Cardio Diseases Flashcards
1
Q
What does the functional model of the cardio system show?
A
the heart and blood vessels as a single closed loop
2
Q
The elastic systemic arteries are a _______ reservoir that maintains blood flow during ventricular relaxation
A
pressure
3
Q
The arterioles have “adjustable screws” that alter their diameter. This is the site of _________ ________
A
variable resistance
4
Q
Exchange between the blood and cells takes place only at the….
A
capillaries
5
Q
Systemic veins serve as an _______ ________ reservoir
A
expandable volume
6
Q
Each side of the heart functions as what?
A
an independent pump
7
Q
Define hemodynamics
A
principles of physics that regulate blood flow
8
Q
Define flow rate
A
volume of blood moving per unit time
9
Q
Velocity (V) = ?
hint: its an eq
A
V= flow rate (Q) / cross sectional area (A)
10
Q
T/F:
We have the same flow rate through entire system
A
TRUE
11
Q
Define velocity (in the context of blood vessels)
A
distance blood is flowing per unit time
12
Q
The ________ the vessel, the faster the velocity of flow
A
narrower
13
Q
What is cross sectional area represented by?
A
pi r^2
14
Q
When talking about the area of blood vessels what does this mean?
A
cross sectional area of the vessel TYPE
15
Q
Velocity of fluid varies ______ w/ cross sectional area. Velocity increases/faster in small area than big area
A
inversely
16
Q
Blood is slower in capillaries than the aorta. Why?
A
bc capillaries are the exchange vessels
17
Q
The flow rate (CO) is the same throughout the vessel and entire system. Why?
A
bc blood moves slower in larger area and faster in smaller area
18
Q
Blood flow depends on what?
A
the pressure difference or pressure gradient between the vessels or 2 ends of a vessel
it also depends on resistance
19
Q
Q= delta P / R
What does this equation mean?
A
blood flow is directly proportional to pressure gradient and blood flows from high to low pressure
blood flow inversely proportional to resistance
20
Q
What does Q stand for?
A
flow or flow rate
21
Q
What does delta P stand for?
A
difference in pressure, or pressure gradient
22
Q
What does R stand for?
A
resistance
23
Q
Blood flow _____ go down a pressure gradient, and will be ______ by resistance
A
must, inhibited
24
Q
Fluid flow through a tube depends on what?
A
pressure gradient
25
What does TPR stand for?
total peripheral resistance
26
What does SVR stand for?
systemic vascular resistance
27
What are the 2 blood vessels that are bringing blood to the R atrium called?
SVC and IVC
28
Is pressure higher, lower or equal at the SVC and IVC than the R atrium?
the pressure is slightly higher than in the R atrium
29
What are the 2 blood circulations in the body?
systemic and pulmonary circulation
30
Which circulation has the greatest resistance in the body? What is this resistance called?
systemic circulation has the greatest resistance = TPR (total peripheral resistance)
31
Resistance to blood flow depends on 3 things. What are they?
1) the radius of vessel
2) vessel length
3) viscosity of blood
32
What does n stand for?
viscosity of blood
33
What does l stand for?
length of blood vessel
34
What does r^4 stand for?
radius of blood vessel to the 4th power
35
What is the Poiseuille eq?
R= 8Ln/ pi r^4
36
In the Poiseuille eq, resistance is _______ proportional to the viscosity of blood
directly
37
What blood cells are responsible for the blood viscosity? Why?
RBCs bc hematocrit is the percentage of RBCs within whole/all blood
38
What is the hematocrit average?
originally, we were told 40-45%
now, Roop tells us it is 45-48%
so 40-48%
39
Increase in RBCs = ________ in blood viscosity
increase
40
In the Poiseuille eq, resistance is ______ proportional to the length of blood vessel
directly
41
In the Poiseuille eq, resistance increases with what?
vessel length
42
Is adipose vascular or avascular?
VASCULAR
43
Increased fat results in what?
increased blood supply AND increased resistance
44
Obesity is related to what blood/heart problem?
hypertension
45
In the Poiseuille eq, resistance is ________ proportional to radius of blood vessels to the 4th power
inversely
46
As the radius of blood vessels becomes smaller, what happens to resistance?
it increases
47
T/F:
As the radius of a tube decreases, the resistance to flow also decreases
FALSE- resistance to flow increases
48
The smaller the radius, the _____ the resistance to the 4th power
hint: less or greater
greater
49
What are the smallest blood vessels?
Capillaries
50
Capillaries have low resistance. Why?
bc its offset by the number of capillaries (remember that were looking at the blood vessel TYPE)
51
What is atherosclerosis and how does it affect the blood?
fatty plaque will decrease the radius of blood vessels, which will increase resistance and increase turbulent flow
52
Vessels that carry well-oxygenated blood are _____; those with less well-oxygenated blood are _____
red, blue
53
Define distensibility
the ease with which a vessel dilates/stretches when filling pressure increases or pressure is applied
basically, ability to expand
54
veins are _____ compliant bc they can expand more
more
55
What are the blood reservoirs of the body?
veins
56
Veins distend more than arteries. So, the venous system has a higher what?
compliance of competence than arterial system
57
Veins are the blood reservoirs and contain the ________ volume
unstressed
58
Arteries have _______ volume because they have higher pressure (than veins)
stressed
59
Every time the L ventricle contracts, or sends blood out to what structure? What is this blood called?
aorta
this blood is called stroke volume (SV) per beat
60
What is stroke volume?
how much blood you are ejecting per heartbeat
61
What is cardiac output?
blood ejecting per unit time
62
What is systole and diastole in simplest terms? What is it in this- 110/60?
systole = contraction
diastole = relaxation
110/60
S/D
63
As blood is being ejected out, the aorta expands to hold ____ stroke volume
1
64
As blood is being ejected out, the aorta expands to hold 1 SV. The aorta, however, cannot get all the blood to capillaries during systole. It gets all the blood over during diastole. What is this known as?
diastolic runoff
65
Large arteries _____ during systole for a full SV, but transmit it to the capillary beds during diastole, which is diastolic runoff
expand
66
The aorta has enough pressure to move blood during ____. Why?
diastole
bc blood has to move down a pressure gradient even if the heart is "relaxed"
67
What is the largest elastic artery?
aorta
68
The energy for flow in diastole is stored where?
elastic tissues of the arteries during systole
69
The energy for flow in diastole is stored in the elastic tissues of the arteries during systole. What does this result in/what is it called?
storage and runoff effect = windkessel
70
If a pt has atherosclerosis and fatty plaque in the aorta, how will the body compensate?
increased:
-hr
-force of contraction (to try to eject same volume of blood)
71
If a pt has atherosclerosis and fatty plaque in the aorta, but no medical intervention, what happens?
the heart workload will increase and hypertrophy
72
What happens to the cardio system, when a pt has arteriosclerosis?
