Cardiac 1 Flashcards
Diseases of the veins
Varicose veins
Chronic venous insufficiency (CVI)
Superior vena cava syndrome (SVCS)
Diseases of the arteries
Hypertension
Orthostatic hypotension
Aneurysm
Peripheral vascular disease
Buerger, Raynauds
Atherosclerosis
Peripheral artery
disease
Coronary artery disease
MI
Acute coronary syndromeVaricose veins causes predisposing factors risk factors clinical features
A vein in which blood has pooled
Damage to valve, causing malfunction
Trauma, gravity
Female, age, family hx, obesity, pregnancy, DVT, previous injury
Distended, tortuous, palpable vessels, edema
Varicose veins tend to happen in what veins?
Superficial veins
Saphenous vein
Chronic vein insufficiency leads to? causes risk factors clinical features
Inadequate venous return over a long period of time
Leads to venous hypertension, blood stasis, and tissue hypoxia in lower extremities
Varicose veins and valvular incompetence
Obesity
Edema up to knee, hyperpigmentation
Chronic venous insufficiency complications
Inflammation, fibrosclerotic remodeling, any trauma/pressure can lead to ulceration
Venous Stasis Ulcer
Leads to high risk of infection
Venous/Arterial disease examples
Thrombus
Thromboembolus or Embolus
Embolism
DVT
Thrombus
Blood clot attached to vessel wall
More common in venous system
Thromboembolus or Embolus
A detached/moving thrombus
Moves freely
Embolism
The obstruction of a vessel by an embolus
DVT
occurs in lower extremity
Venous vs. Arterial emboli
Venous
Origin: DVT, right
heart
Destination:
pulmonary (PE)
Arterial
Origin: left heart (post
MI, valve disease,
endocarditis,
dysrhythmias)
Destination: lower
extremities, coronary
arteries (MI), cerebral
vasculature (stroke)Virchow’s Triad
Etiology
Factors that promote thrombus formation
Stasis of blood flow
Endothelial injury
Blood hypercoagulability
Virchow’s Triad
Stasis of blood
prolonged bedrest
dependent extremities
immobilization
Virchow’s Triad
Endothelial injury
trauma (fractures)
caustic intravenous medications
previous thrombus
Virchow’s Triad
Blood hypercoagulability
inherited coagulopathy medications malignancies pregnancy oral contraceptive/HRT
DVT locations
popliteal site most common
DVT clinical features
Insidious - asymptomatic Swelling from venous pooling Edema with obstruction Pain (most common) walking increases Homan's sign
Homan’s sign
dorsiflexion of the foot
not a reliable test and is contraindicated
increases chance of thrombus being thrown into blood system
DVT complications
Most dissolve High risk of PE where it lodges is an important factor in seriousness size as well
DVT prevention
Early ambulation (any possible movements) Pneumatic devices (SCDs) Prophylactic anticoagulation
DVT diagnosis
D-Dimer (typically high in those that have a DVT)
Doppler
DVT treatment
Anticoagulants
Thrombolytic therapy
Inferior vena cava filter
Superior vena cava syndrome
progressive occlusion of the superior vena cava that leads to venous distension in the upper extremities and head
Superior vena cava syndrome
causes
Bronchogenic cancer (tumors)
Invasive therapies (pacemakers, catheters (central venous and pulmonary artery))
Lymphomas
CA mets
Superior vena cava syndrome
symptoms
Edema Venous distension in UE/face Fullness in head Headache Visual disturbance Changes in LOC Skin head/neck: purple, tight, respiratory distress
Superior vena cava syndrome
diagnosis
X-ray
CT
MRI
US
Superior vena cava syndrome
treatment
Malignancy - treatment of cancer
Nonmalignancy - bypass, thrombolysis, balloon angioplasty, stents
Hypertension
definition
incidence
Consistent elevation of systemic arterial blood pressure
1 in 3 U.S. adults;
>2/3 over 60
in children
Hypertension
risk factors
Family hx Advancing age Black race Gender: M>W before 55 W>M after 55 Smoking Obesity, DM, sedentary Diet - heavy alcohol Metabolic syndrome
