Cardiovascular

Question 1

What are varicose veins?

What are they caused by?

Treatment options?

Answer 1

Veins in which blood has pooled

Caused by:

• trauma or gradual venous distention
• Defective valves from birth - (congenitally defective valves)
• Pregnancy
• Thrombophlebitis

Treatment:

• External compression stockings
• Surgery

Question 2

What are the typical sites of varicose veins?

Answer 2

legs, anus, and lower esophagus

Question 3

What is Thrombophlebitis?

Answer 3

swelling of a vein caused by a blood clot

Question 4

What is venous insufficiency?

Why does it occur?

Answer 4

condition in which the veins have problem getting blood from the legs back to the heart
Long-term condition (goes from varicose veins to venous insufficiency).

Occurs b/c a vein a partly blocked or if blood is leaking around the valves of the veins.

Question 5

If venous insufficiency is not treated, what can it lead to?

Answer 5

Stasis Ulcers.

Where:
Below the knee-primary found on the inner part of the leg just above the ankle.

Ulcers may affect one or both legs.

Base-red in color and may be covered with yellow fibrous tissue.

There may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant.

Boarders-usually irregularly shaped.

The surrounding skin is often discolored and swollen. It may even feel warm or hot.

The skin may appear shiny and tight, depending on the amount of edema.

Question 6

What is a DVT?

Where is it commonly found?

Answer 6

Deep Vein Thrombosis - Obstruction of venous flow leading to increased venous pressure

Blood clot that forms in a vein deep inside a part of the body. Mainly affects large veins in the lower leg or thigh.

DVTs are most common in adults over age of 60. Clot breaks off and moves through the blood stream=embolism. Embolism can get stuck in brain, lungs, heart, or other area….leading to damage.

Question 7

Triad of Virchow

Answer 7

Venous stasis
Venous endothelial damage
Hypercoagulable states

Question 8

What causes a clot in a DVT?

Answer 8

Accumulation of clotting factors causing a clot to form and an inflammatory response.

Question 9

Symptoms of a DVT

Answer 9

may not have symptoms or may cause pain, redness, warmth, and edema

Problem is that it may totally occlude the vein and lead to ulceration or break off and move the lungs (pulmonary embolus)

Question 10

What is Essential Arterial Hypertension?

Answer 10

BP of 140/90 or greater

Question 11

What are the primary and secondary causes of Essential Arterial Hypertension?

Answer 11

Primary: The disease
Secondary: Medications or other disorders

Question 12

Hypertension

Answer 12

Elevations of systolic pressure are caused by increases in cardiac output, total peripheral vascular resistance, or both

Isolated systolic hypertension—becoming prevalent in all age groups

Question 13

Primary hypertension

Answer 13

Also known as essential (familial) or idiopathic (unknown) hypertension

Genetic and environmental factors
Affects 92% to 95% of individuals with hypertension

Question 14

What are some risk factors for Hypertension?

Answer 14

Risk factors: 
High sodium intake
Natriuretic peptide abnormalities
Obesity
Insulin resistance

Question 15

Secondary Hypertension

Answer 15

Caused by a systemic disease (underlying) process that raises peripheral vascular resistance or cardiac output

less than 10% of people have this

Renal artery stenosis, renal parenchymal disease, pheochromocytosis, drugs

Question 16

What are the symptoms of Hypertension?

Answer 16

Early stages may not have symptoms other than increased blood pressure

Silent disease

Most the clinical presentation is due to organ damage

Question 17

How is hypertension diagnosed?

Answer 17

at least (2) readings, (2) minutes apart
Person at rest for 5 minutes
Arm supported at level of the heart
No cigarettes or caffeine in previous 30 minutes

Question 18

Test(s) and treatment(s) for hypertension

Answer 18

Test: 24 hour serial BP monitoring, CBC, urinalysis, BMP for creatinine, cholesterol, and triglycerides and electrolytes, glucose

Tx: exercise, weight loss/control, diet

Question 19

A-type natriuretic peptides

Answer 19

also called atrial natriuretic peptides.

They’re made/stored/released largely by the atria,

High BP = body makes more A-type NP

*seen in congestive heart failure, where increased blood volume and higher levels of extracellular fluid (fluid overload) stretch the heart’s walls.

In patients with heart failure, A-type natriuretic peptides are also made by the ventricles

Question 20

Where are A & B Natriuretic Peptides made?