-vessels become less compliant w/ old age
-arterial walls become stiff/thick
-happens when blood vessels lay down more collagen w/ age
-hypertension develops (high bp)
73
T/F:
Pressure is equal in cardiovascular system
FALSE- its unequal
74
Where is the highest pressure in the cardio system?
aorta
75
Where is the lowest pressure in the cardio system?
vena cava
76
Why does the aorta have the highest pressure in cardio system, and vena cava have the lowest pressure?
because it's how blood moves systemically through body
77
Does systolic pressure or diastolic pressure have a higher pressure?
systolic pressure is higher
78
Diastolic pressure is lower pressure than systolic. Can it still move blood in relaxation phase? Why/why not?
yes, even though the heart is relaxing not contracting, it still has enough pressure to move blood through gradient
79
Blood moves from the:
-left ventricle
-arteries
-arterioles
-capillaries
-venules/veins
-right atrium
As you go down the list is pressure increasing or decreasing?
PRESSURE IS DECREASING
80
The closer you are to the heart, the pressure is ______
pulsatile
81
Pulsations in arteries coincide with what?
the beating of the heart
82
1 pulse = ____ cardiac cycle = _____ heart beat
1:1:1 ratio!
1 pulse, 1 cardiac cycle, 1 heart beat
83
What is the eq for pulse pressure?
pulse pressure (PP) = systolic pressure - diastolic pressure
84
What is the eq for mean arterial pressure?
mean arterial pressure (MAP)= diastolic pressure + 1/3 (pulse pressure)
85
Is pulse pressure related to stroke volume?
yes, bc pulse pressure is dependent on stroke volume (volume of blood ejected from the heart w/ each beat)
86
What is mean arterial pressure (MAP)?
measure of the force of blood moving through system
87
If pulse pressure is an indicator of stroke volume, then....
pathologic conditions that affect one will affect the other
88
What happens to SV and pulse pressure when a pt has a severe hemorrhage?
SV and PP decrease (has less blood moving through system)
89
What happens to the cardio system with congestive heart failure (CHF)? How does this affect SV and PP?
blood is not moving from heart/heart is not a good enough pump anymore
SV and pulse pressure decrease (decreased blood movement through system)
90
What happens to the cardio system with atherosclerosis patients?
-plaque on artery walls
-decreased diameter in vessels
-less compliant vessels
-decreased SV, pulse pressure, and blood circulation
91
What happens to the cardio system with arteriosclerosis?
-decreased diameter in vessels
-less compliant vessels
-decreased SV, PP, and blood circulation
92
Is pulmonary circulation a long or short circuit?
short circulation
93
Does pulmonary circulation have high or low pressure?
low pressure
94
CO of the R side of the heart must _____ the CO of L side of heart
equal
95
CO = VR on ______ person
healthy
96
The heart has 2 different types of cardiac muscle cells. What are they?
contractile cells and conducting cells
97
____ of heart cells are contractile fibers, and ____ are conducting fibers
99%, 1%
98
conducting fibers in the heart are the ones that can't do what?
cannot contract anymore (can no longer generate pressure)
99
What do conducting fibers do?
generate spontaneous APs
100
Every other organ in the body depends on the NS, whereas the heart depends on....
itself for heart rate and APs
101
Does the autonomic NS still have a role with the heart even though it doesn't fully control HR and APs of heart?
yes!!!
102
Autorhythmic cells do what?
generate APs and send APs to contractile fibers which is what causes heart to beat
103
Where are autorhythmic cells found?
-SA node
-AV node
-bundle of His
-bundle branches
-internodal pathway
-Purkinje fibers
104
What are the 5 textbook steps to electrical conduction pathway of heart?
1) SA node depolarizes
2) electrical activity goes rapidly to AV node via internodal pathways
3) depolarization spreads more slowly across atria and conduction slows through AV node
4) depolarization moves rapidly through ventricular conducting system to the apex of the heart
5) depolarization wave spreads from the apex
105
What does "SA" in SA node stand for?
sinoatrial node
106
Where is the SA node located within the heart?
lays within R atrium and at the entrance of the SVC
107
What is the pacemaker of the heart?
SA node
108
What are the functions of the SA node?
set the pace of the heart
generate APs that will spread between both atria (atrial internodal pathway)
109
What is the SA node linked to?
linked to both atria by gap junctions
110
The electrical signal moves through both ______ and gets to the AV node
atria
111
What does "AV" stand for in AV node?
atrioventricular
112
Where is the AV node located?
R atrium of heart
113
What happens at the AV node?
conduction velocity/signal slow down here
this is bc of extra layer of fibrotic CT and plate of cartilage
it acts an electrical insulator
114
Why does the conduction velocity/signal slow down at the AV node?
because it has an extra layer of fibrotic CT and plate of cartilage
acts as an electrical insulator
115
electrical activity ______ mechanical activity
precedes
116
What mechanical activity is the AV node waiting for the heart to catch up with?
waiting for atria to contract and fill w// blood before electrical pathway continues
117
If the heart doesn't slow down at the AV node, what happens?
ventricular filling decreases, which also decreases SV and CO
118
From the AV node, the ventricles must be stimulated to contract from _____ to the superior aspect of the ventricles
apex
119
The heart contracts from the ______ to _____. Why?
apex to base
this is bc this is how blood is ejected out of heart
120
Once the signal leaves the AV node, it goes really fast. Where is its next "stop"?
goes to bundle of His (superior part of the AV septum)
121
Bundle of His splits into R+L ________ _______ and runs along the AV septum and Purkinje fibers
bundle branches
122
Purkinje fibers are electrically connected to what and by what? Additionally, what will this allow?
connected to ventricular cardiac muscles by gap junctions
will allow contractile fibers to take over at this point
123
What are the 5 phases of cardiac muscle APs?
0= Na+ channels open (depolarization)
1= Na+ channels close
2= Ca+2 channels open, fast K+ channels close
3= Ca+2 channels close, slow K+ channels open (repolarization)
4= (stable) resting potential
124
Cardiac muscles have ____ phases to a fast AP
5
125
All cardiac muscle cells on the sarcolemma have what?
voltage-gated ion channels
126
All cardiac muscle cells on their sarcolemma have voltage-gated ion channels. Once they get their signal from the 1% of conducting fibers, what happens?
sodium channels open!
127
Sodium channels are ______ channels going from -90 to 20 mV
FAST
128
Get signal, open, and sodium rushes in. This is called.....
depolarization, or stage 0
129
Phase 0 of AP, what happens?
upstroke, or rapid depolarization caused by opening of sodium channels
130
While sodium channels were opening really fast during AP, what other channels were also opening? What is the difference?
K+ channels were also opening, but K+ channels are slow channels (unlike sodium which is fast)
131
Phase 1 of AP, what happens?
