Cardiovascular disease ppt Flashcards

Question

what occurs in the kidneys from left sided CHF

Answer 1

1. The decreased CO causes decreased Renal pefusion 2. this activated the RAAS causing restention of Na⁺ and H₂O 3. leading to worsening of Pulmonary edema 4. this compensatory reaction is countereacted by the release of ANP through atrial dilatio 5. which acts to decrease ecessive blood volume 6. If kidney perfusion becomes severe the impaired excretion of nitrogenoys products may cause azotemia (in this instance azotemia) ,

Answer 2

1. in far advanced CHF, cerebral hypoxia may give rise to HYPOXIC ENCEPHALOPATHY

Answer 3

1. irritability 2. loss of attention span 3. restlessness 4. stupor 5. coma

Answer 4

LHF usually it is a secondary consequence of left-sided heart failure because any increase in pressure in the pulmonary circulation incidental to left-sided heart failure inevitably produces an increased burden on the right side of the heart. The causes of right-sided heart failure must then include all those that induce left-sided heart failure (Kumar 563) Kumar, Vinay. Robbins & Cotran Pathologic Basis of Disease, 7th Edition. Saunders Book Company, 082004. .

Answer 5

Severe pulm HTN pure right-sided heart failure most often occurs with chronic severe pulmonary hypertension and thus is called cor pulmonale. In this condition, the right ventricle is burdened by a pressure workload due to increased resistance within the pulmonary circulation. Hypertrophy and dilation are generally confined to the right ventricle and atrium, although bulging of the ventricular septum to the left can cause dysfunction of the left ventricle (Kumar 563) Kumar, Vinay. Robbins & Cotran Pathologic Basis of Disease, 7th Edition. Saunders Book Company, 082004. .

Answer 6

1. pulmonary congestion is minimal, 2. engorgement of the systemic and portal venous systems may be pronounced.

Answer 7

1. Hypertrophy and dilation of RV 2. poss septal hypertrophy/bulging

Answer 8

1. Congestive hepatomegaly 2. Cardiac sclerosis/ cirrosis (the central areas can become fibrotic, creating so-called cardiac sclerosis or cardiac cirrhosis) 3. Portal HTN (ascites, varices) 4. congestive slenomegaly

Answer 9

1. Congestion leading to greater fluid retention, peripheral edema, and more pronounced azotemia

Answer 10

1. Encephalopathy symptoms essentially identical to those described in left-sided heart failure may occur, representing venous congestion and hypoxia of the central nervous system

Answer 11

1. Peripheral edema/ anasarca, 2. pleural/pericardial effusions Peripheral edema of dependent portions of the body, especially ankle (pedal) and pretibial edema, is a hallmark of right-sided heart failure. In chronically bedridden patients, the edema may be primarily presacral. Generalized massive edema is called anasarca.

Answer 12

the symptoms of pure left-sided heart failure are largely due to pulmonary congestion and edema. In contrast, in right-sided heart failure, respiratory symptoms may be absent or quite insignificant, and there is a systemic (and portal) venous congestive syndrome, with hepatic and splenic enlargement, peripheral edema, pleural effusion, and ascites. In many cases of chronic cardiac decompensation, however, the patient presents with the picture of biventricular CHF, encompassing the clinical syndromes of both right-sided and left-sided heart failure.

Answer 13

just know the following

Answer 14

1. Atherosclerosis (plaque in the intima and damage to the media Atherosclerosis, the most frequent etiology of aneurysms, causes arterial wall thinning through medial destruction secondary to plaque that originates in the intima.

Answer 15

1. Usually in the abdominal aorta (but anywhere) Atherosclerotic aneurysms occur most frequently in the abdominal aorta (abdominal aortic aneurysm, often abbreviated AAA), but the common iliac arteries, the arch, and descending parts of the thoracic aorta can be involved

Answer 16

1. Familial/genetic There is a genetic susceptibility to AAA beyond the genetic predisposition to atherosclerosis or hypertension. For example, as discussed subsequently in the section on Marfan syndrome and aortic dissection, genetic defects in a connective tissue component responsible for the strength of the aorta can themselves produce aneurysms and dissections. Recent attention has focused on an altered balance of collagen degradation and synthesis mediated by local inflammatory infiltrates and the destructive proteolytic enzymes they produce and regulate

Answer 17

1. True aneurysm. The wall bulges outward and may be attenuated but is intact. 2. False aneurysm. The wall is ruptured, and there is a collection of blood (hematoma) that is bounded externally by adherent extravascular tissues.

