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Pathophysiology II class notes > Ch. 18 Disorders of Blood Flow and Blood Pressure > Flashcards

Ch. 18 Disorders of Blood Flow and Blood Pressure Flashcards

1
Q

What are the five main types of lipoproteins?

A 
Chylomicrions
Very low density lipoprotein
Low density lipoprotein
Intermediate density lipoprotein
high density lipoprotein
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2
Q

Why is LDL considered the “bad” cholesterol?

A

It is the main carrier of cholesterol and leaves it behind for uptake in the arterial wall.

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3
Q

Why is HDL considered the “good” cholesterol?

A

It carries cholesterol from the tissues to the liver for disposal.

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4
Q

How are blood lipid levels elevated?

A

Nutrition
Genetics
Comorbid conditions
Medications

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5
Q

How does nutrition affect blood lipid levels?

A

High-calorie diet increases production of VLDL and it’s conversion to LDL.

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6
Q

What are the non-modifiable risk factors for atherosclerosis?

A 
Increasing age
Male
Post-menopausal women
Family history of premature CAD
Genetically determined alterations in lipoprotein and cholesterol metabolism
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7
Q

What are the modifiable risk factors for atherosclerosis?

A 
Cigarette smoking
Obesity
Hypertension
Hyperlipidemia
Diabetes mellitus
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8
Q

What are some tests that can show risk factors for atherosclerosis?

A

C-reactive protein
Hyperhomocystinemia
Increased serum lipoprotein

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9
Q

How does tobacco use affect the development of atherosclerosis?

A 
Increases blood lipid levels
Damages endothelium
Enhances thrombosis formation
Increases blood viscosity
Increases circulating catecholamines
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10
Q

What is arteriosclerosis?

A

Hardening of medium to large arteries.

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11
Q

What is arteriosclerosis?

A

Hardening of small arterioles.

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12
Q

What is atherosclerosis?

A

Hardening due to atheromatous plaque.

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13
Q

What are characteristics of stable plaques?

A

Thick fibrous caps
Partially block vessels
Don’t tend to form clots/emboli

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14
Q

What are characteristics of unstable plaques?

A

Thin fibrous caps
May rupture causing clot formation
May completely block artery
Clot may break free

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15
Q

What are the most common sites of atherosclerosis?

A 
Abdominal aorta
Proximal coronary 
Thoracic aorta
Femoral & popliteal 
Iliac
Internal carotid 
Vertebral, basilar, middle cerebral 
*At sites of vascular branches*
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16
Q

What are the tree types of atherosclerotic lesions?

A

Fatty streak
Fibrous atheromatous plaque
Complicated lesion

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17
Q

What are fatty streaks?

A

Fat deposits in the arteries found in all ages/geographic areas/races/lifestyles.

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18
Q

What are fibrous atheromatous plaques?

A

Made of lipids, smooth muscle, and scar tissue.

These predispose to thrombus formation.

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19
Q

What is a complicated lesion?

A

A combination of fatty streak and fibrous atheromatous plaque.

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20
Q

What is peripheral artery disease?

A

Atherosclerosis distal to the aortic arch.

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21
Q

What are the risk factors for peripheral artery disease?

A

Male
>60 years old
Smokers
Diabetes mellitus

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22
Q

What are the manifestations of peripheral artery disease?

A

Intermittent claudication (legs hurt when walking)
Thinning of skin and subcutaneous tissue
Gradual atrophy of muscle
Decreased blood supply

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23
Q

What are the results of decreased blood supply due to periopheral artery disease?

A 
Weak/absent pulses
Cool extremities
Brittle toenails
Hair loss
Pallor
Dependent rubor
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24
Q

How is peripheral artery disease diagnosed?

A 
Blood pressure changes in leg
Pulse changes
Doppler Ultrasound
MRI Ateriography/Spiral CT arteriography
Contrast angiography.
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25
Q

What are the complications of peripheral artery disease?

A

Ulcerations/gangrene

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26
Q

What are the treatment methods for peripheral artery disease?