Na+ inactivation and gates close, and there is a fast efflux of K+
132
Phase 2 of AP, what happens?
a plateau, it's a long phase of stable, depolarized membrane potential
plateau is maintained by a Ca+2 influx through L-type channels
133
When K+ ions are equal to Ca+2 (K+ out, Ca+2 in), or inward current = outward current, then there is a.....
flat plateau
134
What are the 2 examples of calcium channel blocker medications we learned in class?
1) nifedipine (procardia)
2) diltiazem (cardizem)
135
What are calcium channel blocker meds used for?
to treat heart failure and hypertension
136
What ion is needed for muscle contraction to happen?
calcium
137
Phase 2 of APs, has 10 steps. What are they?
She didn't go over this in depth but there is chart in pp, so just read over it a few times just in case
1) action potential enters from adjacent cell
2) voltage gated calcium channels open, calcium enters cell
3) calcium induced calcium release through ryanodine receptor channels (RyR)
4) local release causes calcium spark
5) summed calcium sparks create a calcium signal
6) calcium binds to troponin to initiate contraction
7) relaxation occurs when calcium unbinds from troponin
8) calcium is pumped back into the sarcoplasmic reticulum (SR) for storage
9) calcium is exchanged with sodium by the NCX antiporter
10) sodium gradient is maintained by the sodium/potassium ATPase
138
Calcium moves in through L-type calcium channels and causes more calcium to be released from sarcoplasmic reticulum (SR). This is known as.....
CICR (calcium induced calcium release)
139
Influx of calcium causes release of intracellular calcium for ________ ________ _________
excitation-contraction coupling
140
What are antihypertensive drugs used for? How do they work?
decreases contraction, and blocks L-type channels
141
Phase 3 of AP, what happens?
repolarization
a slow K+ channel opens as Ca+2 channels begin to close
142
Phase 4 of AP, what happens?
resting membrane potential or also known as electrical diastole
143
T/F:
Phase 4 of AP is a baseline to be able to repeat process over and over
true
144
What are chronotropic effects?
effects of ANS on HR
145
sympathetic NS ________ HR
increases
146
parasympathetic NS _________ HR
decreases
147
CO is dependent on what?
HR
148
CO= HR x SV
What does this mean in terms of chronotropic effects?
SA node (pacemaker of heart) is heavily regulated by autonomic NS
can change the rate if it needs to in order to maintain CO
149
Sympathetic NS regulates what cells?
autorhythmic cells on SA node
150
Where do autorhythmic cells of the sympathetic NS bind to?
B1 receptors
151
B1 receptors are what type of receptor?
GPCRs
152
Sympathetic NS regulates autorhythmic cells on SA node and these cells bind to B1 receptors. What does this cause?
an increase in adenylyl cyclase and in cAMP
153
What is an example of a second messenger?
cAMP
154
Sympathetic NS regulates autorhythmic cells on SA node and these cells bind to B1 receptors. This causes an increase in adenylyl cyclase and cAMP. What happens now?
increase in sodium and calcium
155
Sympathetic NS regulates autorhythmic cells on SA node and these cells bind to B1 receptors. This causes an increase in adenylyl cyclase and cAMP. This causes an increase in sodium and calcium. What happens as a result?
increased rate of depolarization and increased heart rate
156
Sympathetic neurons release ______ on B1 receptors of the nodal cells. Receptors are coupled to ______ _______ by a G protein.
NE
adenylyl cyclase
157
Parasympathetic NS releases what? What will this react with?
releases Ach
this will react to muscarinic receptors
158
Parasympathetic NS releases Ach which will react to muscarinic receptors. What does this cause?
decrease in adenylyl cyclase and cAMP
159
Parasympathetic NS releases Ach which will react to muscarinic receptors. This causes a decrease in adenylyl cyclase and cAMP. What happens next?
decrease in calcium and sodium influx and INCREASE in potassium EFFLUX
160
Parasympathetic NS releases Ach which will react to muscarinic receptors. This causes a decrease in adenylyl cyclase and cAMP. This allows calcium and sodium influx to decrease, and potassium efflux ro increase. What happens as a result?
decrease in calcium and sodium influx= decreased rate of depolarization and decreased HR
increase in potassium efflux= cell hyperpolarizes and HR decreases even more
161
Parasympathetic neurons release ____ onto nodal cells. This binds to muscarinic type 2 receptors which are also ______, but they inhibit adenylyl cyclase activity
ACh, GPCRs
162
Parasympathetic neurons release Ach onto nodal cells. This binds to muscarinic type 2 receptors which are also GPCRs, but they inhibit adenylyl cyclase activity. But, this G protein also increases the conductance of a _____ channel known as the _____ channel.
K+
K+/Ach channel
163
Parasympathetic neurons release Ach onto nodal cells. This binds to muscarinic type 2 receptors which are also GPCRs, but they inhibit adenylyl cyclase activity. But, this G protein also increases the conductance of a K+ channel known as the K+/Ach channel. The K= efflux results in what?
hyperpolarization
164
Chronotropic effects are of the ________ NS
autonomic
165
Dromotropic effects of the autonomic NS includes.....
conduction/velocity of the AV node
166
If contractions are sped up through AV node, it means what?
decrease in ventricular filling
167
Sympathetic NS has a _________ dromotropic effect
positive
168
Sympathetic NS has a positive dromotropic effect. What does this mean?
increase conduction velocity of the AV node
increasing APs from the atria to ventricles by increased inward calcium current
169
Parasympathetic NS has a _________ dromotropic effect
negative
170
Parasympathetic NS has a negative dromotropic effect. What does this mean?
decrease conduction velocity of AV node
decreasing APs = heart block
171
The only connection between atria and ventricles is the......
AV node
172
What are the 2 types of heart blocks?
mild= few APs coming through
severe= minimal/none APs coming through, pt will need pacemaker
173
Contractility is also regulated by autonomic NS. This is known as....
inotropism
174
What does a positive inotropic effect mean?
increased contractility
175
What does a negative inotropic effect mean?
decreased contractility
176
What ion is in charge of contractility (aka also inotropism)?
calcium
177
Beta- blockers block what receptors on heart? What does this do?
B1 receptors
this decreases rate and force of contraction
178
Beta-blockers like propranolol block _____ and ______
Epi and NE
179
What are 2 examples of cardiac glycosides?
digoxin and ouabain
180
Digoxin, a cardiac glycoside, is most often used when?
in extreme cases of heart failure
181
What is the purpose of cardiac glycosides? What is it used for?
used as positive inotropic agents
inhibits Na+/K+ ATPase (which increases calcium + contractility)
182
_______ disease is major problem in North America
heart
183
List some preventative measures of heart disease
1) diet (decrease cholesterol and salty diets because they cause hypertension)
2) dont smoke (nicotine is a vasoconstrictor and also causes platelet adhesion, which causes clots)
3) don't drink alcohol
4) control weight
5) exercise (keeps heart healthy)
6) medications
184
What are some medications for heart disease?
