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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
What are the complications of peripheral artery disease?
Ulcerations/gangrene
26
What are the treatment methods for peripheral artery disease?
``` 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 ```
27
What is raynaud phenomenon?
Intense episodic vasospastic disorder of arteries and arterioles (usually fingers, less often toes)
28
What are the manifestations of raynaud phenomenon?
Tingling and numbness/aching/throbbing pain | Pallor to cyanosis
29
What are the treatments for raynaud phenomenon?
Avoidance of triggers Avoidance of vasoconstrictive medications Vasodilatory medications Sympathectomy.
30
What are the differences between primary and secondary raynaud phenomenon?
Primary: symmetrical Secondary: non-symmetrical Associated with pre-existing PAD Frostbite, occupational trauma (vibrating tools, hot/cold environment)
31
What is an aneurysm?
Abnormal localized dilation of blood vessel.
32
What are the three forms of true aneurysm?
Berry (bipurcation) Saccular (sac like) Fusiform (involves the whole circumference of the artery)
33
What is considered a "false" aneurysm?
Dissecting
34
What is the difference between a true and a false aneurysm?
In true aneurysms, the arterial wall is intact. In a false aneurysm, the wall is broken (dissecting).
35
How are aortic aneurysms diagnosed?
Often discovered during routine X-ray. | Other diagnostics" ECG, ultrasound, MRI, CT
36
What are the manifestations of a thoracic aortic aneurysm?
``` Substernal, back, neck pain Pressure on: Trachea = stridor, cough, dyspnea Laryngeal nerve = hoarsness Esophagus = difficulty swallowing Superior vena cava = facial/neck edema ```
37
What are the risk factors for an aortic aneurysm?
Atherosclerosis | Age+
38
What are the manifestations of an abdominal aortic aneurysm (Triple A)?
Asymptomatic Pulsating mass if >4cm often first sign Mild to severe abdominal and back pain.
39
What is the most common kind of aortic aneurysm?
Abdominal aortic aneurysm
40
What are the complications of an aneurysm?
Thrombi Compression of vasculature and nerves Rupture
41
What are the risk factors of a dissecting aortic aneurysm?
``` Hypertension 40-60 year old men Marfan’s syndrome Pregnancy Congenital defects of aortic valve Aortic coarctation Blunt trauma ```
42
What are the manifestations of dissecting aortic aneurysm?
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
How is mean arterial blood pressure calculated?
Systolic + two diastolic divided by 3.
44
What is the mean arterial blood pressure?
The amount of blood pressure in general that is supplied to your organs.
45
What are the mechanisms of short term regulation of blood pressure?
``` Neural Mechanisms Humoral Mechanisms (hormones) ```
46
What are the mechanisms of long term regulation of blood pressure?
Kidneys retain or excrete water and sodium to regulate vascular volume (ECV)
47
What are the neural mechanisms (autonomic nervous system) that mediate blood pressure?
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
What are the intrinsic reflexes that mediate blood pressure?
Baroreceptors/stretch receptors | Chemoreceptors
49
What are the extrinsic reflexes that mediate blood pressure?
Diffuse reactions due to pain, cold via hypothalamus/SNS pathways.
50
How do the humoral mechanisms control blood pressure?
Renin-Angiotension-Aldosterone System Released in response to SNS activity, decreased volumes Converts angiotensin I to angiotension II Vasopressin (ADH) Epinephrine
51
What is primary/essential hypertension?
Chronic/ Without evidence of other disease processes
52
What are the risk factors for primary/essential hypertension?
Family history Race Older age Lifestyle factors
53
What blood pressure is considered hypertensive?
140/90 or higher
54
What is secondary hypertension?
Results from another disorder.
55
What are the risk factors for secondary hypertension?
``` Kidney disease Adrenal cortical disorders Pheochromocytoma Coarctation of the Aorta Pharmaceuticals Obstructive Sleep Apnea ```
56
What are lifestyle factors that put people at risk for primary/essential hypertension?
High salt/caloric/fat intake Chronic excessive alcohol consumption Smoking Stress
57
Which organs are damaged by hypertension over the long term?
``` Heart Brain Kidney Liver Lungs Eye ```
58
What is a hypertensive crisis?
Elevated BP with impending target organ damage.
59
What blood pressure is considered severe hypertension/hypertensive crisis?
180/110 mmHg
60
What blood pressure is an emergency?
Diastolic >120 mmHg
61
What is orthostatic hypotension?
Sustained drop in BP d/t a change in body position (usually standing)
62
What are the causes of orthostatic hypotension?
Reduced blood volume Pharmaceuticals Aging Bedrest/immobility
63
What are the manifestations of orthostatic hypotension?
Visual changes Dizziness Syncope Nausea
64
How is orthostatic hypotension defined?
Drop in systolic BP of 20 and diastolic BP of 10 when moving from laying down/sitting to standing.
65
How is orthostatic hypotension diagnosed?
Lying/Standing Blood Pressure with 2-3 minute wait | Tilt Table
66
What are vericose veins?
Diated tortuous veins
67
What are the risk factors for vericose veins?
Obesity | >50 years old
68
What do primary vericose veins originate?
Originate in superficial saphenous veins
69
What causes primary vericose veins?
Caused by prolonged standing, pregnancy, abdominal pressure, prolonged heavy lifting
70
What is secondary varicose veins?
Impaired flow in deep veins due to other disease
71
What causes secondary vericose veins?
Caused by arteriovenous fistulas Venous malformations Tumor Pregnancy
72
What are the causes of chronic venous insufficiency?
Venous hypertension - dilation and stretching of the vessel wall
73
What are the manifestations of chronic venous insufficiency?
``` Impaired blood flow, which results in: Edema, impaired tissue nutrition Ischemia, necrosis Brown pigmentation (hemosiderin deposits) Statis dermatitis Venous ulcers ```
74
What are the three main risk factors for deep vein thrombosis? (Virchow's triad)
Stasis Vessel wall injury Hypercoagulability
75
What are some causes of venous stasis?
Bedrest/immobility SC injury AMI/CHF/Shock Venous obstruction
76
What are some causes of vascular trauma?
Venous catheters Surgery, especially orthopedic Trauma/infection Fractured hip
77
What are some causes of hypercoagulability?
``` Genetics Stress/trauma Pregnancy/Childbirth Oral contraceptives/hormone replacement Dehydration Cancer ```
78
What are the manifestations of deep vein thrombosis?
``` Often asymptomatic (50%) Pain Swelling Deep muscle tenderness Signs of inflammation ```
79
What are some complications of deep vein thrombosis?
Pulmonary/cerebral embolus
80
What are the treatments for deep vein thrombosis?
``` Prevention Anticoagulation Elevate limb Bedrest Gradual ambulation with elastic support Heat ```

Pathophysiology II class notes (15 decks)

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