Cardiac - Class 2 - vessels Flashcards
What can happen if a thrombus forms over the atherosclerotic lesion in PAD? What does it cause?
Complete obstruction of blood flow can occur acutely, causing severe pain, loss of pulses, and skin colour changes in the affected extremity
What does hypertension result from?
It results from a sustained increase in peripheral resistance, an increase in blood volume, or both
Primary Hypertension Vs Secondary Hypertension?
Primary Hypertension – 92-95% of population – primary disease – disease is hypertension – no known cause
Secondary Hypertension – 5-8% of population – caused by underlying disease – underlying disease – possibly renal – causing hypertension
Causes of vascular diseases?
o Obstruction (Tend to create turbulence):
Thrombus - formation (blood clot attached to vessel wall)
Embolus - clot or foreign mass floating in circulation.
Compression by external forces such as tourniquet, cast, circular dressings, tumours, sustained pressure especially over bony prominences
Structural changes to the vessel
o Aneurysms
o Impaired venous valves
o Atherosclerosis (fatty deposits on the walls of the vessel
o Vasospasm - smooth muscle constricts due to local or neurally mediated reflex or disruption of other regulation mechanisms
Where do aneurysms commonly occur? Why?
Most commonly occur In the thoracic or abdominal aorta
The aortic is susceptible to aneurysm formation because of constant stress on the vessel wall and the absence of penetrating vasa vasorum in the media layer
vasospastic attacks – change in skin colour & sensation – causes pallor, numbness, sensation of coldness are symptoms of?
Raynaurd Phenomenon
What is Raynaud Phenomenon?
Attacks of vasospasm in the small arteries and arterioles of fingers (less common toes), circulation cut off until you get away from stimulus, warm hands up
What can complicated primary hypertension occur with?
Can occur with:
Chronic hypertension - normally controlled by medication – acute exacerbation that can no longer be controlled by medication,
Pregnancy
adrenal tumours
What causes Chronic venous insufficiency?
Valvular incompetence
Obesity
Inadequate venous return over a long period
Venous hypertension,
circulatory stasis,
and tissue hypoxia = remodeling of the skin – then ulceration
What is white coat syndrome?
This condition occurs when blood pressure readings at a health care provider’s office are higher than they are in other settings, such as at home. It’s called white coat hypertension because people who measure blood pressure sometimes wear white coats.
White coat syndrome – keep in mind patient anxiety – having them take their blood pressure at home or on an automated BP without a physician present
SNS- development and sustaining HTN?
SNS – development and sustaining HTN:
-Stress/Flight/Fight
1.)Epinephrine/Norepinephrine
2.)Beta 1 = increased heart rate and contraction force =increased BP
3.) Alpha 1 = peripheral vasoconstriction = increased BP
4.) Increased ADH= kidneys release less water = increased BP
Risk factors for Atherosclerosis?
smoking, hypertension, diabetes, increased levels of LDL – low density lipoprotein and decreased levels of HDL – high density lipoprotein,
What do aneurysms have the potential for?
Potential for aortic dissection, rupture, hemorrhage
Infarction and subsequent necrosis of a central organ are life threatening in?
Embolisms
Ischemia or infarction in tissue distal to obstruction – organ dysfunction and pain
Life threatening – coronary – cause MI
- cerebral artery – Stroke
What is Venous Stasis?
1/3 DVT risk factors
- Bed rest
- *Immobility
- Spinal cord injury
- Heart failure
What is Chronic venous insufficiency (CVI)?
Is inadequate Venus return over a long period of time
Main manifestations of PAD?
-Pain worse when elevating legs, improves with dangling
-Sores that do not heal
-Shiny, hairless skin
-Ulceration can occur from a slight injury and in most severe stages gangrene can occur
What are the two kinds of True aneurysms?
Saccular and Fusiform
Complicated hypertension as a hypertensive crisis
Hypertensive crisis – malignant hypertension – sustained over 180 (looking at it repeatedly)
Rapid progression of hypertension -
Increase arterial pressure = vascular fluid pushed into interstitial space – cerebral edema or encephalopathy – other systems involved – medical emergency
Where do pulmonary embolisms originate?
