Topic 5.1 - Cardiovascular Disorders I Flashcards
(110 cards)
1
Q
Reduction of blood flow to arteries can lead to what complications?
A
–> Hypoxia
2
Q
What can cause hypoxia?
A
–> Lack of blood flow to tissues due to arterial obstruction (ischemia)
–> Anemia
–> Lung function issues (asthma)
3
Q
What are some complications of lymph blow blockage?
A
Lymphedema
4
Q
What are some complications of impaired blood flow from tissues by veins?
A
–> Venous engorgement and edema
–> Decreased removal of waste of waste and CO2
5
Q
What is a thrombus?
A
A stationary blood clot formed within a vessel or a chamber of the heart
6
Q
What is an embolism?
A
A free gloating clot blocking a BV
7
Q
What is vascular spasm?
A
Narrowing of arteries due to persistent contraction
8
Q
What is vasculitits?
A
An obstruction caused by the inflammation of BV walls
9
Q
What is mechanical compression of a BV?
A
Obstruction caused by pressure outside of the BV. Might be a mass or tumour.
10
Q
What kind of obstruction is a seal?
A
Seen in arms of bifurcation.
When one arm is blocked, blood flow is shunted into the area that is open with the least resistance.
11
Q
What are pathologically formed blood clots?
A
Clots that have formed despite there being no break in the blood vessel. Thromboses are pathologically formed.
12
Q
What are physiologically formed clots?
A
Clots forms as a result of a break in the walls of vasculature
13
Q
Which hypercoagulable conditions are risk factors associated with thrombosis?
A
–> Polycythemia
–> Platelet aggregation
–> Dehydration
+ trauma
14
Q
What are some heart related risk factors associated with thrombosis
A
–> Heart failure
–> Shock
–> Dysrhythmias
–> Aging
15
Q
What drugs are risk factors associated with thrombosis?
A
–> Anesthetic agents
–> Oral contraceptives
–> Tobacco
16
Q
What is a risk factor for arterial thrombosis?
A
Arteriosclerosis/atherosclerosis
17
Q
What are some risk factors for venous thrombosis?
A
–> Immobilization
–> Sedentary lifestyle
18
Q
What are some causes for embolus formation?
A
–> Clump breaking free from thrombus
–> Amniotic fluid
–> Bacterial/infectious exudate
–> Air
–> Fat
–> Malignant neoplasms or tumours
19
Q
What are some clinical manifestations of an embolus from the left ventricle?
A
Clot might enter cerebral artery and cause ischemic stroke
–> Causes cognitive, motor, or sensory impairment, depending on the location
20
Q
What are some clinical manifestations of an embolus from the right ventricle?
A
Clot might enter the lungs and cause a pulmonary embolism
–> Can be asymptomatic, may cause dyspnea and increased resp rate
–> Can be painful or lead to death
21
Q
How are thromboembolic conditions managed?
A
–> Address the risk factors
–> Prevention by anticoagulant drugs
–> Clot busters (tPA)
–> Surgery
22
Q
Which three factors can cause Deep Vein Thrombosis (DVT)?
A
- Venous stasis
- Venous endothelial damage
- Hypercoagulable states
^This is called the triad of Virchow
23
Q
What are the clinical manifestations of DVT?
A
–> Might be asymptomatic
–> May present with edema, inflammation, dilated superficial veins, and pain.
24
Q
DVT can be potentially life threatening. Why?
A
High likelihood of embolization to the pulmonary circulation –> PE
25
How are DVTs treated?
Treated aggressively with IV anticoagulants, then with long term oral anticoagulants.
26
What is arteriosclerosis?
A general term meaning 'hardening or thickening' of the arterial wall
27
What is atherosclerosis?
A specific form of arteriosclerosis characterized by proliferation of smooth muscle cells and lipid collection within the walls of the arteries.
28
How does atherosclerosis affect blood vessels?
it narrows their lumina and decreases their ability to dilate.
29
What are the consequences of partial and total occlusion of the coronary arteries?
