CH.24 Alterations of cardiovascular function Flashcards
vein which blood has pooled. Distended, tortuous, and palpable veins
Varicose veins
What causes varicose veins?
Trauma or gradual venous distention
When veins and valves become incompetent, backward leaking of blood with pooling occurs. This increases what?
Hydrostatic pressure with second-spacing fluid
Risk factors for varicose veins?
Age, female, family history, obesity, pregnancy, deep vein thrombosis
Tx of varicose veins?
- Compression stockings
- Sclerotherapy
- Laser therapy
- Vein ligation and stripping
Inadequate venous return over a long period of time due to varicose veins or valvular incompetence causes what?
Chronic venous insufficiency
- Venous congestion.
- Increased venous pressure
- Tissue hypoxia
- inflammation
- Fibrosclerotic remodeling
Chronic venous insufficiency
Thrombi obstruct venous flow leading to increased venous pressure
Venous thrombi (clots)
What are contributing factors to venous thrombi?
- Venous stasis
- Venous endothelial damage
- Hypercoagulable
- Other (cancer, orthopedic surgery/trauma, heart failure)
Most clots originate from veins in the ____ _____ (think DVT)
Lower extremities
How to prevent venous thrombi?
VTE prophylaxis using anticoagulants for high-risk patients
How do you diagnose venous thrombi?
Serum D-dimer test and doppler ultrasonography
Treatment for venous thrombi?
- Anticoagulants.
- Thrombolytics
- Inferior vena cava filter
Pulmonary _____ is a potential complication from venous thrombi
emboli
What is superior vena cava syndrome?
Progressive occlusion of the superior vena cava
What typically causes superior vena cava syndrome?
Cancers or thrombosis of CVC’s
Vena caval occlusion leads to _____ ____ of upper extremities and head
venous distention
Symptoms of SVCS
Headache, decreased consciousness, feeling of “fullness” in the head, and tight collars
Is superior vena cava an oncologic emergency?
Yes
What would a patient with superior VC syndrome look like?
presents as neck or facial swelling
How do you diagnose superior VC syndrome
Chest x-ray and venous doppler
Tx for superior VC syndrome
diuretics, anticoagulants, cancer tx, senting, or bypassing the occlusion
- Venous stasis
- Venous endothelial damage
- Hypercoagulable
- Other (cancer, orthopedic surgery/trauma, heart failure)
These factors contribute to?
Venous thrombi
Patient presents with a swollen neck and is complaining of a constant headache that feels “full”. A diagnosis is made after performing chest x-rays and using the venous doppler. The patient receives diuretics and anticoagulants. What does the patient likely have?
Superior Vena Cava syndrome
What indicates hypertension (HTN)
Sustained bp of 140 over 90
Progressive occlusion of the superior vena cava is….
superior vena cava syndrome
How many US adults have HTN
1/3
- Anticoagulants.
- Thrombolytics
- Inferior vena cava filter
There are treatments for…
Venous thrombi
_______ is the consistent elevation of systemic arterial blood pressure
hypertension
Of the 1/3 of adults with hypertension, how many are older than 60 years old?
2/3
Headache, decreased consciousness, feeling of “fullness” in the head, and tight collars. These are symptoms of
Superior Vena Cava syndrome
How do you classify HTN? two main classes.
- Primary vs secondary
2. Complicated and malignant
What are other names for primary hypertension
Essential or idiopathic
What % of people with HTN have primary HTN?
92%-95% of individuals
Which HTN has increased rates among african americans?
Primary
Primary HTN can be caused by high ______ intake
sodium
Primary HTN can be caused by _____ _____ abnormalities
natriuretic peptide
Primary HTN can be caused by ______ (swelling)
inflammation
Which HTN has polygenic origins and is associated with epigenetic changes, diet, and lifestyle?