Answer 18

1. sacular 2. cylindroid 3. fusiform

Answer 19

1. Saccular- usually spherical( involving only a portion of the vessel wall and very in sizes 5-20 cm, often completly or partially filled by thrombus 2. Fusiform- very in diameter up to 20 cm, may involve the entire ascending and transferse portions of aortic arch, or large segments of abdominal aorta or iliacs ( no shape specifics) 3.

Answer 20

aneurysm is a localized abnormal dilation of a blood vessel or the wall of the heart

Answer 21

When an aneurysm is bounded by arterial wall components or the attenuated wall of the heart, it is called a true aneurysm

Answer 22

a false aneurysm (also called pseudoaneurysm) is a breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space (“pulsating hematoma”).

Answer 23

1. Infection of a major artery that weakens its wall gives rise to mycotic aneurysm. 2. Thrombosis and rupture are possible complications. 3. Mycotic aneurysms may originate either (1) from embolization and arrest of a septic embolus at some point within a vessel, usually as a complication of infective endocarditis; (2) as an extension of an adjacent suppurative process (3) by circulating organisms directly infecting the arterial wall

Answer 24

1. Salmonella gastroenteritis Mycotic abdominal aortic aneurysms are atherosclerotic AAAs that have become infected by lodgment of circulating organisms in the wall, particularly in bacteremia from a primary Salmonella gastroenteritis. In such cases, suppuration can further destroy the media, potentiating rapid dilation and rupture

Answer 25

1. dense periaortic fibrosis containing an abundent, inflammatory reaction rich lymphocytes and plasma cells with many macrophages and ften giant cells

Answer 26

1. the aneurysm and the nearby aorta often contain atheromatous ulcers covered by granular mural thrombi, prime sites for the formation of atheroemboli that may lodge in the vessels of the kidneys or lower extremities. 2. Additionally, a thrombus frequently fills at least part of the dilated segment. Occasionally the aneurysm may affect the origins of the renal and superior or inferior mesenteric arteries, either by producing direct pressure on these vessels or by narrowing or occluding their ostia with mural thrombi. Not infrequently, AAAs are accompanied by smaller fusiform or saccular dilations of the iliac arteries.

Answer 27

seperating og the layers Aortic dissection is a catastrophic illness characterized by dissection of blood between and along the laminar planes of the media, with the formation of a blood-filled channel within the aortic wall (Fig. 11–20), which often ruptures outward, causing massive hemorrhage

Answer 28

\*\*\* not associated with dilation\*\*\* In contrast to atherosclerotic and syphilitic aneurysms, aortic dissection may or may not be associated with marked dilatation of the aorta. For this reason, the older term “dissecting aneurysm” is discouraged.

Answer 29

1. HTN 2. Connective tissue abnormality 3. Complications post arterial cannulation/CPB 4. pregnancy (PIH) Aortic dissection occurs principally in two groups of patients: More than 90% of dissections occur in men between the ages of 40 and 60 with antecedent _hypertension_. The second major group of patients, usually younger, has a systemic or localized abnormality of connective tissue that affects the aorta (e.g., _Marfan syndrome,_ discussed in Chapter 5). Dissection can also be iatrogenic, as a complication of _arterial cannulation_ (e.g., during diagnostic catheterization or cardiopulmonary bypass). Rarely, for unknown reasons, dissection of the aorta or its branches, including the coronary arteries, occurs during or _following pregnancy_. ***_Dissection is unusual in the face of substantial atherosclerosis or other cause of medial scarring such as syphilis_***

