cardio part 1 Flashcards
this is the leading cause of death in the us and world
CV diseases
24.6% of US deaths result from…
CV diseases
varicose veins, chronic venous insufficiency, DVT, and superior vena cava syndrome (SVC) are all diseases of what
veins
varicose veins?
distended, torturus, palpable veins where blood has pooled and cannot get back up the the heart because valves are stretched out
what causes varicose veins?
trauma or it can happen gradually over time
what veins are usually affected in varicose veins
superficial ones especially the saphenous
what does varicose vein lead to
chronic venous insufficiency
what is chronic venous insufficiency
when veins do not return the amount of blood you’d expect them to
if someone has chronic venous insufficiency, their legs may be this color
red because the blood is just sitting there
chronic venous insufficiency can lead to
inc risk of DVT, stasis dermatitis, or venous stasis ulcers
what are spider veins?
new veins that develop in legs in order to compensate for valves not working
trmt for chronic venous insufficiency and varicose veins
get gravity on your side…. elevate legs, use compression stockings, exercise, ablate/destroy it, or ligate it and take it out surgically
what is DVT
thrombus forms and obstructs a large vein which causes increased venous pressure in extremities
if a thrombus breaks off from DVT and goes to the lungs what is this called?
pulmonary embolism
virchows triad are risk factors for ?
DVT
virchows triad
venous stasis, venous endothelial damage, hypercoaguable states
when does postthrombotic syndrome occur
after a dvt
what happens in postthrombotic syndrome
chronic leg pain, swelling, redness, ulcers
saddle embolism?
when a DVT clot goes to the lungs and cuts off circulation which is fatal
patent foramen ovale
when foramen ovale does not close at birth
atrial septal defect?
there is a hole in the R atrium where blood can cross into the left atrium without going to the lungs
how can we prevent DVT
remobilize after surgery, prophylactics (blood thinners), look for coagulopathies
trmt for acute DVT
IV thrombolytics like a clot buster, surgery
name some hypercoaguable states
COVID, factor V leiden, cancer, dehydration, immobilization, pregnancy
trmt for chronic DVT
oral anticoagulants, inferior vena cava filter/greenfield filter
coag studies, D dimer, CT and MRI are all ways we can test for what
DVT
what does a inferior vena cava filter/greenfield filter do
prevents clots from going to the heart by trapping them in a filter
what is SVC synd
when the superior vena cava is occluded which leads to venous distension in the upper extremities and head
what is the heading cause of SVC synd
bronchogenic lung cancer
trmt for malignant disorders of SVC synd
radiation, chemo, surgery, diuretics, steroids, anticoagulants… want to stop it from growing
trmt for nonmalignant disorders of SVC synd
bypass, thrombolysis, balloon angioplasty, stent
how does the tunica media differ in arteries and veins
thick in arteries and thin in veins
what is an aneurysm
dilation of a weakened BV or cardiac chamber
what does a true aneurysm involve?
involves all 3 layers of the bv wall
false aneurysm/pseudoaneurysm?
when blood is trapped in tissue adjacent to an artery bc there is a hole in the bv wall
dissecting aneurysm?
starts as a tear in the intima layer of a BV that flows into the media creating a false lumen
a giant aneurysm is a subtype of what aneurysm
saccular
berry aneurysms are common near…
circle of willis
when is an aneurysm most likely to rupture?
when it’s larger and SBP is higher
symptoms for aortic aneurysm
asymptomatic; tearing chest pain radiating to the back
symptoms for thoracic aneurysm
dysphagia and dyspnea due to increased pressure of the aneurysm
why can abdominal aortic aneurysms be a surgical emergency
flow to organs can be impaired and cause ischemia
trmt for aneurysms
low bp and volume, stop smoking, beta adrenergic blocker, surgery when appropriate
when do we typically repair AAA
when they are over 5.5cm
embolisms, thromboangiitis obliterans, raynaud disease and phenomenon, atherosclerosis are all what type of disease
peripheral arterial diseases
what is a thrombus
trapped RBC with fibers
if emboli are not clots, what can they be
air bubbles, amniotic fluid, fat, bacteria, cancer cells, foreign substances,
where do many arterial emboli come from
heart
coronary artery is occluded.. this leads to what
MI
cerebral artery is occluded.. this leads to what
stroke
symptoms of peripheral arterial occlusion
pain, pallor, pulselessness, parathesias, paralysis, poiklothermia (cold)
thrombus trmt?
