Cardiovascular Flashcards
EDV
ESV
- End diastolic volume- how much blood in ventricles when filled
- End systolic volume- how much blood in ventricles after ejection
Heart Failure characterized by back up of fluids into the pulmonary circulation that can give rise to pulmonary edema
Left sided HF
ineffective left ventricular contractile function
Drug class that reduces fluid retention but can cause hypokalemia and arrhythmias
Diuretics
Most commonly occurs in the lower extremity and is a serious disorder, complicated by pulmonary embolisms, recurrent episodes, and chronic venous insufficiency
Fluid accumulation in the pericardial sac
Pericardial Effusion
Increased hydrostatic pressure as fluid accumulates from fluid backup
Heart Failure
Heart Failure characterized by fluid back up into the systemic and hepatic venous systems, peripheral edema or ascites, external jugular veins
Right Sided HF- “cor pulmonale”
ineffective right ventricular contractile function
Can be caused by massive vasodilation from allergic response or absolute losses of fluids due to sweating, burns, vomiting, diarrhea, hemorrhage
Too little perfusion can lead to shock, decrease in blood flow to tissues and organs can lead to loss of function
Hypotension
Systole
Diastole
- Systole- contraction
- Diastole- relaxation
- Decreased cardiac output because of reduced end diastolic volumes
- Any condition impedes expansion of the ventricles (pericardial effusion)
Dystolic dysfunction
Reduced ability of the left ventricle to relax and fill during diastole
Cholesterol Levels
LDL
HDL
Total
Triglycerides
LDL < 100mg/dl
HDL > 40-60 mg/dl
Total <200mg/dl
Triglycerides <10-150mg/dl
Hypertrophy of muscle mass that can lead to obstruction of blood filling
Hypertrophic Cardiomyopathy
- Usually caused by genetic mutations that may be inherited or acquired
- Adaption of the heart due to increased workload of the heart over time
Involves extremely rigid ventricular walls that restrict blood filling by spare contractile properties of the muscle
Restricve Cardiomyopathy
- Primary cause is endocarditis
- Secondary causes are amyloidosis, hemochromatosis, sarcoidosis
Results from narrowing of coronary arteries due to atherosclerotic processes, reduced blood flow to the heart
Coronary Artery Disease (CAD)
- Classic sign: angina
- nitrates such as nitroglycerin are potent vasodilators, can help reperfuse blocked tissues
Increased tension on blood vessel walls leads to an increase in blood pressure
Over time can lead to hypertrophy
Hypertension
Formation of scar tissue between the pericardial layers
Restrictive/Constrictive Pericarditis
Bad cholesterol
Can lead to atherosclerosis
LDL - Low-density lipoproteins
List some complications of shock
- Acute respiratory distress syndrome
- acute renal failure
- GI ulceration
- DIC
- multiple organ dysfunction syndrome
Venous stasis ulcers is caused by _____
Advanced venous insufficiency/ hypertension
fluid is shifting that leads to edema that gives rise to skin breakdown and ulcers, at risk for necrosis and infection
Accumulation of exudates such as blood in the pericardial sac leading to rapid increase in pressure
The rapid compression of heart impairs diastolic filling reducing cardiac output and compromising perfusion to the body
Cardiac Tamponade
- A sudden elevation in MAP
- May occur with ischemia, chest pain, pulm edema, intercerebral hemorrhage, abnormal renal function
-
causes problems in all body systems
- renal- decreased perfusion, uremia, renal failure
- cardiac- CAD, angina, heart failure
- cerebral function- TIA’s aneurysm formation, intracranial hemorrhage
- CAN BE FATAL
Hypertensive Crisis
usually due to increase in TPR causes by reduced arterial radius
Increases afterload, atherosclerosis and MI may increase as a result of HTN
Drugs aimed at reducing TPR:
- Beta-adrenergic blockers, calcium channel blockers to promote vasodilation
- ACE inhibitors that block vasoconstrictor angiotensin II