Answer 30

cystic medial degeneration

Answer 31

1. intimal tear into (NOT THROUGH) the media 2. usually laminar spread (middle and outer third) 3. poss re-rupture into aorta- new luman 4. rupture and death In spontaneous dissection, an intimal tear that is presumably the origin extends into but not through the media of the ascending aorta, usually within 10 cm of the aortic valve (Fig. 11–20A). Such tears are typically transverse or oblique, 1 to 5 cm in length, with sharp but jagged edges. The dissection can extend along the aorta proximally toward the heart as well as distally, sometimes all the way into the iliac and femoral arteries. The dissecting hematoma spreads characteristically along the laminar planes of the aorta, usually between the middle and outer thirds (Fig. 11–20B). It often ruptures out, causing massive hemorrhage. In some instances, the blood reruptures into the lumen of the aorta, producing a second or distal intimal tear and a new vascular channel within the media of the aortic wall (to produce a “double-barreled aorta” with a “false channel”). In the course of time, false channels may become endothelialized (“chronic dissection”

Answer 32

AV dysfunction

Answer 33

1. fibrillin gene 2. annuloaortic ectasia

Answer 34

1. Type A: involves the Ascending portion or both ascending and descending aorta (these are more common and more serious and damaging) 2. Type B: distal lesions not involving the ascending part and begining distal to the subclavian artery \*\*\*\* A = Ascending \*\*\* B= Below

Answer 35

1. Type A: from root down 2. Type B: Root only (stops there) 3. Type C: distal LSC 4. Type D: type A but with multiple tears

Answer 36

impeded forward flow of venous blood

Answer 37

1. Varicose veins-usuually surerficial, dilated, tortuous vellses, valvular dysfunction 2. peripheral edema- from orthostatic, hydrostatic and lymphatic pressures 3. predisposes to thrombosis- b/c of HF, neoplasms, obesity, immobility

Answer 38

* deep leg veins others- pelvic, dural sinuses

Answer 39

1. unilateral edema 2. pain 3. homans sign

Answer 40

* embolic episode (PE)

Answer 41

1. Stasis Dermatitis 2. Venous Ulcer

Answer 42

* Hyperpigmentation * dermal sclerosis * dilation of superficial veins * erythema

Answer 43

* Melleolar area * superficial, irregular * maderate to heavy drainage * stasis dermatitis WET

Answer 44

* over bony pressure points * deep, circular, well demarcated * dry necrosis

Answer 45

* neolasms * aneurysms

Answer 46

obstruction of SVC everything above mass becomes edematous dialtion of all proximal veins poss pulmonary veins The superior vena caval syndrome is usually caused by neoplasms that compress or invade the superior vena cava, most commonly a primary bronchogenic carcinoma or mediastinal lymphoma. The consequent obstruction produces a distinctive clinical complex manifested by dusky cyanosis and marked dilation of the veins of the head, neck, and arms. Commonly the pulmonary vessels are also compressed, inducing respiratory distress

Answer 47

* Exaggerated vasomotor response Raynaud phenomenon refers to paroxysmal pallor or cyanosis of the digits of the hands or feet and, infrequently, the tips of the nose or ears (acral parts) owing to cold-induced vasoconstriction of the digital arteries, precapillary arterioles, and cutaneous arteriovenous shunts \*\*\*\* interesting \*\*\*\*\*the fingers change color in the sequence white—blue—red In contrast to uncomplicated, or primary, Raynaud phenomenon, **_secondary Raynaud phenomenon_** refers to arterial insufficiency of the extremities caused by various conditions, including SLE, systemic sclerosis (scleroderma), atherosclerosis, or Buerger disease (see above).

Answer 48

* Arteritis that often involves the coroary arteries, usually in young children and infants * associated with mucocutaneous lymph node syndrome---manifested by fever, conjunctival and oral erythema and erosion, edema of hands and feet, erythemia of palms and soles, a skin rash and enlargment of cervical lymph nodes

Answer 49

1. temporal 2. kawasaki 3. takayasu

Answer 50

* most common in older individuals and rare before age 50 * Symptoms are either only vague and constitutional—fever, fatigue, weight loss—without localizing signs or symptoms, or facial pain or headache, often most intense along the course of the superficial temporal artery, which may be painful to palpation. * More serious are ocular symptoms

Answer 51

* Vasculitis of the medium and larger arteries * characterized by occular disturbancs and marked weakening of the pulses in the upper extremities * PULSLESSNESS DISEASE

Answer 52

and his noodle arms