Answer 20

In the Ventricles

Question 21

What is the function of the A-Natriuretic Peptides?

Answer 21

causes a reduction in blood volume and therefore a reduction in heart output and blood pressure

Question 22

What is the funciton of B-Natriuretic Peptides?

Answer 22

acts as a natural diuretic, eliminating fluid, relaxing blood vessels and funneling sodium into the urine.

When the heart is damaged, the body secretes very high levels of B-type natriuretic peptide into the bloodstream in an effort to ease the strain on the heart

Question 23

What is the function of C-Natriuretic Peptides?

Answer 23

They cause relaxation of blood vessels, helping to lower blood pressure.

produced by cellsthat line the blood vessels.

Unlike A-type and B-type natriuretic peptides, they don’t have direct natriuretic activity.

Question 24

Complicated Hypertension

Answer 24

Chronic hypertensive damage to the walls of systemic blood vessels

Smooth muscle cells undergo hypertrophy and hyperplasia with fibrosis of the tunica intima and media

Affects heart, kidneys, retina most especially
Can result in transient ischemic attack/stroke, cerebral thrombosis, aneurysm, dementia

Question 25

Malignant Hypertension

Answer 25

Rapidly progressive hypertension Diastolic pressure is usually >140 mm Hg Life-threatening organ damage

Question 26

Postural Hypotension

Answer 26

Decrease of BP 20/10 within 3 minutes of moving Can be acute or chronicto a standing position S/Sx: dizziness, blurring or loss of vision, syncopy or fainting *Can be controlled with drugs or by increasing fluid and salt intake, wearing thigh-high compression stocking

Question 27

atherosclerosis

Answer 27

chronic inflammatory process in blood vessels. Endothelial injury plays a critical role in initiating the process. (plaque builds up) Circulating lipids in the blood are instrumental in the evolution of a lesion.

Question 28

Aneurysms

Answer 28

Weakening and rupture of vessels The majority occur in the abdomen. are typically without s/sx until they rupture…severe pain and hypotension Marfan syndrome individuals are at high risk

Question 29

Blood Clot How is it diagnosed? Tx?

Answer 29

Pooling blood Diagnosed via doppler ultrasound or angiography Tx blood thinners, thrombolytics

Question 30

What is one of the most important observations to make in a post-operative patient?

Answer 30

observe for presence of thrombus formation, prevention

Question 31

Thrombus formation

Answer 31

Blood clot that remains attached to the vessel wall Risk factors include intimal injury/inflammation, obstruction of flow, pooling (stasis) Thromboembolus Thrombophlebitis Arterial thrombi Venous thrombi

Question 32

Embolism

Answer 32

can be any bolus of matter that is circulating in the bloodstream ``` Dislodged thrombus Air bubble Amniotic fluid Aggregate of fat Bacteria Cancer cells Foreign substance ```

Question 33

Thromboangiitis obliterans (Buerger disease)

Answer 33

Occurs mainly in young men who smoke Inflammatory disease of peripheral arteries resulting in the formation of nonatherosclerotic lesions (Hands and feet) Obliterates the small and medium-sized arteries S/Sx: pain and tenderness of the extremity, b/c blood flow slows down in the vessels and it causes the skin to have a red color (rubor) Tissue does not get enough oxygen, it becomes thin and shiny, nails become malformed and thickened…can progress to gangrene Dx is based on age < 45, history of smoking, and S/Sx Tx: Stop smoking, drugs to relax vasospasms, exercise to increase blood flow to the extremity

Question 34

Raynaud phenomenon and Raynaud disease

Answer 34

small vessels of the hands and feed constrict excessively in an exaggerated response to cold. The fingers and toes become cold and blue. Stress has also been implicated in triggering this response. Raynaud disease is a primary vasospastic disorder of unknown origin Manifestations include pallor, cyanosis, cold, pain Tx: prevention (avoid cold environments, dress warmly, decrease stress) Some medications can be use to dilate the blood vessels if symptoms become hard for the patient to control.

