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380: Patho/Physio > CH.24 Alterations of cardiovascular function > Flashcards

CH.24 Alterations of cardiovascular function Flashcards

1
Q

vein which blood has pooled. Distended, tortuous, and palpable veins

A

Varicose veins

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2
Q

What causes varicose veins?

A

Trauma or gradual venous distention

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3
Q

When veins and valves become incompetent, backward leaking of blood with pooling occurs. This increases what?

A

Hydrostatic pressure with second-spacing fluid

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4
Q

Risk factors for varicose veins?

A

Age, female, family history, obesity, pregnancy, deep vein thrombosis

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5
Q

Tx of varicose veins?

A
  1. Compression stockings
  2. Sclerotherapy
  3. Laser therapy
  4. Vein ligation and stripping
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6
Q

Inadequate venous return over a long period of time due to varicose veins or valvular incompetence causes what?

A

Chronic venous insufficiency

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7
Q
  1. Venous congestion.
  2. Increased venous pressure
  3. Tissue hypoxia
  4. inflammation
  5. Fibrosclerotic remodeling
A

Chronic venous insufficiency

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8
Q

Thrombi obstruct venous flow leading to increased venous pressure

A

Venous thrombi (clots)

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9
Q

What are contributing factors to venous thrombi?

A
  1. Venous stasis
  2. Venous endothelial damage
  3. Hypercoagulable
  4. Other (cancer, orthopedic surgery/trauma, heart failure)
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10
Q

Most clots originate from veins in the ____ _____ (think DVT)

A

Lower extremities

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11
Q

How to prevent venous thrombi?

A

VTE prophylaxis using anticoagulants for high-risk patients

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12
Q

How do you diagnose venous thrombi?

A

Serum D-dimer test and doppler ultrasonography

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13
Q

Treatment for venous thrombi?

A
  1. Anticoagulants.
  2. Thrombolytics
  3. Inferior vena cava filter
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14
Q

Pulmonary _____ is a potential complication from venous thrombi

A

emboli

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15
Q

What is superior vena cava syndrome?

A

Progressive occlusion of the superior vena cava

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16
Q

What typically causes superior vena cava syndrome?

A

Cancers or thrombosis of CVC’s

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17
Q

Vena caval occlusion leads to _____ ____ of upper extremities and head

A

venous distention

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18
Q

Symptoms of SVCS

A

Headache, decreased consciousness, feeling of “fullness” in the head, and tight collars

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19
Q

Is superior vena cava an oncologic emergency?

A

Yes

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20
Q

What would a patient with superior VC syndrome look like?

A

presents as neck or facial swelling

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21
Q

How do you diagnose superior VC syndrome

A

Chest x-ray and venous doppler

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22
Q

Tx for superior VC syndrome

A

diuretics, anticoagulants, cancer tx, senting, or bypassing the occlusion

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23
Q
  1. Venous stasis
  2. Venous endothelial damage
  3. Hypercoagulable
  4. Other (cancer, orthopedic surgery/trauma, heart failure)
    These factors contribute to?
A

Venous thrombi

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24
Q

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?

A

Superior Vena Cava syndrome

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25
Q

What indicates hypertension (HTN)

A

Sustained bp of 140 over 90

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26
Q

Progressive occlusion of the superior vena cava is….

A

superior vena cava syndrome

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27
Q

How many US adults have HTN

A

1/3

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28
Q
  1. Anticoagulants.
  2. Thrombolytics
  3. Inferior vena cava filter
    There are treatments for…
A

Venous thrombi

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29
Q

_______ is the consistent elevation of systemic arterial blood pressure

A

hypertension

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30
Q

Of the 1/3 of adults with hypertension, how many are older than 60 years old?

A

2/3

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31
Q

Headache, decreased consciousness, feeling of “fullness” in the head, and tight collars. These are symptoms of

A

Superior Vena Cava syndrome

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32
Q

How do you classify HTN? two main classes.