They originate on the venous side (mostly from DVT of the legs) of the systemic circulation or in the right heart
What is malignant hypertension?
It is a rapidly progressive hypertension in which diastolic pressure is usually greater than 140mm HG and is a hypertensive crisis /medical emergency
Causes of Atherosclerosis?
Consumption of high fat and cholesterol containing LDL foods
Hypertension, smoking and obesity (inhibits the oxidation of LDL
Diabetes, hyperlipidemia
Insulin resistance, infection and periodontal disease
What is a significant cause of venous thrombosis?
altered blood coagulation, stasis of blood, vessel wall injury
Patho process for DVT? what does it result in?
Accumulation of clotting factors and platelets – particularly close to valves lead to thrombus formation in a vein
Inflammation around thrombus – more platelets
After significant obstruction – increased pressure behind clot = edema in extremity
Most thrombi dissolve without treatment
What is Atherosclerosis?
It is a* form of arteriosclerosis* that is caused by the accumulation of lipid-laden macrophages within the arterial wall, which leads to the formation of a lesion called a PLAQUE
Manifestations of aneurysms?
Manifestations depend on location:
Can be asymptomatic until they rupture – then severe pain and hypotension
Thoracic – dysphagia, dyspnea – bulge affects surrounding tissue
Femoral aneurysm – if it affects circulation - Ischemia to lower limbs
Cerebral – circle of Willis – to be studied in neuro – increased ICP – signs of stroke – leaking cerebral aneurysm
What is an aneurism?
It is a localized dilation or outputting of a vessel wall or cardiac chamber
What is secondary hypertension? what does it frequently involve?
Occurs with another underlying disease – frequently involves kidneys (there is a cause)
Medications can cause hypertension, pregnant, tumour…
Fix the disease, BP will resolve
An underlying disease process or medication that rises peripheral vascular resistance or cardiac output can cause secondary hypertension
What happens if there is permanent occlusion of the peripheral writers in Buerger’s disease?
Permanent occlusion – collateral vessels develop but are inadequate – not quick enough, lower blood volume
What is Buerger’s disease?
-It is a peripheral vascular disease (peripheral partiers are occluded)
-It is an inflammatory disease of the peripheral arteries and is associated with smoking
Formation of thrombi in peripheral arteries – overtime thrombi organized and fibrotic (eventually become necrotic if not watching it)
How are embolisms introduced to the body?
Bolus of Air – IV lines, chest trauma
Amniotic fluid – intraabdominal pressure during delivery – amniotic fluid forced into blood stream
Fat – trauma of the long bones (car accident)
Bacteria – subacute bacterial endocarditis or abscess (cancer cells)
Foreign body – introduced through IV or arterial lines
What is Atherosclerosis Vs Arteriosclerosis
Arteriosclerosis – thickening and hardening of vessel/artery walls
Atherosclerosis – build up of plaques of lipid material on artery walls, clot off coronary arteries
Veins Vs Arteries?
Arteries:
Away from heart
Thicker
Elastic
More susceptible to spasms
Deeper in the body
Veins:
Back to heart
Valves
What does orthostatic hypotension refer to?
- Refers to ↓systolic BP of 20mmHg or ↓diastolic BP of 10mmHg within 3min of standing
What is a dissecting aneurysm?
Dissecting aneurysm - splits the vessel wall along the length of the vessel, not going outside the outer layer, can be dangerous or fix themselves, can clot it off, no blood loss
What is the major risk associated with untreated DVT?
High risk of embolization
What happens with fluid IN PAD? Venous ulcer Vs arteriole ulcer?
Fluid can get down but it can’t get up— swelling, sloughing skin, oozing (venous ulcer)
Pale, shiny, hairless skin, no edema, pin point, dry—cannot get fluid down there (arteriole ulcer)
What is Peripheral Artery Disease (PAD)? What does it describe?
- Atherosclerotic disease of arteries that perfuse lower limbs
- Describes any condition that cause partial/complete obstruction of the flow of blood
What are most clinical manifestations of hypertension caused by?