Metabolic syndromes
Obesity
HTN
Dyslipidemia
Glucose intolerance condition that increases risk of HD, stroke, and DM
Types of HTN
Primary
Secondary
Complicated
Hypertensive Crisis
Primary HTN
Idiopathic - multiple pathologic mechanisms 92-95% of cases SNS hyperactivity Overactive RAAS Defect in natriuresis Insulin resistance (obesity hormones) Inflammation and endothelial dysfunction
Clinical manifestations of HTN
Often no signs or symptoms (early) - silent disease Headaches Dizziness Blurred vision Tinnitus Anxiety Chest pain SOB Nausea
HTN evaluation
Diagnosis: requires measurement on 2 separate occasions
Conditions: at rest for 5 min, seated, arm at heart level, no caffeine or smoke within 30 min
May do 24 hr BP monitoring
Can keep a log and self check
Complicated HTN
Prolonged high pressure on vessel walls causes thickening and stiffening
Causes arterial smooth muscle hypertrophy and hyperplasia
Vessel lumen narrows
Vessel thickening - increases smooth muscle contraction
Vasoconstriction - increased pressure
HTN Heart complications
Increased workload Increased afterload LV hypertrophy Accelerated CAD/HF Decreased myocardial O2 Aorta - aneurysms
HTN Vessel complications
Extremities: arterial vessels of lower extremities
Accelerated atherosclerosis results in PVD/PAD
May have no symptoms then develop pain, loss of circ - amputation
Results in intermittent claudication
HTN Renal complications
Decreased renal blood flow
Increased RAA
HTN Brain complications
Reduced blood flow
Ischemia
Vessel damage/rupture
HTN Eye complications
Retinal damage
Hypertensive Crisis
Malignant HTN
Rapidly progressing HTN with DBP >140
A medical emergency
Hypertensive Crisis
causes
complication in pregnancy
cocaine/amphetamines
adrenal tumors (pheochromocytoma)
drug/alcohol withdrawal
Hypertensive Crisis
symptoms
chest pain
blurred vision
SOB
Hypertensive Crisis
consequences
HTN -> cerebral arterioles/capillaries unable to regulate blood flow -> fluid shifts = cerebral edema, dysfunction, cerebrovascular accident
Also cardiac failure, kidney failure, retinopathy
Hypotension
Decrease in SBP of at least 20 mmHg or DBP of at least 10 mmHg within 3 min of moving to standing
Neurogenic - often seen in older adults (risk for falls)
Normal compensation - arteriolar/venous constriction and increased HR
Abnormal: blood pools, BP drops
Symptoms: dizziness, blurred vision, fainting, nausea, weakness
Aneurysm
definition
Localized dilation or outpouching of a vessel wall or cardiac chamber
Aneurysm
weakened medial layer
Atherosclerosis (most common)
Genetic/congenital
HTN, smoking, diet
Collagen-Vascular disorders (Marfan)
Types of Aneurysms
True Involve all 3 layers of the arterial wall Weakening of the vessel wall Fusiform/saccular Can happen on 1 or both sides of the wall False Extravascular hematoma that communicates with the intravascular space
Aneurysms
affected sites
Abdominal aorta - 75%
Thoracic aorta
Large peripheral arteries
Cerebral
Aneurysms
clinical features
Often asymptomatic
Detected by US, CT, MRI
Sx indicate large aneurysms or rupture and depend on site
Rupture: severe pain and hypotension
Aneurysms
treatment
Meds: BP reduction
Surgery (graft)
Drugs for Hypertension (Angina)
FIRST LINE: Diuretics, ACE Inhibitors, ARBs, Calcium Channel Blockers
SECOND LINE: Beta Blockers, Adrenergic Agonists/Antagonists, Vasodilators/Nitrates
Monitoring for any drugs that affect BP
BP (both arms / lying, sitting) HR (at home too) Intake/Output Electrolytes ECG Weight - BMI Report: sx of liver dysfunction - weight gain, edema, SOB
Review lifestyle modifications for HTN
Sodium restrictions DASH diet Alcohol restrictions Smoking cessation Aerobic activity Weight loss
Volume x Vasoconstriction =
Hypertension