PARTIAL
--> Angina Pectoris (Ischemic Heart Disease)
TOTAL
--> Myocardial Infarction (MI)
30
What are the consequences of partial and total occlusion of the carotid or cerebral arteries?
PARTIAL
--> Transient Ischemic Attack (TIA)
TOTAL
--> Cerebrovascular Accident (CVA)
31
What are the consequences of occlusion of the aorta?
Aneurism - which might rupture and hemorrhage
32
What are the consequences of occlusion of the iliac arteries?
Peripheral vascular disease
--> Gangrene and amputation
33
What is an aneurism?
Localized dilation of an arterial wall - represents a weakened area in the artery that may eventually rupture
34
Aneurisms are a two fold problem: what are the two issues?
a) Spike in BP increases potential of tearing
b) Dilation can interrupt blood flow + cause turbulence
35
What are some risk factors for aneurism formation?
--> Hypertension
--> Atherosclerosis
36
Where are aneurisms most frequently found?
--> Cerebral circulation
--> Thoracic + abdonimal aorta
37
What are the two kind of true aneurisms?
Fusiform
--> Symmetrical widening
Saccular
--> One area dilates and blood loops through it (kind of resembles diverticulosis)
38
What is a a false aneurism?
Widening caused by physiological formation in result to BV damage.
39
What is a dissecting aneurism?
One that forms as a result of the tearing in BV wall that separates one of the three layers.
40
What are some possible consequences of cerebral, aortic, and thoracic aneurisms?
Brain Rupture
--> Increased intracranial pressure + Stroke
Aortic Aneurisms
--> Painless until rupture
--> Severe pain and hypotension
Thoracic Aneurysm
--> Dysphagia, dyspnea
41
What occurs when peripheral veins develop valvular incompetence?
Varicose veins
42
What happens when deep veins develop valvular incompetence?
Chronic venous insufficiency
--> Can lead to severe tissues hypoxia and venous stasis ulcers
43
What are some risk factors for valvular incompetence?
--> Obesity
--> Pregnancy
--> Right heart failure
--> Prolonged standing
--> Family history
--> Previous leg injury
44
How can peripheral valvular incompetance lead to hypoxia?
Decreased venous return --> decreased cardiac output
45
What are the clinical manifestations of venous valvular incompetence?
--> Edema + statis dermatitis
--> Ulcer formation
--> Pruritis (itching)
46
How is venous valvular incompetence treated?
--> Stop smoking, exercise, weight loss
--> Compression socks, elevation
--> Anticoagulants, sclerotherapy, vein stripping/ ligation
47
What are some complications of lymphedema?
Inflammatory response, hypertrophy of subcutaneous adipose tissue, and fibrosis
48
What is primary lymphodema?
A congenital anomaly or lymphatic system dysfunction.
49
What are some causes for secondary lymphodema?
--> Filarial worm
--> Latrogenic - surgical removal of lymph node or vessel, or destruction during radiation therapy
50
How is lymphedema diagnosed?
--> Take patient history and rule out other issues
--> Ultrasound, CT, or MRI
51
How is lymphedema treated?
There is no cure, but it can be managed with compression garments, skin care, massage, exercise, and surgery.
52
BP = ___ x ___
BP = CO x PR
Cardiac output, Peripheral resitance
53
Cardiac output = ___ x ___
CO = HR x SV
54
What BP values are considered medium and high risk?
Medium
--> 121-134/80-84
High
--> 135+/85+
55
Essential or primary HNT account for what percentage of hypertention?
90-95% of cases
56
What are two subtypes of primary hypertension?
Isolated Systolic
--> Systolic > 140
--> Diastolic < 90
Isolated Diastolic
--> Diastolic >90
--> Systolic <140
57
What are some non-modifiable risk factors for hypertension?
--> Age
--> Family history
--> Genetics
--> Enthnicity
58
What are some modifiable risk factors for hypertension?
--> Obesity
-- Sedentary lifestyle
--> Metabolic syndrome
--> Dietary factors (increased salt and fat, inadequate potassium or calcium)
--> Cigarette smoking
59
What is the shift in pressure-natriuresis?