- Decreased contractility of the heart
- Decreased ejection fraction, usually less than <40%
Systolic dysfunction
left ventricle can’t pump enough blood into the systemic circulation during systole
_____ shock: Inadequate blood volume
Venous return reduced as fluid is lost from the intravascular space and results in decreased ventricular filling and drop in stroke volume
Hypovolemic Shock
Change in dilation of blood vessel wall, can lead to rupture and bleeding
Typically formed in aorta, vessel off left side of heart, under pressure, can also form in arteries or veins
Aneurysm
Increased aterial or venous pressure or arterial dilation
Decreased plasma proteins or increased permeability to proteins
Lymph failure
Decreased osmotic pressure, Increased Hydrostatic Pressure, Obstruction
Increased Hydrostatic pressure
Decreased osmotic pressure
Obstruction
Stroke Volume = _____
Stroke Volume = EDV- ESV
Stroke Volume- how much blood gets out in a stroke (beat)
End diastolic volume - End systolic volume
Includes Trauma, Venous stasis, and Altered coagulability
Virchow’s Triad
contributes significantly to thrombus formation
Management of Hypercholesteremia
- Primary target is lowering LDL
- Dietary and lifestyle changes
- pharmacologic treatments
- Statins- prevent liver from manufacturing cholesterol
- Bile acid sequestrants
- Cholesterol absorption inhibitors
- Fibrates
- NIctonic acid
- Low-resistance vessels that stretch and constrict like a coil
- Vasoconstricts/vasodilates to effect distribution of blood
- primarily responsible for blood pressure
Arteries
- Regulates blood pressure
- CO X total peripheral resistance (TPR- radius of vessels)
Mean Arterial Pressure (MAP)
end-diastolic volume at the beginning of systole, directly related to the degree of stretch of the myocardial sarcomeres
Preload
Risk factors of atherosclerosis
- Hypertension
- Smoking
- High cholesterol
- Obesity
- Diabetes
Results in:
- CAD, TIA’s, CVA’s, renal stenosis, arterial occlusive disease
Disease of the lower extremities characterized by venus hypertension, varicose veins, and venous ulcers
S/S associated with impaired blood flow, tissue congestion, edema, impairment of tissue nutrition
Chronic Venous Insufficiency
Acute inflammatory response that results in exudate accumulation around the heart
Acute Pericarditis
Small, spherical dilation of vessel at a bifurcation point
Seen in structures like Circle of Willis in brain where bifurcated vessels are common
Berry aneurysm
HTN without evidence of other diseases
accounts for 90% of htn
causes: genetic factors, sodium intake, DM, smoking, alcohol
>140/90
Primary/essential Hypertension
Another disease condition increases CO or TPR and indirectly increases MAP
Examples: Adrenal tumors (release catecholamine), aldosterone (increased fluid retention), stress
Secondary HTN
- Vasculitis that affects medium-size arteries
- Plantar or digital vessels (foot/leg)
- Men 25-40 years old, heavy smokers
- primarily arterial but inflammation can involve adjacent veins and nerves
- S/S- pain, impaired circulation, sensitivity to cold
- Chronic ischemia -> ulceration and gangrene
Thromboangiitis obliterans (Buerger’s disease)
Narrowing of valve opening leads to greater resistance to blood flow throught the valve
Stenosis
Sudden, progressive loss of consciousness
Can be from:
- Vasovagal response- stimulation of vagus nerve
- Postural syncope- Getting up too quickly
- Carotid sinus syncope- pressure on carotid arteries
Syncope
Major function is to maintain blood volume but also important in defense and fat absorption
Lymphatics
Difference between hydrostatic and interstitial fluid pressure favors _____
Filtration
Good cholesterol
HDL- High-density lipoproteins
Cardiac Drugs
- Digitalis inhibits _____
- Nitroglycerine & Calcium channel blockers are _____
- Beta-adrenergic antagonists reduce _____ & _____
- NA-K-ATPase
- vasodilators
- reduce contractility and heart rate