A
  1. Primary vs secondary

2. Complicated and malignant

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33
Q

What are other names for primary hypertension

A

Essential or idiopathic

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34
Q

What % of people with HTN have primary HTN?

A

92%-95% of individuals

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35
Q

Which HTN has increased rates among african americans?

A

Primary

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36
Q

Primary HTN can be caused by high ______ intake

A

sodium

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37
Q

Primary HTN can be caused by _____ _____ abnormalities

A

natriuretic peptide

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38
Q

Primary HTN can be caused by ______ (swelling)

A

inflammation

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39
Q

Which HTN has polygenic origins and is associated with epigenetic changes, diet, and lifestyle?

A

Primary

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40
Q

Primary HTN can be caused by ______ and ______ resistance

A

obesity and insulin

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41
Q

Primary HTN can be caused by ______ and heavy use of ______

A

tobacco and alcohol

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42
Q

The sympathetic nervous system and Renin-angiotensin-aldosterone system are pathophysiologic mechanisms of what?

A

Primary HTN

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43
Q

High sodium intake, natriuretic peptide abnormalities, inflammation, obesity and insulin resistance, and tobacco+alcohol use. THese are risk factors for

A

Primary HTN

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44
Q

_____ hypertension is caused by a systemic disease process that raises peripheral vascular resistance or cardiac output

A

Secondary

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45
Q

Renal vascular or parenchymal disease: increased renin secretion. This is associated with which HTN?

A

secondary

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46
Q

Adrenocortical tumors: aldosterone secretion. Associated with _____ HTN

A

secondary

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47
Q

Adrenomedullary tumors: catecholamine secretion. Associated with ______ HTN

A

secondary

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48
Q

Which drugs can cause secondary HTN?

A

Oral contraceptives, corticosteroids, and antihistamines

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49
Q

Treatment of HTN is to reduce the numbers to

A

less than 130 over 80 in most populations

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50
Q

Tx of HTN?

A

Lifestyle modifications and antihypertensive medications

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51
Q

92%-95% of individuals have this type of HTN

A

primary

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52
Q

Clinical manifestations of HTN?

A
  • Asymptomatic

- Elevated BP

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53
Q

Diagnosis of HTN

A

Serial BP measurement and investigation for causative conditions

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54
Q

Chronic hypertensive damage to blood vessels and tissues is indicative of _____ hypertension

A

complicated

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55
Q

_____ HTN leads to target organ damage in the heart, kidney, brain, and eyes

A

complicated

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56
Q

_____ HTN causes left ventricular hypertrophy due to pumping against higher pressure which increases myocardial oxygen demand (risk for MI and HF)

A

Complicated

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57
Q

Which hypertension is a risk for myocardial infarction and heart failure

A

complicated HTN

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58
Q

_____ hypertension is rrapidly prorgressive

A

Malignant

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59
Q

With _____ HTN, the diastolic pressure is usually > 140

A

Malignant

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60
Q

Tx of Malignant HTN?

A

Antihypertesives

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61
Q

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

A

Malignant

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62
Q

Decrease in both systolic and diastolic blood pressure upon standing within 3 minutes

A

Orthostatic (postural) HYPO tension

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63
Q

What is the pathophysiologic mechanism of postural hypotension?

A

Lack of normal blood pressure compensation in response to gravitational changes on the circulation

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64
Q
  • Reflex vasoconstriction mediated by baroreceptors, increased heart rate.
  • Impact of venous valves, leg muscle contraction, decreased intrathoracic pressure
A

Orthostatic (postural) hypotension

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65
Q

Four main causes of orthostatic hypotension?

A
  1. medications
  2. Dehydration
  3. Immobility
  4. Venous pooling of blood
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66
Q

Chronic orthostatic hypotension is due to…

A

chronic diseases

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67
Q

Tx of _____ ____: compression stockings, increase fluid and Na+. These treatments are for primary or secondary?