Question 35

Raynaud phenomenon

Answer 35

``` secondary to other systemic diseases or conditions: Collagen vascular disease Smoking Pulmonary hypertension Myxedema Cold environment ```

Question 36

Arteriosclerosis

Answer 36

Chronic disease of the arterial system Abnormal thickening and hardening of the vessel walls Smooth muscle cells and collagen fibers migrate to the tunica intima

Question 37

Atherosclerosis

Answer 37

Form of arteriosclerosis Thickening and hardening caused by accumulation of lipid-laden macrophages in the arterial wall Plaque development

Question 38

Intermittent Claudication

Answer 38

muscle cramp like pain which comes on with exercise. most often occurs as a pain in the calf, thigh or buttock after walking a certain distance and is relieved by rest. caused by narrowing or blockage in the arteries taking blood to the leg.

Question 39

Coronary Artery Disease

Answer 39

coronary arteries which deliver oxygen and nutrients to the heart's own tissue become blocked by a buildup of cholesterol fats, often referred to as "plaque". Plaque deposits can make the arteries stiff and irregular (atherosclerosis). Any narrowing, or blockage, of the coronary arteries reduces the blood supply to the heart tissue, therefore reducing the amount of oxygen and nutrients delivered. This inhibits the normal function of the heart muscle.

Question 40

Myocardial ischemia

Answer 40

Local, temporary deprivation of the coronary blood supply When a thrombus forms over a ruptured plaque, unstable angina can be a “red flag”…when the plaque is becoming eroded, it can cause episodes of occlusion and vasoconstriction for about 10-20 minutes with return to normal perfusion.

Question 41

Stable angina

Answer 41

pain with exercise or stress; when oxygen demand outweighs oxygen supply; once blood flow is restored, the pain subsides (usually treated with rest and nitrates)

Question 42

Prinzmetal angina

Answer 42

(variant angina) as a result of vasospasms and can happen at rest (during sleep)

Question 43

Silent ischemia

Answer 43

can be asymptomatic; person may complain of fatigue, dyspnea or feeling of unease…this type of ischemia may be heralding an imminent MI.

Question 44

3 types of Angina "C.U.P."

Answer 44

(C) Chronic Stable Angina (fixed stenosis) -Demand Ischemia (U) Unstable Angina (thrombus) -Supply Ischemia (P) Printzmetal's Variant Angina (vasospasm) -Supply Ischemia

Question 45

Myocardial Infarction

Answer 45

when coronary blood flow is interrupted for an extended period of time.

Question 46

non-STEMI

Answer 46

When the occlusion in an MI resolves before necrosis of distal tissues occurs

Question 47

STEMI

Answer 47

When necrosis occurs in a MI characterized by an elevated ST segment on ECG

Question 48

Hyperglycemia occurs about _______ after an MI and is associated with an increased risk of death.

Answer 48

72 hours

Question 49

What does Ang. II do during a MI?

Answer 49

causes an increase in water and salt in the circulation and vasoconstriction of blood vessels->increase work load on the heart. Ang II also causes cardiac remodeling

Question 50

Remodeling

Answer 50

the heart’s attempt to compensate for damage that has resulted from ischemic tissues; over time the changes will not continue to function. walls of the ventricles thicken The left ventricle becomes non-compliant to blood volume changes...becomes ridged...can cause problems with pumping against increased peripheral resistance. a process caused by angiotensin II, aldosterone, catecholamines, adenosine, and inflammatory cytokines that cause hypertrophy of cardiac cells but in the changes, they lose contractility.

Question 51

How long does it take for cardiac cells to die without access to oxygen?

Answer 51

20 minutes

Question 52

What are the manifestations of a MI?

Answer 52

``` Manifestations: Sudden severe chest pain; may radiate Nausea, vomiting Diaphoresis Dyspnea ```

Question 53

What are (3) major disorders of the pericardium: "Pericardial C.A.P."

Answer 53

(C) Constrictive pericarditis (A) Acute pericarditis (P) Pericardial effusion (Tamponade)

Question 54

Acute pericarditis

Answer 54

is an inflammation of the sac surrounding the heart the area becomes roughened and scarred. Exudates develop and pericardial effusions are possible.

Question 55

Pericardial effusions

Answer 55

refer to an accumulation of fluid in the pericardial cavity due to inflammation or infection Accumulation of fluid in the pericardial cavity May be exudate Serosanguineous Frank blood

Question 56

Pericardial Effusion: Cardiac Tamponade What is the treatment?

Answer 56

fluid compresses the heart…this is life-threatening because it limits ventricular filling reducing stroke volume and cardiac output. May develop right-sided heart failure Treatment: pericardiocentesis (aspiration of excessive pericardial fluid)

Question 57

Constrictive Pericarditis Treatment?

Answer 57

is due to fibrous scar tissue that develops gradually. It puts too much pressure on the heart. treatment: initially to restrict sodium intake and to give medications to improve cardiac output.