A 
Walking to the point of claudication 
Avoiding surface injury as slow to heal
Address causes 
Antiplatelet therapy (ASA, Clopidogrel)
Statins
Femoralpopliteal bypass grafting
Percutaneous transluminal angioplasty and stenting
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27
Q

What is raynaud phenomenon?

A

Intense episodic vasospastic disorder of arteries and arterioles
(usually fingers, less often toes)

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28
Q

What are the manifestations of raynaud phenomenon?

A

Tingling and numbness/aching/throbbing pain

Pallor to cyanosis

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29
Q

What are the treatments for raynaud phenomenon?

A

Avoidance of triggers
Avoidance of vasoconstrictive medications
Vasodilatory medications
Sympathectomy.

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30
Q

What are the differences between primary and secondary raynaud phenomenon?

A

Primary: symmetrical
Secondary: non-symmetrical
Associated with pre-existing PAD
Frostbite, occupational trauma (vibrating tools, hot/cold environment)

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31
Q

What is an aneurysm?

A

Abnormal localized dilation of blood vessel.

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32
Q

What are the three forms of true aneurysm?

A

Berry (bipurcation)
Saccular (sac like)
Fusiform (involves the whole circumference of the artery)

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33
Q

What is considered a “false” aneurysm?

A

Dissecting

34
Q

What is the difference between a true and a false aneurysm?

A

In true aneurysms, the arterial wall is intact. In a false aneurysm, the wall is broken (dissecting).

35
Q

How are aortic aneurysms diagnosed?

A

Often discovered during routine X-ray.

Other diagnostics” ECG, ultrasound, MRI, CT

36
Q

What are the manifestations of a thoracic aortic aneurysm?

A 
Substernal, back, neck pain
Pressure on:
Trachea = stridor, cough, dyspnea
Laryngeal nerve = hoarsness
Esophagus = difficulty swallowing
Superior vena cava = facial/neck edema
37
Q

What are the risk factors for an aortic aneurysm?

A

Atherosclerosis

Age+

38
Q

What are the manifestations of an abdominal aortic aneurysm (Triple A)?

A

Asymptomatic
Pulsating mass if >4cm often first sign
Mild to severe abdominal and back pain.

39
Q

What is the most common kind of aortic aneurysm?

A

Abdominal aortic aneurysm

40
Q

What are the complications of an aneurysm?

A

Thrombi
Compression of vasculature and nerves
Rupture

41
Q

What are the risk factors of a dissecting aortic aneurysm?

A 
Hypertension
40-60 year old men
Marfan’s syndrome
Pregnancy
Congenital defects of aortic valve
Aortic coarctation
Blunt trauma
42
Q

What are the manifestations of dissecting aortic aneurysm?

A

Excruciating pain anterior chest and back
Blood pressure
Initially high
Later unobtainable in one or both arms
Syncope
Lower extremity hemiplegia/paralysis
Heart failure if aortic valve involvement

43
Q

How is mean arterial blood pressure calculated?

A

Systolic + two diastolic divided by 3.

44
Q

What is the mean arterial blood pressure?

A

The amount of blood pressure in general that is supplied to your organs.

45
Q

What are the mechanisms of short term regulation of blood pressure?

A 
Neural Mechanisms
Humoral Mechanisms (hormones)
46
Q

What are the mechanisms of long term regulation of blood pressure?

A

Kidneys retain or excrete water and sodium to regulate vascular volume (ECV)

47
Q

What are the neural mechanisms (autonomic nervous system) that mediate blood pressure?

A

Medulla and lower pons

Parasympathetic impulses via vagus nerve to heart = slows HR

Sympathetic impulses via spinal cord & peripheral sympathetic nerves to heart and blood vessels = increased HR and vasoconstriction (jncr PVR).

48
Q

What are the intrinsic reflexes that mediate blood pressure?

A

Baroreceptors/stretch receptors

Chemoreceptors

49
Q

What are the extrinsic reflexes that mediate blood pressure?

A

Diffuse reactions due to pain, cold via hypothalamus/SNS pathways.

50
Q

How do the humoral mechanisms control blood pressure?