A

Orthostatic hypotension; primary

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68
Q

What is the tx for secondary hypotension?

A

Treat the cause. ex: adrenal insufficiency

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69
Q

Which vessel or cardiac chamber is most susceptible to aneurysms?

A

Aortic: especially abdominal

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70
Q

What is the most common causes of aortic aneurysms?

A

Atherosclerosis and hypertension.

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71
Q

What do aneurysms lead to?

A

Aortic dissection or rupture

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72
Q

____ _____: all arterial wall layers. Fusiform aneurysms, circumferential, and saccular

A

True aneurysms

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73
Q

____ _____: extravascular hematoma

A

False aneurysms

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74
Q

Are aneurysms asymptomatic before rupture?

A

Yes

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75
Q

Are patients hypertensive or hypotensive when an aneurysm ruptures?

A

Hypotensive

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76
Q

Dx of aneurysm

A

Imaging studies

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77
Q

Tx of aneurysm

A

Clipping, coiling, and grafting

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78
Q

____ _____: blood clot that remains attached to the arterial wall

A

arterial thrombi

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79
Q

Risk factors for arterial thrombi?

A

Damage to intima (during surgery, trauma), infection, hypotension, aneurysm, and endocarditis(damaged valves)

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80
Q

If a patient gets an arterial thrombi caused by hypotension…what is worst case scenario with that?

A

From septic shock with Systemic Inflammatory Response Syndrome (SIRS)

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81
Q

What is a potential complication from arterial thrombi?

A

Thromboembolus

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82
Q

Bolus of matter that is circulating in the blood steam

A

Arterial embolism

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83
Q

Complication of arterial embolism

A

Arterial occlusion with subsequent ischemia and tissue hypoxia

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84
Q

Tx of arterial thrombi and embolus

A
  • Anticoagulants
  • Thrombolytics
  • Manual extraction with catheter
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85
Q

Autoimmune, inflammatory disease of the peripheral arteries

A

PVD–thromboangiitis obliterans (buerger disease)

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86
Q

Which disease is strongly associated with smoking?

A

Buerger disease (thrombo obliterans)

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87
Q

Characterized by the formation of thrombi filled with inflammatory and immune cells

A

PVD (buerger disease)

88
Q

Thrombi become organized and fibrotic–result in permanent occlusion and obliteration of portions of small and medium sized arteries in feet and sometimes hands

A

PVD–Buerger disease

89
Q

Manifestations include pain and tenderness in the affected area. Symptoms are caused by slow, sluggish blood flow.

A

PVD- thromboangitis obliterans

90
Q

What does PVD often lead to?

A

Gangrenous lesions and amputations?

91
Q

Tx of PVD?

A

Stop smoking. Vasodilators.

92
Q

Patient presents with episodic vasospams in her fingers. This is

A

PVD…the raynaud phenomenon

93
Q

What causes raynaud phenomenon

A

Imbalance between endothelium-derived vasodilators and vasoconstrictors

94
Q

Primary PVD- R. phenomenon

A

Vasoplastic disorder of unknown origin

95
Q

Secondary PVD–raynaud phenomenon

A

Secondary to other systemic diseases or conditions.

  • Collagen vascular disease
  • Smoking
  • Pulmonary hypertension
  • Myxedema
  • cold env. vib. stress.
96
Q

Pallor, cyanosis, cold to the touch, and pain

A

Raynaud phenomenon

97
Q

Tx of Raynaud

A

Avoid triggers. Vasodilators

98
Q

Chronic disease of the arterial system–abnormal thickening and hardening of the vessel walls

A

Arteriosclerosis

99
Q

Causes of arteriosclerosis

A

Loss of elastin with aging and chronic hypertension that results in arterial damage

100
Q

A form of arteriosclerosis. Thickening and hardening caused . by accumulation of . lipid-laden macrophages

