Chapter 24 - Alterations in Cardiovascular Function Flashcards
What is a varicose vein?
a vein where blood has pooled, producing distended and palpable vessels
What 2 things cause varicose veins?
- trauma that damages valves
- gradual distention by gravity
How do vein valves get damaged?
increased pressure and blood volume due to the pressure of gravity
Which veins usually become varicose veins?
saphenous veins of the legs
Varicose veins: __________ remodel the vessel wall
enzymes
When varicose veins swell from pressure, what is pushed through the vessel wall?
plasma
Why does standing for long periods of time put one at risk for varicose veins?
it diminishes the action of muscle pump
What are 4 other risk factors for varicose veins
-age
-obesity
-genetics
-pregnancy
-previous leg injury
What is the non-invasive treatment for varicose veins?
-elevate legs
-compression stockings
What is the invasive treatment for varicose veins?
surgical ligation
What is surgical ligation?
tying up the blood vessel
What is chronic venous insufficiency?
inadequate venous return over an extended period
What are the symptoms of chronic venous insufficiency?
-edema of lower extremities
-hyperpigmentation of ankle and feet skin
Poor circulation, and thus reduced oxygen cells leads to ____________
necrosis
What is a risk of chronic venous insufficiency?
infection
reduced __________ makes surgery a risk
circulation
Venous stasis ulcers is an infection that occurs due to ______ __________ in veins
poor circulation
Venous stasis ulcers result from impaired oxygen delivery that leads to __________
necrosis
What is a thrombus?
a blood clot that remains attached to the vessel wall
What is a thromboembolism?
a detached thrombus
Why are venous thrombi more common that arterial thrombi?
flow and pressure are lower in veins
Thrombi occur more often where?
lower extremities
What is the the Virchow triad?
the 3 factors that promote Deep Venous Thrombosis (DVT)
What are the Virchow triad?
- venous stasis (immobility, age, heart failure)
- venous endothelial damage
- hyper-coagulable states
What is a hyper-coagulable state?
increased tendency of blood to thrombose
What causes a hyper-coagulable state?
-pregnancy
-oral contraceptives
-heredity
What causes a venous obstruction?
accumulation of clotting factors and platelets near a venous valve
With thrombus formation, _________ promotes further platelet aggregation
inflammation
Obstruction creates __________ edema and possible ulceration of limb
extremity
Ulceration of Limb
break on the skin surface
Most thrombus dissolve without treatment but others can be treated with ________________
anticoagulants
What are some examples of anticoagulants?
aspirin and warfarin
How are venous thrombi diagnosed?
doppler ultrasonography
What is a doppler ultrasound?
a non-invasive test that estimates blood flow through vessels by bouncing high-frequency sound waves
What is superior vena cava (SVC) syndrome?
the progressive occlusion of the superior vena cave leading to venous distention
Where does SVC syndrome venous distension affect?
upper extremities and head
Bronchogenic cancer is the cause of _____% of SVC syndrome cases
75%
What results from SVC syndrome?
-edema
-venous distension in upper extremities and face
Symptoms of SVC Syndrome
-tightness of shirt collars and necklaces
-headache
-visual disturbances
How is SVC syndrome diagnosed?
-chest x-ray
-CT
-MRI
What is hypertension?
consistent elevation of systemic arterial blood pressure
_______ and _______ pose risk for hypertension
age and diabetes
What two mechanisms are essential for maintaining a proper blood pressure?
exercise and proper nutrition
Primary hypertension can be essential or __________
idiopathic
95% of cases are _____________ hypertension
primary
What causes secondary hypertension?
a separate underlying disorder
___% of cases involve secondary hypertension
5%
What is malignant hypertension?
rapidly progressing hypertension
Malignant hypertension involves a systolic BP above ______ mmHg and a diastolic BP above ______ mmHg
180; 120
Malignant hypertension can lead to ________ and _________ complications
systemic; organ
Malignant hypertension is considered…
a medical emergency
What is a normal blood pressure value?
systolic <120 and diastolic <80
What is an elevated blood pressure value?
systolic 120-129 and diastolic <80
Stage 1 Hypertension value:
systolic 130-139 OR diastolic 80-89
Stage 2 Hypertension value:
systolic ≥140 OR diastolic ≥90
What are the values of a hypertensive crisis?
systolic >180 and/or diastolic >120
Primary hypertension is caused by a combination of genetic and ____________ factors
environmental
Epigenetics
how behaviours and environment affect gene function
Hypertension results from sustained peripheral ___________ and/or an increase in ________ ________
resistance; blood volume
What two primary factors contribute to primary hypertension?
