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Pathophysiology (NRSG 502) > Blood Flow & Blood Pressure (Ch. 26)-- Term First > Flashcards

Blood Flow & Blood Pressure (Ch. 26)-- Term First Flashcards

Exam 2

1
Q

Lipid Function

A
  • Energy storage
  • Protection
  • Insulation
  • Cellular communication
  • Phospholipid membrane
  • Lipoproteins
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2
Q

Atherosclerosis Clinical Manifestations

A
  • Any organ
    • Heart
    • Brain
    • Kidneys
    • Lower extremities (PAD)
    • Small intestine
  • Vessel damage
    • Narrowing or ischemia
    • Sudden obstruction/occlusion
    • Aneurysm
  • Larger vessels
    • Thrombus formation
  • Medium arteries
    • Ischemia
    • Infarction
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3
Q

Deep Vein Thrombosis

A

Clot formation in large veins (primarily lower extremities) → Venous thromboembolism (VTE) → VTE to pulmonary circuit → Pulmonary embolism (PE)

d/t–

  • Platelet & clotting factor accumulation
    • Venous thrombus formation
  • Inflammation around thrombus
    • Platelet aggregation
      • VWF (adhere to endothelium)
    • Thrombus grows proximally
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4
Q

Hypothyroidism

A

⇣ LDL receptors → Dyslipidemia

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5
Q

Target-Organ Damage

A

Long-Term effects of HTN on organs

  • CKD → Renal Failure
  • PVD → Endothelial cell damage → Atherosclerosis
  • Retinopathy
  • CVD → TIA/Stroke
  • Cardiac
    • ⇡ Afterload → LV Hypertrophy → HF
    • MI
  • Sexual Dysfunction
    • ED
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6
Q

Endothelium Function

A
  • Secrete cytokines & enzymes
  • ⇣ Platelet aggregation
  • ⇡ Vasodilation
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7
Q

Hypertension in the Elderly

A

Prevalence ⇡ w/ age

  • Stiffening of large arteries
  • ⇣ Baroreceptor sensitivity
  • ⇡ PVR
  • ⇣ Renal flow
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8
Q

Buerger Disease (Thromboangiitis Obliterans)

A

Inflammatory Disorder

Segmental, thrombosing, acute & chronic inflammation

  • Thrombus formation
    • Medium-sized arteries
      • Lower extremities
        • Plantar
        • Digital
      • Upper extremities
        • Arms
        • Hands

d/t– Smoking/Vaping (seen in < 35 y.o), Genetics

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9
Q

Arteriole Structure & Function

A

Structure–

  • Thinner layers
  • Smaller lumen

Function–

  • Transport blood away from heart
    • To capillary beds
  • Vasoconstriction/Vasodilation
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10
Q

LDL

A
  • 3rd largest lipoprotein
    • “bad” cholesterol when high levels in blood
  • Much denser
    • TGs (10%)
    • Protein (25%)
    • Cholesterol (50%)
  • Endogenous
    • Synthesized in liver
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11
Q

Varicose Veins Clinical Manifestations

A
  • Visual assessment
  • Lower extremity pain & edema
  • Stasis dermatitis
    • CO2-rich blood sits in dependent areas
      • Acidic gas damages tissue
  • Venous ulcers
    • Skin easily injured

Treatment– Sclerotherapy, Prevention (Compression stockings, Avoid standing for extended periods, Weight loss)

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12
Q

VLDL

A
  • 2nd largest lipoprotein
  • Denser
    • TGs (55-65%)
    • Protein (5-10%)
    • Cholesterol (10%)
  • Endogenous
    • Synthesized in liver
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13
Q

Third Step of Atherosclerosis Development

A

Lipid Accumulation and SMC Proliferation

  • Foam cell formation
    • Lipid-filled macrophages
      • Release growth factors
  • SMCs secrete ECM
    • Stimulated by growth factors
      • Release collagen & elastin
  • Reactive oxygen species
    • Toxic ROS cause damage
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14
Q

