Chapter 24 - Alterations in Cardiovascular Function Flashcards
1
Q
What is a varicose vein?
A
a vein where blood has pooled, producing distended and palpable vessels
2
Q
What 2 things cause varicose veins?
A
- trauma that damages valves
- gradual distention by gravity
3
Q
How do vein valves get damaged?
A
increased pressure and blood volume due to the pressure of gravity
4
Q
Which veins usually become varicose veins?
A
saphenous veins of the legs
5
Q
Varicose veins: __________ remodel the vessel wall
A
enzymes
6
Q
When varicose veins swell from pressure, what is pushed through the vessel wall?
A
plasma
7
Q
Why does standing for long periods of time put one at risk for varicose veins?
A
it diminishes the action of muscle pump
8
Q
What are 4 other risk factors for varicose veins
A
-age
-obesity
-genetics
-pregnancy
-previous leg injury
9
Q
What is the non-invasive treatment for varicose veins?
A
-elevate legs
-compression stockings
10
Q
What is the invasive treatment for varicose veins?
A
surgical ligation
11
Q
What is surgical ligation?
A
tying up the blood vessel
12
Q
What is chronic venous insufficiency?
A
inadequate venous return over an extended period
13
Q
What are the symptoms of chronic venous insufficiency?
A
-edema of lower extremities
-hyperpigmentation of ankle and feet skin
14
Q
Poor circulation, and thus reduced oxygen cells leads to ____________
A
necrosis
15
Q
What is a risk of chronic venous insufficiency?
A
infection
16
Q
reduced __________ makes surgery a risk
A
circulation
17
Q
Venous stasis ulcers is an infection that occurs due to ______ __________ in veins
A
poor circulation
18
Q
Venous stasis ulcers result from impaired oxygen delivery that leads to __________
A
necrosis
19
Q
What is a thrombus?
A
a blood clot that remains attached to the vessel wall
20
Q
What is a thromboembolism?
A
a detached thrombus
21
Q
Why are venous thrombi more common that arterial thrombi?
A
flow and pressure are lower in veins
22
Q
Thrombi occur more often where?
A
lower extremities
23
Q
What is the the Virchow triad?
A
the 3 factors that promote Deep Venous Thrombosis (DVT)
24
Q
What are the Virchow triad?
A
- venous stasis (immobility, age, heart failure)
- venous endothelial damage
- hyper-coagulable states
25
What is a hyper-coagulable state?
increased tendency of blood to thrombose
26
What causes a hyper-coagulable state?
-pregnancy
-oral contraceptives
-heredity
27
What causes a venous obstruction?
accumulation of clotting factors and platelets near a venous valve
28
With thrombus formation, _________ promotes further platelet aggregation
inflammation
29
Obstruction creates __________ edema and possible ulceration of limb
extremity
30
Ulceration of Limb
break on the skin surface
31
Most thrombus dissolve without treatment but others can be treated with ________________
anticoagulants
32
What are some examples of anticoagulants?
aspirin and warfarin
33
How are venous thrombi diagnosed?
doppler ultrasonography
34
What is a doppler ultrasound?
a non-invasive test that estimates blood flow through vessels by bouncing high-frequency sound waves
35
What is superior vena cava (SVC) syndrome?
the progressive occlusion of the superior vena cave leading to venous distention
36
Where does SVC syndrome venous distension affect?
upper extremities and head
37
Bronchogenic cancer is the cause of _____% of SVC syndrome cases
75%
38
What results from SVC syndrome?
-edema
-venous distension in upper extremities and face
39
Symptoms of SVC Syndrome
-tightness of shirt collars and necklaces
-headache
-visual disturbances
40
How is SVC syndrome diagnosed?
-chest x-ray
-CT
-MRI
41
What is hypertension?
consistent elevation of systemic arterial blood pressure
42
_______ and _______ pose risk for hypertension
age and diabetes
43
What two mechanisms are essential for maintaining a proper blood pressure?
exercise and proper nutrition
44
Primary hypertension can be essential or __________
idiopathic
45
95% of cases are _____________ hypertension
primary
46
What causes secondary hypertension?
a separate underlying disorder
47
___% of cases involve secondary hypertension
5%
48
What is malignant hypertension?
rapidly progressing hypertension
49
Malignant hypertension involves a systolic BP above ______ mmHg and a diastolic BP above ______ mmHg
180; 120
50
Malignant hypertension can lead to ________ and _________ complications
systemic; organ
51
Malignant hypertension is considered...
a medical emergency
52
What is a normal blood pressure value?
systolic <120 and diastolic <80
53
What is an elevated blood pressure value?
systolic 120-129 and diastolic <80
54
Stage 1 Hypertension value:
systolic 130-139 OR diastolic 80-89
55
Stage 2 Hypertension value:
systolic ≥140 OR diastolic ≥90
56
What are the values of a hypertensive crisis?
systolic >180 and/or diastolic >120
57
Primary hypertension is caused by a combination of genetic and ____________ factors
environmental
58
Epigenetics
how behaviours and environment affect gene function
59
Hypertension results from sustained peripheral ___________ and/or an increase in ________ ________
resistance; blood volume
60
What two primary factors contribute to primary hypertension?
