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Patho > Cardiac and Lymphatic Pathophysiology > Flashcards

Cardiac and Lymphatic Pathophysiology Flashcards

1
Q

Cardiovascular and Pulmonary Systems

A

Circulate oxygenated blood through the arterial system to all cells in the body

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2
Q

Deoxygenated blood is collected from the venous system and delivered….

A

to the lungs for reoxygenation

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3
Q

What happens when the arteries become narrow or blocked?

A

Areas of the myocardium supplied by the artery does not receive enough oxygen

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4
Q

Disorders of the myocardium as a result of insufficient blood supply are:

A

Ischemic heart disease (IHD)
Coronary heart disease (CHD)
Coronary artery disease (CAD)***

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5
Q

Hypertension (HTN)

A

One of the main risk factors in both CAD and cerebrovascular accidents

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6
Q

What results from HTN?

A

Cardiac hypertrophy
Heart failure
Aortic dissection
Renal failure

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7
Q

Blood Pressure

A

Force exerted against the arterial walls

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8
Q

Systolic Pressure

A

Pressure exerted when the heart contracts

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9
Q

Diastolic Pressure

A

Pressure when the heart is relaxed between beats

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10
Q

Normal Blood Pressure

A

Systolic <120
and
Diastolic <80

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11
Q

Pre-hypertensive
High-normal/elevated

A

Systolic 120-129
and
Diastolic <80

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12
Q

Stage 1 Hypertension

A

Systolic 130-139
or
Diastolic 80-89

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13
Q

Stage 2 Hypertension

A

Systolic ≥140
or
Diastolic ≥90

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14
Q

Hypertensive Crisis
(Malignant HTN)

A

Systolic ≥180
and/or
Diastolic >120

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15
Q

When does HTN happen?

A

When the relationship between blood volume and peripheral resistance is altered

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16
Q

Primary HTN
(Idiopathic)

A

Accounts for 90-95%

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17
Q

Modifiable Primary HTN

A

High sodium
Obesity
DM
Hypercholesterolemia

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18
Q

Non-Modifiable Primary HTN

A

Family history
Age (>55)
Gender
–>Male (<55)
–>Female (>55)
Ethnicity

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19
Q

*Secondary HTN

A

Accounts for 5-10%
Renal
Endocrine
ETOH abuse
Drug induced
Pregnancy induced
Acute stress

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20
Q

Blood flow determined by:

A

Cardiac Output

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21
Q

What is cardiac output?

A

Ejection of blood (strength, rate, rhythm of heartbeat; blood volume)

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22
Q

BP is regulated by two factors, what are they?

A

Blood flow and peripheral resistance (vessel diameter, blood viscosity)

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23
Q

Single most common characteristic of HTN

A

Increased peripheral resistance as a result of the narrowing of the arterioles

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24
Q

How do you control the constriction of peripheral arterioles?

A
  1. Autonomic regulation
  2. Renin-angiotensin system
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25
Q

Autonomic Regulation
(Sympathetic NS activity)

A

~Norepinephrine is released by the adrenal medulla in response to stress
~Epinephrine is secreted resulting in increased force of cardiac contraction, increased cardiac output, and vasoconstriction

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26
Q

Renin-Angiotensin System

A

~Vasoconstriction results in decreased blood flow to kidney
~Renin is secreted: angiotensinogen to angiotensin I
~Angio I to Angiotensin II by ACE causes vasoconstriction within renal system - increases peripheral resistance
~Angio II stimulates aldosterone production - promotes sodium and water retention in the kidney = Increase in blood (intravascular) volume

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27
Q

Prolonged HTN leads to

A

Elastic tissue within the arterioles being replaced with fibrous collagen tissue = arteriosclerosis

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28
Q

Arteriosclerosis

A

Arteriole becomes less distensible - greater resistance to blood flow
~Accelerates degenerative changes in the walls of the arteries

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29
Q

Narrowing or complete obstruction of the lumina

A

Progressively - arthrosclerosis
Completely - thrombus (blood clot)

Weakening of the walls
–>dilation
–>rupture

30
Q

Atherosclerosis

A

~Generic term for thickening and loss of elasticity of arterial walls
~Refers to the buildup of fats, cholesterol and other substances in and on the artery walls which restrict blood

31
Q

What is atherosclerosis characterized by?