-the sympathetic nervous system
-RAAS
How does increased SNS stimulation increase blood pressure?
increased HR, increased contractibility, systemic vasoconstriction
What does RAAS stand for?
renin-angiotensin-aldosterone system
How does aldosterone increase bp?
it increases Na+ reabsorption to increase blood volume (water follows Na+)
How does angiotensin II increase bp?
it increases vasopressin (ADH) which increases vasoconstriction
What is sclerosis?
abnormal hardening of body tissue
What is arteriosclerosis?
a generic term for vascular disease that causes thickening and inelasticity of arteries
Atherosclerosis is a dominant pattern of __________
arteriosclerosis
What is atherosclerosis?
formation of fatty plague with a core rich in lipids
Athera is the Greek word for ______ and it means…
athero; porridge
Treatment for hypertension begins with lifestyle modifications such as:
-diet
-exercise
-stopping smoking
-weight loss
What are two advances treatments for hypertension?
-diuretics
-angiotensin II blockers
Orthostatic hypotension is defined as a decrease in systolic bp of ___ mmHg or a decrease in diastolic BP of ___ mmHg within ___ minutes of standing
20; 10; 3
What adjustments are normally made to maintain BP when standing?
-baroreceptors
-vasoconstriction
-heart rate
What are the signs and symptoms of orthostatic hypotension?
-dizziness
-vision loss
-reduced brain blood flow
Is there a curative Tx for orthostatic hypotension?
no
What are ways to manage orthostatic hypotension?
-increased fluid and salt intake
-thigh high stockings
What is an aneurysm?
a localized dilation of a vessel wall
An aneurysm involves all ______ layers of the vessel wall
three
Aneurysms progressively _______ the vessel wall
weaken
What is the most common vessel to suffer an aneurysm?
aorta - a region of constant high pressure stress
What are 3 risk factors for aneurysm?
-smoking
-genetics
-diet
What are the 3 layers of the blood vessel from innermost to outermost?
tunica intima, tunica media, tunica adventita
What is an embolsim?
a vessel obstruction by an embolus
What is an embolus?
a bolus of matter circulating in the blood stream
An embolism can can consist of a dislodged _______, aggregation of fat/_______ cells, or foreign substance
thrombus; cancer
An embolus travels in the blood stream until it reaches…
a vessel through which it can’t pass
An embolism causes ischemia and if not resolved can lead to infarction which is…
ischemia resulting in necrosis
What is thromboangiitis obliterans?
inflammation of peripheral arteries
Thromboangiitis obliterans aka _______ disease
Buerger’s
Thromboangiitis obliterans is strongly associated with ________
smoking
Thromboangiitis obliterans is an ____________ disease that involves a thrombus filled with ______ cells
autoimmune; immune
Thromboangiitis obliterans occludes _________ arteries
smallers
What are the symptoms of Thromboangiitis obliterans?
-pain
-tenderness in affected areas (extremities usually)
What are the signs of Thromboangiitis obliterans?
-reddish skin
-thickened and malformed nails
Advanced Thromboangiitis obliterans can cause ________ and possible ________ may be needed
gangrene; amputation
What is the treatment for Thromboangiitis obliterans?
stopping smoking
_____________ is the leading cause of Coronary Artery Disease (CAD)
atherosclerosis
What can cause atherosclerosis?
-smoking
-hypertension
-diabetes
-increased low-density lipoproteins (LDLs)
-decreased high-density lipoproteins (HDLs)
-autoimmune action
Atherosclerosis begins with injury to the __________ cells that line the artery wall, causing them to become inflamed
epithelial
Atherosclerosis: the inflamed cells express __________ molecules that bind ________ which release cytokines and enzymes to further damage the wall
adhesion; macrophages
Atherosclerosis: inflammation causes ____ ______ to oxidize LDL that have accumulated in the tunica ______
free radicals; intima
What is a “foam cell”?
a macrophage that engulfs oxidized LDLs
What accumulates to form the fatty streak?
foam cells
The fatty streak leads to __ cells being recruited in an autoimmune response to cause further damage
T
Which cells release growth factors to produce collagen?
macrophages
Collagen accumulation over the fatty streak forms a _______ ______
fibrous plague
Protrusion of the fibrous plague from the lumen…
obstructs/occludes blood flow
What is a complicated plague?
when the fibrous plague ruptures
What do complicated plagues form?
rapid thrombus formation
Thrombus formation from atherosclerosis can lead to ______ or ________
ischemia or infarction
The ischemia and infarction from atherosclerosis causes ______ from deprived oxygen and nutrients which impairs function
hypoxia
With CAD, the myocardial cells remain _______ but not properly functioning
alive
What causes Acute Coronary Syndromes (ACS)?