Primary
Primary HTN can be caused by ______ and ______ resistance
obesity and insulin
Primary HTN can be caused by ______ and heavy use of ______
tobacco and alcohol
The sympathetic nervous system and Renin-angiotensin-aldosterone system are pathophysiologic mechanisms of what?
Primary HTN
High sodium intake, natriuretic peptide abnormalities, inflammation, obesity and insulin resistance, and tobacco+alcohol use. THese are risk factors for
Primary HTN
_____ hypertension is caused by a systemic disease process that raises peripheral vascular resistance or cardiac output
Secondary
Renal vascular or parenchymal disease: increased renin secretion. This is associated with which HTN?
secondary
Adrenocortical tumors: aldosterone secretion. Associated with _____ HTN
secondary
Adrenomedullary tumors: catecholamine secretion. Associated with ______ HTN
secondary
Which drugs can cause secondary HTN?
Oral contraceptives, corticosteroids, and antihistamines
Treatment of HTN is to reduce the numbers to
less than 130 over 80 in most populations
Tx of HTN?
Lifestyle modifications and antihypertensive medications
92%-95% of individuals have this type of HTN
primary
Clinical manifestations of HTN?
- Asymptomatic
- Elevated BP
Diagnosis of HTN
Serial BP measurement and investigation for causative conditions
Chronic hypertensive damage to blood vessels and tissues is indicative of _____ hypertension
complicated
_____ HTN leads to target organ damage in the heart, kidney, brain, and eyes
complicated
_____ HTN causes left ventricular hypertrophy due to pumping against higher pressure which increases myocardial oxygen demand (risk for MI and HF)
Complicated
Which hypertension is a risk for myocardial infarction and heart failure
complicated HTN
_____ hypertension is rrapidly prorgressive
Malignant
With _____ HTN, the diastolic pressure is usually > 140
Malignant
Tx of Malignant HTN?
Antihypertesives
Patient has been in the hospital with an in range BP for a week. Suddenly her BP is 160/90 and she has cerebral edema. The nurse understands she has which type of HTN
Malignant
Decrease in both systolic and diastolic blood pressure upon standing within 3 minutes
Orthostatic (postural) HYPO tension
What is the pathophysiologic mechanism of postural hypotension?
Lack of normal blood pressure compensation in response to gravitational changes on the circulation
- Reflex vasoconstriction mediated by baroreceptors, increased heart rate.
- Impact of venous valves, leg muscle contraction, decreased intrathoracic pressure
Orthostatic (postural) hypotension
Four main causes of orthostatic hypotension?
- medications
- Dehydration
- Immobility
- Venous pooling of blood
Chronic orthostatic hypotension is due to…
chronic diseases
Tx of _____ ____: compression stockings, increase fluid and Na+. These treatments are for primary or secondary?
Orthostatic hypotension; primary
What is the tx for secondary hypotension?
Treat the cause. ex: adrenal insufficiency
Which vessel or cardiac chamber is most susceptible to aneurysms?
Aortic: especially abdominal
What is the most common causes of aortic aneurysms?
Atherosclerosis and hypertension.
What do aneurysms lead to?
Aortic dissection or rupture
____ _____: all arterial wall layers. Fusiform aneurysms, circumferential, and saccular
True aneurysms
____ _____: extravascular hematoma
False aneurysms
Are aneurysms asymptomatic before rupture?
Yes
Are patients hypertensive or hypotensive when an aneurysm ruptures?
Hypotensive
Dx of aneurysm
Imaging studies
Tx of aneurysm
Clipping, coiling, and grafting
____ _____: blood clot that remains attached to the arterial wall
arterial thrombi
Risk factors for arterial thrombi?
Damage to intima (during surgery, trauma), infection, hypotension, aneurysm, and endocarditis(damaged valves)
If a patient gets an arterial thrombi caused by hypotension…what is worst case scenario with that?
From septic shock with Systemic Inflammatory Response Syndrome (SIRS)
What is a potential complication from arterial thrombi?