A

Atherosclerosis

101
Q

Modifiable risk factors of atheroslerosis

A

Smoking, diabetes, hypertension, and hyperlipidemia/dys

102
Q

Progression of ______: inflammation of endothelium, cellular proliferation, LDL oxidation, and fatty streak

A

Atherosclerosis

103
Q

Dx of atherosclerosis

A

Blood tests, scans, and angiography

104
Q

Tx of atherosclerosis

A

Eliminate or manage modifiable risk factors. Manage HTN, DM

105
Q

Complications of atherosclerosis

A

Stroke, MI (due to inadequate perfusion, ischemia…ultimately leads to infarction

106
Q

Complications of atherosclerosis

A

Stroke and MI

107
Q

PAD stands for

A

Peripheral Artery Disease

108
Q

Atherosclerotic disease of arteries that perfuse extremities

A

PAD

109
Q

Clinical signs of PAD

A

Intermittent claudication–pain with ambulation

110
Q

Dx of PAD

A

Venous doppler

111
Q

PAD has an increased risk with what two factors?

A

Age and smoking

112
Q

Tx of PAD

A

Antithrombotic drugs, vasodilators

113
Q

Any vascular disorder that narrows or occludes the coronary arteries

A

Coronary Artery Disease

114
Q

Risk of CAD

A

Myocardial ischemia, injury, and infarction

115
Q

Most common cause of CAD?

A

Atherosclerosis

116
Q

List some non-modifiable risk factors of CAD

A
  • Increased age
  • Family history
  • Gender
  • post menopause
117
Q

List some modifiable factors of CAD

A
  • Dyslipidemia
  • Hypertension
  • Smoking
  • Diabetes Mell.
  • Obesity/inactive lifestyle
  • Atherogenic diet
118
Q

First sign of CAD?

A

Transient myocardial ischemia

119
Q

Angina, ischemic chest pain: substernal pain or pressure…may radiate. Stable angina relieved by rest and nitrate medications

A

First symptoms of CAD

120
Q

Prinzmetal angina–a variant angina, due to coronary vasospasm w/ or with out atherosclerosis

A

First sign of CAD

121
Q

Management of stable angina

A

Dx by patient report.

  • ECG
  • Blood tests for cardiac enzymes
  • Angiograms
122
Q

Tx of stable angina if no MI

A
  • Medications (VasoD)
  • Lifestyle modifications
  • PCI (percutaneous coronary intervention)
123
Q

____ angina: symptom of complicated atherosclerotic plaque

A

unstable

124
Q

Causes ischemia, which is reversible and if reversed in time will prevent myocardial death

A

Unstable angina

125
Q

Temporary loss of contractile ability

A

Myocardial stunning

126
Q

Adaptation to decreased O2 supply

A

Hibernating myocardium

127
Q

Mycocyte hypertrophy, widespread loss of contractibility

A

Myocardial remodeling

128
Q

Manifestations of MI

A
  • Sudden severe chest pain
  • Nausea, vomiting
  • Diaphoresis
  • Dyspnea
129
Q

Complications of MI

A

Sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability

130
Q

Dx of MI

A

ECG, blood tests, angiogram

131
Q

Tx of MI

A

Reperfusion: thrombolytics, emergent PCI with angioplasty, stenting, and revascularization (CABG)

132
Q

If you suspect a patient is experiencing chest pain or MI, what do you order first?

A

Oxygen

133
Q

Clinical signs of pericarditis

A

Low grade fever, severe chest pain, friction rub on auscultation, ECG changes

134
Q

Scarred pericardial layers adher

A

Constrictive pericarditis

135
Q

What causes constrictive peri.

A

can be idiopathic, viral infections, and seen with patients with TB (immunocompromised population)

136
Q

Tx of pericarditis

A

Anti-inflammatory drugs

137
Q

Complication of pericarditis

A

Pericardial effusion

138
Q

If fluid volume large enough, can cause tamponade

A

Pericardial effusion

139
Q
  • Distant heart sounds
  • Dyspnea on exertion
  • Dull chest pain
A

Signs of effusion

140
Q

Key clinical sign of tamponade?

