Cardiovascular system part 2 (Peripheral vascular disorders)

Question 1

Which term refers to the pressure changes occurring during breathing that enhance venous return? Where during inhalation, pressure decreases in the thoracic cavity and increases in the abdominal cavity creating an upward “sucking” effect that pulls blood toward the heart into the right atrial, and then the right ventricle

Answer 1

Respiratory pump

Question 2

Which term refers to when right atrial pressure falls during cardiac diastole, where the elastic potential energy stored in the myocardium during each vigorous contraction is released during diastole, thus creating a negative pressure which sucks blood into the ventricles?

Answer 2

Cardiac suction effect

Question 3

Veins have something called a ___ ___, which prevents bidirectional the movement of blood. We have constant movement of blood toward cardiac system, even against gravity.

Answer 3

• Venous valve

Question 4

Which term refers to distended, torturous, palpable, and superficial veins where it occurs due to stasis of blood within the venous system?

This can be due to trauma to the saphenous (a large, subcutaneous, superficial vein of the leg) results in damage to one or more valves or when blood is not being moved back to heart due to gravity pulling it back down

What are some risk factors for said condition?

Answer 4

Varicose veins
- Older age, female gender, (huge part) family history, other factors that damage the intima, obesity , pregnancy (During we have pressure of growing uterus, not allowing venous return to be done properly, they have some degree of vercose), DVT, & previous leg injury (trauma to vessels & damage the valves)

Question 5

Which term refers to when your leg veins don’t allow blood to flow back up to your heart due to valve dysfunction? (similar to varicose vein)

This can be caused by valvular incompetence, damages to venous due to trauma or previous DVT, obesity, high pressure in venous over a long period(due to sitting or standing for long periods, pregnancy), or family history

What are some risk factors for said condition?

Answer 5

Chronic venous insufficiency

• Sitting or standing for long periods of time, lack of exercise, smoking, & history of DVT

Question 6

Edema to lower extremities – can extend to knees, hyperpigmentation of skin (Brown-colored skin, often near the ankles), Tight feeling in your calves or itchy, pain when walking that stops when you rest, varicose veins, painful leg cramps or muscle spasms, Venous stasis ulcers which might be hard to treat
(Cellular demand because removal of metabolic waste is not
fully met=> increased infection risk are all manifestations of..?

Answer 6

Chronic venous insufficiency

Question 7

Why do thromboemboluses occur more frequently in veins than arteries?

Answer 7

• Occurs more frequently in veins than arteries due to lower pressure.

Question 8

(Thrombus Formation in Veins)
Accumulation of clotting factors and platelets particularly close to valves leads to…?

Age, obesity, pregnancy, smoking, thick blood (increased in RBCS or WBCS polycytopenia), & trauma are all risk factors of..?

& what are the manifestations of said state?

Answer 8

• thrombus formation in a vein, where inflammation around thrombus causes attracting more platelets
• Deep Vein Thrombosis
• Unilateral leg pain starting in calf & cramping, red or discolored skin on the leg, & feeling of warmth on the leg

Question 9

(Thrombus Formation in Veins)

Immobility, age, heart failure leads to..?

Trauma, intravenous medications causes…?

Inherited disorders, pregnancy, oral contraceptives, hormone replacement therapy… lead to…?

Answer 9

• Venous stasis
• Venous endothelial damage
• Hypercoagulable states

Question 10

In venous insufficiency, elevating your legs, wearing support/compressive stockings, & increasing physical exercise will all do what?

Answer 10

• Reduce pain & reduces heaviness.
• Simulates muscle action to push the blood, it’s a preventive action
• Improves circulation

Question 11

Which term refers to the abnormal thickening and hardening of the vessel walls?

Answer 11

Arteriosclerosis

Question 12

Which term refers to the thickening & hardening caused by accumulation of lipid-laden macrophages in the arterial wall? & is also the leading cause of cerebral vascular diseases and coronary artery disease & cerebrovascular disease

What are the causes of said condition?

Answer 12

Atherosclerosis

• Consumption of high fat & cholesterol containing LDL foods,
• Hypertension, smoking and obesity (inhibits the oxidation of LDL)
  -Diabetes, hyperlipidemia
  -Insulin resistance, infection & periodontal disease

Question 13

Partial vessel occlusion which can result in transient ischemic events during exercising or stress, tissue infarction, & obstruction of peripheral arteries causing significant pain & disability are all manifestations of..?

