Blood Vessel and Pressure Disorders

Question 1

What is Hyperlipidemia?

Answer 1

An abnormally elevated concentration level of fats or lipids in the blood.

Cholesterol, Phospholipids, Triglycerides.

Question 2

Name three Non-modifiable risk factors of cardiovascular disease?

Answer 2

1. Men over 45
2. Postmenopausal women
3. Family History of Cardiovascular disease

Question 3

Name three modifiable risk factors of cardiovascular disease?

Answer 3

1. Hypertension
2. Smoking
3. Obesity

Question 4

What is a Aproprotein?

Answer 4

A protein that transports lipids

An aproprotein and a lipid = a Lipoprotein

Question 5

What is a Lipoprotein?

Answer 5

A lipoprotein is a aproprotein and a lipid.
Lipoproteins vary in density and are named based on the protein content

VLDL - Very low density lipoprotein - 5 to 10% protein, 55 to 65% triclycerides, 10% cholesterol
LDL - Low density lipoprotein - 25 % protein, 10% triglycerides, 50% cholesterol (BAD!!)
HDL - High density lipoprotein - 50% protein, 5% triglycerides, 20% cholesterol

Question 6

What is hypercholesterolemia?

Answer 6

Excessive Cholesterol in the Blood (40% of Canadians)

Question 7

What is Artherosclerosis?

Answer 7

Sclerosis = hardening of the blood vessel wall beccause of damage.

Question 8

What are the 3 leigon stages of Arthersclerosis?

Answer 8

1. Fatty Streak (Yellowish discoloration - Stable)
2. Fibrous Atheromatous Plaque (Clinically noticable - Stable)
3. Complicated Leison (Thrombus forming inside the lumen - Not Stable)

Question 9

What is ischemia?

Answer 9

Inadequate blood supply (perfusion).

Question 10

What percentage of all death in Canada are due to Artherosclerosis?

Answer 10

32%! Artherosclerosis affects perfusion leading to ischemia leading to stroke, MI, and PVD.

Question 11

What is the pathogenesis of Atherosclerosis?

Answer 11

Insidious in nature.
1. Endothelial Cellular Injury. Smoking, LDL levels, immune mechanisims all potential for causing injury which causes adhesion of monocytes and platelets.
2. The adhered monocytes enter the intima and transform into macrophages, release free radicals causing cell damage and engulfing lipoprotiens (usually LDL).
3. The Macrophages are now called Foam Cells which release growth facotrs which cause the proliferation of smooth muscle cells.
4. This process requires space therefor an atheroma forms, pushing into the lumen. The centre of the atheroma is called the neucrotic core. Blood goes into the core, forming a clot which can be dislodged to a thrombus.

Question 12

What are the 5 most common sites of atherosclerosis in order of frequency?

Answer 12

1. Abdominal Aorta and Iliac Arteries
2. Proximal Coronary Arteries
3. Thoracic Aorta, Femoral and Popliteal Arteries
4. Internal Carotid Arteries
5. Vertebral, Basilar and Middle Cerebral Arteries

Question 13

What is Hypertension?

Answer 13

A persistent increase in blood pressure greater than 140/90

Question 14

Name the four control systems of Hypertension?

Answer 14

1. Arterial Baroreceptors (aorta and wall of ventricles)
2. Renin-Angiotensin-Aldosterone System
3. Vascular Autoregulation (ability to dilate and constrict)
4. Regulation of Fluid Volume (by kidney with ADH and Aldosterone)

Question 15

Blood Pressure is a product of _______ and __________?

Answer 15

Cardiac Output and Peripheral Resistance

Question 16

At rest Blood Pressure is managed by?

Answer 16

Peripheral Resistance

Question 17

On exertion, blood pressure is managed by?

Answer 17

Cardiac Output

Question 18

What is normal BP?

Question 19

What is a high normal BP?

Answer 19

120-139/80-90

Question 20

Name the three stages of HTN and the corresponding BP?

Answer 20

Stage 1 Mild: Systolic 140-159 - Diastolic 90-99
Stage 2 Moderate: Systolic 160-179 - Diastolic 100-109
Stage 3 Severe: Systolic >180 - Diastolic >110

Question 21

What is Primary HTN?

Answer 21

> 140/90

Known as essential or idiopathic. It has no know cause. Thus, it is impossible to treat the underlying problem. Idiopathic HTN represents 90% of HTN cases.

Etiology: Multifactorial (kidney is implicated)

Question 22

What is Secondary HTN?

Answer 22

> 140/90

Identifiable etiology (ex. Renal disease). We know there is a problem in the kidney. Secondary HTN represents 10% of HTN cases.

Question 23

What is Systolic HTN?

Answer 23

Systolic pressure >140, diastolic pressure

Question 24

Name three other types of HTN?

Answer 24

1. White Coat: HTN in a clinical setting. Elevated due to stress, nervousness.2. Gestational: elevated blood pressure during pregnancy. May resolve post-preg, or may continue as primary HTN post-preg.3. Malignant: A very serious form of HTN. Diastolic pressure in excess of >120

Question 25

What are the manifestations of HTN?

Answer 25

Hypertension only has one initial manifestation. Increased BP. This is why it is known as the “Silent Killer”.

Late manifestations: fatigue, palpatations (sensation of forceful, irregular heartbeat), AM headaches (circadium rhythm, BP higher), Blurred vision, dizziness (impact to brain), progressive organ damage.

Question 26

What are the first, second and third levels of treatment?

Answer 26

1st: Life style modifications - diet, exercise, weight. Lasts for about 3 months as only treatment. If working, continue.
2nd: Rx - diuretic (excreation of fluid, risk: hyponatremia/hypokalemia
3rd: If required add one of the following:

Ca channel blocker: decreases contractility of heart, need Ca for smooth muscle contraction.
Angiotensin II receptor blocker
ACEI: Angiotensin Converting Enzyme Inhibitor (prevents Angiotensin I from converting to Angiotensin II)