Cardiovascular Disorders of the Human Body

Question 1

Endocardium

Answer 1

Inner most layer of the heart

Question 2

Myocardium

Answer 2

Forms muscle layer between atria and ventricles, composed of myocytes

Question 3

Pericardium

Answer 3

Outer layer: Tough, fibrous; resistant to distention by restricting left ventricle

Inner layer: serous; visceral (epicardium) & parietal layer

Question 4

Pericardial cavity

Answer 4

contains 30-50 mL of serous fluid to lubricate/prevent friction

Question 5

Autonomic Nervous System

Answer 5

SNS stimulation– Increases HR, controls smooth muscle tone of blood vessels
PNS stimulation– Decreases HR (vagus nerve), little/no control of blood vessels

Question 6

SA Node

Answer 6

Pacemaker, 60-100 BPM, atrial systole

Question 7

AV Node

Answer 7

40-60 BPM

Impulse travels down to eventually cause ventricular systole

Question 8

Stroke Volume

Answer 8

The difference between end-diastolic & end-systolic volumes.

Question 9

Ejection Fraction

Answer 9

Percentage of end-diastolic volume ejected w/ each heartbeat at systole. Normal = 60%. 30-40% is bad/HF

Question 10

Cardiac Output

Answer 10

Is the amount of blood pumped by the ventricle per minute
CO=SV x HR
Ranges from 4 to 8 L/min

Question 11

Frank Startling Law

Answer 11

Muscle stretching

Question 12

Preload

Answer 12

The volume of blood in the ventricles at the end of diastole that the heart must pump w/ each beat
Determined by amt of venous return and degree of muscle stretch.

Question 13

Afterload

Answer 13

The resistance or pressure the heart must overcome to eject blood from the left ventricle into the aorta. 184/100 BP.

Question 14

Factors influencing CO

Answer 14

Cardiac Factors: HR, Contractility, Preload, Afterload

Renal, Fluid/Volume control
Renin-Angiotensin
Aldosterone
Atrial Natiuretic factor: released when there’s too much volume

Question 15

Primary Hypertension

Answer 15

Essential or idiopathic hypertension/Silent Killer
Occurs without evidence of other disease
Affects 90% to 95% of individuals with hypertension
Blood pressure of 140/90 mmHg or higher

Some of the common causes:
Overactive SNS (sympathetic)
Secretion of norepi release of adrenaline (Epi) from adrenal medulla increase BP
Overactive Renin-angiotensin-aldosterone system
Salt and water retention & increased vascular tone
Insulin resistance/Metabolic Syndrome

Question 16

Secondary Hypertension

Answer 16

Kidney disease- most common cause is renal artery stenosis
Hyperthyroidism
Hypersecretion of aldosterone or catecholamines
Pheochromocytoma: cancer of adrenal gland
Pregnancy induced hypertension (PIH)

Question 17

Clinical Manifestations of Hypertension

Answer 17

S/S often secondary to TOD:
HeadAche, blurred vision, fatigue, dependent edema, palpitation, angina, dyspnea

Complications:
Specific target organ damage
Cerebral vascular disease (stroke)
Cardiac disease (CAD, LVH, Heart Failure)
Peripheral Arterial Disease (PAD)
Renal damage 
Retinal damage

Question 18

Orthostatic (postural) Hypotension

Answer 18

Decrease in both systolic and diastolic blood pressure upon standing
Drop in SBP≥ 20mmHg / DBP ≥ 10mmHg
Lack of normal blood pressure compensation
Reduction of blood flow to brain
Vasodilation, pooling of blood in blood vessels of the lower extremities
S/S: Dizziness, blurred vision, syncope

Question 19

Hyperlipidemia

Answer 19

RISK FACTORS
Genetic predisposition (primary or “familial” )
Age (over age 45 in men and age 55 in women)
Diabetes & hypothyroidism (↑ triglycerides)
Gender (after menopause, women’s LDL levels tend to rise)
Certain medications
High dietary intake of cholesterol (↓LDL receptor formation & activity = ↓ LDL removal)
Obesity

Question 20

Cholesterol

Answer 20

Cholesterol and triglycerides are the two main lipids in blood. The body uses cholesterol, an essential component of all cell membranes, to form steroid hormones and bile acids. The liver produces most of the body’s cholesterol, but an estimated 20-40% comes from food sources.