A

Intimal lesions that protrude into and obstruct the vascular lumina
–>weakens the underlying media

32
Q

Atherosclerosis primarily affects

A

Elastic arteries, and large / medium muscular arteries

33
Q

Atherosclerotic plaque

A

~Intimal thickening and lipid accumulation giving rise to an atheroma

34
Q

3 principal components of Atherosclerotic plaque

A

~Smooth muscle cells, macrophages, and leukocytes
~ECM with collagen, elastic fibers
~Intra and extracellular lipids

~foam cells - large lipid laden cells derived from monocytes

35
Q

Atherosclerosis Epidemiology

A

Genetic predisposition
Hyperlipidemia (>200mg/dL)
HTN
Cigarette smoking
Diabetes

36
Q

Atherosclerosis Pathogenesis

A

Chronic inflammatory response of the arterial wall initiated by injury to the endothelium
–>harmful substances in the blood or the result of high BP

37
Q

Ischemic Heart Disease (IHD)

A

~group of closely related syndromes caused by an imbalance between myocardial oxygen demand and blood supply

38
Q

IHD most common cause of

A

narrowing of the lumina of the coronary arteries - most often termed coronary artery disease (CAD)

39
Q

Myocardial Infarction (MI)
(Aka Heart attack)

A

~development of myocardial necrosis caused by local ischemia (occurs when a blood clot blocks blood flow to the heart; no blood =tissue loses O2 and dies)

40
Q

Syndromes that may develop due to CAD

A

~Angina pectoris
~Acute myocardial infarction
~Sudden cardiac death
~Chronic IHD with congestive heart failure

41
Q

MI Pathogenesis

A

~Coronary artery thrombus
~Atherosclerotic plaque serves as the source for the generation of the thrombus
~location of the MI determined by the site of vascular occlusion

42
Q

MI Morphology

A

LAD (40-50%) - widow maker
R coronary artery (30-40%)
Left circumflex (15-20%)

43
Q

MI Pain Patterns

A

Sudden sensation of pressure; crushing chest pain radiating to arms, throat, neck, and back
Pain lasts 30min to hours
Women - shortness of breath (midnight) and chronic fatigue

44
Q

Congestive Heart Failure (CHF)

A

~Multisystem derangement that occurs when the heart is no longer able to eject the blood delivered to it by the venous system
~Inadequate cardiac output accompanied by congestion of the venous circulation

45
Q

CHF

A

~Failing ventricle unable to eject normal volume of venous blood delivered to it
~Increases blood in the ventricle at the end of a diastole
–>Increased end diastolic pressure
–>Elevated venous pressure

46
Q

Systolic CHF

A

Contractile failure of the myocardium

47
Q

Diastolic CHF

A

Increased pressures are required to maintain adequate cardiac output despite normal contractile function
—>Heart failure with preserved ejection fraction

48
Q

Left and Right CHF

A

Left - left ventricle can no longer maintain normal cardiac output

Right - right ventricular dysfunction due to left sided failure or pulmonary disease (cor pulmonale)

49
Q

Ejection Fraction

A

~Amount, percentage, of blood that is pumped (or ejected) out of the ventricles with each contraction

Normal: 55-70%

50
Q

Vicious Cycle of CHF - Positive Feedback

A

When there is a decreased blood pressure
Kidney releases renin, which starts process to retain sodium and water
LV dysfunction still exists, unable to eject blood
Kidney keeps retaining fluid