Thromboembolus
Bolus of matter that is circulating in the blood steam
Arterial embolism
Complication of arterial embolism
Arterial occlusion with subsequent ischemia and tissue hypoxia
Tx of arterial thrombi and embolus
- Anticoagulants
- Thrombolytics
- Manual extraction with catheter
Autoimmune, inflammatory disease of the peripheral arteries
PVD–thromboangiitis obliterans (buerger disease)
Which disease is strongly associated with smoking?
Buerger disease (thrombo obliterans)
Characterized by the formation of thrombi filled with inflammatory and immune cells
PVD (buerger disease)
Thrombi become organized and fibrotic–result in permanent occlusion and obliteration of portions of small and medium sized arteries in feet and sometimes hands
PVD–Buerger disease
Manifestations include pain and tenderness in the affected area. Symptoms are caused by slow, sluggish blood flow.
PVD- thromboangitis obliterans
What does PVD often lead to?
Gangrenous lesions and amputations?
Tx of PVD?
Stop smoking. Vasodilators.
Patient presents with episodic vasospams in her fingers. This is
PVD…the raynaud phenomenon
What causes raynaud phenomenon
Imbalance between endothelium-derived vasodilators and vasoconstrictors
Primary PVD- R. phenomenon
Vasoplastic disorder of unknown origin
Secondary PVD–raynaud phenomenon
Secondary to other systemic diseases or conditions.
- Collagen vascular disease
- Smoking
- Pulmonary hypertension
- Myxedema
- cold env. vib. stress.
Pallor, cyanosis, cold to the touch, and pain
Raynaud phenomenon
Tx of Raynaud
Avoid triggers. Vasodilators
Chronic disease of the arterial system–abnormal thickening and hardening of the vessel walls
Arteriosclerosis
Causes of arteriosclerosis
Loss of elastin with aging and chronic hypertension that results in arterial damage
A form of arteriosclerosis. Thickening and hardening caused . by accumulation of . lipid-laden macrophages
Atherosclerosis
Modifiable risk factors of atheroslerosis
Smoking, diabetes, hypertension, and hyperlipidemia/dys
Progression of ______: inflammation of endothelium, cellular proliferation, LDL oxidation, and fatty streak
Atherosclerosis
Dx of atherosclerosis
Blood tests, scans, and angiography
Tx of atherosclerosis
Eliminate or manage modifiable risk factors. Manage HTN, DM
Complications of atherosclerosis
Stroke, MI (due to inadequate perfusion, ischemia…ultimately leads to infarction
Complications of atherosclerosis
Stroke and MI
PAD stands for
Peripheral Artery Disease
Atherosclerotic disease of arteries that perfuse extremities
PAD
Clinical signs of PAD
Intermittent claudication–pain with ambulation
Dx of PAD
Venous doppler
PAD has an increased risk with what two factors?
Age and smoking
Tx of PAD
Antithrombotic drugs, vasodilators
Any vascular disorder that narrows or occludes the coronary arteries
Coronary Artery Disease
Risk of CAD
Myocardial ischemia, injury, and infarction
Most common cause of CAD?
Atherosclerosis
List some non-modifiable risk factors of CAD
- Increased age
- Family history
- Gender
- post menopause
List some modifiable factors of CAD
- Dyslipidemia
- Hypertension
- Smoking
- Diabetes Mell.
- Obesity/inactive lifestyle
- Atherogenic diet
First sign of CAD?
Transient myocardial ischemia
Angina, ischemic chest pain: substernal pain or pressure…may radiate. Stable angina relieved by rest and nitrate medications
First symptoms of CAD
Prinzmetal angina–a variant angina, due to coronary vasospasm w/ or with out atherosclerosis
First sign of CAD
Management of stable angina
Dx by patient report.
