Cardiovascular Path Flashcards
What is the cardiovascular systems job
To maintain sufficient blood pressure to perfume the body
What is the lowest MAP pressure you can have
Normal is 70mmHg, 60 is the bottom end of the range the kidney can regulate itself
-below this is shock
What is MAP
COxTPR
Body will alter what’s variables to maintain MAP
CO and TPR
-mainly HR, to change CO
Blood volume maintained by
Sodium
Mineralocorticoids
ANP
What does ANP do
If you have too much blood volume, allows you to pee it out
Things that constrict
Angiotensin II Catecholamines Thromboxane Leukotrienes Endothelin
Things that dilate
Prostaglandins
Kinins
NO
Things that affect cardiac output
Blood volume
Heart rate (B1, M2)
Contractility
Which of the folllowing would increase BP?
A. Increasing arteriolar diameter
B.increasing venule diameter
C. Increasing HR
D. Increasing PNS stimulation to the heart
Increasing HR
Which of the following would be an appropriate response to increased BP? A. Increasing angII B. Increasing renin C. Increasing aldosterone D. Increasing ANP
ANP
Leading cause off disease and death in the US
Cardiovascular disease
Most common cardiovascular diseases
HTN, coronary artery disease
Cardiovascular disease risk factors
Age and lifestyle
- males >45, females >55
- DM, elevated cholesterol, smoking, HTN
Why do women get cardiovascular diseases later than men
Hormones protect them until menopause
What is considered high BP
140/90
Primary HTN
Just have HTN
Most common
Secondary HTN
Due to another disease/drug. Can resolve with cause
-least common
Prolonged HTN
Damages vessel walls
-arteriosclerosis, atherosclerosis, stroke, and CAD
Damaged vessels walls due to HTN cause risk of
Cardiac hypertrophy and failure, retinal exudates, and flame hemorrhage’s
Injury to the vessel wall leads to
Remodeling
- endothelial damage neointima formation
- normal process of aging
- exaggerated in HTN, hyperlipidemic states, and dm
Excessive vessel remodeling
Can lead to arteriosclerosis or atherosclerosis
-hardening and occlusion of arteries
A patient presents to the clinic with a fever and complains of flu like symptoms. A full work up shows she has a BP of 145/95 and the flu. After several days, she has recovered from he flu and her BP is once again 119/79. This was an exmple of
Secondary HTN
Aginging process accerlated by HTN, usually in less severe HTN. Smooth muscles increase production of ECM, increased ECM narrows artery and reduced compliance
Hyaline arteriosclerosis
This is present in severe HTN, layers of ECM and new smooth muscle cells are produced, narrows vessel, reduces compliance, and causes vessel necrosis
Hyperplastic arteriosclerosis
Which is present in bad HTN, hyaline arteriosclerosis or hyperplastic arteriosclerosis
Hyperplastic arteriosclerosis
What’s the difference between hyaline arteriosclerosis and hyperplastic arteriosclerosis
Hyperplastic is with bad HTN and causes the development of new smooth muscle, it looks like an onion
Atherosclerosis
Cholesterol deposits and angry macrophages, forms a weak, fibrous cap
- weakens the vessels, if it ruptures, large clot can form
- clot can break off and lodge elsewhere, pulmonary embolism, stroke, MI, retinal occlusion
Critical stenosis
Seen in corotid stenosis
Tx for vascular things like atherosclerosis and HTN
-lifestyle changes: exercise,
weight loss, low salt, underlying disease
-Cardiac: B blockers and Ca channel blockers
-vessels: CCB
-kidneys: diuretics
-RAAS system: ACEI and ARBs
-lipid metabolism: cholesterol lowering meds (statin)
Heart diseases
- Failure to pump (issue with the muscle contracting or relaxing)
- Obstruction to flow (stenosis valve or systemic HTN increases workload)
- Regurgitant flow (incompetent valves allow backward flow and increase volume)
- Disorders of flow (rupture of vessels or shunted flow)
- Disorders of conduction (arrhythmia)
Occurs when heart cannot maintains cardiac output OR can only maintain it at altered fillingpressure
Pump failure-heart failure
Systolic pump failure
Heart cannot generate enough force, due to ischemia or HTN
Diastolic pump failure
Heart cannot properly relax due to HTN, fibrosis or pericarditis
What can HTN cause
Pump failure
Which of the following would most likely result from HTN?
Cardiac hypertrophy
Lack of sufficient blood flow to the heart, can occur due to reduced blood flow to overworked muscle or a clot in the coronary circulation. Results in loss of heart muscle and production of non-contractile scar
Myocardial infarction (MI) Heart attack
What is MI usually preceded by
Periods of angina (chest pain), dyspnea, and confusion
-as heart muscle dies, biomarkers are released and can be examined
Treatment for MI
Restore blood flow by stent or bypass
Which of the folllowung would most likely happen during prolonged cardiac ischemia?
Cardiac necrosis
Which is the best lab to look at to see if someone had a MI?
Troponin
Left ventricle is cause of failure
Left sided heart failure
What is left sided heart failure
Left side cant pump what right gives it, volume builds up in lungs
- increased volume increases pressure and causes pulmonary edema
- increases workload on right heart
Right sided heart failure
- right side cant pump what the left gives it, volume build up in periphery
- edema in the liver and legs
- increases workload on left side
Where do you see edema in right sided heart failure
Liver and legs
Treatments for right/left sided heart failure
Reduce workload of heart
- reduce BP or blood volume
- Bblockers CCB and diuretics
Increase contractility to increase CO and maintain function
-cardiac glycosides, B agonistis
Heart transplant is only cure
-pretty rare to get one unless genetic disorder caused HF
A patient presents to the ER with a 100% blockage of their left anterior descending coronary artery. After bypass, blood flow is restored but significant heart tissue was lost. Which fo the following will occur first
Pulmonary edema
Obstruction to flow
- stenosis valves or HTN increase pressure required to move blood
- lead to cardiac hypertrophy and fibrosis
Regurgitant flow
- valves do not close properly, increase volume moving backwards
- leads to dilation of heart
Disordered flow
- vessels abnormalities reduce flow to periphery
- aneurysms, coarcted aorta, patent ductus arteriosus
Treatments for flow abnormalities
- fix reason for altered blood flow
- usually surgery and replace old valves with mechanical or animal valves
- generally have to be replaced every couple of decades
A patient presents with a severely stenosis pulmonary valve. Which of the following would you expect on echocardiographic examination of the heart?
Right ventricular hypertrophy
Conduction abnormalities
Arrhythmia
Most dangerous are ventricular fibrillation
Most common are atrial fib
What si the most dangerous conduction abnormalities
Ventricular fibrillation
-need to shock to reset the heart
What is the most common conduction abnormality
Atrial fib
- atria no longer contract in a coordinated way
- will just tremble
Damage to the conducting system causes altered conduction pathways and irregular heart beats
Arrhythmia
Non-contracting atria have what effect on CO
Little effect
-atria only matter at high heart rates or in late heart failure
Lack of contraction in atria can cause what
Pooling of blood
- clots can form on walls
- can break off and embolism in coronary artery, brain, retina, etc
What should all afib patients be on
Anti-coagulant
While examining a 75yo patient he mentions the doctor has changed his medicine and added a “blood thinner”. He doesn’t like the sound of that and asks you if he should be taking it. You say yes because wit could help prevent
Pulmonary embolism
Retinal ischemia
Heart attack