A dysfunction in the SNS, RAAS and natriuretic hormones that causes less salt excretion --> Increase in Blood volume --> HNT
60
Sustained hypertension can lead to what complication?
Vascular Remodeling
--> Retinal changes
--> Nephrosclerosis
--> Coronary artery disease
--> Congestive heart failure
--> Stroke, dementia, encephalopathy
61
What might cause secondary hypertension?
Renal disease, coarctation of the aorta, obstructive sleep apnea (triggers SNS), hyperaldosteronism caused by tumor of adrenal cortex, or oversecreting of NE or E due to adrenal medulla dysfunction.
62
How do the kidneys impact blood pressure?
They respond to the RAAS and to natriuretic hormones to regulate blood volume.
63
What is classified as a hypertensive crisis?
An acute increase in blood pressure
Characterized by:
Diastolic >120
Systolic >180
64
What is the prognosis of a hypertensive crisis?
The 1 year mortality rate is 79%
65
What are some possible causes for a hypertensive crisis? (5)
--> Complications due to pregnancy
--> Cocaine and amphetamine use
--> Reaction to certain medications
--> Adrenal tumors
--> Alcohol withdrawal
66
What are some chronic complications of a hypertensive crisis?
High Arterial Pressure
--> Cerebral arterioles are incapable of regulating blood flow into capillary beds - increase in intracranial pressure
High Hydrostatic pressure in capillaries leads to fluid leaks into interstitial space
67
What are the two kinds of hypertensive crises?
Hypertensive Emergencies
--> Sudden increase in blood pressure with evidence of organ damage
Hypertensive Urgency
--> Sudden increase in blood pressure with no evidence of organ damage
68
Which percent of pregnancies develop hypertension?
5-12%
69
What are some risks of maternal hypertension?
Preterm labor, abruptio placentae, hemorrhagic stroke, liver failure, acute renal failure
70
What is pre-eclampia?
HNT in pregnant women accompanied by edema and protein in urine
71
What is Eclampsia?
HNT in pregnant individuals that can cause seizures, coma, and death
72
Who is more at risk for HNT in pregnancy?
Those pregnant with multiples, those who already have HNT or who have a history of HNT while pregnant, women with diabetes, and African-American women.
73
Which demographic is most affected by secondary HNT?
Young children
74
Which demographic is most affected by orthostatic hypertension?
Elderly - 6-30% are affected
75
What are some causes for orthostatic hypertension?
--> CNS problems (MS, Parkinsons)
--> Decreased fluid intake
--> Increased fluid loss
--> Dysrhythmias
--> Heat exposure
76
Why is orthostatic hypertension exacerbated by exposure to heat?
Because sweat causes fluid loss and heat triggers vasodilation
77
How can orthostatic hypotension be managed?
--> Move/change position slowly
--> Mobility aids
--> Lower head, cross legs, leg binders
--> Avoid heat/ large carb meals
78
Why should those with orthostatic hypotension avoid large, carb heavy meals?
It will cause the body the shunt blood towards the digestive system.
79
What is ejection fraction?
The percent of end diastolic volume that is ejected when the LV contracts
80
What can ECGs be used to detect?
Issues with electrical conduction in heart
81
What are MRIs useful for in cardiology?
Imaging structures
--> Myocardial thickening, pericardial sac disease, valvular structures, congenital malformations, coronary plaque burden
--> Acute and chronic MI - if used with contrast
82
What can CT scans be used to in cardiology?
Useful for imaging structures, such a coronary plaque burden.
83
What are echocardiographs used for?
Visualizing cardiac structures and motion within the chest
--> Heart enlargement, valvular disorders, collection of fluid in precardiac space, cardiac tumors, abnormalities with left ventricular motion.
--> Provides estimation of ejection fraction and assessments of ventricular systolic and diastolic function
84
What is nuclear cardiography used for?
To assess adequacy of blood flow to cardiac tissues - cold spots indicate inadequate perfusion.
85
What is a single photon emission computed tomography (SPECT) scan used for?
To evaluate cardiac perfusion
86
What is cardiac catheterization used for?
Passed through brachial artery to assess aorta + L side of heart
Passed through femoral to inferior vena cava to assess R side of heart.
