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

Question

Peripheral Artery Disease (PAD)

Answer 1

**Atherosclerotic Disorder** * **Occlusive** disease * Lower extremities d/t-- **Hypercholesterolemia, ⇡ Blood LDL levels,** Smoking, DM, other atherosclerosis risk factors…

Answer 2

Structure-- * Very **thin layers** * Gradually enlarge Function-- * Transport **blood toward the heart** * From capillary bed

Answer 3

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

Answer 4

* **⇣ 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**

Answer 5

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

Answer 6

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

Answer 7

* **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)

Answer 8

* **Elimination of tobacco/nicotine** * Vasodilation * **Injury prevention** * Difficult for injuries to heal w/ reduced blood flow to extremities

Answer 9

**True** Aneurysm * Extends over **part of vessel circumference** * Saclike

Answer 10

* 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**

Answer 11

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**

Answer 12

* **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

Answer 13

* **Varicose Veins** * **Venous Insufficiency** * **Deep Vein Thrombosis**

Answer 14

* Proteinuria * ⇣ Albumin * ⇡ LDL in blood → **Dyslipidemia**

Answer 15

**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)**

Answer 16

**Corrects temporary imbalance** (emergency) Occurs w/i seconds → minutes * **Neural** * SANS * PANS * **Most rapid** * **Humoral** * RAAS * ADH/Vasopressin

Answer 17

* **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**

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

**False** Aneurysm * Tear in tunica intima * Blood enters vessel wall * **Blood-filled cavity b/w tunica intima & tunica media**

Answer 22

**Average pressure** in arterial system during **ventricular contraction and relaxation** ## Footnote **MAP = .60 (DBP) + .40 (SBP)**

Answer 23

Blood remains **within vascular compartment** * **Berry aneurysm** * **Fusiform aneurysm** * **Saccular aneurysm**

Answer 24

**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**

Answer 25

* 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

Answer 26

Imbalance of lipid components within the blood * Low blood HDL * ⇣ Reverse cholesterol transport * High blood LDL * ⇡ Risk atherosclerosis * High blood TGs

Answer 27

* 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

Answer 28

Diagnosis-- History of **vasospastic attacks** Treatment-- **Smoking abstinence, Cold protection, Emotional stress control**

Answer 29

**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

Answer 30

* ⇣ 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

Answer 31

**Amount of blood** the heart pumps through circulatory system in **one minute** **~4-6 L** **CO = SV x HR**

Answer 32

**Difference** between **systolic** and **diastolic** BP * Affected by * **SV** * Arterial **distensibility** (elasticity) * **⇣ Distensibility → ⇡ BP**

Answer 33

Insulin resistance + * ⇡ Fasting BG * HTN * ⇡ Waist circumference * **Dyslipidemia**

Answer 34

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**

Answer 35

**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**

Answer 36

Disruption in **lipid transport/synthesis** → **Dyslipidemia**

Answer 37

**True** Aneurysm * Small * Spherical * Located @ **bifurcation** * Circle of Willis (brain)

Answer 38

* **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)

Answer 39

Structure-- * **Thinner tunica media** * **Larger lumen** * Internal valves * Unidirectional blood flow Function-- * Transport of **blood toward the heart** * To R atrium

Answer 40

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

Answer 41

Determine by **radius of arterioles** and **blood viscosity**

Answer 42

**True** Aneurysm * **Entire circumference** of vessel * Gradual & progressive vessel dilation

Answer 43

* Largest lipoprotein * Least dense * TGs (80-90%) * Protein (2%) * Dietary * Absorbed in SI

Answer 44

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)

Answer 45

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

Answer 46

* 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

Answer 47

**⇡ 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**

Answer 48

* **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**

Answer 49

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**

Answer 50

**Blood clot** that **detaches** and migrates

Answer 51

* Beta-blockers * Estrogens * Protease inhibitors * HIV treatment

Answer 52

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

Answer 53

* 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

Answer 54

**Migration of Inflammatory Cells** **Leukocytes** migrate & adhere to **endothelial wall** → **Macrophages** enter tunica media & **endocytose LDL**

Answer 55

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

Answer 56

**Endothelial Cell Injury** d/t-- **Injury to endothelial cells** (smoking, ⇡ LDL, HTN, inflammatory mediators) **Hemodynamics** (mechanical stress)

Answer 57

* **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

Answer 58

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

Answer 59

* 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

Answer 60

Structure-- * **Single-layer** * **Endothelial cells** surrounded by pericytes Function-- * Exchange of materials b/w blood and IF * **Gas exchange**

Answer 61

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

Answer 62

* 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

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

Exam 2