A

Pulsus paradoxus

141
Q

Dx of pericardial effusion

A

echocardiogram

142
Q

Tx of pericardial effusion

A

Pericardiocentesis

143
Q

Diseases in which the myocardium itself is diseased or damaged

A

Cardiomyopathies

144
Q

Name three types of causes for Cardio myop.

A

Genetic, non genetic, and mixed

145
Q

CMYO non genetic causes include…

A

Secondary to HTN, ischemia, infection, myocarditis

146
Q

CMYO genetic causes…

A

Hypertrophic cardiomyopathy (autosomal dominant)

147
Q

Tests show dilation and thinning of myocardial wall (left V) Structural change with perivascular fibrosis

A

Dilated Cardiomyopathy

148
Q

Systolic function is decreased, progressive heart failure, with clinical manifestations such as dyspnea, fatigue, and edema

A

Dilated CAMY

149
Q

What is the most common cardiomyopathy?

A

Hypertrophic cardiomyopathy

150
Q

Myocyte function disarray, fibrosis, altered sacromere function. Hypertrophy of the LV

A

Hypertrophic CAMY

151
Q

Rigidity and noncompliance of myocardial wall (rare)

A

Restrictive CAMY

152
Q

What do you see with restrictive CAMY?

A

Impaired V filling, decreased cardiac output

153
Q

Dx of CAMY

A

chest x-ray, echocardiogram, ECG, treadmill test

154
Q

Tx (depending n cause)

A
  • Drug support
  • Myectomy (hypertrophic)
  • Pacemaker
  • Implant device
  • heart transplant
155
Q

Valves are continuous with the _____

A

endocardium

156
Q

Opening is constricted(valves)

A

Valvular stenosis

157
Q

____ ____ results in resistance to forward blood flow

A

Valvular stenosis

158
Q

Causes of VS

A

Congenital with aging.

Secondary to inflammation, trauma, ischemia, infection

159
Q

Complications of VS

A

cardiomyopathy, MI, HF, dysrhythmias

160
Q

Most commonVS

A

Aortic

161
Q

____ stenosis: negative impact on left ventricle, causing hypertrophy which increases oxygen demand

A

aortic

162
Q

_____ stenosis: common form of rheumatic heart disease

A

Mitral

163
Q

____ stenosis: negative impact on left atrium, causing atrial dilation and/or hypertrophy

A

mitral

164
Q

Patients with mitral stenosis run a risk of

A

increased risk of atrial fibrillation

165
Q

Along with congenital, aging, and HTN, what else causes valve regurge?

A

rheumatic heart disease, endocarditis, and marfan syndrome

166
Q

Examples of different valve regurges make sense if you know the anatomy
Aorotic overflows the ___

A

LV

167
Q

If the tricuspid valve is regurging, what will overload?

A

THe right ventricle

168
Q

Clinical sign of regurge?

A

Dyspnea and fatigue

169
Q

Percent of people with MVP

A

3%

170
Q

MVP, the valve prolapses _____

A

backward

171
Q

Systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by rhe group A-B hemolytic strep

A

Rheumatic fever

172
Q

____ ______: inflammation of the joints, skin, nervous system, and heart

A

Febrile illness

173
Q

If left untreated, rheumatic fever causes

A

rheumatic heart disease.

174
Q

Which bacteria causes rheumatic fever

A

Group A beta hemolytic streptococci

175
Q

Damage/scarring of valve leaflets, myocarditis, pericardial inflammation, cardiomegaly, left HF…results from untreated

A

Rheumatic fever

176
Q

Patient presents with fever, nausea vomiting, tachycardia, abdominal pain, and arthalgia

A

Rheumatic fever–common signs

177
Q

Patient presents with carditis, polyarthritis, chorea, and subcutaneous nodules

A

Major clinical manifestations of rheumatic fever

178
Q

Tx of rheumatic fever

A

Antibiotics; anti-inflammatory drugs

179
Q

Inflammation of the endocardium due to infection

A

Infective endocarditis

180
Q

Rickettsiae and parasites can cause

A

Endocarditis

181
Q

Patient presents with fever, new or changed cardiac murmur, and has petechial lesions of the skin, and oral mucosa.