It usually starts with lipids first, and the WBCs start swallowing the lipids, and these macrophages trying to swallow the lipids create foam cells. These foam cells get ruptured and release some growth factors and cytokines. These cytokines aggregate inflammation process making the situation even worse. Inflammation is one huge factor & level of lipids. LDL is the lipid in question. This accumulation of debris, will decrease the size of vessel lumen, creating venous insufficiency, hypertension, etc.. Sometimes some of these plugs an be ruptured, and increase risk for creation of clots over the plug, then we might have total obstruction. This can happen in our heart or bran vessels, creating stroke or infraction in the heart.

Also, if there is a systemic presentation in one area, what does that mean?

Answer 13

Atherosclerosis

• It may indicate risk for complications elsewhere

Question 14

Which term refers to the system that controls blood pressure & is a long-term regulatory factor of blood pressure?

Answer 14

• Renin-angiotensin-aldosterone system (RAAS)

Question 15

Which term refers to a high blood pressure of a systolic blood pressure > 140 mm Hg - OR
Diastolic blood pressure > 90 mm Hg? & 90% of Canadians will develop this condition in a normal lifespan

It also puts people at risk for developing cardiac events, kidney disease, and stroke

Answer 15

Hypertension

Question 16

This type of high blood pressure accounts for 92-95% of the populous, & is due to a primary disease with no known cause?

This type of high blood pressure accounts for 5-8% of the populous, & is caused by underlying disease such as possibly renal diseases?

Which term refers to when blood pressure readings at a health care provider’s office are higher than they are in other settings, such as at home?

& which term refers to a blood pressure reading of less than 90/60?

Answer 16

• Primary hypertension
• Secondary hypertension
• White coat hypertension
• Hypotension

Question 17

Which type of hypertension is also called idiopathic hypertension since there aren’t any known defined reason for it, where It can be genetic & passed to offspring?

Answer 17

• Primary hypertension

Question 18

High sodium intake, natriuretic peptide abnormalities, inflammation within vessels, obesity, & Insulin resistance (Type 2 diabetes) are all risk factors for..?

Answer 18

• Primary hypertension

Question 19

Which term refers to substances made in your heart, which are involved inthe long-term regulation of sodium and water balance, blood volume & arterial pressure? Where high levels indicate insufficient pumping by the heart

& name the 2 major pathways of this peptides actions

Answer 19

Natriuretic peptides (NPs)

• 1) Vasodilator effects, & 2) Renal effects that leads to natriuresis (sodium excretion in the urine through the action of the kidney) & diuresis (increased urination).

Question 20

(Hypertension)
Increase in sodium which leads to increase plasma volume, which increases stroke volume causing…?

Vasoconstriction peripheral vascular arterioles – increases calcium mediated contraction in smooth muscle… causing…?

What is primary hypertension mainly related to?

Answer 20

• Increases in systolic blood pressure (SBP)
• Increases in diastolic blood pressure (DBP)
• Increases in peripheral resistance

Question 21

(Causes of primary hypertension)
Beta 1 (increases SA node, AV node, & ventricular muscular firing) = increased heart rate and contraction force =increased BP

Alpha 1 = peripheral vasoconstriction = = increased BP

Increased ADH (antidiuretic hormone) = kidneys release less water = Increased BP.

These are all components of which system? what binds to these receptors? & how does this system contribute to primary hypertension?

Answer 21

• Increase in SNS, leads to the development & sustaining of hypertension:
• Epinephrine/Norepinephrine

Question 22

(Causes of primary hypertension)
RAAS: Renin => Angiotensin I= > ACE in lungs => Angiotensin I to ANGIOTENSION II… Which causes___ leading to___ & also causes secretion of ___ from the adrenal cortex which retains sodium & the reabsorption of water, which increases ___

Answer 22

• Vasoconstriction; increased bp
• Aldosterone; increased bp

Question 23

(Causes of primary hypertension) What is the peptide called that issecreted primarily by the atrial myocardium in response to dilation & functions to reduce arterial pressure by decreasing blood volume and systemic vascular resistance?

What is it called when this peptide is decreased or isnt functioning well & how does that affect bp?

Answer 23

• Natriuretic peptides
• Natriuretic peptides dysfunction (NPD), promoting arterial hypertension

Question 24

(Causes of primary hypertension) What is the term called that causes the hardening and narrowing of the arteries, & thus increasing the cardiac force?

& how does that affect bp?

Answer 24

• Atherosclerosis
• Increases bp

Question 25

(Causes of primary hypertension) Which disease state increases atherosclerosis & increases sodium with decreases in potassium, magnesium, and calcium?

& how does that affect bp?

Answer 25

Diabetes
- Increases bp

Question 26

(Causes of primary hypertension)

What is it called when the vessels constrict instead of dilating?