persistent ischemia
Myocardial infarction is an _____
ACS
Infarction can trigger a _____ _____
heart attack
What is a cardiac infarction?
obstruction of blood supply causing irreversible myocardial damage
LDLs are responsible for the delivery of _________ to tissues
cholesterol
A high intake of __________ and __________ fats elevates serum LDL levels
cholesterol; saturated
High LDL levels causes LDL __________ into vessel walls which imitates ___________
migration; atherosclerosis
HDLs are responsible for the delivery of excess cholesterol back to the ________
liver
HDLs play a role in endothelial ______ which decreases _________
repair; thrombosis
Have elevated HDL levels proven to prevent cv disease?
no
___________ is responsible for the 2-3-fold increase in CAD risk
hypertension
Hypertension causes _________ injury, which leads to atherosclerosis and myocardial hypertrophy
endothelial
Myocardial hypertrophy increases the ________ demand of the heart
oxygen
Smoking promotes _______ ______ generation
free radical
What does nicotine stimulate that increases BP?
catecholamines (epi and nor-epi)
How do catecholamines increase BP?
by increasing HR and inducing vasoconstriction
CAD risk decreases when…
smoking stops
Smoking is associated with ________ LDL and ___________ HDL levels
increased; decreased
Abdominal obesity is the strongest risk of ______
CAD
Abdominal obesity is related to __________ and ________ HDL
inflammation; decreased
A sedentary lifestyle increases risk for ________ and CAD
obesity
What is an atherogenic diet?
a diet that promotes the formation of fatty plagues in arteries
Atherogenic diet aka “______-style Diet”
Western
Which diet is most recommended for health?
Mediterranean
What is a high-sensitivity C-reactive protein test (hs-CRP test)
a blood test that can detect very low levels of C-reactive protein
Elevated serum hs-CRP is linked to _____
CAD
What is C-reactive protein (CRP)?
a protein synthesized in the liver in response to inflammation in the body
hs-CRP is used to determine risk of heart disease and ______ in people without known heart disease
stroke
hs-CRP value <1 mg/L =
low risk of cardiovascular disease
hs-CRP value 1-3 mg/L =
average risk of cardiovascular disease
hs-CRP value >3 mg/L =
high risk of cardiovascular disease
What are adipokines?
hormones released from adipose cells - leptin and adiponectin
Obesity is associated with increased ___________
inflammation
Obesity involves ________ leptin and _________ adiponectin
increased; decreased
What does adiponectin do?
protect vascular endothelium and is anti-inflammatory
When does myocardial ischemia develop?
when blood-borne oxygen levels aren’t meeting metabolic demands
How does atherosclerosis cause myocardial ischemia?
plague ruptures and forms a thrombus which occludes blood flow
Myocardial cells become ischemic within ___ seconds of occlusion
10
Myocardial ischemia causes a shift to anaerobic respiration causing _____ _____ to accumulate and decreasing the rate of _____ re-phosphorylation
lactic acid; ATP
After several minutes of myocardial ischemia, the heart loses the ability to _______
contract
If perfusion is not restored within ____ seconds, myocardial infarction occurs
20
Angina
chest pain caused by myocardial ischemia
What is stable angina pectoris?
gradual narrowing and hardening of arterial walls associated with inflammation and decreased endothelial vasodilators
With stable angina pectoris, vessels can’t response to increase demand during…
exercise or emotional stress
Stable angina pectoris decreases with ______ and _______
rest and nitrates
What is Prinzmetal’s angina?
transient angina that occurs unpredictably and often at rest/sleep
What is the cause of Prinzmetal’s angina?
vasospasm of coronary arteries
Silent ischemia involves the symptoms of fatigue and ______
dyspnea
Silent ischemia can occur _______ or with ______
alone; angina
Slient ischemia increases risk for a…
cardiac event
Physical examination for myocardial ischemia displays:
-rapid pulse
-extra heart sounds
Pulmonary congestion indicates impaired _____ ventricular function
left
What is the most effective tool to detect myocardial ischemia?
SPECT - single-photon emission computed tomography
What is the treatment for myocardial ischemia?
-diet
-exercise
-surgery: placement of coronary stent
What is unstable angina?
harbinger of impending infarction - when a coronary thrombosis leads to myocardial ischemia
Harbinger
announces the “coming of something”
An acute attack of harbinger angina signals…
atherosclerotic plague has become unstable and infarction may soon follow
Superficial erosion of plague leads to _________ episodes of thrombotic occlusion and vasoconstriction
transient
Thrombotic occlusion from unstable angina lasts no more than ___ to ___ minutes
10 to 20
Unstable angina symptom:
Prinzmetal angina increasing in severity
How is unstable angina diagnosed?
ECG during attack or hs-cTnt
How is unstable angina seen on an ECG?