Acute BP Regulation– Humoral Mechanism

A
  • RAAS
    • Angiotensin II
      • Vasoconstriction → ⇡ PVR → ⇡ BP
      • ⇡ Blood volume → ⇡ BP
        • via Aldosterone secretion
    • Aldosterone (adrenal cortex)
      • Na+ & H2O retention
      • ⇡ Blood volume → ⇡ BP
  • ADH/Vasopressin (posterior pituitary)
    • Released in response to
      • ⇣ blood volume, ⇣ BP, or ⇡ osmolality
    • ⇡ H2O retention → ⇡ Blood volume → ⇡ BP
    • Vasoconstriction → ⇡ BP
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15
Q

Raynaud Disease/Phenomenon

A

Vasospastic Disorder

Intense vasospasm of arteries/arterioles of fingers and toes

  • Disease
    • No known cause

d/t– ⇡ SANS (exposure to cold, strong emotions)

  • Phenomenon
    • Associated w/ other diseases

d/t– Frostbite, Occupational trauma (heavy vibrating tools, alternating hot/cold), Neurological disorder, Chronic arterial occlusive disorder, Collagen disorder (first sign– Scleroderma, Lupus)

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16
Q

Artery Structure & Function

A

Structure–

  • Thick tunica media
  • Contractile & elastic

Function–

  • Transport blood away from heart
    • Toward capillary beds
  • BP maintenance
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17
Q

Thoracic Aortic Aneurysm Clinical Manifestations

A

d/t– Atherosclerosis, HTN, Degeneration of tunica media, Male smoker > 50 y.o.

  • Asymptomatic (until rupture)
    • Common
  • Substernal, back, & neck pain
  • Dyspnea, stridor, brassy cough
    • Pressure on trachea
  • Hoarseness
    • Pressure on laryngeal nerve
  • Difficulty swallowing
    • Pressure on esophagus
  • Distention of neck veins (JVD)
    • Facial & neck edema
    • Pressure on superior vena cava

Diagnosis– Imaging (ultrasound, echocardiogram, CT, MRI)

Treatment– Surgery

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18
Q

Thrombus

A

Blood clot that remains attached to vessel wall

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19
Q

2021 AHA/ACC Hypertension Guidelines

A
  • Stage 1
    • SBP: 130-139 mmHg
      • OR
    • DBP: 80-89 mmHg
  • Stage 2
    • SBP: >140 mmHg
      • OR
    • DBP: >90 mmHg

OR → AND = Move up one stage

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20
Q

Baroreceptors

A

Pressure-sensitive receptors that respond to stretch

⇣ BP → Baroreceptors inactive → ⇡ SANS → Vasoconstriction

⇡ BP → Baroreceptors active → ⇡ PANS → Vasodilation

  • High Pressure
    • Stretch → changes in HR & vascular tone
      • Carotid & Aortic arteries
  • Low Pressure
    • Stretch → ⇡ ADH
      • Large systemic veins
      • Pulmonary vessels
      • Walls of RA
      • Ventricles
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21
Q

3 Layers of Blood Vessels

A
  • Tunica Externa
    • Outermost
    • Collagen & elastin fibers
  • Tunica Media
    • Middle
    • Smooth muscle cells (SMCs)
      • Vasoconstriction/Vasodilation
      • Synthesis of biomolecules (elastin, collagen…)
      • Vascular repair
  • Tunica intima
    • Innermost
    • Endothelial cells
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22
Q

IDL

A
  • Intermediate between VLDL & LDL
  • Non-functional
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23
Q

Buerger Disease (Thromboangiitis Obliterans) Clinical Manifestations

A

Early Stages–

  • Intermittent claudication
    • Arch of foot & digits
  • Cold sensitivity
  • Weak or absent peripheral pulses

Advanced Stages–

  • Pain at rest
    • Severe
  • Color change of extremities
    • Cyanotic w/ standing
    • Reddish-blue w/ sitting/laying
  • Thin, shiny skin
  • Slowed hair growth
  • Thick, malformed nails
    • Chronic
  • Ulceration
  • Gangrene
    • Possible limb amputation
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24
Q

Infarction

A

Area of ischemic necrosis due to occlusion of arterial blood supply OR venous drainages.