A

Renin-Angiotension-Aldosterone System
Released in response to SNS activity, decreased volumes
Converts angiotensin I to angiotension II
Vasopressin (ADH)
Epinephrine

51
Q

What is primary/essential hypertension?

A

Chronic/ Without evidence of other disease processes

52
Q

What are the risk factors for primary/essential hypertension?

A

Family history
Race
Older age
Lifestyle factors

53
Q

What blood pressure is considered hypertensive?

A

140/90 or higher

54
Q

What is secondary hypertension?

A

Results from another disorder.

55
Q

What are the risk factors for secondary hypertension?

A 
Kidney disease
Adrenal cortical disorders
Pheochromocytoma
Coarctation of the Aorta
Pharmaceuticals
Obstructive Sleep Apnea
56
Q

What are lifestyle factors that put people at risk for primary/essential hypertension?

A

High salt/caloric/fat intake
Chronic excessive alcohol consumption
Smoking
Stress

57
Q

Which organs are damaged by hypertension over the long term?

A 
Heart
Brain
Kidney
Liver
Lungs
Eye
58
Q

What is a hypertensive crisis?

A

Elevated BP with impending target organ damage.

59
Q

What blood pressure is considered severe hypertension/hypertensive crisis?

A

180/110 mmHg

60
Q

What blood pressure is an emergency?

A

Diastolic >120 mmHg

61
Q

What is orthostatic hypotension?

A

Sustained drop in BP d/t a change in body position (usually standing)

62
Q

What are the causes of orthostatic hypotension?

A

Reduced blood volume
Pharmaceuticals
Aging
Bedrest/immobility

63
Q

What are the manifestations of orthostatic hypotension?

A

Visual changes
Dizziness
Syncope
Nausea

64
Q

How is orthostatic hypotension defined?

A

Drop in systolic BP of 20 and diastolic BP of 10 when moving from laying down/sitting to standing.

65
Q

How is orthostatic hypotension diagnosed?

A

Lying/Standing Blood Pressure with 2-3 minute wait

Tilt Table

66
Q

What are vericose veins?

A

Diated tortuous veins

67
Q

What are the risk factors for vericose veins?

A

Obesity

>50 years old

68
Q

What do primary vericose veins originate?

A

Originate in superficial saphenous veins

69
Q

What causes primary vericose veins?

A

Caused by prolonged standing, pregnancy, abdominal pressure, prolonged heavy lifting

70
Q

What is secondary varicose veins?

A

Impaired flow in deep veins due to other disease

71
Q

What causes secondary vericose veins?

A

Caused by arteriovenous fistulas
Venous malformations
Tumor
Pregnancy

72
Q

What are the causes of chronic venous insufficiency?

A

Venous hypertension - dilation and stretching of the vessel wall

73
Q

What are the manifestations of chronic venous insufficiency?

A 
Impaired blood flow, which results in:
Edema, impaired tissue nutrition
Ischemia, necrosis
Brown pigmentation (hemosiderin deposits)
Statis dermatitis
Venous ulcers
74
Q

What are the three main risk factors for deep vein thrombosis? (Virchow’s triad)

A

Stasis
Vessel wall injury
Hypercoagulability

75
Q

What are some causes of venous stasis?

A

Bedrest/immobility
SC injury
AMI/CHF/Shock
Venous obstruction

76
Q

What are some causes of vascular trauma?

A

Venous catheters
Surgery, especially orthopedic
Trauma/infection
Fractured hip

77
Q

What are some causes of hypercoagulability?

A 
Genetics 
Stress/trauma
Pregnancy/Childbirth
Oral contraceptives/hormone replacement
Dehydration
Cancer
78
Q

What are the manifestations of deep vein thrombosis?

A 
Often asymptomatic (50%)
Pain
Swelling
Deep muscle tenderness
Signs of inflammation
79
Q

What are some complications of deep vein thrombosis?

A

Pulmonary/cerebral embolus

80
Q

What are the treatments for deep vein thrombosis?

A 
Prevention
Anticoagulation
Elevate limb
Bedrest
Gradual ambulation with elastic support
Heat

Pathophysiology II class notes (15 decks)

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