Answer 26

Endothelial (lining of arteries) dysfunction, increasing bp

Question 27

(Pathological Effects of Sustained, Complicated Primary Hypertension)

Left ventricular hypertrophy, angina, heart failure, MI as heart is having to work too hard… are all potential pathological effects caused…? To the …?

Answer 27

• Increased workload combined with diminished blood flow through coronary arteries of the myocardium

Question 28

Renal complications, arterial sclerosis (thickening over time due to increased pressure) & damage to endothelium, cerebrovascular complications such as transient ischemia, stroke, cerebral thrombosis, aneurysm, hemorrhage, & dementia – too much volume is pumped through vessels

Are all pathological effects of ____

Answer 28

Complicated Primary Hypertension

Question 29

(Pathological effects of sustained, complicated primary hypertension)

Which term refers to retinal vascular damage caused by hypertension where fundus examination shows: vascular changes, hemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema?

Answer 29

Hypertensive retinopathy

Question 30

(Pathological effects of sustained, complicated primary hypertension)

Which term refers to the medical emergency of a bp > 180/120 where there is a rapid progression of hypertension causing an increase in arterial pressure, & vascular fluid is pushed into interstitial space leading to cerebral edema or encephalopathy – other systems involved – medical emergency?

Answer 30

Hypertensive crisis

Question 31

Which type of hypertension is caused by a systemic disease process that raises peripheral vascular resistance or cardiac output? Such as Renal vascular or parenchymal disease, (renal failure) OR.. Adrenal tumours: adrenocortical tumors or adrenomedullary tumors; OR… Medications: NSAIDS, acetaminophen

What does it frequently involve though?

Answer 31

Secondary hypertension

• Kidneys, where if you fix the disease the hypertension will be solved

Question 32

Why is hypertension labeled as a silent killer?

& what do manifestations include once damage is done?

Answer 32

Since it is frequently asymptomatic until affected organ disease (no manifestations early on)

• Heart disease , myocardial infarction, cerebrovascular accident (CVA or stroke), kidney failure, vision loss
  headaches, epitaxies (nose bleeds), confusion, & dyspnea

Question 33

Which term refers to low blood pressure occuring when there is one or a combination of the following factors: decrease in blood volume, vasodilation, &/or decrease in cardiac contractility ?

Answer 33

Severe hypotension

Question 34

Symptoms of hypotension include..?

Answer 34

fatigue, lightheadedness, dizziness, nausea, clammy skin, depression, loss of consciousness, blurry vision, & irritation

Question 35

Pregnancy, large amounts of blood loss, heart attack or faulty valves causing impaired circulation, weakness & a state of shock, anaphylactic, infections of the bloodstream, & endocrine disorders such asdiabetes,adrenal insufficiency, and thyroid disease. Are all potential causes for…?

Answer 35

Acute Hypotension

Question 36

Which term refers to a sudden decrease in bp from moving from sitting to standing, or from lying down to standing, gravity acts on the vascular system which reduces the volume of blood returning to the heart and blood pools in the leg?
Where the lower venous return reduces the volume of blood that is available to pump out of the heart, which causes a drop in Cardiac output and a momentary drop in BP. This drop can be particularly marked when moving from lying down to standing and can increase the risk of falls.

Answer 36

Orthostatic hypotension

Question 37

Which term refers to a localized dilation or outpouching of a vessel wall or cardiac chamber?

Answer 37

Aneurysm

Question 38

Which term refers to an aneurysm involving all three layers of the arterial wall and are best described as a weakening of the vessel wall? Where the artery or vessel weakens and bulges, sometimes forming a blood-filled sac

Answer 38

True aneurysm

Question 39

Which term refers to when a blood vessel wall is injured and the leaking blood collects in the surrounding tissue leading to an extravascular hematoma?

Answer 39

False aneurysm, a pseudoaneurysm, or pseudoaneurysm of the vessels

Question 40

Which term refers to an aneurysm that splits the vessel wall along the length of the vessel?

Answer 40

Dissecting aneurysm

Question 41

Which types of aneurysms are the most common?

Answer 41

Abdominal aortic aneurysms (AAA) & thoracic aortic Aneurysm

Question 42

Smoking, bad diet, atherosclerosis, & hypertension are all risk factors for..?

Answer 42

Aneurysms

Question 43

Manifestations of aneurysms depend on..?

Where they can be..?

Answer 43

• Location
• Can be asymptomatic until they rupture, causing severe pain & hypotension

Question 44

Dysphagia, dyspnea – bulge affects surrounding tissue are all manifestations of which type of aneurysm?

