Cardio and lymph lecture Flashcards
Coronary arteries carry O 2 blood to the
myocardium
When Coronary arteries become narrow or blocked, the areas of the myocardium supplied by that artery do not receive enough Oxygen this can lead to
ischemia and injury
can lead to infarction
aaaand that can lead to disorders like….
Ischemic heart disease (IHD)
Coronary heart disease (CHD)
Coronary artery disease (CAD)
Disorders of the myocardium as a result of insufficient blood supply are collectively
known as
Ischemic heart disease (IHD)
Coronary heart disease (CHD)
Coronary artery disease (CAD)
One of the most important risk factors in both coronary heart disease and
cerebrovascular accidents
HYPERTENSION (HTN)
HYPERTENSION (HTN) can lead to
Cardiac hypertrophy
Heart failure
Aortic dissection
Renal failure
Marks Note: Systolic Pressure
System Engage pressure - pressure exerted when the heart contracts
Marks Note: diastolic pressure
Disengage pressure (pressure when the heart is relaxed between beats)
Blood pressure is the force exerted against the
arterial walls
Systolic
pressure exerted when the heart contracts
Diastolic
pressure when the heart is relaxed between beats
If kidney fails, the heart will
not do well :(
The silent Killer
HTN
HTN, Occurs when the relationship between ______ and ______ is
altered
blood volume, peripheral resistance
Primary (essential) HTN
cause unknown
Secondary HTN
cause known
Renal
Endocrine
ETOH abuse
Drug induced
Pregnancy induced
Acute stress
Primary HTN (cause unknow) accounts for what percentage of HTN?
90-95% maybe thats why its primary
Primary HTN - Modifiable vs non modifiable
Modifiable - can do something about it
* High sodium intake
* Obesity
* DM
* Hypercholesterolemia
Non modifiable - Can’t do anything about it
* Family history
* Age (> 55)
* Gender
* Male (<55)
* Female (>55)
* Ethnicity
Cardiac output is the _______ of blood
ejection
Ejection of blood can be a a product of what characteristics of heart
rhythm, rate, strength of heart
Peripheral resistance can be due to what things?
diameter of vessels, thickness of blood or viscosity of blood
BP = CO x
PR
Blood pressure = cardiac output x peripheral resistance
T/F, hyperthyroidism can cause an increase in cardiac output which would increase BP
T
an increase in Pereipheral resistance can increase
blood pressure
HTN Pathogenesis
-Blood flow (CO)
-Peripheral resistance (vessel diameter, blood viscosity)
Increased peripheral resistance as a result of the narrowing of the _______ is the
single most common characteristic
arterioles
T/F Increased peripheral resistance as a result of the narrowing of the Veins is the
single most common characteristic
FALSE
Increased peripheral resistance as a result of the narrowing of the ARTERIOLES is the
single most common characteristic
Peripheral resistance can be regulated by
-Autonomic regulation
Norepinephrine is released in response to stress
Epinephrine is secreted → increased cardiac contraction, increased cardiac output, vasoconstriction
-Renin-angiotensin system
Vasoconstriction causes decrease blood flow to the kidneys
Renin is secreted and angiotensin is formed
Causes vasoconstriction within the renal system – increases peripheral resistance
Angiotensin stimulates aldosterone production
Promotes sodium and water retention in the kidney causing intravascular volume
Renin-angiotensin system
Vasoconstriction causes decrease blood flow to the kidneys
Renin is secreted and angiotensin is formed
Causes vasoconstriction within the renal system – increases peripheral resistance
Angiotensin stimulates aldosterone production
Promotes sodium and water retention in the kidney causing intravascular volume
arteriosclerosis
Arteriole becomes less distensible
Greater resistance to blood flow
Accelerates degenerative changes in the walls of arteries
T/F, Prolonged hypertension leads to elastic tissue within the arterioles being replaced
with fibrous collagen tissue
True
T/F, Prolonged hypertension leads to elastic tissue within the arterioles being replaced
with awesome 100% repaired collagen tissue
F, Fibrous
T/F, Prolonged hypertension leads to elastic tissue within the arterioles being replaced
with FIBROUS collagen tissue
Narrowing or complete obstruction of the lumina
Progressively – atherosclerosis
Completely – thrombus
Weakening of the walls can lead to
Dilation
Rupture
in ARTERY: Lesions at the Tunica, can block the lumen, weakens the lumen, loss of elasticity
basically i believe, a blockage will weaken walls and lose elasticity
T/F, Arteriosclerosis is a broad term, atherosclerosis is a more specific term and will be used interchangeably
T
Arteriosclerosis / atherosclerosis basically means decreased _____ to parts of body
blood flow
ATHEROSCLEROSIS
Generic term for thickening and loss of elasticity of arterial walls
Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably
Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on the artery walls
which restricts blood flow
T/F Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably
T
Atherosclerosis
Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on the artery walls
which restricts blood flow
ATHEROSCLEROSIS Characterized by intimal lesions that protrude into and obstruct the vascular lumina