dissolve clot, remove clot, or manage with drugs
what is thromboangiitis obliterans/beurger disease
inflammatory disease of small and medium sized peripheral arteries that causes sluggish blood flow, rubor, and cyanosis
where on the body is thromboangiitis obliterans/beurger disease
digital, tibial, palmar, ulnar, and plantar arteries
who does thromboangiitis obliterans/beurger disease typically occur in
young male smokers
trmt for thromboangiitis obliterans/beurger disease
stop smoking, exercise, vasodilators
what is raynauds synd/phenonmenon
episodic vasospasm which leads to ischemia in arteries are arterioles of hands
clinical manifestations of raynauds synd/phenonmenon
changes in skin color and sensation changes caused by ischemia
what do hands look like in raynauds synd/phenonmenon with red white and blue
white-blue-red
is raynauds syndrome primary or secondary
primary; no known origin
trmt for raynauds syndrome
stop smoking, avoid cold and stress, Ca channel blockers
is raynauds phenomenon primary or secondary
secondary
trmt for raynauds phenomenon
arm exercises and meds
arteriosclerosis?
arteries become thick and stiff
atherosclerosis?
subset of arteriosclerosis; thickening and hardening of walls of arteries due to lipid laden macrophages
leading cause of coronary artery and cerebrovascular disease
atherosclerosis
lipid accumulation and endothelial dysfunction are keys to what disease
atherosclerosis
endothelial dysfunction occurs early in plaque development affecting arteries throughout the body before…
gross evidence of plaque
where do plaques love to deposit themselves?
areas where blood flow is high such as artery branches
what does NO do?
facilitates vasodilation, inhibits plaque aggregation and inflammation, stimulates angiogenesis ( good for collateral circulation)
cv risk factors decrease vasodilation and NO availability and inc ROS. what are some key cv risk factors
smoking, dys/hyperlipidemia, diabetes, smoking, hyperhomocystemia
steps in atherosclerosis development
endothelial injury- endothelial inflammation- cytokines released- cellular proliferation- macrophage migration- oxidation by foam cell foramtion- fatty streak- fibrous plaque- calcified outer layer- complicated plaque- rupture
sx of atherosclerosis
depends on organ affected
trmt for atherosclerosis
reduce risk factors, prevent lesion progression, stop smoking, control htn, lipids, DM, diet, meds, may need stent or CABG,
atherosclerosis in coronary artery is called…
CAD which leads to MI
atherosclerosis in limb artery is called…
PAD
atherosclerosis in renal artery is called…
HTN, kidney disease
what is PAD
atherosclerotic disease of arteries that affect the lower extremities
who is PAD most common in
diabetes and smokers
common sx of PAD
intermittent claudication
trmt for PAD
vasodilators, antiplatelet or antithrombolytic meds, cholesterol lowering meds, exercise, may need bypass or stent
what is coronary artery disease
any disease that narrows or occludes the coronaries resulting in mismatch btwn coronary blood supply and myocardial demand for oxygen and nutrients
MCC of CAD?
atherosclerosis
what can CAD lead to
reversible ischemia or irreversible infarction
nonmodifiable risk factors of CAD
age, male, women after menopause, fx in men over 55 or women over 65
what does smoking lead to
vasoconstriction, high ldl and low hdl
what does dm and insulin resistance lead to
endothelial damage and vessel wall thicking
metabolic syndrome?
obesity + dyslipidemia + HTN
what is c reactive protein a marker for
inflammation and thrombosis
what is troponin 1 a marker for
chronic myocardial damage
what are adipokines
hormones secreted by fat cells; adiponectin and leptin
lipoprotein?
lipid + protein carrier
what are lipids soluble in
nonpolar solvents (not water)
how do lipids get in the body
they are made in the body or eaten
exogenous lipids enter the body via the…
lymphatic system
what are chylomicrons
made mostly of triglycerides that transport ingested lipids from the intestines
where are triglycerides transported?
muscles for nrg or adipose tissue for storage
remnants of chylomicrons contain what?
cholesterol which need to be taken up by the liver
LDL?
supplies cholesterol needed for cell flexability
HDL?
retrieves excess cholesterol for reprocessing
what are VLDL made of
mainly triglycerides + a carrier protein