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25
Q

Peripheral Artery Disease (PAD)

A

Atherosclerotic Disorder

  • Occlusive disease
    • Lower extremities

d/t– Hypercholesterolemia, ⇡ Blood LDL levels, Smoking, DM, other atherosclerosis risk factors…

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26
Q

Venule Structure & Function

A

Structure–

  • Very thin layers
  • Gradually enlarge

Function–

  • Transport blood toward the heart
    • From capillary bed
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27
Q

Varicose Veins

A

Dilated, tortuous veins of lower extremities

d/t– prolonged standing, ⇡ Intraabdominal pressure (pregnancy, occupations that require heavy lifting), Incompetent venous valves (backflow of blood)

  • Primary
    • Originate in superficial saphenous veins
  • Secondary (80-90%)
    • Impaired blood flow in deep venous channels
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28
Q

Orthostatic Hypotension Causes

A
  • ⇣ Blood volume (Diuretics, GI loss, Dehydration)
  • Medications (Anti-HTN, Psychotropics)
  • Aging (⇣ or slowed CV response)
  • Bed rest/Immobility
    • Physical deconditioning
    • ⇣ Blood volume
  • ANS Dysfunction
    • Diabetic neuropathy
    • Spinal cord injury
    • CVA (Stroke)
    • Parkinson’s
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29
Q

Long Term Blood Pressure Regulation Mechanism

A
  • Kidneys
    • ⇡ BP
      • Decrease blood volume
        • Diuresis
          • H2O excretion
        • Natriuresis
          • Na+ excretion
    • ⇣ BP
      • Increase blood volume
        • Na+ & H2O retention
          • ⇡ CO and/or PVR
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30
Q

Aortic Dissection

A

d/t– HTN, Degeneration of tunica media, Connective tissue disease (Marfan syndrome), Pregnancy, Congenital aortic defect, Cardiac surgery complication

Classifications–

  • Type A
    • Proximal legions
      • Ascending aorta
      • Ascending AND Descending aorta
  • Type B
    • Distal to subclavian artery
  • Acute
    • w/i 14 days of S/S onset
  • Chronic
    • longer than 14 days of S/S onset
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31
Q

Deep Vein Thrombosis Clinical Manifestations

A
  • Asymptomatic
  • Swelling and/or pain in affected extremity
  • ⇡ WBCs
  • ⇡ Erythrocyte sedimentation rate (ESR)
    • Inflammation indicator

Diagnosis– Ultrasound, CT, D-dimer (⇡ Blood clot fragments → Hypercoagulation)

Treatment– Prevention (SCDs, Ambulation, Anticoagulants)

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32
Q

Buerger Disease (Thromboangiitis Obliterans) Treatment

A
  • Elimination of tobacco/nicotine
  • Vasodilation
  • Injury prevention
    • Difficult for injuries to heal w/ reduced blood flow to extremities
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33
Q

Saccular Aneurysm

A

True Aneurysm

  • Extends over part of vessel circumference
    • Saclike
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34
Q

Buerger Disease (Thromboangiitis Obliterans) Diagnosis

A
  • Physical exam
    • Inspect limbs
      • Thick, malformed nails
      • Hair loss
      • Thin, shiny skin
      • Cyanosis
      • Coolness
  • Level of Obstruction
    • Palpitation of pulses
    • Doppler ultrasound
      • Radial, posterior tibial & dorsalis pedis pulses
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35
Q

Abdominal Aortic Aneurysm Clinical Manifestations

A

d/t– Atherosclerosis, HTN, Degeneration of tunica media, Male smoker > 50 y.o.