-ST depression
-T inversion
-ST elevation
High-sensitivity Cardiac Troponin test identifies tiny amounts of enzymes released from damaged _______
myocytes
What is the treatment for unstable angina?
immediate hospitalization
Myocardial infarction can be non-______ or _______
STEMI
Non-STEMI Myocardial Infarction
persistent occlusion leads to infarction of myocardium closest to endocardium
STEMI Myocardial Infarction
continued occlusion leads to infarction from endocardium to pericardium
Name layers of the heart from innermost to outermost:
endocardium, myocardium, pericardium
How long does oxygen depletion occur after onset of myocardial infarction?
10 seconds
After 10 seconds, affected myocardium becomes ________ and cooler
cyanotic
anaerobic metabolism leads to ___ and ______ _____ accumulation and reduced ATP production
H+ and lactic acid
Why do electrolyte disturbances affect the hearts ability to contract?
myocardial cells need K+ and calcium
_______ cells accompany electrolyte disturbances with O2 deprivation and contribute to further tissue damage
immune
Cardiac cells can withstand ischemic conditions for ____ mins before irreversible damage
20
What are the symptoms of a myocardial infarction?
acute, sudden, severe chest pain
How is a myocardial infarction diagnosed?
hs-cTnT
Heart failure definition: when the heart is unable to generate adequate cardiac output causing inadequate ________ of tissues and/or increased ________ filling pressure of the ____ ventricle, so that pulmonary capillary pressures are increased.
perfusion; diastolic; left
Heart failure affects 10% of individuals older than ___
65
What is the most common reason for hospital admission in people over 65?
heart failure
Most heart failure is due to the dysfunction of the ______ ventricle
left
Left Ventricular Failure with Reduced Ejection Factor definition: left ventricle ejection fraction less than ___% normal which results in the inability of the heart to ________ tissue
40%; perfuse
CO = ____ x ____
SV x HR
What are the determinants of SV?
-contractility
-preload
-afterload
Ventricular remodelling results in ________ of the left ventricle
dilation
What causes ventricular remodelling?
progressive myocyte contractile dysfunction
Ventricular remodelling results in reduced _____ _____ and increased left ventricular ___-_______ _______
stroke volume; end-diastolic volume
The main causes of myocardial dysfunction are:
-myocardial infarction
-ischemic heart disease
-hypertension
Reduced perfusion due to ↓CO and ↓ systemic BP results in ↑ _______ activity
sympathetic
Increased sympathetic activity means…
-increased catecholamine secretion
-increased vasoconstriction
Decreased perfusion of kidneys activates the _____ to increase __________ and blood volume
RAAS; vasoconstriction
The overall result of L ventricular failure with reduced ejection factor is…
-↑ cardiac after load
-↑ BP
-↑ HR
and thus ventricular remodelling
↓ myocyte function = increased _______ (due to decreased contractility)
preload
What are the effects of increased preload?
-stretching of myocardium
-sarcomere dysfunction
What are the effects of increased afterload?
-systemic hypertension
-myocardial hypertrophy (remodelling)
-increased O2 demand
The changes from increased afterload are called…
hypertensive hypertrophic cardiomyopathy
____% of heart failure patients have previous hypertension
75%
Hypertrophy
increase in size of cells
↓ in CO = ↓ in ______ perfusion
renal
With LVF w/ reduced ejection factor, ________ continue to detect a decreased blood pressure so catecholamine release and vasoconstriction are still increased
baroreceptors
What pharmacological interventions are needed for LVF w/ reduced ejection factor?
inhibition of aspects of RAAS and SNS
What is left ventricular failure with preserved ejection factor?
pulmonary congestion despite normal stroke volume and cardiac output
What is the prevalence of LVFpEF in the population?
1-5%
LVFpEF is caused by abnormal diastolic _______ so a normal LVEDV results in an _________ left-ventricular end-diastolic pressure (LVEDP)
relaxation; increased (aka normal amount of blood returning to heart results in an increased ventricular pressure)
How does LVFpEF result in pulmonary edema and right ventricular hypertrophy?
the pressure is reflected back into pulmonary circulation
How is LVFpEF diagnosed?
-dyspnea on exertion
-fatigue
-evidence of pulmonary edema
What is right ventricular failure?
inability of the right ventricle to provide adequate blood flow into pulmonary circulation at a normal venous pressure
Right ventricular failure can be caused by ______________ that reflects pressure back into the pulmonary system and right ventricle
left ventricular failure
Why does the right ventricle dilate and fail from increased pressure?
it is poorly prepared
Systemic hypertension leads to…
peripheral edema
Cor Pulmonale
when a lung issue causes your right ventricle to fail