- ECG
- Blood tests for cardiac enzymes
- Angiograms
Tx of stable angina if no MI
- Medications (VasoD)
- Lifestyle modifications
- PCI (percutaneous coronary intervention)
____ angina: symptom of complicated atherosclerotic plaque
unstable
Causes ischemia, which is reversible and if reversed in time will prevent myocardial death
Unstable angina
Temporary loss of contractile ability
Myocardial stunning
Adaptation to decreased O2 supply
Hibernating myocardium
Mycocyte hypertrophy, widespread loss of contractibility
Myocardial remodeling
Manifestations of MI
- Sudden severe chest pain
- Nausea, vomiting
- Diaphoresis
- Dyspnea
Complications of MI
Sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability
Dx of MI
ECG, blood tests, angiogram
Tx of MI
Reperfusion: thrombolytics, emergent PCI with angioplasty, stenting, and revascularization (CABG)
If you suspect a patient is experiencing chest pain or MI, what do you order first?
Oxygen
Clinical signs of pericarditis
Low grade fever, severe chest pain, friction rub on auscultation, ECG changes
Scarred pericardial layers adher
Constrictive pericarditis
What causes constrictive peri.
can be idiopathic, viral infections, and seen with patients with TB (immunocompromised population)
Tx of pericarditis
Anti-inflammatory drugs
Complication of pericarditis
Pericardial effusion
If fluid volume large enough, can cause tamponade
Pericardial effusion
- Distant heart sounds
- Dyspnea on exertion
- Dull chest pain
Signs of effusion
Key clinical sign of tamponade?
Pulsus paradoxus
Dx of pericardial effusion
echocardiogram
Tx of pericardial effusion
Pericardiocentesis
Diseases in which the myocardium itself is diseased or damaged
Cardiomyopathies
Name three types of causes for Cardio myop.
Genetic, non genetic, and mixed
CMYO non genetic causes include…
Secondary to HTN, ischemia, infection, myocarditis
CMYO genetic causes…
Hypertrophic cardiomyopathy (autosomal dominant)
Tests show dilation and thinning of myocardial wall (left V) Structural change with perivascular fibrosis
Dilated Cardiomyopathy
Systolic function is decreased, progressive heart failure, with clinical manifestations such as dyspnea, fatigue, and edema
Dilated CAMY
What is the most common cardiomyopathy?
Hypertrophic cardiomyopathy
Myocyte function disarray, fibrosis, altered sacromere function. Hypertrophy of the LV
Hypertrophic CAMY
Rigidity and noncompliance of myocardial wall (rare)
Restrictive CAMY
What do you see with restrictive CAMY?
Impaired V filling, decreased cardiac output
Dx of CAMY
chest x-ray, echocardiogram, ECG, treadmill test
Tx (depending n cause)
- Drug support
- Myectomy (hypertrophic)
- Pacemaker
- Implant device
- heart transplant
Valves are continuous with the _____
endocardium
Opening is constricted(valves)
Valvular stenosis
____ ____ results in resistance to forward blood flow
Valvular stenosis
Causes of VS
Congenital with aging.
Secondary to inflammation, trauma, ischemia, infection
Complications of VS
cardiomyopathy, MI, HF, dysrhythmias
Most commonVS
Aortic
____ stenosis: negative impact on left ventricle, causing hypertrophy which increases oxygen demand
aortic
_____ stenosis: common form of rheumatic heart disease
Mitral
____ stenosis: negative impact on left atrium, causing atrial dilation and/or hypertrophy
mitral
Patients with mitral stenosis run a risk of
increased risk of atrial fibrillation
Along with congenital, aging, and HTN, what else causes valve regurge?
rheumatic heart disease, endocarditis, and marfan syndrome
Examples of different valve regurges make sense if you know the anatomy
Aorotic overflows the ___
LV
If the tricuspid valve is regurging, what will overload?
THe right ventricle
Clinical sign of regurge?
