chapter 26: disorders of blood flow and blood pressure Flashcards
what is ARTERIOSCLEROSIS?
NATURAL degenerative disease that blocks arterial walls due to aging
what happens in ARTERIOSCLEROSIS?
small arteries and arterioles narrow resulting in ischemia
what is ATHEROSCLEROSIS?
build up of fats (atheroma) in & on artery walls (causes narrowing and blocks blood flow)
when do the signs and symptoms of atherosclerosis appear?
when there is blood blockage or bv is severely narrowed
what are the stages of atherosclerosis?
1) endothelial cell damage
2) fatty streak formation
3) plaque growth
4) plaque ruptures
what can unstable plaques do?
rupture creating a clot (thrombus) to form
what are non-modifiable factors of atherosclerosis?
age, gender, genetics
what are modifiable factors of atherosclerosis?
obesity or diet
cigarette smoking
sedentary life style
diabetes mellitus
htn
what are some additional and nontraditional factors of atherosclerosis?
inflammation markers
increased lipoprotein a
how can we treat atherosclerosis?
1) diet
2) drugs (statins, cholesterol lowering drugs)
3) primary disorder control
4) stop smoking
5) angioplasty
6) bypass surgery
what does atherosclerosis in the heart lead to?
angina pectoris or mi (total occlusion)
what does atherosclerosis in the brain lead to?
transient ischemic attack or cerebrovascular accident (total occlusion)
what does atherosclerosis in the aorta lead to?
aneurysm (occlusion, rupture and hemorrhage)
what is atherosclerosis in the legs?
peripheral vascular disease (gangrene and amputation)
what is peripheral artery disease (pad)?
obstruction of large arteries that supply your limbs (arms and legs)
what causes pad?
atherosclerosis
inflammation
what are the risk factors of pad?
smoking
diabetes
obesity
high bp
high cholesterol
what are the s/s of pad?
1) gradual onset
2) pain while walking
3) foot cool to the touch
4) weak/absent pedal/femoral pulse
5) blood flow is severely reduced (ischemic pain at rest, ulcerations, gangrene)
how do we treat pad?
1) walking (with claudication too!)
2) avoid injury
3) avoid risk factors
4) drugs (anti-platelet therapy, statins, vasodilator)
5) femoral bypass, stents, balloon angioplasty
what is vasculitis?
inflammation of the bv’s
what are the two ways you get vasculitis?
1) direct invasion of a pathogen, immune mediated
2) non-pathogen mediated by medications
what are aneurysms?
bv wall is weakened, stretches, then forms a pocket
what is the difference between a true and false aneurysm?
true: bound within the wall, blood present
false: tear in wall, forms a blood clot outside
what is a berry/saccular aneurysm?
sac that protrudes from where the bv branches out
what is a fusiform aneurysm?
bulges on all sides within the vessel
what is a dissecting aneurysm?
bleeding into vessel wall
what do aortic aneurysms and dissections lead to?
aneurysm: abdominal aortic or thoracic aneurysm
dissection: bleeding into vessel wall w/longitude tear
what are some causes of aneurysms?
1) congenital defects
2) trauma
3) infection
4) atherosclerosis
which is responsible for short term regulation of bp? baroreceptors or renal mechanism?
baroreceptors
cardiac output
heart rate X stroke volume
mean arterial pressure (map)
1/3 systolic + 2/3 diastolic
pulse pressure
systolic - diastolic
blood pressure
co X total peripheral resistance
hypertension range pathophysiology
s: 140mmHg>
d: 90mmHg>
what is pre hypertension?
systolic: 120-139
diastolic: 80-89
what is stage 1 hypertension?
sys: 140-159
dias: 90-99
what is stage 2 hypertension?
sys: >160
dias: >100
what is primary/essential hypertension?
makes up 90-95% of all cases, no other disease present
what are the risk factors of primary/essential htn?
family
race
age
what are the life style risk factors of primary/essential htn?
insulin resistance
diet
obesity
alcohol
what is secondary htn?
results from another disorder
what disorders can secondary htn result from?
renal htn
adrenocortical hormones
pheochromocytoma
aortic coarctation
oral contraceptives
which organs does htn target?
1) heart (L ventricular atrophy, angina, heart failure, mi)
2) brain (stroke)
3) kidney (chronic kidney disease)
4) eyes (retinopathy)
5) blood vessels (pad)
how do we diagnose hypertension?
1) measure bp
2) scans + blood tests
how do we treat hypertension?
1) life style changes
2) reduce body weight
3) exercise
4) low salt diet
5) mild diuretics, ace inhibitors, beta blockers, calcium channel blockers, alpha blockers
what is gestational hypertension?
high bp when you are ONLY pregnant; NO protein in urine (after 20 weeks, resolves after 12 weeks postpartum)
what are the characteristics of preeclampsia-eclampsia?
1) htn after 20 weeks
2) proteinuria
3) elevates serum creatinine + liver enzymes
4) decreased platelets
what are the characteristics of chronic hypertension?
1) htn UNRELATED to pregnancy
2) present BEFORE and AFTER pregnancy
3) increased risk of developing preeclampsia
what are the characteristics of preeclampsia superimposed on chronic htn?
1) htn before 20 weeks
2) develop proteinuria
3) worse prognosis
a normal drop in bp upon standing is considered normal. true or false?
true. it’ll be quick due to the baroreflex
an abnormal drop in bp upon standing is called orthostatic htn. true or false?
true. fall in CO > fall BP > fall in blood flow to brain
who is susceptible to orthostatic htn?
1) low blood volume leads to dehydration
2) drug induced
3) aging
4) bed rest
5) ans problems
how do we diagnose orthostatic htn?
1) measure bp (supine)
2) tilt table
3) 24 hr BP monitoring
3) patient hx
how do we treat orthostatic htn?
1) get rid of identified cause (if possible)
2) learn to cope with it
3) pharmacological (change bp meds..)
what are varicose veins?
dilated veins (lower extremities)
what is the difference between primary and secondary varicose veins?
primary: prolonged standing and increased abdominal pressure
secondary: ateriovenous fistula, venous malformations, prolonged increase pressure on abdominal veins
what are the s/s of dvt?
1) inflammation (pain, swelling, deep muscle tenderness)
2) elevated wbc count
3) fever
what are some treatments of a dvt?
1) anticoagulants
2) pneumatic compression devices (preventative)
what causes a dvt?
1) stasis of blood (bed rest, immobility, chf)
2) increased blood coagulation (dehydration, pregnancy, genetic factors)
3) vessel wall injury (indwelling venous catheters, surgery, trauma/infection)