They are caused by complications that damage organs and tissues outside the vascular system
DVT Risk factors?
Immobile for a while
Injuries
Flights (long)
Elderly who have fallen
Heart failure
Hyper-coagulable
Oral contraceptives
Hormone therapies
What is Raynaud Phenomenon?
Attacks of vasospasm in the small arteries and arterioles of fingers (less common toes), circulation cut off until you get away from stimulus, warm hands up
What does a ruptured aneurysm present with?
Ruptured aneurysm presents with hypotension and severe back pain – large amount of bleeding internally, moves into lower extremities due to gravity
Patho process for DVT?
Accumulation of clotting factors and platelets – particularly close to valves lead to thrombus formation in a vein
Inflammation around thrombus – more platelets
After significant obstruction – increased pressure behind clot = edema in extremity
Most thrombi dissolve without treatment
What kind of cerebrovascular issues can we have with complicated primary hypertension?
Cerebrovascular – transient ischemia, stroke, cerebral thrombosis, aneurysm, hemorrhage, & dementia – too much volume is pumped through vessels
Where do arterial embolisms originate? what are they commonly associated with?
Commonly originate in the left ventricle and are associated with thrombi after MI, vascular disease, left ventricular failure, endocarditis, and dysrhythmias
What is Venous endothelial damage?
damage occurs to the vascular endothelium, the thin layer of cells that lines blood vessel
1/3 DVT risk factors
- Trauma (surgical intervention, infection, inflammation of vessel wall
- Hip surgery and total hip replacement due to trauma of femoral and iliac veins
- Thermal damage from heat generated during the procedure (cementing new joint )
- Venous catheters
- Smoking
Causes of primary hypertension?
Genetic predisposition, low physical activity
Stress, increased alcohol intake
Diabetes, sodium and water retention— increase in our fluid
Examples of normal compensation for position changes in orthostatic hypotension?
-baroreceptor-mediated reflex – increase heart rate
-Closure of valves in venous system
Contraction of leg muscles
-Decrease in intrathoracic pressure
-Heart rate is increased with constriction of system arterioles
What is Bruit?
turbulent blood flow (on PAD slides)
What are some possible symptoms of hypertension?
Heart disease , MI, CVA, kidney failure, vision loss
Headaches, epitaxies, confusion, dyspnea
Risk facts for peripheral artery disease (PAD)?
o Same as those for atherosclerosis
high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.
What insufficiency causes this?
“venous hypertension, circulatory stasis, and tissue hypoxia cause can inflammatory reaction in vessels and skin ulcerations?
CVI - Chronic venous insufficiency
What is the BP value for hypertension?
140/90
Symptoms of hypotension?
atigue.
lightheadedness.
dizziness.
nausea.
clammy skin.
depression.
loss of consciousness.
blurry vision.
What does hypertension put an individual at risk for?
Hypertension puts individual at risk for developing cardiac events, kidney disease, and stroke
Systolic BP Vs Diastolic BP?
Systolic BP: Pressure when ventricle is contracting
Diastolic BP: Pressure when relaxing
What is the most common cause of arterial aneurysms?
Athersclerosis because plaque formation erodes the vessel wall and contributes to inflammation
Manifestations of atherosclerosis?
Partial vessel occlusion can result in transient ischemic events – when exercising or stress
As lesion becomes complicated – thrombosis may result in tissue infarction
Obstruction of peripheral arteries – significant pain and disability
Systemic - Presentation in one area may indicate risk for complications elsewhere
Embolisms travel throughout the blood stream until?
until becomes lodged in a smaller vessel 0 till it reaches a vessel through which it cannot pass
Causes of hypotension?
HF
Shock
Hemorrhagic
Dehydrated
What is complicated primary hypertension? Why is it the silent killer?
Complicated primary hypertension– uncontrolled hypertension – no other underlying disease – hypertension causes the problems
-Silent killer because we don’t know our BP unit it damages our organs
It is also a Hypertensive crisis – rapidly progressive hypertension with diastolic BP > 140mmHg
What are varicose veins?
varicose vein is a distended, torturous, and palpable vessel that results from pooling of blood
-Varicose veins (stretching out— increasing in size) we need the muscles massaging the veins back up to not get these, veins don’t reach/touch anymore
What is an embolism/embolus?