Dyspnea and fatigue
Percent of people with MVP
3%
MVP, the valve prolapses _____
backward
Systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by rhe group A-B hemolytic strep
Rheumatic fever
____ ______: inflammation of the joints, skin, nervous system, and heart
Febrile illness
If left untreated, rheumatic fever causes
rheumatic heart disease.
Which bacteria causes rheumatic fever
Group A beta hemolytic streptococci
Damage/scarring of valve leaflets, myocarditis, pericardial inflammation, cardiomegaly, left HF…results from untreated
Rheumatic fever
Patient presents with fever, nausea vomiting, tachycardia, abdominal pain, and arthalgia
Rheumatic fever–common signs
Patient presents with carditis, polyarthritis, chorea, and subcutaneous nodules
Major clinical manifestations of rheumatic fever
Tx of rheumatic fever
Antibiotics; anti-inflammatory drugs
Inflammation of the endocardium due to infection
Infective endocarditis
Rickettsiae and parasites can cause
Endocarditis
Patient presents with fever, new or changed cardiac murmur, and has petechial lesions of the skin, and oral mucosa.
Infective endocarditis
Patient presents with osler nodes and janeway lesions.
Endocarditis
Nonpainful hemorrhagic lesions on hte palms and soles
Janeway lesions seen with infective endoCard
Painful erythematous nodules on pads of fingers and toes
Osler nodes seen in patients with Infective endocarditits
Other manifestations of infective endocarditis?
Weight loss, back pain, night sweats, heart failure
Tx of infective endocarditis
Antibiotics
People with prosthetic valves and transplants are given what to prevent I.E
ABX prophylaxis
Cardiac complications of aids
- Myo, endo, and peri carditis. -Left heart failure
- Cardiomyopathy
- Pericardial effusion
- Pulmonary HTN
- Cardiotoxicity from viral drugs
Abnormal impulses can originate from Sinus node, AV node, and….
rogue pacemaker cells in atrial and ventricles
Abnormal conduction is often _____ or ____ conductions
Delayed or slowed
_____ can range from occasional, to rapid, to “blocks” of conduction
Dysrhythmias
Name the two more serious abnormal rhythms that impair the hearts pumping ability
Ventricular tachycardia and ventricular fibrillation
Rapid rhythms. E.G _____
tachycardias
Dx of Dysrhythmias
ECG
Tx of Dysrhythmias
Anti-dysrhythmic medications, radiofrequency ablation, and pacemaker
Prevalence of HF
adults > 65 yrs
Which chamber predominates others when it comes to HF
Left ventricle
Risk factors for HF
-HTN, Ischemic heart disease, valve disease, and cardiomyopathy
____ is the volume in the chamber
preload
_____ is the force of contraction
Contractility
_____ is the peripheral resistance
Afterload
Patient presents with frothy sputum, fatigue, and edema. Physical examination shows pulmonary edema and an S3 gallop. Patient has
Left heart failure
Management of Left HF?
Reduce preload and afterload…typically with drugs
Impaired perfusion of lungs by right ventricle
Right heart failure
Most commonly caused by a diffuse hypoxic pulmonary disease
Right heart failure
Hepatosplenomegaly is a manifestation of
Right heart failure
Inability of the heart to supply the body with blood-borne nutrients despite adequate blood volume and normal or elevated myocardial contractility
High-output failure
What causes high output failure?
Anemia, hyperthyroidism, septicemia, and beriberi
______: cardiovascular system fails to perfuse the tissues adequately
Shock
Shock leads to impaired _____ metabolism
cellular
shock leads to impaired ____ and ____ use
oxygen and suggaaaaa
Manifestations vary based on stage but often include hypOtension, tachycardia, increased RR
Shock
How to manage shock
Fluid resuscitation, vasopressors, and supplemental oxygen. Also, find and treat the cause
Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury
Multiple organ dysfunction syndrome
What causes MODS
sepsis, septic shock, and trauma (burns, major surgery)
Tx of MODS
Treat cause, control infection, restore oxygen and perfusion.