A

Infective endocarditis

182
Q

Patient presents with osler nodes and janeway lesions.

A

Endocarditis

183
Q

Nonpainful hemorrhagic lesions on hte palms and soles

A

Janeway lesions seen with infective endoCard

184
Q

Painful erythematous nodules on pads of fingers and toes

A

Osler nodes seen in patients with Infective endocarditits

185
Q

Other manifestations of infective endocarditis?

A

Weight loss, back pain, night sweats, heart failure

186
Q

Tx of infective endocarditis

A

Antibiotics

187
Q

People with prosthetic valves and transplants are given what to prevent I.E

A

ABX prophylaxis

188
Q

Cardiac complications of aids

A
  • Myo, endo, and peri carditis. -Left heart failure
  • Cardiomyopathy
  • Pericardial effusion
  • Pulmonary HTN
  • Cardiotoxicity from viral drugs
189
Q

Abnormal impulses can originate from Sinus node, AV node, and….

A

rogue pacemaker cells in atrial and ventricles

190
Q

Abnormal conduction is often _____ or ____ conductions

A

Delayed or slowed

191
Q

_____ can range from occasional, to rapid, to “blocks” of conduction

A

Dysrhythmias

192
Q

Name the two more serious abnormal rhythms that impair the hearts pumping ability

A

Ventricular tachycardia and ventricular fibrillation

193
Q

Rapid rhythms. E.G _____

A

tachycardias

194
Q

Dx of Dysrhythmias

A

ECG

195
Q

Tx of Dysrhythmias

A

Anti-dysrhythmic medications, radiofrequency ablation, and pacemaker

196
Q

Prevalence of HF

A

adults > 65 yrs

197
Q

Which chamber predominates others when it comes to HF

A

Left ventricle

198
Q

Risk factors for HF

A

-HTN, Ischemic heart disease, valve disease, and cardiomyopathy

199
Q

____ is the volume in the chamber

A

preload

200
Q

_____ is the force of contraction

A

Contractility

201
Q

_____ is the peripheral resistance

A

Afterload

202
Q

Patient presents with frothy sputum, fatigue, and edema. Physical examination shows pulmonary edema and an S3 gallop. Patient has

A

Left heart failure

203
Q

Management of Left HF?

A

Reduce preload and afterload…typically with drugs

204
Q

Impaired perfusion of lungs by right ventricle

A

Right heart failure

205
Q

Most commonly caused by a diffuse hypoxic pulmonary disease

A

Right heart failure

206
Q

Hepatosplenomegaly is a manifestation of

A

Right heart failure

207
Q

Inability of the heart to supply the body with blood-borne nutrients despite adequate blood volume and normal or elevated myocardial contractility

A

High-output failure

208
Q

What causes high output failure?

A

Anemia, hyperthyroidism, septicemia, and beriberi

209
Q

______: cardiovascular system fails to perfuse the tissues adequately

A

Shock

210
Q

Shock leads to impaired _____ metabolism

A

cellular

211
Q

shock leads to impaired ____ and ____ use

A

oxygen and suggaaaaa

212
Q

Manifestations vary based on stage but often include hypOtension, tachycardia, increased RR

A

Shock

213
Q

How to manage shock

A

Fluid resuscitation, vasopressors, and supplemental oxygen. Also, find and treat the cause

214
Q

Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury

A

Multiple organ dysfunction syndrome

215
Q

What causes MODS

A

sepsis, septic shock, and trauma (burns, major surgery)

216
Q

Tx of MODS

A

Treat cause, control infection, restore oxygen and perfusion.

380: Patho/Physio (8 decks)

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