  • Asymptomatic (until rupture)
    • Common
  • Aorta diameter > 3 cm
    • > 4 cm → Aneurysm is palpable
  • Saccular or Fusiform
  • Pulsating mass
  • Calcification
    • X-ray
  • Mid-abdominal and lumbar pain
  • Thrombus formation

Diagnosis– Imaging (ultrasound, echocardiogram, CT, MRI)

Treatment– Surgery

36
Q

Secondary Hypertension

A
  • Renal HTN
    • ⇣ Renal blood flow → RAAS over-activation
  • Adrenocortical hormone disorders
    • H2O retention
      • Hyperaldosteronism
      • Hypercortisolism (Cushing Syndrome)
  • Pheochromocytoma (Paraneoplasm)
    • Tumor of adrenal chromaffin cells
      • Catecholamine (Epi, NE) secretion
        • ⇡ SANS → Vasoconstriction
  • Oral contraceptives
    • Na+ and H2O retention
37
Q

Disorders of Systemic Venous Circulation

A
  • Varicose Veins
  • Venous Insufficiency
  • Deep Vein Thrombosis
38
Q

Nephrotic Syndrome

A
  • Proteinuria
  • ⇣ Albumin
  • ⇡ LDL in blood → Dyslipidemia
39
Q

Fourth Step of Atherosclerosis Development

A

Fibrous Atheromatous Plaque Structure

  • Foam cells
  • Lymphocytes
  • Necrotic core
    • Necrotic SMCs
    • Foam cells
  • Fibrous cap
    • SMCs
      • ECM (elastin & collagen)
    • Endothelial layer

Plaque Rupture → Hemorrhage or Thrombosis (Clot formation) → Lumen blocked (Occlusion)

40
Q

Acute Blood Pressure Regulation Mechanisms

A

Corrects temporary imbalance (emergency)

Occurs w/i seconds → minutes

  • Neural
    • SANS
    • PANS
    • Most rapid
  • Humoral
    • RAAS
    • ADH/Vasopressin
41
Q

Acute BP Regulation– Neural Mechanism

A
  • PANS
    • Vagus nerve → Impulses to heart
      • ⇣ HR
  • SANS
    • Spinal cord & peripheral nerves → impulses to heart & blood vessels
    • ⇡ HR & Contractility → ⇡ CO, SV, & BP
    • Vasoconstriction (small arteries) → ⇡ PVR
42
Q

Types of False Aneurysms

A

Tear in the artery wall leads to the formation of an extravascular hematoma & vessel enlargement

  • Dissecting aneurysm
43
Q

Primary Hypertension

A
  • Risk Factors
    • Non-modifiable
      • Genetics
      • Age
    • Modifiable
      • Lifestyle
      • Metabolic abnormalities
        • Insulin resistance
        • Obesity
      • Dyslipidemia
      • Obstructive sleep apnea
        • Hypoxemia → Endothelial dysfunction → Atherosclerosis
44
Q

Primary Dyslipidemia

A

Independent of other health problems

  • Genetic (autosomal dominant)
    • Heterozygous
      • LDL= 350 mg/dL
      • S/S in adulthood
      • Xanthomas
    • Homozygous
      • LDL= 1000 mg/dL
      • S/S in childhood
      • ⇡ Risk of death d/t MI in young adulthood
45
Q

Dissecting Aneurysm

A

False Aneurysm

  • Tear in tunica intima
    • Blood enters vessel wall
      • Blood-filled cavity b/w tunica intima & tunica media
46
Q

Mean Arterial Pressure (MAP)

A

Average pressure in arterial system during ventricular contraction and relaxation

MAP = .60 (DBP) + .40 (SBP)

47
Q

Types of True Aneurysms

A

Blood remains within vascular compartment

  • Berry aneurysm
  • Fusiform aneurysm
  • Saccular aneurysm
48
Q

Peripheral Artery Disease Clinical Manifestations

A

50% Narrowing before S/S manifest–

  • Pain w/ walking (calves)
    • Intermittent claudication
  • Aching/Numbness
  • Thinning of skin
  • Reduced muscle size
    • Legs
  • Cold feet
  • Weak or absent popliteal pulse
  • Stark change in limb color
    • Blanches w/ elevation
    • Deep red w/ standing