-the sympathetic nervous system
-RAAS
61
How does increased SNS stimulation increase blood pressure?
increased HR, increased contractibility, systemic vasoconstriction
62
What does RAAS stand for?
renin-angiotensin-aldosterone system
63
How does aldosterone increase bp?
it increases Na+ reabsorption to increase blood volume (water follows Na+)
64
How does angiotensin II increase bp?
it increases vasopressin (ADH) which increases vasoconstriction
65
What is sclerosis?
abnormal hardening of body tissue
66
What is arteriosclerosis?
a generic term for vascular disease that causes thickening and inelasticity of arteries
67
Atherosclerosis is a dominant pattern of __________
arteriosclerosis
68
What is atherosclerosis?
formation of fatty plague with a core rich in lipids
69
Athera is the Greek word for ______ and it means...
athero; porridge
70
Treatment for hypertension begins with lifestyle modifications such as:
-diet
-exercise
-stopping smoking
-weight loss
71
What are two advances treatments for hypertension?
-diuretics
-angiotensin II blockers
72
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
73
What adjustments are normally made to maintain BP when standing?
-baroreceptors
-vasoconstriction
-heart rate
74
What are the signs and symptoms of orthostatic hypotension?
-dizziness
-vision loss
-reduced brain blood flow
75
Is there a curative Tx for orthostatic hypotension?
no
76
What are ways to manage orthostatic hypotension?
-increased fluid and salt intake
-thigh high stockings
77
What is an aneurysm?
a localized dilation of a vessel wall
78
An aneurysm involves all ______ layers of the vessel wall
three
79
Aneurysms progressively _______ the vessel wall
weaken
80
What is the most common vessel to suffer an aneurysm?
aorta - a region of constant high pressure stress
81
What are 3 risk factors for aneurysm?
-smoking
-genetics
-diet
82
What are the 3 layers of the blood vessel from innermost to outermost?
tunica intima, tunica media, tunica adventita
83
What is an embolsim?
a vessel obstruction by an embolus
84
What is an embolus?
a bolus of matter circulating in the blood stream
85
An embolism can can consist of a dislodged _______, aggregation of fat/_______ cells, or foreign substance
thrombus; cancer
86
An embolus travels in the blood stream until it reaches...
a vessel through which it can't pass
87
An embolism causes ischemia and if not resolved can lead to infarction which is...
ischemia resulting in necrosis
88
What is thromboangiitis obliterans?
inflammation of peripheral arteries
89
Thromboangiitis obliterans aka _______ disease
Buerger's
90
Thromboangiitis obliterans is strongly associated with ________
smoking
91
Thromboangiitis obliterans is an ____________ disease that involves a thrombus filled with ______ cells
autoimmune; immune
92
Thromboangiitis obliterans occludes _________ arteries
smallers
93
What are the symptoms of Thromboangiitis obliterans?
-pain
-tenderness in affected areas (extremities usually)
94
What are the signs of Thromboangiitis obliterans?
-reddish skin
-thickened and malformed nails
95
Advanced Thromboangiitis obliterans can cause ________ and possible ________ may be needed
gangrene; amputation
96
What is the treatment for Thromboangiitis obliterans?
stopping smoking
97
_____________ is the leading cause of Coronary Artery Disease (CAD)
atherosclerosis
98
What can cause atherosclerosis?
-smoking
-hypertension
-diabetes
-increased low-density lipoproteins (LDLs)
-decreased high-density lipoproteins (HDLs)
-autoimmune action
99
Atherosclerosis begins with injury to the __________ cells that line the artery wall, causing them to become inflamed
epithelial
100
Atherosclerosis: the inflamed cells express __________ molecules that bind ________ which release cytokines and enzymes to further damage the wall
adhesion; macrophages
101
Atherosclerosis: inflammation causes ____ ______ to oxidize LDL that have accumulated in the tunica ______
free radicals; intima
102
What is a "foam cell"?
a macrophage that engulfs oxidized LDLs
103
What accumulates to form the fatty streak?
foam cells
104
The fatty streak leads to __ cells being recruited in an autoimmune response to cause further damage
T
105
Which cells release growth factors to produce collagen?
macrophages
106
Collagen accumulation over the fatty streak forms a _______ ______
fibrous plague
107
Protrusion of the fibrous plague from the lumen...
obstructs/occludes blood flow
108
What is a complicated plague?
when the fibrous plague ruptures
109
What do complicated plagues form?