1) nitroglycerin
2) cholesterol lowering drugs "statins"
3) Beta-blockers
4) anticoagulants or blood thinners
5) calcium channel blockers
6) diuretics
7) cardiac glycoside
8) ACE inhibitors
185
Nitroglycerin is used for heart disease. Why?
-increases vasodilation
-increases oxygen supply to organs
186
What is an example of a cholesterol lowering drug "statin"?
simvastatin (zocat)
187
What is the purpose of cholesterol lowering drugs "statins"?
the liver makes good cholesterol, we don't need anymore "bad cholesterol" from our diets
188
What is an example for Beta- blockers besides propranolol?
lopressor (metoprolol)
189
Beta blockers, such as propranolol or metoprolol, do what?
decreases HR and contractility
block the B1 adrenergic receptors of heart
190
What are 2 examples of anticoagulants or blood thinners?
low dose aspirin or warfarin (coumadin)
191
What are calcium channel blockers usually used for?
hypertension
192
What do calcium channel blockers do?
decrease contractility
193
What is an example of a calcium channel blocker?
cardizem (diltiazem)
194
What is diuresis?
production of increased/excess urine
195
What are diuretics used for?
kidneys will excrete more sodium (and water always follows)
196
What is the most common drug prescribed in US for hypertension?
lasix (furosemide)
it's a diuretic
197
What is a cardiac glycoside that is "old" and only used in extreme cases?
lanoxin (digoxin)
198
What does ACE stand for?
angiotensin-converting enzyme
199
What are ACE inhibitors commonly used for?
hypertension
200
ACE inhibitors convert _____ to ____
Ang I to Ang II
201
What is the most potent vasoconstrictor in our body?
Ang II
202
ACE inhibitors decrease....
vasoconstriction and hypertension
203
What is an example of an ACE inhibitor?
captopril
204
What does CAD stand for?
coronary artery disease
205
What does CAD include?
angina pectoris and MI
206
Describe pain in CAD
pain is dull and can radiate to arm, neck, or jaw for both angina and MI
207
T/F:
For patients with CAD, pain will get worse upon breathing
FALSE
breathing does not affect patients with CAD
208
What are the 3 types of angina?
1) stable angina
2) unstable angina
3) prinzmetal angina
209
What is stable angina?
patient will be able to do activity, but will progressively develop pain throughout exertion
pain will go away upon rest
210
What is unstable angina?
pain is random and can happen at any point with or w/o exertion
211
What is prinzmetal angina?
pain happens primarily in women in their 30s at night/ rest
pain is caused by vasospasms
THIS DOES NOT HAPPEN DURING SLEEP
212
What is MI?
heart attack, damage to heart muscle that is irreversible
pain does NOT stop w/ rest
pain will be uninterrupted until heart tissue is dead
213
What are the 4 causes of CAD?
1) atherosclerosis
2) spasm
3) emboli
4) congenital
214
What is the most common cause of CAD?
atherosclerosis
215
What are the risk factors for atherosclerosis?
1) hypertension
2) hypercholesterolemia
3) DM
4) smoking
5) genetics
216
coronary artery vasospasm (one of causes of CAD) can occur in which population?
any population, but most prevalent in Japanese
217
Vasoconstriction appears to be mediated by what?
Hint: 4 things
1) histamine
2) serotonin
3) catecholamines
4) endothelium-derived factors
218
Because spasm can occur at any time, the chest pain is often not _______ related
exertion
219
What is the rarest cause of CAD?
emboli
220
When can an embolism occur (in regards to CAD)?
from vegetations in patients with endocarditis
221
Congenital coronary artery abnormalities are present in 1-2% of the population. However, only a small fraction of these abnormalities cause ________ ________
symptomatic ischemia
222
What is the leading cause of death in men/women in the US?
CAD
223
T/F:
More men have CAD, but women tend to have more complications
TRUE
224
What is a general term for changes in small arteries/arterioles that occur with age?
arteriosclerosis
225
Atherosclerosis occurs where?
in medium/large arteries
226
What is the good cholesterol?
HDL
227
What is the bad cholesterol?
LDL
228
Lipids move through circulation bound to ______
proteins
229
HDL transports cholesterol from cells to _______, and liver will convert it and excrete it as a part of ________
liver, bile
230
LDL transports _________ to cells
cholesterol
231
LDL damages _________ of blood vessel walls, especially at areas of branching
endothelium
232
With atherosclerosis, the body reacts with lots of inflammation. What happens here?
will bring in macrophages, complement proteins, and C reactive proteins
macrophages have scavenger receptors and will recognize LDL
233
Injury to vessel and changes like oxidation of LDLs will result in what?
inflammation, which will bring in macrophages, complement, and c-reactive protein
234
macrophages phagocytize LDLS and form ______ cells with fatty streaks
foam
235
After vascular injury, __________ bind to the endothelium, then cross it to the subendothelial space, and become activated tissue _________.
monocytes, macrophages
236
After vascular injury, monocytes bind to the endothelium, then cross it to the subendothelial space, and become activated tissue marchpages. The macrophages take up oxidized low-density lipoproteins (______), becoming foam cells.
LDLs
237
After vascular injury, monocytes bind to the endothelium, then cross it to the subendothelial space, and become activated tissue marchpages. The macrophages take up oxidized low-density lipoproteins (LDLs), becoming foam cells. T cells release _______, which also activate ________.
cytokines, macrophages
238
After vascular injury, monocytes bind to the endothelium, then cross over to the subendothelial space, and become activated tissue macrophages. The macrophages take up oxidized low-density lipoproteins (LDLs), becoming foam cells. T cells release cytokines, which also activate macrophages. In addition, the ________ cause smooth muscle cells to proliferate.
cytokines
239
Under the influence of _______ _______, the smooth muscle cells then move to the subendothelial space, where they produce collagen and take up LDL, adding to the population of foam cells
growth factors
240
T cells produce cytokines to recruit more macrophages and stimulate smooth muscle cells in ______ ______to proliferate and phagocytize
tunica media
241
T cells release cytokines which will _______ inflammatory response
increase
242
Platelets see all of the fat tissue and stick to it, which develops an _______ (fatty plaque). This causes 3 things. What are they?
atheroma
1) creates turbulent flow
2) can cause embolism
3) can cause an aneurysm
all 3 of these is because of increased inflammation
243
An atheroma partially blocking the coronary arteries would cause what?
angina pectoris (Ischemic heart disease)
244
An atheroma with total occlusion of coronary arteries would cause what?
MI
245
Partial occlusion to the carotid or cerebral arteries would cause what?
TIA
246
Total occlusion to the carotid or cerebral arteries would cause what?
CVA
247
Total occlusion to the peripheral arteries or aorta causes what?
aneurysm
248
Atheroma to the legs, specifically, the iliac arteries would cause what?
