Alterations of cardiac function Flashcards
Varicose veins
- Vein in which blood has pooled
- Distended, tortuous and palpable
- Cause: Trauma or gradual vein distention
- Typically the saphenous vein
Chronic venous insufficiency
- Inadequate venous return over a long period due to varicose veins, valvular incompetence
- Venous stasis ulcers
Venous stasis
Venous hypertension, circulatory stasis, and tissue hypoxia leads to an inflammatory reaction that causes fibrosclerotic remodeling of the skin. Ulceration and hyperpigmentation can occur
Deep Venous Thrombosis
-Obstruction of venous flow leading to venous pressure.
-Factors (Virchow triad);
Venous stasis, venous endothelial damage, hypercoagulable states
-Post thrombotic syndrome
-Usually asymptomatic: prophylaxis for at risk individuals is crucial
Post thrombotic syndrome
-Frequent complication of DVT characterized by chronic, persistent pain, swelling, and ulceration of the affected limb
Thrombus formation
- Blood clot that remains attached to the vessel wall
- Thromboembolus (detached-has traveled)
- Arterial thrombi (more serious due to ischemia-Most common from mitral and aorta)
- Venous thrombi (more common low pressure, low flow system)
Aneursym
- Local dilation or outpouching of a vessel wall or cardiac chamber
- True aneursym-all 3 layers of the arterial wall (fusiform, circumferential)
- False aneursyms (saccular) -Usually near a vascular graft and natural artery
- Most common site is aorta (htn, and arteriosclerosis are risk factors)
Aortic dissection
dysphagia, dyspena, tearing of cp
-Infection, collagen disorders like marfans and chest trauma can also cause this
Embolism
- Bolus of matter that circulates in bloodstream, then lodges obstructing blood flow.
- Dislodged DVT, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance
- Many arterial emboli are from the heart (post MI, valve disease, endocarditis, dysrhythmias, HF)
Peripheral artery disease (PAD)
- atherosclerotic disease of arteries that perfuse the limbs (esp lower)
- Risk factors: esp those with diabetes
- Intermittent claudication
- Often asymptomatic
Intermittent claudication
- Obstruction of arterial blood flow in the iliofemoral vessels resulting in pain with ambulation
- Claudication-gets better with rest
Peripheral artery diseases-Thromboangiitis obliterans (Buerger disease)
- Occurs mainly in young men who smoke
- Inflammatory disease of peripheral arteries resulting in nonathersclerotic lesions (Digital, tibial, plantar, ulnar, palmar arteries)
- Obliterates the small and medium sized arteries
- Produces dry gangrene
- Causes pain, tenderness, and hair loss in the affected area
- Symptoms are caused by slow sluggish blood flow
Peripheral artery disease-Raynaud phenomenon or raynaud disease
- Episodic vasospasm (ischemia) in arteries and arterioles of the fingers, less commonly the toes
- Raynaud’s is secondary to other systemic diseases or conditions
- Primary vasospastic disorder of unknown origin
Raynaud’s disease
- Collagen vascular disease (scleroderma), smoking, pulmonary hypertension, myxedema, and environmental factors (cold or prolonged to vibrating machinary)
- Endothelial dysfunction that causes decreased nitric oxide production (this is a potent vasodilator)
Risk factors for hypertension
- Family hx
- age, gender (male greater than female)
- Black race, high sodium
- glucose intolerance
- heavy alcohol use, obesity, cigarrettes
- Low K, Mg, Ca
Primary hypertension
- Genetics plus environment
- Other contributing factors: insulin resistance, dysfunction of SNS, RAAS, adducin, and natriuretic hormone, and inflamamtion
- This in turn causes vasoconstriction, renal salt and water retention, increased peripheral resistance, and increased blood volume
Treatment of HTN
-diuretics, adrenergic blockers, Ca channel blockers, ACE inhibitors, ang 2 receptor blockers.
Arteriosclerosis
-Chronic disease of arterial system
-Abnormal thickening, and hardening of vessel walls
-Smooth muscle cells and collagen fibers migrate to the tunica
intima
-This can be an inevitable result of aging w/ cross linking of collagen and deposits of Ca
Atherosclerosis
- Form arteriosclerosis
- Thickening and hardening by accumulation of lipid-laden macrophages in the arterial wall
- Plaque development
- This is leading cause of CAD and CVD
Risk factors of atherosclerosis
- inflammatory disease that begins with endothelial and progresses through several stages of fibrotic plaque
- elevated CRP, increased serum fibrinogen, oxidative stress, infection, and periodontal disease
Progression of atherosclerosis
- Inflammation of endothelium
- cellular proliferation
- macrophage migration
- LDL oxidation (foam cell formation)
- Fatty streak
- Fibrous plaque
- Complicated plaque
Endothelial injury
- Endothelium stops making normal antithrombotic and vasodilatory subtances, like nitric oxide and prostaglandins
- Leukocytes and macrophages adhere to the endothelium and release cytokines
- Oxidation and phagocytosis of LDL
Complications of atherosclerosis
- Calcification of fibrous plaque
- Rupture or ulceration of plaque
- Hemorrhage of plaque
- Embolization of fragments
- Weakening of vessel wall
