Cardi Patho Flashcards
Varicose veins:
what is is
signs and symptoms
cause
A vein in which blood has pooled
Distended, tortuous (painful), and palpable veins
Caused by trauma or gradual venous distention (lack of movement)
what causes Chronic venous insufficiency
due to what (2)
Inadequate venous return to the heart over a long period
Due to varicose veins or valvular incompetence
What causes Venous stasis ulcers
Venous hypertension, decreases circulation, and tissue hypoxia cause an inflammatory reaction in vessels and tissue leading to ulceration.
what is a thrombus
A blood clot that remains attached to the vessel wall.
what is a Thromboembolus:
clot become detached from the vessel wall due to increased pressure building up behind it and moving through the vessels (DVT develops into a PE)
what is a Thrombophlebitis:
Inflammation of vein wall around the clot (from starting an IV).
what is a Arterial thrombi:
Virchow’s triad, atherosclerosis plaques.
Travels not very far b/c arteries are getting smaller.
Brain- ischemic, CVA; heart- MI
what is a Venous thrombi:
Related to pooling blood
likely starts as a DVT leading to a PE.
Travels further b/c veins are getting larger closer to the heart and lung.
what is an Embolism:
examples
what can this cause
anytime there is a circulating bolus in the vascular system.
Dislodged thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells (tumors), or a foreign substance
*Causes ischemia or narcosis/ infarction of tissue distal to obstruction
PE
pulmonary embolism
DVT
Deep Vein Thrombosis
what is an Aneurysm:
where is this most likely to occur?
what is the cause by?
Local dilation or out pouching of a vessel wall or cardiac chamber. Due to pressure.
Most common occurring in the aorta or brain from atherosclerosis and hypertension (more likely happening in the arteries)
Caused by weakening of the arterial wall making it vulnerable to high pressure
Weakening can be caused by hypertension, atherosclerosis, infection, trauma, congenital weakness, inflammation
Dissecting saccular
damage to tunica intima, but not the adventitia (outer layer) causing fluid to pool around the vessel and expand
Aortic aneurysms-
causes
75% of aneurysms
Causes: atherosclerosis eroding vessel wall
HTN, Collagen vascular disorders, infection of vessel wall
Primary Hypertension
what is it
who is more predisposed
prevalence
Essential or idiopathic (don’t know what is causing it) hypertension. May be genetic or diet
BP > 140/90 mm Hg
Genetic (African American) and environmental factors (diet, Na+ intake)
Affects 92% to 95% of individuals with hypertension
Secondary HTN to known causes/dz
what is it
prevalence
examples (3)
Caused by a systemic disease that raises peripheral vascular resistance or cardiac output
<5% of population
-Renal disease: most common (elimination of extra fluid is inhibited)
-Endocrine: Primary hyperaldosteronism, Cushing syndrome, pheochromocytoma, hyperthyroidism
DM
-Aortic malformations (congenital)
Complicated HTN
Long term/severe hypertension causing tissue damage in the vessels and tissues
Most common complications of HTN are target organ diseases occurring in the:
Heart
Cardiac remodeling - Hypertrophy: reduces the size of the chambers= eventually weakened and fail; imbalance in fuel need leading to ischemia= MI
Most common complications of HTN are target organ diseases occurring in the:
Brain
Cerebrovascular disease: hemorrhagic CVA, clot formation and ischemic CVA.
Most common complications of HTN are target organ diseases occurring in the:
Vasculature
Peripheral Vascular disease: peripheral obstruction
Most common complications of HTN are target organ diseases occurring in the:
Kidneys
Nephrosclerosis: Filter organ, BP decrease causes fluid to not be filtered. Renal failure
Most common complications of HTN are target organ diseases occurring in the:
Eyes
Retinopathies: prolonged pressure leading to blindness
EOD
what it is
END Organ Damage: the effect of high pressure damaging tissues
*HTN is often asymptomatic until damage to tissues/organs
Malignant Hypertension
Hypertensive Crisis
Rapidly progressive hypertension
Diastolic pressure is usually >140 mmHg
210/140 = MAP of 163!! (range 70-110)
HTN emergency vs HTN urgency
HTN emergency – evidence of EOD
HTN urgency – no evidence of EOD
Orthostatic
Decrease in both systolic and diastolic blood pressure upon standing
PVD
Peripheral Vascular Disease
Thromboangiitis Obliterans (Burger's) what is it Who does it occur most in What do the thrombi do?
Inflammatory disease of peripheral arteries resulting in the formation of nonatherosclerotic lesions of clots made of immune/inflammatory cells
Mostly in young men, heavy cigarette smokers
Autoimmune activation
Thrombi permanently block and obliterate small and medium-sized arteries
PAD
caused by?
Peripheral Artery disease:
Arteriosclerosis/Atherosclerotic disease of the arteries
Plaques that are exclusive of: coronary (CAD), aortic (aneurysm), and of the brain (CVD)
Arteriosclerosis:
caused by?
Abnormal thickening and hardening of the vessel walls (decrease lumen size): loss of elasticity (thus lose compliance) leading to PVD (can be due to age).
Increase smooth muscle cells and collagen fibers migrate to the tunica intima
Atherosclerosis:
leads to?
caused by?
Thickening and hardening due to fatty plaque deposits leading to Arteriosclerosis
cholesterol- LDL deposited behind vessel walls
CAD what is it caused by? Biggest concern? How is this preventable?
Coronary Artery disease: Any vascular disorder that narrows or occludes the coronary arteries causing ischemia then infarction
Atherosclerosis is the most common cause
MI
Dyslipidemia (high LDL and Low HDL)
CVD
caused by?