Must be carried by lipoproteins (LDL)
High Density L picks up cholesterol and takes it to liver

Question 21

Clinical Manifestations of Hyperlipidemia

Answer 21

Atherosclerosis
Coronary artery disease
Stroke
Peripheral artery disease
High Blood pressure

Question 22

Diagnosing Cholesterol/Hyperlipidemia

Answer 22

LDL: Less than 100
HDL: Between 40-60
Total: Less than 200

Question 23

Treatment of Hyperlipidemia

Answer 23

Reduce caloric intake, saturated & trans fats, & cholesterol
Increase intake of soluble fiber
Daily exercise (at least 30 minutes a day)
Weight reduction if overweight or obese
Smoking cessation
Lipid-lowering medications

Question 24

Atherosclerosis

Answer 24

Significant correlation to Hyperlipidemia
Thickening and hardening is caused by accumulation of lipid-laden macrophages in the intimal wall of the artery
Most common in: Aorta, coronary arteries, and large vessels of the brain
Plaque development (LDL cholesterol, lipids, inflammatory response)
Formation of fibrofatty lesions in the intimal lining of the large and medium-sized arteries, and the large vessels that supply the brain

Question 25

Atherosclerosis (in a nutshell)

Answer 25

Lipids get into the vascular endothelium White blood cells try to clear them away foam cells WBCs (monocytes→activated macrophage) release growth factors that promote plaque formation in the vascular endothelium

Question 26

Risk Factors for Atherosclerosis

Answer 26

Modifiable: Hypercholesterolemia (Hyperlipidemia), Hypertension, Cigarette smoking, Sedentary lifestyle Type II diabetes Non-modifiable: age, genetics, CHD, males (45 yrs), females (55 yrs), High homocysteine levels

Question 27

Clinical Manifestations for Atherosclerosis

Answer 27

``` Ischemia caused by vessel narrowing Thrombus and formation of emboli Infarction caused by vessel occlusion (coronary & cerebral arteries) Aneurysms and dissections Peripheral artery disease (PAD) ```

Question 28

Atherosclerosis Treatment

Answer 28

Reduction of risk factors: high cholesterol, high blood pressure, Type II diabetes, dietary modifications smoking cessation

Question 29

Peripheral artery disease and Intermittent Claudication

Answer 29

Peripheral artery disease Atherosclerotic disease of the arteries that perfuse the limbs Intermittent Claudication: Primary symptom of chronic obstructive arterial disease Ischemia (lack of O2) to the calf, especially during walking or exercise Pain is relieved with rest If pain occurs at rest, condition is worsening and may lead to ulceration and gangrene Weak/absent pulses in lower extremities Hair loss

Question 30

Raynaud disease

Answer 30

Vasospastic disorder of unknown origin | Possible hyperreactivity of SNS

Question 31

Raynaud phenomenon

Answer 31

Can be secondary to other systemic diseases or conditions or associated w/ previous vessel injury Collagen vascular disease (scleroderma), smoking, pulmonary hypertension, and environmental factors (cold and prolonged exposure to vibrating machinery)

Question 32

Thromboangiitis Obliterans (Buerger disease)

Answer 32

``` Vasculitis of medium-sized arteries Arterial ischemia, especially to distal extremities (mostly the foot or lower leg) Most common in men (before age 50) Most common to individuals who smoke Painful, cyanosis to extremities ```

Question 33

Aneurysm

Answer 33

Local dilation or out-pouching of a vessel wall or cardiac chamber Most common to arteries Most common to Aorta Most commonly caused by atherosclerosis & HTN

Question 34

Aortic dissection (medical emergency)

Answer 34

Tear in intimal layer of aorta, disrupting flow through arterial branches Associated with: Chronic HTN Trauma to the aorta S&S Sudden excruciating pain (“tearing” of “ripping”). Chest &/or back Syncope, hemiplegia, paralysis of Lower Extr

Question 35

Pericardial Effusion

Answer 35

Result of injury & inflammation Sudden accumulation of fluid and increase in intrathoracic pressure impede venous return to the heart and constricts ! Cardiac tamponade: Life-threatening! Decreased ventricular diastolic filling …decreased SV…decreased CO…decreased SBP…circulatory shock Pulsus paradoxus- KEY diagnostic finding

Question 36

Acute Pericarditis

Answer 36

Increased capillary permeability…leakage of plasma proteins into pericardial space Chest pain, sitting up relieves pain

Question 37

Constrictive Pericarditis

Answer 37

Scar tissue between visceral & parietal layers interfere w/ diastolic filling