Progression– Blood flow insufficient for O2 needs of muscles and nerves → Necrosis

  • Ischemic pain at rest
  • Ulceration
  • Gangrene
  • Severe pain in region of necrosis
    • Worse @ night
    • Improved w/ standing
49
Q

Aortic Dissection Clinical Manifestations

A
  • High mortality rate
    • Untreated
  • Abrupt onset of excruciating pain
    • Tearing/ripping pain
  • Pain in anterior chest
    • Ascending aorta
  • Pain in back
    • Descending aorta
  • Early–
    • ⇡ BP
  • Later–
    • BP and pulse unobtainable
      • One or both arms
  • Blood vessel occlusion
    • Brain & spinal cord
      • Syncope
      • Hemiplegia
      • Paralysis
        • Lower extremities
  • Heart failure
    • Aortic valve
50
Q

Dyslipidemia

A

Imbalance of lipid components within the blood

  • Low blood HDL
    • ⇣ Reverse cholesterol transport
  • High blood LDL
    • ⇡ Risk atherosclerosis
  • High blood TGs
51
Q

Raynaud Disease/Phenomenon Clinical Manifestations

A
  • Skin color change
    • Palor → cyanosis
  • Cold sensation
  • Parasthesia
    • Numbness/tingling
  • Ischemic episode
    • Pale → blue → redness, throbbing, parasethesia → normal color

Severe–

  • Brittle nails
  • Skin on tips of fingers thickens
  • Arthritis
  • Ulceration
  • Superficial gangrene
    • Fingers
52
Q

Raynaud Disease/Phenomena Diagnosis & Treatment

A

Diagnosis– History of vasospastic attacks

Treatment– Smoking abstinence, Cold protection, Emotional stress control

53
Q

Triad of Virchow

A

Three factors that promote venous thrombosis

  • Venous stasis
    • Prolonged immobility
    • Leg dependency
  • Venous endothelial damage
    • Trauma
    • Medications
    • Surgery
    • Fractures
  • Hypercoagulable states
    • Genetic disorders
    • Malignancies
    • Pregnancy
    • Oral contraceptives
    • HRT
    • Antiphospholipid syndrome
54
Q

Hypertension Pharmacologic Treatment

A
  • ⇣ Vascular volume
    • Diuretics
  • ⇣ SANS
    • Beta-blockers
      • ⇣ HR & CO
      • Block renin (juxtaglomerular cells of kidneys)
        • ⇣ Vasoconstriction
  • RAAS System
    • ACE (Angiotensin Converting Enzyme) Inhibitors
      • ⇣ Angiotensin II → ⇣ Vasoconstriction & ⇣ Aldosterone
        • AEs: Chronic cough, Angioedema
    • ARBs (Angiotensin II Receptor Blockers)
      • ⇣ Binding of Angiotensin II → ⇣ Vasoconstriction & ⇣ Aldosterone
        • Less AEs than ACE-Is
  • Vasodilation
    • Calcium Channel Blockers
      • ⇣ Ca2+ into SMCs → Smooth muscle stays relaxed
    • Hydralazine
      • Interferes w/ Ca2+ movement
55
Q

Cardiac Output (CO)

A

Amount of blood the heart pumps through circulatory system in one minute

~4-6 L

CO = SV x HR

56
Q

Pulse Pressure

A

Difference between systolic and diastolic BP

  • Affected by
    • SV
    • Arterial distensibility (elasticity)
      • ⇣ Distensibility → ⇡ BP
57
Q

Metabolic Syndrome

A

Insulin resistance +

  • ⇡ Fasting BG
  • HTN
  • ⇡ Waist circumference
  • Dyslipidemia
58
Q

Orthostatic Hypertension

A

Abnormal ⇣ in BP w/ change of position from lying/sitting to standing → Dizziness or Syncope

Within 3 minutes of standing

⇣ SBP @ least 20 mmHg

and/or

⇣ DBP @ least 10 mmHg

59
Q

Hypertensive Crisis

A

EMERGENCY!