rapid thrombus formation
110
Thrombus formation from atherosclerosis can lead to ______ or ________
ischemia or infarction
111
The ischemia and infarction from atherosclerosis causes ______ from deprived oxygen and nutrients which impairs function
hypoxia
112
With CAD, the myocardial cells remain _______ but not properly functioning
alive
113
What causes Acute Coronary Syndromes (ACS)?
persistent ischemia
114
Myocardial infarction is an _____
ACS
115
Infarction can trigger a _____ _____
heart attack
116
What is a cardiac infarction?
obstruction of blood supply causing irreversible myocardial damage
117
LDLs are responsible for the delivery of _________ to tissues
cholesterol
118
A high intake of __________ and __________ fats elevates serum LDL levels
cholesterol; saturated
119
High LDL levels causes LDL __________ into vessel walls which imitates ___________
migration; atherosclerosis
120
HDLs are responsible for the delivery of excess cholesterol back to the ________
liver
121
HDLs play a role in endothelial ______ which decreases _________
repair; thrombosis
122
Have elevated HDL levels proven to prevent cv disease?
no
123
___________ is responsible for the 2-3-fold increase in CAD risk
hypertension
124
Hypertension causes _________ injury, which leads to atherosclerosis and myocardial hypertrophy
endothelial
125
Myocardial hypertrophy increases the ________ demand of the heart
oxygen
126
Smoking promotes _______ ______ generation
free radical
127
What does nicotine stimulate that increases BP?
catecholamines (epi and nor-epi)
128
How do catecholamines increase BP?
by increasing HR and inducing vasoconstriction
129
CAD risk decreases when...
smoking stops
130
Smoking is associated with ________ LDL and ___________ HDL levels
increased; decreased
131
Abdominal obesity is the strongest risk of ______
CAD
132
Abdominal obesity is related to __________ and ________ HDL
inflammation; decreased
133
A sedentary lifestyle increases risk for ________ and CAD
obesity
134
What is an atherogenic diet?
a diet that promotes the formation of fatty plagues in arteries
135
Atherogenic diet aka "______-style Diet"
Western
136
Which diet is most recommended for health?
Mediterranean
137
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
138
Elevated serum hs-CRP is linked to _____
CAD
139
What is C-reactive protein (CRP)?
a protein synthesized in the liver in response to inflammation in the body
140
hs-CRP is used to determine risk of heart disease and ______ in people without known heart disease
stroke
141
hs-CRP value <1 mg/L =
low risk of cardiovascular disease
142
hs-CRP value 1-3 mg/L =
average risk of cardiovascular disease
143
hs-CRP value >3 mg/L =
high risk of cardiovascular disease
144
What are adipokines?
hormones released from adipose cells - leptin and adiponectin
145
Obesity is associated with increased ___________
inflammation
146
Obesity involves ________ leptin and _________ adiponectin
increased; decreased
147
What does adiponectin do?
protect vascular endothelium and is anti-inflammatory
148
When does myocardial ischemia develop?
when blood-borne oxygen levels aren't meeting metabolic demands
149
How does atherosclerosis cause myocardial ischemia?
plague ruptures and forms a thrombus which occludes blood flow
150
Myocardial cells become ischemic within ___ seconds of occlusion
10
151
Myocardial ischemia causes a shift to anaerobic respiration causing _____ _____ to accumulate and decreasing the rate of _____ re-phosphorylation
lactic acid; ATP
152
After several minutes of myocardial ischemia, the heart loses the ability to _______
contract
153
If perfusion is not restored within ____ seconds, myocardial infarction occurs
20
154
Angina
chest pain caused by myocardial ischemia
155
What is stable angina pectoris?
gradual narrowing and hardening of arterial walls associated with inflammation and decreased endothelial vasodilators
156
With stable angina pectoris, vessels can't response to increase demand during...
exercise or emotional stress
157
Stable angina pectoris decreases with ______ and _______
rest and nitrates
158
What is Prinzmetal's angina?
transient angina that occurs unpredictably and often at rest/sleep
159
What is the cause of Prinzmetal's angina?
vasospasm of coronary arteries
160
Silent ischemia involves the symptoms of fatigue and ______
dyspnea
161
Silent ischemia can occur _______ or with ______
alone; angina
162
Slient ischemia increases risk for a...
cardiac event
163
Physical examination for myocardial ischemia displays:
-rapid pulse
-extra heart sounds
164
Pulmonary congestion indicates impaired _____ ventricular function
left
165
What is the most effective tool to detect myocardial ischemia?
SPECT - single-photon emission computed tomography
166
What is the treatment for myocardial ischemia?