PVD (gangrene and amputation)
249
What is a multifactorial disease we discussed during cardio lecture?
atherosclerosis
250
List some conditions that accelerate the progression of atherosclerosis
1) males (or females after menopause)
2) family hx of ischemic heart disease or stroke
3) primary/secondary hyperlipidemia
4) cigs smoking
5) hypertension
6) DM 1 and 2
7) Obesity (abdominal obesity)
8) nephrotic syndrome
9) hypothyroidism
10) high lipoprotein
11) elevated plasma homocysteine
251
Angina is chest pain, and is due to what?
lack of oxygen because of lack of blood supply
252
In normal circumstances, what is it called when the body can help regulate itself?
autoregulation
253
T/F:
With arteriosclerosis and atherosclerosis, there is no autoregulation
TRUE
254
Why is there no autoregulation with atherosclerosis and arteriosclerosis?
bc they cannot vasodilate enough in order to get oxygen to meet the demands
255
What is chest pain/angina usually due to?
sudden exertion and increased need for oxygen
256
Where does chest pain/angina usually start?
center chest
257
Where does chest pain/angina typically radiate to?
extend down to L arm, can extend to neck or jaw
258
How long does angina last for?
few sec- min of dull pain
259
What are the treatment options for angina?
-rest in upright position
-nitroglycerin pills
260
What are nitroglycerin pills taken for and how? What happens once metabolized?
-taken for angina
-taken sublingually to reach bloodstream quickly
-once metabolized, it becomes nitric oxide (NO- which is a vasodilator)
261
MI is caused by the blockage of one of the _______ arteries or its branches
coronary
262
If a pt has a MI, what are they increased risk for?
-second MI
-stroke
-CHF
263
MI results in ______, _______, and _______
ischemia, necrosis, and infarction
264
What are the major branches from the L coronary artery?
L anterior descending artery (LAD) and circumflex artery
265
What are the major branches from the R coronary artery?
marginal artery and posterior interventricular artery
266
LAD used to be known as what?
widowmaker
bc if there was a blockage in it, the patient's wife will become a widow
267
What is the most commonly blocked coronary branch?
LAD (L anterior descending artery), also known as anterior interventricular artery because it runs in anterior interventricular groove
268
Most infarctions are _______. What does this mean?
transdermal
will go through all layers of heart and all 3 layers of heart will be damaged
269
Can cardiac tissue regenerate? What happens as a result?
no, scar tissue/ fibrotic CT will replace it and decrease function of heart
270
With MI, oxygen will decrease. What happens as a result?
inflammation and myocardium releases enzymes
271
With MI, if oxygen continues to decrease, what happens?
decreased conduction and contractility
272
For MI pts, if blood flow can be restored by _______ circulation or by ______ within 20-30min, damage can be reversed
collateral, thrombolytics
273
What are the S&S of MI?
-severe steady pain
-men: chest pain radiated to L arm, neck, and/or jaw
-women: acid reflux/indigestion
-low-grade fever
-pallor
-dyspnea
-diaphoresis (excess sweat)
-hypotension
-anxiety
-shock
274
What are the diagnostic tests for MI?
-EKG
-blood tests for inflammatory enzymes of biomarkers released from necrotic tissue (LDH1 and CPK-MB, myosin and cardiac troponin T levels, leukocytosis, ESR, CPK, CRP)
275
What are the 2 most common biomarkers to be elevated after MI? When can you see this in blood work?
LDH1 and CPK-MB
within 4-6 hrs after MI, and peak at 24 hrs
276
What are 2 other biomarkers commonly seen in blood work besides LDH1 and CPK-MB? When will it be seen?
myosin and cardiac troponin T levels
elevated 2-6 hrs after MI, and peaks 12-26 hrs
277
Which biomarker in blood work indicates MI damage?
troponin (higher levels= the worse the damage)
278
Blood work is used as a diagnostic tool for MI to look for inflammation. What are some of the inflammatory signs or proteins to look out for?
-leukocytosis
-ESR
-CPK
-C-reactive protein
279
For MI, 25% of patients will not make it and die from some kind of _____. This is because conducting fibers of the heart have been damaged
arrhythmia
280
If function of L ventricle is compromised, then this is....
CHF
281
What are the treatment options for MI?
-analgesic (morphine)
-oxygen
-if pt makes it to hospital within 20-30 min= streptokinase (a thrombolytic)
-defib
-cardiac cath
-bypass
282
If pt survives MI, what is the protocol and following risks?
-cardiac rehab and diet/lifestyle changes
-high risk for second MI
283
What is A?
P wave (atrial depolarization)
284
What is B?
QRS complex (ventricular depolarization)
285
What is C?
T wave (atrial depolarization)
286
If a normal sinus rhythm has an atrial depolarization, ventricular depolarization, and ventricular repolarization visible, then where is atrial repolarization?
its hidden by QRS complex
287
Are arrhythmias and dysrhythmias the same thing?
yes, they both mean irregular heart beat
288
What are some causes for arrhythmias?
-electrolyte imbalances (especially potassium)
-stress
-MI
-inflammatory disease
289
T/F:
Arrhythmias are not usually constant
true!
290
What is a diagnostic tool for arrhythmias?
holter monitor, it monitors ECG for an extended period (according to Roop it's about a week)
291
If a pt has an arrhythmia, what is it impacting?
CO
292
What is bradycardia?
heart beat less than 60 bpm
293
What is this showing?
Rhythm strip showing bradycardia resulting from sinus node pause
the black arrows are showing atrial activity suddenly ceasing and after approx 3sec a junctional escape beat is observed (J)
294
What is an ectopic pacemaker?
abnormal pacemaker
SA node is no longer acting as pacemaker and something else takes over
295
Bradycardia can result from.....
AV block (heart block, will need pacemaker bc impulses are not getting to the ventricles)
296
What does NSR stand for?
normal sinus rhythm
297
What does PAT stand for and what is it?
paroxysmal (sudden) tachycardia
rhythm pattern remains the same, even with the rapid heart rate
298
What is tachycardia?
heartbeat is more than 100 bpm
previously she said 90+ in pds
299
What can tachycardia be caused from?
exercise, stress, etc.
300
With tachycardia, the heart is ________ compensating for something in body. What is it most commonly compensating for?
ALWAYS
usually compensating for low blood volume
301
With tachycardia, if QRS complex is narrow, what does this mean?
supraventricular tachycardia (ventricles are depolarizing and tachycardia is happening at AV node or above AV node)
302
With tachycardia, if QRS complex is wide, what does this mean?
ventricular tachycardia (tachycardia is originating in the ventricles)
303
What is sick sinus syndrome?
alternating bradycardia and tachycardia (pacemaker is def needed)
304
What is the most common type of arrhythmia?
atrial conduction abnormalities
305
What is an example of a type of atrial conduction abnormality?