Directly measures pressures within cardiac chambers, visualizes chambers, samples blood for O2 content, measures cardiac output and ejection fraction.
Can also be used in conjunction with thrombolytic drugs, laser therapy, stents, and coronary balloon angioplasty.
87
What is an angiography used for?
Visualization of coronary arteries with fluorescent dyes
88
What is coronary heart disease?
aka ischemic heart disease, myocardial ischemia, or coronary artery disease
Characterized by insufficienct oxygen delivery to myocardium
89
What is the number one cause of coronary heart disease?
Athersclerosis
90
What are some downstream problems of coronary heart disease?
--> Angina pectoris
--> Heart failure
--> Sudden cardiac death
91
What arteries are most commonly affected by atherslerosis?
--> Coronary
--> Cerebral
--> Carotid
--> Femoral
--> Aorta
92
Atherosclerosis, thrombus formation, coronary vasospasm, endothelial cell dysfunction are common causes of ischemia.
What are some uncommon causes of ischemia?
--> Abnormalities in blood O2 content (respiratory failure)
--> Poor perfusion pressure through coronary arteries
--> Abnormalities in microcirculation
93
What are the non-modifiable risk factors for coronary artery disease and athersclerosis?
--> Age
--> Gender (males, and women after menopause)
--> Family history
--> Ethnicity
94
What are some modifiable risk factors for coronary heart disease and athersclerosis?
--> Dyslipidemia (major)
--> HNT
--> Cigarette smoking
--> Diabetes + insulin resistance
--> Obesity
--> Sedentary lifestyle
--> Diet low in produce, high in saturated fat and processed food.
95
Describe the process of an atherosclerotic plaque developing.
1. Chronic endothelial injury
2. Increased permeability, leukocyte and monocyte emigration and adhesion.
3. Macrophage activation, smooth muscle recruitment
4. Macrophages and smooth muscle cells engulf lipids and produce fatty streak
5. Smooth muscle proliferation + collage and extracellular matrix deposition as well as extracellular lipid contributes to formation of fibrofatty atheroma
96
Significant blood flow reduction occurs when plaque occupies how much of vessel lumen?
75%
97
Sometimes when a vessel is highly occluded, the body develops ___
Collateral pathways
98
Which factors contribute to plaque vulnerability in athersclerosis?
--> Active inflammation
--> Large lipid core with thin cap
--> Endothelial denudation with superficial platelet adherence
--> Fissured or ruptured cap
--> Severe stenosis
99
Why is it important that an atherosclerotic cap is stable?
If its endothelium ruptures it will trigger a clot formation --> MI
100
What is the diagnostic criteria for athersclerosis?
--> Patient history + physical assessment
--> Exercise or stress test
--> Angiography
100
How is athersclerosis treated?
--> Address modifiable risk factors
--> Weight loss / exercise
--> Lipid lowering and plaque stabilizing drugs
Laser + balloon angioplasty or coronary artery bypass graft might be necessary
101
Ischemia of cardiac cells occurs when the oxygen supply is _______
insufficient to meet metabolic demands
Therefor, managing it can be done by increasing rate of coronary perfusion or decreasing myocardial workload.
102
What is preload?
End diastolic volume
103
What is afterload?
The backpressure being exerted on aortic valve that the heart has to overcome to pump more blood.
104
Why is cardiac ischemia more of an issue when a person is exercising.
Because although demand is increasing, the supply is not. The heart can not keep up.
105
How can we increase the rate of coronary perfusion?
--> Remove blockage (angioplasty)
--> Bypass blocked vessels
--> Reversal of vasospasm with drugs
106
What happens when a heart is under ischemic attack for less than 20 minutes?
Abnormal response to electrical impulses
107
What happens when a heart is under ischemic attack for over 20 minutes?
Is has a complete lack of response to electrical impulses.
108
Ischemic cardiomyopathy and stable angina pectoris are characteristic of what kinds of coronary syndromes?
Chronic
109
Unstable angina and myocardial infarction are characteristic of what kinds of coronary syndromes?
Acute