_____ shock: blood flow impeded by physical or mechanical obstruction
Inadequate circulating blood volume results from obstruction in great vessels that interferes with filling/emptying of the heart- results in reduced cardiac output
Obstructive Shock
- A regulated variable governed by feedback inhibition
- changes in cardiac output may be compensated by changes in TPR and the reverse
- Hemorrhage or other severe blood loss causes lowered cardiac output
- reaction would be to increase vasoconstriction to increase TPR which would then maintain it
- Controlled variables: Heart rate, vasoconstriction, vasodilation
Mean Arterial Pressure (MAP)
CO X TPR
Involves dilation of heart chambers impairing the function of the heart as a pump
Dilated Cardiomyopathy
- Generally there is impairment of the ventricles ability to pump during systole
- Leads to hypertrophy of the heart
- Causes include damage to the heart from toxic, metabolic, or infectious agents
- Atherosclerosis distal to aortic arch
- typically seen in older men
- Risk factors: smoking, diabetes
- Gradual vessel occlusion
- Ischemic pain at rest
- Damage and ulceration of blood vessels
- gangrene can develop
Peripheral artery disease (PAD)
Extends over part of circumference of vessel, appears like a sac
Saccular aneurysm
Intravascular volume is inappropriately distributed
Vasodilation causes hypovolemia
Includes septic shock, neurogenic shock, and anaphylactic shock
Distributive Shock
Ejection Fraction
- How well the ventricles are at getting the blood out
- Assesses efficiency of the heart
- Ideally want >75%
- SV/EDV
- Leaky thin-walled vessels with a large cross-sectional area allowing slow passage of blood that facilitates transport and exchange
- Site of fluid balance regulation
- “Starling forces” govern filtration on arterial side and reabsorption on venus side
- If not enough volume is returned, can lead to accumulation in tissues (edema)
Capillaries
Group includes :
- acute myocardial infarction (MI)
- STEMI
- NSTEMI
- unstable angina
Caused by _____ and _____
Risk factors _____
Acute Coronary Syndrome (ACS)
- caused by atherosclerosis and embolism
- risk factors include: diabetes, hypertension, obesity, smoking, high fat-to-carb ratio, family history of heart disease
Infection of the endocardium, heart valves, or cardiac prosthesis resulting from bacterial or fungal invasion
Endocarditis
- Caused by IV drug use, prosthetic heart valves, or have had rheumatic heart disease
- Bacteremia leads to ulceration and necrosis of heart valves
- Treatment includes antibiotics and supportive therapy
Cardiac Output = _____
Cardiac Output = HR X SV
Cardiac Output- volume pumped by each ventricle per minute
Heart Rate X Stroke Volume
Atrial Depolarization
Ventricular depolarization
Ventricular Repolarization
P wave
QRS complex
T wave
the force that the heart must work against to eject blood from the ventricle, ventricular pressure at the end of systole
Afterload
False aneurysm resulting from a tear in tunica intima, allows blood to enter vessel wall and creates pockets filled with blood
Dissecting aneurysm
Failure of valve to close completely results in backflow (regurgitation) of blood to previous compartment
Insufficiency
Difference between osmotic pressures in plasma and interstitial fluid favor _____
Absorption
_____ shock: The heart fails as a pump and can’t maintain cardiac output
Cadiogenic Shock
- Intense vasospasm of arteries/arterioles in fingers/toes
- Young women, restriction of blood flow
- secondary type associated w/ other diseases or vasospasm like frostbite, occupational trauma, collagen diseases, neurologic disorders, occlusive disorders
- Scleroderma
Raynauds Phenomenon
Involves the entire circumference of vessel, characterized by gradual, progressive dilation
Fusiform aneurysm
- Low-resistance vessels that help maintain blood pressure
- ensure proper venous return (preload, EDV)
- Sympathetic stimulation contracts smooth muscle to raise pressure
Veins