SBP > 180 and/or DBP > 120

  • End-organ damage
    • One year mortality rate (79%)
      • Hypertensive encephalopathy
        • AMS
      • Intracranial or subarachnoid hemorrhage
        • Brain
      • HF
      • MI
      • Renal Failure
      • Aortic Aneurysm
        • Dissection
      • Retinopathy
60
Q

Obstructive Liver Disease

A

Disruption in lipid transport/synthesis → Dyslipidemia

61
Q

Berry Aneurysm

A

True Aneurysm

  • Small
  • Spherical
  • Located @ bifurcation
    • Circle of Willis (brain)
62
Q

Risk Factors for Atherosclerosis

A
  • Hypercholesterolemia
  • ⇡ Blood LDL levels
  • Age
  • Family history
  • Male
  • Genetics
  • Smoking
  • Obesity
    • Visceral/Abdominal fat
  • HTN
  • DM
  • Inactivity
  • Stress
  • Inflammation
    • ⇡ CRP levels
  • Inadequate nutrition (low folic acid, B6, and/or B12)
    • ⇡ Homocysteine levels (homocystinuria)
  • Hypothyroidism
    • ⇡ Homocysteine levels (homocystinuria)
63
Q

Vein Structure & Function

A

Structure–

  • Thinner tunica media
  • Larger lumen
  • Internal valves
    • Unidirectional blood flow

Function–

  • Transport of blood toward the heart
    • To R atrium
64
Q

Secondary Dyslipidemia

A

Associated with other health problems

d/t– Diet, Obesity, T2DM

Chronic systemic inflammation → Insulin resistance

  • ⇡ TGs
  • ⇡ LDL
  • ⇣ HDL

Recommendation– D.A.S.H Diet, Mediterranean Diet

65
Q

Peripheral Vascular Resistance (PVR)

A

Determine by radius of arterioles and blood viscosity

66
Q

Fusiform Aneurysm

A

True Aneurysm

  • Entire circumference of vessel
    • Gradual & progressive vessel dilation
67
Q

Chylomicrons

A
  • Largest lipoprotein
  • Least dense
    • TGs (80-90%)
    • Protein (2%)
  • Dietary
    • Absorbed in SI
68
Q

Aortic Dissection Diagnosis and Treatment

A

Diagnosis– History, Physical exam, Vascular imaging, CT, MRI

Treatment– Stabilize (control HTN, medications to decrease force of systolic ejection), Surgery (resection and replacement with prosthetic graft)

69
Q

Ischemia

A

Reduction of arterial flow to a level insufficient to meet O2 demands of the tissue; causes pain.

70
Q

Blood Pressure (BP) Maintenance

A
  • Two major determinants
    • CO
      • Adjustments accommodate changes in PVR
    • ⇡ CO = ⇡ BP
      • ⇡ Blood volume → ⇡ Pressure on arterial walls
        • & vice versa
  • PVR
    • Adjustments accommodate changes in CO
  • ⇡ PVR = ⇡ BP
    • ⇡ Vasoconstriction + ⇡ Blood viscosity → ⇡ Pressure on arterial walls
      • & vice versa
71
Q

Venous Insufficiency

A

⇡ Venous Hypertension (⇡ Hydrostatic Pressure) → Reflux through incompetent veins → Pooling of blood in lower extremities → Dilation & stretching of vessel walls

d/t– Prolonged standing, Incompetent valves, DVTs, Inflammation, Endothelial dysfunction (atherosclerosis), ⇣ Skeletal muscle pump function

72
Q

Types of Atherosclerotic Legions

A
  • Fatty streaks
    • Thin, flat, yellow discolorations of the tunica intima
      • Macrophages
      • Foam cells
    • Form in childhood for everyone
      • Stop or regress @ age 20
  • Fibrous atheromatous plaque
    • Necrotic core
      • Foam cells
      • Necrotic SMC
    • Fibrous cap
      • SCM → ECM
  • Complicated lesion
    • Deposits from:
      • Hemorrhage
      • Ulceration
      • Scar tissue
      • Thrombosis
73
Q