51
Q

Peripheral Vascular Disease (PVD)
or
Peripheral Artery Disease (PAD)

A

~Diseases of the blood vessels supplying the extremities and major abdominal organs
~PVD encompasses disorders affecting both the arterial and venous blood vessels

52
Q

PADS

A

Functional:
Doesn’t have an organic cause
Doesn’t involve defects in blood vessels’ structure, usually short-term effects and come and go

Organic:
Caused by structural changes in the blood vessels, such as inflammation

53
Q

Arteriosclerosis Obliterans

A

~In PAD, fatty deposits build up in the inner linings of the artery walls
~Early stages: cramping, fatigue in the legs/buttocks during activity

54
Q

Intermittent Claudication

A

Muscle pain (ache, cramp, numbness or sense of fatigue), usually in the calf muscle during exercise and is relieved by a short rest

55
Q

Buerger Disease

A

~Segmental, thrombosing, acute and chronic inflammation of medium and small arteries
~Occurs in smokers

56
Q

Raynaud Disease

A

~Intense vasospasm of small arteries or arterioles
~Paroxysmal pallor or cyanosis of the digits or feet

57
Q

Anuerysms

A

~Localized abnormal dilation of a blood vessel or the heart
~Causes:
—->Atherosclerosis and degeneration of the arterial media
—->Trauma

58
Q

Abdominal Aortic Anuerysm (AAA)

A

~Rupture into peritoneal cavity
~Obstruction of iliac, renal, mesenteric, or vertebral branches
~Embolism from atheroma or thrombus
~Impingement of adjacent structure (ureter)

59
Q

Varicose Veins

A

~Abnormally dilated, tortuous veins produced by prolonged, intraluminal pressure w/loss of vessel wall support
~Venous stasis, congestion, edema, pain, and thrombosis
~Usually form in the LEs
~Thrombus formation can lead to embolism

60
Q

Edema

A

Fluid excess in the tissues due to overload of interstitial or intracellular fluid causing congestion

61
Q

Non-pitting Edema

A

Skin that is stretched, shiny, with hardness of underlying tissue

62
Q

Deep Vein Thrombosis (DVT)

A

~Immobilization (bed rest, travel, Fx stabilization)
~Injuries to LEs
~Increased age
~Clotting disorders
~Infections and inflammatory diseases
~Orthopedic pts - post THA, TKA

63
Q

Lymphedema

A

Swelling of the soft tissues that results from the accumulation of protein-rich fluid in the extracellular spaces

64
Q

Lymphedema Facts

A

23-45% pts after breast cancer (post-surgery)
21% pt after ovarian cancer
28% pt after endometrial cancer
Up to 70% pt after prostate cancer

65
Q

Lymphedema Chief Complaints

A

Limb heaviness, paresthesias, achiness, skin tightness, poor fitting clothes, altered cosmesis, decreased ADLs and ROM

66
Q

Primary Lymphedema
(Idiopathic)

A

~Less common
~10% of all cases
~Congenital malformation / impairment of lymphatics
~LE affected most often

67
Q

Secondary Lymphedema
(Acquired)

A

~Most common
~Acquired
~Disruption of or damage to lymphatics
~Filariasis (parasitic infection)
~Cancer treatment
~Chronic venous insufficiency

68
Q

Stage 0 Lymphedema

A

Latent

No edema
Reduced lymph system transport capacity
Most commonly due to radiation or surgery

69
Q

Stage 1 Lymphedema

A

Reversible

Pitting edema
Greatly or completely reduces with elevation
No 2ary skin changes

70
Q

Stage 2 Lymphedema

A

Spontaneously irreversible

Does not pit
Does not substantially reduce with elevation
Skin becomes brawny and fibrotic
May have frequent skin infections

71
Q

Stage 3 Lymphedema

A

Lymphostatic elephantiasis

Extreme increase in limb volume
Deep skin folds
Papillomas present
Frequent skin infections

Patho (7 decks)

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