PAC (premature (paroxysmal) atrial contraction)
306
What happens in a PAC (premature (paroxysmal) atrial contraction)?
-there is an early P wave that differs from the normal P wave (an extra heartbeat)
307
What is a fibrillation or palaption? What can it be due to?
heart racing
due to:
-stress
-caffeine
-smoking
308
What is an atrial fibrillation (A-fib)?
-rapid P waves and irregular QRS complexes
-more than 300 bpm
-blood is regurgitating into atria/pooling
309
A-fib pts are high risk for......
heart failure
310
A-fib is a type of ________ _________
supraventricular tachycardia
311
What is atrial flutter?
-160-300 bpm
-problem w/ ventricular filling, SV, and CO
312
What is a bundle branch block?
-R or L bundle branch is blocked
-delayed conduction in 1 of the branches
-wide QRS on EKG
-doesn't really have effect on pt bc its only 1 bundle branch affected
313
What is ventricular fibrillation (V-fib)?
-complete disruption of a normal rhythm
-no CO
314
Pts w/ V-fib are prone to getting what?
heart attack
315
What is PVC (premature ventricular contraction)?
-most people will get this at least once in lifetime
-doesn't happen often/doesn't really have an affect
-ectopic beats in ventricles
-If it continues long term, then it can eventually convert to v-fib (problematic)
316
Find the cause and treat the cause for any _______
arrhythmia
317
What is asystole (cardiac arrest)?
-no conduction of impulses (heart stops beating)
-respiration stops
-brain is losing oxygen fast
318
What should you do if you see a flatline on EKG?
call 911, AED, and CPR (in that order)
319
T/F:
CHF is an end result of something else
true
320
What is CHF?
heart cannot pump enough blood to maintain the system (heart is weak)
321
____ million people in the US are affected with CHF
3
322
There are ________ new cases of CHF every year in US
400,000
323
What are the causes of CHF?
-heart problems (ex: past MI)
-valvular problems
-HTN
-lung disease
-decreased ventricular filling or contractility (not enough CO)
324
T/F:
With CHF, regardless of cause, both sides of the heart will fail at same time
false!!!!!
one side of heart will fail before the other
325
Compensations for the heart are also _________
complications!
326
Describe how the body is compensating with CHF
Dont hate me, this is long, but hey its "all logical" ;)
-body recognizes it is not getting enough blood from the heart
-ANS will step in and kidneys will activate RAAS (renin-angiotensin-aldosterone system)
-CO is decreased and so is BP
-ANS will have sympathetic NS vasoconstrict to try to increase BP
-kidneys will reabsorb more sodium, and water will (of course) always follow
-this will result in increased blood volume and bp
-this will increase the "afterload" which is pressure L ventricle has to overcome in order to open valve so blood can move
-this will increase overall heart workload when its already not working properly
327
If there is systolic dysfunction with CHF, what is affected?
CO
328
If there is a diastolic dysfunction w/ CHF, what is affected?
there will be a ventricular filling problem
329
What is the primary cause of CHF?
CAD (angina + MI)
330
What are some causes of L ventricular failure?
-volume overload (ex: regurgitant valves such as mitral or aortic valve, anemia, or hyperthyroidism)
-pressure overload (ex: systemic HTN, aortic stenosis)
-loss of muscle (ex: MI from CAD or connective tissue disease such as systemic lupus erythematosus)
-loss of contractility (ex: poisons such as alcohol, cobalt, or doxorubicin, bacterial or viral infections, and genetic mutations)
-restricted filling (ex: mitral stenosis, pericardial disease)
331
What are some pathophysiological changes associated with heart failure?
-hemodynamic changes (decreased output or filling)
-neurohormonal changes (RAAS)
-cellular changes (fibrosis, apoptosis, etc.)
332
What is the pathway with L-sided congestive heart failure?
1) L ventricle weakens and cannot empty
2) decreased CO
3) decreased renal blood flow stimulates RAAS
4) backup of blood into pulmonary vein
5) high pressure in pulmonary capillaries leads to pulmonary congestion or edema
333
L sided CHF can be a result of what?
MI in L ventricle or HTN
334
What happens to heart/body with left-sided CHF?
increased:
-pressure
-afterload
overtime, L ventricle will hypertrophy
CO will decrease
blood will regurg and cause increased hydrostatic pressure, which will result in pulmonary congestion
fluid will go into alveoli, dilute surfactant, and alveoli will collapse = no gas exchange
335
What is another name for CHF?
hypertensive heart disease
336
What are the S&S of L-sided CHF?
-dyspnea
-orthopnea (decreased breathing laying down)
-paroxysmal nocturnal dyspnea
-cough or hemoptysis
-rale breath sounds
-subject to infections
337
What is the pathway with R-sided congestive heart failure?
1) right ventricle weakens and cannot empty
2) decreased CO
3) decreased renal blood flow stimulates RAAS
4) backup of blood into systemic circulation (IVC + SVC)
5) increased venous pressure results in edema in legs and liver and abdominal organs
6) very high venous pressure causes distended neck vein and cerebral edema
338
R- sided CHF can be the result of what?
something wrong with pulmonary semilunar valves (such as stenosis) or pulmonary disease that damages blood vessels
339
What happens to heart/body with R-sided CHF?
increased resistance and workload on R ventricle will result in muscle hypertrophy
this also results in systemic congestion
340
What is a common symptom seen with R-sided CHF when there is an issue with semilunar valve?
edema of legs, ankles, and feet
341
If there is R sided CHF due to pulmonary disease, what is this called?
Cor pulmonale
342
What are the S&S of R-sided CHF, specifically cor pulmonale?
-edema of legs/feet
-ascites (accumulation of fluid in peritoneal cavity), which will result on abdominal edema, hepatomegaly, and/or splenomegaly
343
If a pt has cor pulmonale and does not receive medical intervention what happens?
-once IVC is full, blood will go through SVC
-pts will have distended neck, may be delirious, or have seizures
344
What are the general S&S of both L AND R sided CHF?
-fatigue
-dyspnea
-exercise intolerance
345
What are the secondary compensations for both L AND R sided CHF?
-tachycardia
-polycythemia (increased EPO/RBCs)
-decreased daytime oliguria (urine output)
346
What does CHD stand for?
congenital heart defect
347
When can a CHD occur?
as early as 8 weeks in embryonic stage
348
Every year ~40K babies in US are born with some kind of ______ _______. Surgery has decreased mortality rate in US
heart defect
349
CHD is a problem with what?
valve or septum of heart
350
What is the first sign of CHD?
dr will detect heart murmur
351
Any kind of heart defect usually means.....
decreased oxygen (minor or major) systemically
352
Most cases of CHD are _________ but genetics play a big role
multifactorial
353
What are some causes for CHD?
-multifactorial
-infection during pregnancy will impact baby such as Rubella (German measles)
-alcoholic pregnant mama
-smoking pregnant mama
354
How will the body try to compensate with CHD?