-diet
-exercise
-surgery: placement of coronary stent
167
What is unstable angina?
harbinger of impending infarction - when a coronary thrombosis leads to myocardial ischemia
168
Harbinger
announces the "coming of something"
169
An acute attack of harbinger angina signals...
atherosclerotic plague has become unstable and infarction may soon follow
170
Superficial erosion of plague leads to _________ episodes of thrombotic occlusion and vasoconstriction
transient
171
Thrombotic occlusion from unstable angina lasts no more than ___ to ___ minutes
10 to 20
172
Unstable angina symptom:
Prinzmetal angina increasing in severity
173
How is unstable angina diagnosed?
ECG during attack or hs-cTnt
174
How is unstable angina seen on an ECG?
-ST depression
-T inversion
-ST elevation
175
High-sensitivity Cardiac Troponin test identifies tiny amounts of enzymes released from damaged _______
myocytes
176
What is the treatment for unstable angina?
immediate hospitalization
177
Myocardial infarction can be non-______ or _______
STEMI
178
Non-STEMI Myocardial Infarction
persistent occlusion leads to infarction of myocardium closest to endocardium
179
STEMI Myocardial Infarction
continued occlusion leads to infarction from endocardium to pericardium
180
Name layers of the heart from innermost to outermost:
endocardium, myocardium, pericardium
181
How long does oxygen depletion occur after onset of myocardial infarction?
10 seconds
182
After 10 seconds, affected myocardium becomes ________ and cooler
cyanotic
183
anaerobic metabolism leads to ___ and ______ _____ accumulation and reduced ATP production
H+ and lactic acid
184
Why do electrolyte disturbances affect the hearts ability to contract?
myocardial cells need K+ and calcium
185
_______ cells accompany electrolyte disturbances with O2 deprivation and contribute to further tissue damage
immune
186
Cardiac cells can withstand ischemic conditions for ____ mins before irreversible damage
20
187
What are the symptoms of a myocardial infarction?
acute, sudden, severe chest pain
188
How is a myocardial infarction diagnosed?
hs-cTnT
189
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
190
Heart failure affects 10% of individuals older than ___
65
191
What is the most common reason for hospital admission in people over 65?
heart failure
192
Most heart failure is due to the dysfunction of the ______ ventricle
left
193
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
194
CO = ____ x ____
SV x HR
195
What are the determinants of SV?
-contractility
-preload
-afterload
196
Ventricular remodelling results in ________ of the left ventricle
dilation
197
What causes ventricular remodelling?
progressive myocyte contractile dysfunction
198
Ventricular remodelling results in reduced _____ _____ and increased left ventricular ___-_______ _______
stroke volume; end-diastolic volume
199
The main causes of myocardial dysfunction are:
-myocardial infarction
-ischemic heart disease
-hypertension
200
Reduced perfusion due to ↓CO and ↓ systemic BP results in ↑ _______ activity
sympathetic
201
Increased sympathetic activity means...
-increased catecholamine secretion
-increased vasoconstriction
202
Decreased perfusion of kidneys activates the _____ to increase __________ and blood volume
RAAS; vasoconstriction
203
The overall result of L ventricular failure with reduced ejection factor is...
-↑ cardiac after load
-↑ BP
-↑ HR
and thus ventricular remodelling
204
↓ myocyte function = increased _______ (due to decreased contractility)
preload
205
What are the effects of increased preload?
-stretching of myocardium
-sarcomere dysfunction
206
What are the effects of increased afterload?
-systemic hypertension
-myocardial hypertrophy (remodelling)
-increased O2 demand
207
The changes from increased afterload are called...
hypertensive hypertrophic cardiomyopathy
208
____% of heart failure patients have previous hypertension
75%
209
Hypertrophy
increase in size of cells
210
↓ in CO = ↓ in ______ perfusion
renal
211
With LVF w/ reduced ejection factor, ________ continue to detect a decreased blood pressure so catecholamine release and vasoconstriction are still increased
baroreceptors
212
What pharmacological interventions are needed for LVF w/ reduced ejection factor?
inhibition of aspects of RAAS and SNS
213
What is left ventricular failure with preserved ejection factor?
pulmonary congestion despite normal stroke volume and cardiac output
214
What is the prevalence of LVFpEF in the population?
1-5%
215
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)
216
How does LVFpEF result in pulmonary edema and right ventricular hypertrophy?
the pressure is reflected back into pulmonary circulation
217
How is LVFpEF diagnosed?
-dyspnea on exertion
-fatigue
-evidence of pulmonary edema
218
What is right ventricular failure?
inability of the right ventricle to provide adequate blood flow into pulmonary circulation at a normal venous pressure
219
Right ventricular failure can be caused by ______________ that reflects pressure back into the pulmonary system and right ventricle
left ventricular failure
220
Why does the right ventricle dilate and fail from increased pressure?
it is poorly prepared
221
Systemic hypertension leads to...
peripheral edema
222
Cor Pulmonale
when a lung issue causes your right ventricle to fail