Hypertension (HTN)

A

Sustained elevation of BP w/i arterial circuit

Primary risk factor for CVD

Leading cause of death worldwide

  • Primary
    • HTN w/o evidence of cause
  • Secondary
    • HTN d/t presence of another disease/condition
      • ex: Renal Failure
74
Q

Thromboembolus/Embolus

A

Blood clot that detaches and migrates

75
Q

Medications that may cause dyslipidemia

A
  • Beta-blockers
  • Estrogens
  • Protease inhibitors
    • HIV treatment
76
Q

HDL

A
  • Smallest lipoprotein
    • “good” cholesterol
  • Most dense
    • TGs (5%)
    • Protein (50%)
    • Cholesterol (20%)
  • Endogenous
    • Synthesized in liver
    • Reverse cholesterol transport
77
Q

Venous Insufficiency Clinical Manifestations

A
  • Impaired venous flow
    • Tissue congestion
    • Edema
    • Necrosis of surrounding tissue
    • Stasis dermatitis
      • CO2-rich blood sits in dependent areas
        • Acidic gas damages tissue
    • Venous ulcers
      • Skin easily injured
78
Q

Second Step of Atherosclerosis Development

A

Migration of Inflammatory Cells

Leukocytes migrate & adhere to endothelial wall → Macrophages enter tunica media & endocytose LDL

79
Q

Hypertension in Children & Adolescents

A

Increasing prevalence

d/t– Obesity, FMH, Kidney abnormalities, Coarctation of aorta, Endocrine disorders

  • ⇡ Obesity
    • Physical inactivity
    • Diet
      • High Calorie/Fat/Na+
      • High fructose corn syrup
        • Metabolic dysregulation
80
Q

First Step of Atherosclerosis Development

A

Endothelial Cell Injury

d/t–

Injury to endothelial cells (smoking, ⇡ LDL, HTN, inflammatory mediators)

Hemodynamics (mechanical stress)

81
Q

Hypertension During Pregnancy

A
  • Preeclampsia-Eclampsia
    • ⇡ BP + Proteinuria
      • SBP >140 and/or DBP >90
    • >20 weeks gestation or postpartum
    • S/S
      • HA
      • Seizures (Eclampsia)
        • EMERGENCY!
  • Gestational HTN
    • New-onset HTN w/o proteinuria
      • Resolves w/i 12 wks. of childbirth
82
Q

Atherosclerosis

A

Hardening of the arteries due to fibrofatty lesions in the tunica intima of large and medium-sized arteries

83
Q

Peripheral Artery Disease Diagnosis

A
  • Physical exam
    • Inspect limbs
      • Subcutaneous atrophy
      • Brittle toenails
      • Hair loss
      • Pallor
      • Coolness
      • Dependent rubor
  • Level of Obstruction
    • Palpitation of pulses
    • Doppler ultrasound
      • Femoral, popliteal, posterior tibial & dorsalis pedis pulses
    • Low BP along leg
  • Imaging
    • Ultrasound
    • MRI
    • Spiral CT
    • Invasive contrast angiography
84
Q

Capillary Structure & Function

A

Structure–

  • Single-layer
  • Endothelial cells surrounded by pericytes

Function–

  • Exchange of materials b/w blood and IF
    • Gas exchange
85
Q

Stroke Volume (SV)

A

Amount of blood ejected from L ventricle in one contraction (per beat)

86
Q

Peripheral Artery Disease Treatment

A
  • Reduce risk
    • Evaluate for coronary or cerebrovascular atherosclerosis
    • Smoking
    • HTN
    • Dyslipidemia
    • DM
  • Reduce symptoms
    • D.A.S.H. or Mediterranean diet
    • Anti-platelet medication
    • Statins
  • Move until point of claudication
    • Walk until it hurts
  • Surgery
    • Disabling claudication
    • Limb-threatening ischemia

Pathophysiology (NRSG 502) (16 decks)

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