Sympathetic NS will try to compensate by increasing HR/contractility
heart will work over time and can hypertrophy
355
Babies w/ CHD will suffer from hypoxia, this can develop into....
secondary polycythemia (increased EPO)
356
Most minor defects are _______ and are discovered by dr during check-ups. Can patient live with it?
asymptomatic
yes, pt can live with it and sometimes it corrects on its own as pt gets older
357
If a baby is born with CHD and it's a major problem, what is usually required?
surgical intervention
358
What are the S&S of major CHD?
-pallor or cyanotic
-developmental delay
-tachycardia
-tachypnea
-exercise intolerance
359
All CHD patients should be given _______ ________ before any kind of medical procedure
prophylactic antibiotics
360
Ventricular septal defect has blood flow through defect usually from ______ to _______
left to right
361
What is wrong with a ventricular septal defect?
something is wrong with the septum between the 2 ventricles
362
What is the most common type of congenital abnormality/heart defect?
Ventricular septal defect
363
What is an atrial septal defect?
foramen ovale does not close properly at birth
364
In basic terms what is ventricular or atrial septal defect?
hole in heart
365
Ventricular septal defect is sometimes called a _____ to ____ shunt. Why?
L to R shunt
bc of pressure gradient
366
What happens when ventricular septal defect is severe?
blood will regurg and convert to R to L shunt
367
Where are valvular defects usually found?
in semilunar valves (aortic and pulmonary valves)
whack bc roop also said that one of the most common valvular defects is a mitral valve stenosis
368
What is a stenosis in the heart?
valvular defect, very narrow opening
heart has to work harder to push same amount of CO though opening
369
What is an incompetent valve?
does not close properly = backflow
370
What is the most common type of incompetent valve? What happens here?
mitral valve prolapse
mitral valve flaps are enlarged and cannot close properly
371
All valvular defects will cause.....
decreased SV = heart will work harder = hypertrophy
372
What is the treatment for valvular defects?
valve replacement
373
How does a porcine or mechanical heart valve differ from a normal heart valve?
porcine/mechanical heart valve:
-lasts decades
-thrombus can develop around valve
-pts are usually put on low-dose aspirin to prevent thrombus
374
Tetralogy of Fallot includes ____ defects
4
375
Babies with tetralogy of fallot are born _______, this is why they are called " _____ babies"
cyanotic, blue
376
What is the first defect of Tetralogy of Fallot?
pulmonary valve stenosis
heart is trying to pump full SV through a valve that will not open properly
377
What is the 2nd defect of Tetralogy of Fallot?
R ventricular hypertrophy
378
What is the 3rd defect of Tetralogy of Fallot?
ventricular septal defect (VSD)
this increases pressure in RV
379
What is the 4th defect of Tetralogy of Fallot?
overriding aorta
aorta is over both ventricles and VSD
this means that both ventricles will have bad blood flow
380
What is the treatment for Tetralogy of Fallot?
babies will have surgery approx 1 month after birth, or sometimes 1 year after
1st surgery is to try to open pulmonary valve and close VSD
will need additional surgeries later, especially for overriding aorta
381
What are the 4 causes of mitral stenosis?
1) rheumatic
2) calcific (usually causes mitral regurg but can cause mitral stenosis in some cases)
3) congenital
4) collagen-vascular disease (systemic lupus erythematosus and rheumatoid arthritis, but extremely rare)
382
What is the most common cause of mitral stenosis?
rheumatic fever
narrowing results from fusion and thickening of the commissures, cusps, and chordae tendineae
symptoms usually develop 20 years after acute rheumatic fever
383
One of the causes of mitral stenosis is rheumatic fever. When does rheumatic fever usually occur?
children 5-15 yrs old
384
One of the causes of mitral stenosis is rheumatic fever. How does infection begin? How does it develop
sorry its kinda long
-strains of Group A beta hemolytic streptococcus
-some people react with abnormal immune response (inflammation affecting skin, joints, and heart)
-starts as URT infection or strep throat
-most people will recover, those who don't recover will have Abs and those Abs will react with/bind to CT in skin, joints, brain and heart, leading to inflammation
-heart will have scar tissue and develop to rheumatic heart disease
385
Rheumatic fever affects large joints in body and results in....
synovitis
386
Rheumatic fever affects small joints in body and results in....
subcutaneous nodules in wrists and ankles
387
5% of population with rheumatic fever will have skin affected with non-pruritic rash called....
erythema marginatum
388
20-30% of people w/ rheumatic fever will have basal nuclei in brain affected. What is this called and what does it result in? Whats recovery time?
sydenham's chorea or St. vitus dance
uncontrolled rapid jerking movements of arms, legs, and/or face
pts will spontaneously recover within 2 months- 2 years
389
What is the major problem with rheumatic fever?
inflammation of heart, can affect all 3 layers
390
If rheumatic fever affects the pericardium, what is this called and what happens?
pericarditis
effusion= fluid collecting around the heart
heart will be unable to pump how it should
391
If rheumatic fever affects the myocardium, what is this called and what happens?
myocarditis
nodules appearing in myocardium (made up of lymphocytes, macrophages, and fibrotic CT), this is called Ashoff-Geipel bodies
this can cause arrhythmias because the myocardium is so damaged
392
If rheumatic fever affects the endocardium, what is this called and what happens?
endocarditis
will damage valves bc heart valves are made up of endothelium
393
What is the most common heart layer to be affected with rheumatic fever?
endocardium, leading to endocarditis
394
What is the diagnosis process for rheumatic heart disease?
test serum for Abs and perform ECG
395
What is the treatment for rheumatic heart disease?
-antibiotics such as PCM (penicillin)
-antiinflammatories such as prednisone
396
Rheumatic heart disease is when there is thicken flaps of _____ valve and ______ ______. This results in mitral stenosis.
mitral, chordae tendineae
397
What are the 2 types of HTN?
primary (essential) and secondary HTN
398
What are some causes of secondary HTN?
-renal HTN
-endocrine-metabolic HTN
-Drug-induced or drug-related
399
Vascular disorders include....
the heart and blood vessels
400
HTN is an ______ vascular disorder
arterial
401
Which disorder is said to be the silent killer?
HTN
402
____ adults in US have hypertension
1/3
403
HTN is more common in _____ than women until ________, then women take over with higher number
men, menopause
404
The majority of HTN is.....
essential/primary HTN and is idiopathic
405
~10% of all HTN is _________ HTN. What is it usually due to?
secondary, usually due to some kind of renal disease or endocrine disorder
406
endocrine disorder = high risk for what vascular problem?
