases sympathetic act
41
Describe the effects of pheochromacytoma
* Very rare adrenal tumors that secrete a ton of catecholamine’s (norep and ep- fight and flight response)
* Sweating and always anxious
42
Describe the effects of Tumors of the Adrenal cortex
• High Aldosterone or cortisol
| o See low potassium if high aldosterone
43
Describe the effects of drugs
• Any kind of stimulants
• Aderol, rinalin, nicotine
-Increases BP
44
Describe the effects of Beta agonists
• Increases HR and increases BP
45
What can uncontrolled hypertension cause?
• Causes problems in eyes and kidney
46
Describe hypertensive kidney disease
o High pressure destroys commonly afferent arterioles (bc high hemodynamic pressure)
o If you slice the walls of the kidneys you can see…
o Hyaline Arteriolosclerosis
o Hyperplastic Arteriosclerosis
47
Describe hyaline Arteriosclerosis
Fingerprint of hypertension
Narrowing of the arteriolar lumen and waxy (hyaline) degenerative changes of the arteriolar walls
Glassy appearance
Increased elastic because of increased pressure
Can cause atrophy and damage of glomeruli and kidney
48
Describe Hyperplastic Arteriosclerosis
- Severe hypertension
- Concentric layers of hyperplastic cells (like onion skinning)
- Increasing arteriole wall thickness
49
Where does Atherosclerosis start?
The crib- begins when you are young and processes due to out habits
-Starts by vascular endothelial cell injury or damage- some sort of inflammation
50
What things contribute to atherosclerosis
o Smoking- little injuries stimulate inflammatory response
o Hypertension- increased pressure can damage lining
o Hypergylcemia- leads into development of plaques
o Diabetes can accelerate this
51
What is the Leading etiology for aneurisms
atherosclerosis
52
What are some risk factors for atherosclerosis
- Age
- Gender
- Genetics
- Hypertension
- Smoking
- Diabetes
- Cholesterol
- Homosystein
- C-reactive protein
53
Describe the effect of Age
Increases atheriosclerosis by -40-60 increases MI by 5 times
54
Describe the effect of gender
- Men are more at risk
- Women have an increased risk after menopause
- Because cause estrogen protects us
55
Describe the effect of genetics
Familial hypercholesterolemia
Causes hyperlipidemia
Family cardiac disease
• Male in your family over 50 with MI is significant and same with woman
56
Describe the effects of smoking
Smoking also lowers HDL levels
57
Describe the effects of hypergylcemia
High sugars and high cholesterol
58
What are the effects of cholesterol
Increased LDL or low HDL increased risk
59
What are the effects of homosystein
```
Toxic to endothelial cells
Causes platelet aggregation
Genetic predisposition have strokes and MI in their 20s
• Aspirin- life of a platelet
• Folic Acids
```
60
What are the effects of C- reactive protein
Indicated of inflammation
61
What are the 2 kinds of atheromas?
- Young
| - Old
62
Describe young atheromas
o Squishy and spontaneous
63
Describe old atheromas
o Calcified and stuck
64
This is a loss of integrity of the blood vessels
| -Abnormal dilation of blood vessels
Aneurysms
65
Characteristics of aneurysm
* Most common place is the circle of Willis
* Get weakness, traumatic, and infection
* Increasing radius increases the wall tension
* Start getting ballooning
66
Describe ruptured aneurysms
high pressure and you bleed out
o NEVER GOOD
o Only symptom is a rupture
o Asymptomatic until they rupture
67
Describe cerebral aneurysms
```
o Maybe dizziness
o Pain- headache
o Large hemorrhage
o Family history you have to be screened MRA- every 5 years
o High mortality rates
```
68
Describe aortic aneurysm
o Smoking increases risk (with hypertension or hyperlipidemia)
o Can have back or abdominal pain
o Ultrasound screening- looking at caliber of the aorta
o High rate of rupture greater than 5 years
69
What is the goal of a coronary catherization?
-See narrowing of the lumen and put a stent in
70
What can a hematoma cause?
False Lumen