It is a bolus of matter circulating in the bloodstream (embolism) that can lead to an obstruction of a vessel
What kind of condition is Buerger’s diseases?
It is an autoimmune condition that is characterized by the formation of thrombi filled with inflammatory and immune cells
In orthostatic hypotension the reflex mechanisms are?
Reflex mechanisms are dysfunctional or inadequate – individual stands – blood pools and normal arterial pressure cannot be maintained
Diagnosis od Rhaynaurd phenomenon?
Diagnosis – vasospastic attacks – change in skin colour & sensation – causes pallor, numbness, sensation of coldness
What is secondary Raynaud Phenomenon?
It is associated with systematic diseases (lupus), particularly collagen vascular disease
What happens in Raynaud phenomenon/disease?
Attacks of vasospasm in the small arteries and arterioles of fingers (less common toes), circulation cut off until you get away from stimulus, warm hands up
What has a 100% likelyhood of developing DVT without any preventative measures?
Orthopedic surgery/trauma, spinal cord injury, obs/gyne
What does atherosclerosis form? Where does it form?
o Forms a lesion in large and medium arteries called plaque:
Peripheral arteries
Coronary Arteries
Cerebral Arteries
Aorta
Symptoms of Buerger’s disease?
Symptoms – pain and tenderness – sluggish blood flow – rubor (redness) of skin
Due to dilated capillaries under skin – skin is thin and shiny & nails are thick and deformed
Why does thromboembolism occur more frequently in veins than arteries?
Due to lower flow pressure in the veins rather than arteries
Symptoms of chronic venous insufficiency?
Edema to lower extremities – can extend to knees,
hyperpigmentation of skin – feet and ankles, brownness
Cellular demand for oxygen and removal of metabolic waste – not fully met
Any trauma or pressure – can lower oxygen supply and cause venous stasis ulcers – decreased circulation = increased infection risk
Primary Vs Secondary Raynaud phenomenon/disease?
Primary (disease)– vasospastic disorder with unknown origin
Secondary (phenomenom)– associated with systemic diseases – Lupus,
True Vs False((Pseudoaneurysm) aneurysm?
True: Involves all 3 layers of the arterial wall and best described as a weakening of the vessel wall
False: Is an extravascular hematoma - gone through all of the layers, outside the adventitia
What are the three causes of DVT?
Venous stasis – immobility, age, heart failure
Venous endothelial damage – trauma, intravenous medications
Hypercoagulable states – inherited disorders, pregnancy, oral contraceptives, hormone replacement therapy
What are hypercoaguable states?
1/3 DVT risk factors
o Orthopedic trauma/surgery, spinal cord injury, OB/GYN conditions increase 100% chance of DVT
o Inherited abnormalities
V Leiden mutation
Prothrombin mutations
Deficiencies of protein C, protein S, antithrombin
o Asymptomatic and difficult to detect clinically
What causes varicose veins?
Trauma to the saphenous veins – damage to one or more valves
blood is not being moved back up – gravity is pulling it back down
What kind of renal complication can we have with complicated primary hypertension?
Renal complications – arterial sclerosis, insufficiency or failure – thickening over time due to increased pressure – damage to endothelium
what must we always assume with hypertension?
Must always assume it is primary hypertension until we find a causative factor
Manifestations of DVT if there is any?
Leg pain – starts in calf – cramping
Red or discolored skin on the leg
Feeling of warmth on the leg
Acute hypotension causes?
-pregnancy, due to an increase in demand for blood from both mother and the growing fetus
-large amounts of blood loss through injury
impaired circulation caused by heart attacks or faulty heart valves
weakness and a state of shock that sometimes accompanies dehydration
-Anaphylactic - a severe form of allergic reaction
infections of the bloodstream
-endocrine disorders such asdiabetes,adrenal insufficiency, and thyroid disease