Weakens the underlying media
Atherosclerosis = build up of stuff > lesion >protrude into lumina (space of the vessels)
ATHEROSCLEROSIS Primarily affects the elastic arteries, and large/medium muscular arteries and can lead to
Myocardial infarction
Cerebral infarction
Aortic aneurysms
Peripheral vascular disease (gangrene of the LEs)
ATHEROSCLEROSIS happens by a
Intimal thickening and lipid
accumulation giving rise to an
atheroma
Atherosclerotic plaque
ATHEROSCLEROTIC PLAQUE
Three principal components:
-Smooth muscle cells, macrophages, and leukocytes
-ECM with collagen, elastic fibers
-Intra and extracellular lipids
Foam cells – large lipid laden cells derived from monocytes
Evidence of neovascularization
The plaques continue to change and progressively enlarge through cell death,
synthesis, and remodeling
ATHEROSCLEROTIC PLAQUE
3 principal components
-Smooth muscle cells, macrophages, and leukocytes
-ECM with collagen, elastic fibers
-Intra and extracellular lipids
ATHEROSCLEROSIS Pathogenesis
Chronic inflammatory response of the arterial wall initiated by injury to the endothelium
Harmful substances in the blood or the result of high blood pressure
ATHEROSCLEROSIS Epidemiology
Genetic predisposition
Hyperlipidemia (> 200mg/dL)
LDL (BAD) (≥ 130 mg/dL)
HDL (GOOD) (≤ 39 mg/dL)
Triglycerides (> 150 mg/dL)
HTN
Cigarette smoking
Diabetes
ISCHEMIC HEART DISEASE
Group of closely related syndromes caused by an imbalance between myocardial
oxygen demand and blood supply
Most common cause is a narrowing of the lumina of the coronary arteries
Most often termed coronary artery disease (CAD)
One of four syndromes may develop:
Angina pectoris
Acute myocardial infarction
Sudden cardiac death
Chronic ischemic heart disease with congestive heart failure
Angina pectoris has intermittent
chest pain
Atherosclerosis is a narrowing of the
lumina
ischemic heart disease may lead to one of four syndromes
Angina pectoris
Acute myocardial infarction
Sudden cardiac death
Chronic ischemic heart disease with congestive heart failure
MYOCARDIAL INFARCTION (MI)
Development of myocardial necrosis caused by local ischemia
Pathogenesis
Coronary artery thrombus
Atherosclerotic plaque serves as the source for the generation of the thrombus
Location of the MI is determined by the site of vascular occlusion
Dead heart tissue = decrease in blood flow and a decrease in
oxygen for heart muscle
MI Morphology
LAD (40-50%)
R coronary artery (30-40%)
Left circumflex (15-20%)
MI of the LAD - left anterior descending artery
the WIDOW MAKER, this area pushes blood out to the entire body
The widow maker, where would this clot occur
this clot would be at the LAD
Way for me to remember:
the LAD died, and the widow was LEFT by herself and she was DOWN
MI PAIN PATTERNS
chest, neck, L shoulder, medial arm, right below chest, upper back
Women can have very minor feelings that would actually be an MI
Women can have unexplained anxiety - and like a feeling of DOOM coming
CONGESTIVE HEART FAILURE (CHF)
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
Failing ventricle unable to eject normal volume of venous blood delivered to it
Increased blood in the ventricle at the end of diastole
Increased end diastolic pressure
Elevated venous pressure
CHF 4 types
Systolic – contractile failure of the myocardium
Diastolic – increased pressures are required to maintain adequate cardiac output despite normal
contractile function
Heart failure with preserved ejection fraction
Left side – left ventricle can no longer maintain normal cardiac output
Right side – right ventricular dysfunction due to left sided failure or pulmonary disease (cor pulmonale)
EJECTION FRACTION
Amount, percentage, of blood that is pumped (or ejected) out of the ventricles with
each contraction
if pt doesnt die from heat attack will probably in up with CHF, ejection of blood decreased, decrease in overall
cardiac output
CHF means a back up of the
venous system
EJECTION FRACTION percentages
Ejection Fraction (EF) 55% to 70%
Pumping Ability of the Heart: Normal
Ejection Fraction (EF) 40% to 54%
Pumping Ability of the Heart: Slightly below normal
Ejection Fraction (EF) 35% to 39%
Pumping Ability of the Heart: Moderately below normal
Ejection Fraction (EF) Less than 35%
Pumping Ability of the Heart: Severely below normal
CHF is a positive feed back loop
LV Dysfunction causes, Decreased cardiac output > Decreased Blood Pressure and
Decreased Renal perfusion > Stimulates the release of renin, Which allows conversion of Angiotensin to Angiotensin II. Angiotensin II stimulates Aldosterone secretion which causes retention of Na + and water, increasing filling pressure»_space; repeats
CHF is a positive feed back look and will continue because there heart is pumping out a decreased amount of cardiac output
This continues to make the system feel like something is wrong that it can just adjust buuuut the shit aint working right at the heart
CHF symptoms
Anxiety, confusion, nausea and vomiting, tachycardia, hypotension, decreased urine output, lower leg edema
hypoxia, jugular venous distention, infarct, hepatosplenomegaly, weak pulse, cool moist skin, pale grey or cyanotic skin, dyspnea orthopenea crackles wheeze cough, ascites