Question 58

Dilated Cardiomyopathy

Answer 58

The left ventricle becomes enlarged. ``` This type can be caused by: Alcoholism Pregnancy Genetic Diffuse ischemic injury ```

Question 59

Hypertrophic Cardiomyopathy

Answer 59

The walls of the left ventricle become so enlarged that they encroach on the space inside the ventricle.

Question 60

Restrictive Cardiomyopathy

Answer 60

The heart muscle becomes stiff and cannot accommodate the usual volume of blood during diastole.

Question 61

Aortic Valve Stenosis

Answer 61

narrowing of the valve that causes resistance to the outflow (flow of blood moving forward) of blood through that valve.

Question 62

Valve Regurgitation

Answer 62

Regurgitation of the valve is when the valve does not close properly allowing blackflow (reverse flow of blood) of blood.

Question 63

Rheumatic Fever

Answer 63

Systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by the group A beta-hemolytic streptococci Febrile illness (Inflammation of the joints, skin, nervous system, and heart) untreated = rheumatic fever causes rheumatic heart disease

Question 64

Rheumatic Heart Disease Treatment?

Answer 64

Vegetation accumulates on the valves causing lesions; these eventually cause scarring and cause the valves to lose their eleacity and may cause the leaflets to adhere to each other. Tx: 10 days of oral penicillin or erythromycin and NSAIDS

Question 65

Infective Endocarditis Treatment?

Answer 65

Infections and inflammation of the endocardium; can be bacterial or viral. Tx: anti-infectives, may need surgery to excise infected tissues, valve replacement

Question 66

Heart Failure

Answer 66

When the heart is not able to pump blood to perfuse tissues or when there is an increase diastolic filling pressure of the left ventricle or both of these situations heart failure can occur

Question 67

Systolic heart failure

Answer 67

Inability of the heart to generate adequate cardiac output to perfuse tissues Ventricular remodeling Causes include myocardial infarction, myocarditis, cardiomyopathy

Question 68

Diastolic heart failure

Answer 68

Pulmonary congestion despite normal stroke volume and cardiac output Causes include myocardial hypertrophy and ischemia, diabetes, valvular and pericardial disease

Question 69

Manifestations of left heart failure:

Answer 69

Result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation-- Include dyspnea, orthopnea, cough of frothy sputum, fatigue, decreased urine output, and edema Physical examination often reveals pulmonary edema (cyanosis, inspiratory crackles, pleural effusions), hypotension or hypertension, an S3 gallop, and evidence of underlying CAD or hypertension

Question 70

Right heart failure Signs and symptoms?

Answer 70

Most commonly caused by a diffuse hypoxic pulmonary disease Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation ``` S/Sx: Shortness of breath Swelling of feet and ankles Voiding frequently Fatigue Weakness Fainting ```

Question 71

What is Shock?

Answer 71

Cardiovascular system fails to perfuse the tissues adequately Leads to impaired cellular metabolism Impaired oxygen use Impaired glucose use Manifestations: hypotension, tachycardia, increased respiratory rate

Question 72

What are the (4) types of shock? "CHampS rN" or "CHaNS -pron. like chance"

Answer 72

Cardiogenic Hemorrhagic Septic Neurogenic

Question 73

Cardiogenic shock

Answer 73

is caused by heart failure. Essentially, the heart cannot maintain cardiac output for adequate perfusion.

Question 74

Hemorrhagic Shock

Answer 74

when there is such a low volume of blood that the heart cannot pump it adequately

Question 75

Septic shock

Answer 75

when there is a systemic dilation of small vessels due to the toxins released by bacteria…causes pooling of blood in the periphery.

Question 76

Neurogenic shock

Answer 76

when there is a systemic dilation of the small vessels due to problems with neuronal innervation…causes an inadequate return of blood to the heart, causing it to pool in the periphery.

Question 77

Multiple Organ Dysfunction Syndrome (MODS)

Answer 77

Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury. Triggered by: chronic inflammation, necrotic tissue, severe trauma, burns Most common: sepsis, septic shock (low grade fever, tachycardia, dyspnea, altered mental state)

Question 78

MODS manifestations

Answer 78

Manifestations: Respiratory-lungs are the first to fail (Adult respiratory distress syndrome-ARDS) Hepatic-7-10 days then the liver fails Renal-14-21 days, the kidneys and the GI fails Myocardial failure-eventually the heart fails