Answer 44

Thoracic aneurysm

Question 45

Ischemia to lower limbs occurs if this type of aneurysm affects circulation..?

Answer 45

Femoral aneurysm

Question 46

Which often occur in the circle of Willis, are associated with signs and symptoms of increased intracranial pressure. Signs and symptoms of stroke occur when this type of aneurysms leak

This is…?

Answer 46

Cerebral aneurysm

Question 47

___ ____ presents with hypotension and severe back pain – large amount of bleeding internally, moves into lower extremities due to gravity

Answer 47

Ruptured aneurysm

Question 48

Which term refers to the obstruction of a vessel by an embolus—a bolus of matter circulating in the bloodstream? The embolus may consist of a dislodged thrombus; an air bubble; an aggregate of amniotic fluid; an aggregate of fat, bacteria, or cancer cells; or a foreign substance. An embolus travels in the bloodstream until it reaches a vessel through which it cannot pass.

Answer 48

Embolism

Question 49

(Dislodged thrombus)
Pulmonary emboli originate on the ___? Usually due to ___

Arterial emboli originate in ___ ___? Due to __?

Answer 49

• On the venous side, usually due to a DVT
• Left ventricle, after a MI, valvular disease, endocarditis, & dysrhythmias

Question 50

Which term refers to a bolus of air that displaces blood in vasculature; source usually room air entering circulation through intravenous (IV) lines; trauma to chest also may allow air from lungs to enter vascular space?

Answer 50

Air embolism

Question 51

Which term refers to extensive intra-abdominal pressure attending labour and delivery can force amniotic fluid into bloodstream of mother; introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and immune responses?

Answer 51

Amniotic fluid embolism

Question 52

Which term refers to globules of fat floating in bloodstream associated with trauma to long bones; lungs in particular are affected?

Answer 52

Fat embolism

Question 53

Which term refers to an aggregate of bacteria in the bloodstream; source is subacute bacterial endocarditis or abscess?

Answer 53

Bacterial embolism

Question 54

Which term refers to small particles or fibres introduced during trauma or through an IV or intra-arterial line; coagulation cascade is initiated and thromboemboli form around particles?

Answer 54

Foreign matter embolism

Question 55

What does an embolism cause in tissue distal to obstruction?

Answer 55

• Ischemia or infarction, & can be life threatening depending on the location.
  It also produced organ dysfunction & pain

Question 56

What will occlusion in the coronary artery cause..?

What will occlusion in the cerebral artery cause..?

What will occlusion in the pulmonary artery cause..?

Answer 56

• MI
• Stroke
• Emboly

Question 57

Which term refers to atherosclerotic disease of arteries in limbs, with intermittent claudication, which is muscle pain that happens when you’re active and stops when you rest?

Answer 57

Peripheral artery disease

Question 58

When peripheral artery disease is gradual, what occurs?

Answer 58

• There is pain with ambulation, such as walking more than 50 steps, or climbing the stairs, and it stops if ambulation stops

Question 59

When peripheral artery disease is acute, what occurs?

Answer 59

• Thrombus development over atherosclerotic lesion

Question 60

Which term refers to an inflammatory disease of the peripheral arteries, that is strongly associated with smoking, where this disease condition is characterized by the formation of thrombi filled with inflammatory and immune cells, also, over time, these thrombi become organized and fibrotic and result in permanent occlusion and obliteration of portions of small- and medium-sized arteries in the feet and sometimes in the hands?

Symptoms of said disease condition are…? Which are caused by manifestations are caused by sluggish blood flow and include rubor (redness of the skin), which is caused by dilated capillaries under the skin, and cyanosis, which is caused by tissue ischemia.

Due to dilated capillaries under skin, the skin becomes..?

This disease has also been associated with..?

Answer 60

• Thromboangiitis Obliterans (Buerger’s Disease)
• Pain & tenderness.
• Skin is thin and shiny & nails are thick and deformed
• Cerebrovascular disease (stroke), & rheumatic symptoms (joint pain)

Question 61

Which term refers to a disease that is characterized by attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, the toes?

The primary type of this disease is…?

The secondary type of this disease is…?

Answer 61

Raynaud Phenomenon
- Primary Raynaud phenomenon: Is a common primary vasospastic disorder of unknown origin

• Secondary Raynaud phenomenon: Is associated with systemic diseases, such as lupus

Question 62

Which disease is associated with clinical manifestations such as changes in skin colour and sensation caused by ischemia, & vasospasm occurs with varying frequency and severity and causes pallor, numbness, and the sensation of coldness in the digits?

Answer 62

Raynaud Phenomenon