HTN
407
What is normal BP? Hypertensive?
normal = 120/80
hypertensive = 140/90 or higher on 3 consecutive dr visits
408
Systolic number ________ increases w/ age
ALWAYS
409
What is the most common cause of HTN?
increased resistance
410
MAP = CO x TPR
What does this mean?
increase CO = increase MAP
increase R = increase MAP
basically increased MAP causes HTN
411
As you increase ______usually due to vasoconstriction, vasoconstriction will also occur in the kidneys and decrease _____ ______. Once they detect that they are getting less blood, then they will trigger RAAS and cause further vasoconstriction. This will cause damage to blood vessels and increase ______
resistance
blood flow
BP
412
overtime, hypertensive arteries can become hard and cause an ________
aneurysm
413
HTN can result in 3 things. What are they?
1) renal HTN (kidneys fail)
2) hypertensive encephalopathy
3) hypertensive retinopathy
414
What is hypertensive encephalopathy affecting? What are the symptoms?
brain
seizures, confusion, cerebral edema
415
What is hypertensive retinopathy?
-blood vessels in eyes become infected
-blood vessels can rupture and cause retinal hemorrhages
-pts can go blind
416
What are the risks of primary HTN?
-bad diet (increased salt, cholesterol)
-smoking
417
lots of pts with HTN will be ______ and won't know till they go to dr that they have HTN
asymptomatic
418
What is PVD?
peripheral vascular disease
anything abnormal in arteries or veins far away from heart (in periphery)
419
What is PVD primarily caused by?
plaques or atheroma
420
A partial occlusion in PVD would result in what?
pts will have problems w/ muscle function in legs
may lose sensory function in legs
421
A complete occlusion in PVD would result in what?
ischemia, necrosis, ulcers, and gangrene
422
Most commonly affected blood vessels with PVD are the......
abdominal aorta, femoral artery, and iliac arteries
423
What are the S&S for PVD?
-intermittent claudication
-increased fatigue
-weakness
-paresthesias
-decreased or absent pulses distal to occlusion
-pallor when legs are elevated (or cyanotic), and dependent erythema when legs are released
424
If a pt tells you they have intermittent claudication, automatically assume what?
they have PVD
425
what are the treatment options for PVD?
-lifestyle changes (diet with decreased cholesterol, exercise, etc)
-vasodilator meds
-anticoagulants
-surgery (bypass)
426
What is an aortic aneurysm?
weakness in wall, usually turbulent flow causes this (typically because of some type of atheroma)
427
What are the 3 types of aortic aneurysms?
1) fusiform
2) saccular
3) dissecting
428
What is a fusiform aortic aneurysm?
dilation all around the vessel
429
What is a saccular aortic aneurysm?
dilation on one side of the vessel
430
What is a dissecting aortic aneurysm?
tear in the tunica intima allowing blood to flow between the layers
431
If aortic aneurysms are not treated, what can happen?
they can rupture
432
What is the worst type of aortic aneurysm?
dissecting
433
aortic aneurysms result from problem with....
tunica media or in thoracic/abdominal aorta
434
w/ aortic aneurysm, overtime the dilation increases or ______ forms
thrombus
435
aortic aneurysms can be asymptomatic. If this is the case, dr will find a bruit. What does this mean and for what type of aortic aneurysms?
turbulent blood flow for fusiform or saccular aortic aneurysms, typically in abdomen, and may have mild pain
436
If a pt complains of severe, sharp pain and you suspect they have an aortic aneurysm, what type of aneurysm is this?
dissecting
437
What are the diagnostic tests for aortic aneurysms?
CT scan and/or US
438
aortic aneurysms are considered _______ emergencies, and a graft will need to be done
surgical
439
What is the most common venous disorder?
varicose veins
440
What are varicose veins?
torturous, dilated vessels in legs (superficial or deep veins of legs, can also occur in rectum or esophagus)
441
Superficial veins don't have a lot of mechanical support from muscles. This is why superficial veins are the most common ones to be affected with .....
varicose veins
442
Varicose veins have _____ hydrostatic pressure bc of ______ ______
increase, incompetent valves
443
Varicose veins are common in who?
pregnant women or people who stand for long periods of time
444
As valves fail, blood regurges and pools in periphery veins. What is this?
varicose veins
445
What are pts told to do if they have been diagnosed with varicose veins?
to elevate legs whenever sitting and to wear compression stocking to help blood move up
446
What are the treatment options for severe cases of varicose veins?
vein stripping (bypass surgery) or sclerotherapy (saline injected into veins and will collapse them)
447
What is thrombophlebitis?
inflammation + thrombus in veins
448
What is phlebothrombosis?
thrombus w/o inflammation in veins
449
Venous blood has to go ________ gravity
against
450
venous disorders develop bc of....
-sluggish blood flow
-endothelial damage/injury
-increased coagulability (such as through polycythemia)
451
What are the S&S of venous disorders?
-erythematous
-warm legs
-edema
- positive homan sign (dorsiflex foot and its extremely painful in calves)
452
What are the treatment options for thrombophlebitis or phlebothrombosis?
anticoagulant therapy or in severe cases= surgery
453
What are the 4 different types of shock?
1) hypovolemic shock (decreased blood volume)
2) distributive shock (also called vasogenic or low-resistance shock, marked vasodilation)
3) cardiogenic shock (inadequate output by disease heart)
4) obstructive shock (obstruction of blood flow)
454
What are some causes of hypovolemic shock?
-hemorrhage
-trauma
-surgery
-burns
-fluid loss associated with vomiting or diarrhea
455
Distributive shock is system-wide _______
vasodilation
456
What are some causes of distributive shock?
-fainting (neurogenic shock)
-anaphylaxis
-sepsis (also causes hypovolemia due to increased capillary permeability with loss of fluid into tissues)
457
What are some causes of cardiogenic shock?
-MI
-Heart failure
-arrhythmias
458
cardiogenic shock is where the heart is _______ as a pump
failing
459
What are some causes of obstructive shock?
-tension pneumothorax
-pulmonary embolism
-cardiac tumor
-pericardial tamponade
460
Shock is any abnormality in the _____________ system
circulatory
461
Shock will _____ CO, _____ tissue perfusion, and cause hypoxia
decrease, decrease
462
Shock will _____ BP
decrease
463
What are the S&S of shock?
-restless
-thirsty (osmoreceptors will be activated w/ low blood volume)
-vasoconstriction will cause cold/pale skin
-tachycardia
-oliguria
464
Septic shock is caused by some kind of ______
pathogen
465
With septic shock, the skin will look ______ and feel ____ to touch
erythematous, warm
466
Septic shock decreases BP, which will make pt feel....
weak and dizzy
467
CO is low in septic shock. What does this mean?
oxygen is also low, which means CO2 is high
this is metabolic acidosis
468
Metabolic acidosis will increase with septic shock and affect what?
CNS and renal system as glomerular-filtration rate (GRF) decreases
469
Metabolic acidosis will make pt breath faster or slower during septic shock?
faster
470
What is the treatment option for shock?
call 911, keep them warm, treat cause