Biggest concern?
Cerebero (brain) vascular disease: Atherosclerosis causing decreased flow
CVAs
Lack of normal blood pressure compensation in response to gravitational changes on the circulation
Orthostatic
Raynaud Disease
Primary
unknown vasospasm disorder Recurrent vasospasm involving small arteries/arterioles of hands and feet Women > Men Triggered by cold and emotional distress (PVD)
Raynaud Disease
Secondary
Collagen vascular disease (scleroderma), smoking, pulmonary HTN, and environmental factors (vibrating machinery)
(PVD)
Atherosclerosis Progression (7)
1) Endothelial damage/inflammation: caused by HTN, smoking, DM
2) LDL deposit in vessel wall oxidize causing them to be recognized as foreign
3) Monocyte activation/macrophage migration- ingestion of LDL, but cannot digest become a foam cell
4) Foam cell formation- send out cytokines causing tissue change that leads to smooth muscle moving into the lumen
5) Fatty streak- activation of fibroblasts creating collagen over the foam cells
6) Fibrous plaque= diagnosed Atherosclerosis
7) Complicated plaque- plaque with a clot on top of it. Plaque ruptures and the release of collagen causes a fast clot reaction creating a blockage (most concerning the brain and the heart)
MI is caused by what?
what can be used to test if someone is about to have an MI
Prolonged ischemia causing irreversible damage and cell death
EKG
Angina
chest pain, demand is greater than supply
Stable angina vs Unstable angina
- exercise, increased exertion.
- plaque became complicated, the blockage is more obstructive
Prinzmetal angina:
vasospasm (idiopathic), not due to a blockage
Silent ischemia:
No angina, higher in women
Transient ischemia:
unstable angina
Sustained ischemia:
Blockage is not going away, high chance of going into MI
Angioplasty vs Stent
Angioplasty is a procedure to open narrowed or blocked artery.
A stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty
CABG
Coronary Artery Bypass Graft
Acute pericarditis
cause
pericarditis (inflamed pericardium)
viral (more common) or idiopathic
Constrictive pericarditis:
fibrous/ scared- idiopathic
Pericardial effusion
Tamponade:
build up between the pericardial layers
-when fluid starts to compress and push back on the heart
Myocardium
cardiac muscle
Myocardium: Cardiomyopathies (3)
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Dilated cardiomyopathy
(value issues, vascular)
Congestive cardiomyopathy: blood sits and pools in the heart chambers
Hypertrophic cardiomyopathy
increased work load by the heart (eg: HTN)
Restrictive cardiomyopathy:
more ridge, college genetic problems
Pericardium
fibrous membrane enclosing the heart
Endocardium
the innermost layer of tissue that lines the chambers of the heart.
Endocardium: Valvular dysfunctions (4)
Valvular stenosis
Valvular regurgitation
Mitral valve prolapse syndrome (MVPS)
Acute Rheumatic Heart Disease
Valvular stenosis -
Failure of the valve to open completely, workload behind valve increases. Blood buildup in the chamber.
Valvular regurgitation
Inability of the valve to close, eventually causing heart failure. Not preventing blood back flow. Leading to MVPS
MVPS
Mitral valve prolapse syndrome - Cusps billow upward into left atrium
Most common valve disorder b/c it is under the most pressure
Acute Rheumatic Heart Disease
(autoimmune after untreated strep)
Secondary to pharyngeal infection of group A β-hemolytic streptococcus
Only 3% of those with untreated strep throat will get rheumatic (Rh) fever, and 10%of those get Rh Heart disease.
Endocarditis
Inflammation and infection of the endocardium
Especially on valves
Usually bacterial
Dysrhythmias: Flutter Fibrillation PVCs PACs Asystole
Flutter: extra little contraction inside a regular contraction
Fibrillation: quivering, shaking
Premature ventricular contractions: early contraction (problem with conduction pathway)
Premature atrial contractions: early contraction (problem with conduction pathway)
Asystole: loss of regular contraction
Left heart failure
CHF. Blood backs up in pulmonary circulation
Left heart failure : Systolic heart failure
Inability to generate adequate cardiac output to perfuse tissues (HTN, MI)
Ventricular remodeling or loss of myocytes
Left heart failure: Diastolic heart failure
Pulmonary congestion despite normal stroke volume and cardiac output (prolonged HTN). fluid into lungs
Ventricles can’t fill with blood because they won’t relax or are too thick
Right heart failure
cause
Most commonly caused by a diffuse hypoxic pulmonary disease (COPD/ARDS)- vasoconstriction due to shunting
Also caused by left vent. failure
Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation
Heart Failure: High-output failure
common causes
not a problem w/ the heart, the problem is with the lack of supply!
Inability of the heart to supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility
Common causes:
Severe anemia
Septicemia
Hyperthyroidism (exaggerated metabolic demand)
Shock at the tissues
Cardiovascular system fails to perfuse the tissues adequately:
Impaired oxygen use
Impaired glucose use
Types of shock: Cardiogenic Hypovolemic Neurogenic Anaphylactic Septic
Cardiogenic: heart failure
Hypovolemic: not enough blood volume
Neurogenic: lack of neuro stimulation
Anaphylactic: widespread inflammatory response
Septic: Bacterial
MOD
Multiple Organ Dysfunction Syndrome
Multiple Organ
Dysfunction Syndrome:
what is it
cause
manifestations
Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury
Causes:
Most common = sepsis
Other - trauma, burns, major surgery
Manifestations: Respiratory, Hepatic, Renal, GI, Myocardial failure
