Class 10 - Alterations in Cardiovascular Functions, Vessels Flashcards
Hypotension
Influenced by cardiac output (blood volume, effective contraction), size of arterioles
Due to
- Less blood volume
- Poorly functioning heart
- Larger size of artery
Orthostatic Hypotension
- A drop in blood pressure when position is changes
- Prolonged for at least 3 minutes
Etiology
- Aging, older population. Over age of 70 have a higher risk
- Drug induced, blood pressure medications and anti-hypertensive drugs
- Bed/rest and immobility because of decrease circulating blood volumes
- ANS dysfunction
Manifestations
- Dizziness: huge risk for syncope (fainting), falls and fractures
Hypertension
- Prevalence 1/5 of Canadians
- 140/90 mm Hg in Adults
- 135/85 in diabetics, because it’s a potent combination for vascular and cardiac disease
- Primary is there all by itself, 92-95% of all patients
Synonyms
- Essential hypertension
- Idiopathic hypertension
Risk Factors
- Genetics
- Men are more at risk
- Ancestry - African
- Obesity
- Excessive alcohol comsumption
- High salt intake
Pathophysiology
- Increase in peripheral resistance
- RAAS
- SNS
- Natriuretic peptides, helps you pee
- Inflammation
- Endothelial dysfunction
- Obestiy
- Insulin resistance
Manifestations
- Early has no symptoms
- A silent killer
- Any manifestations are a result of impact on target organs
- Brain (stroke, dementia)
- Heart (coronary artery disease, heart failure)
- Kidney failure
- Retinopathy, vision loss
Treatments
- Lifestyle modification
- Exercise
- Waist circumference
- Alcohol
- Diet
- Sodium
- Stress management
Secondary Hypertension
Caused by systemic disease process that raises peripheral vascular resistance
- Renal disease
- Adrenal cortex tumours
- Congenital heart defects
- Medications (contraceptives)
Vascular Disease
Any factor affecting pressure, resistance, flow velocity, and or turbulence inside the artery or vein
Examples
- Clots
- Thrombus
- Embolus
- Excessive Vasoconstriction
- Aneurism
Atherosclerosis - Pathophysiology
- The development of atheromatous plaques in arteries
- Systemic arterial disease in multiple arteries
- Lesions in large and medium sized arteries
- Narrowing of artery lumen (decrease blood flow)
Affected areas
- Peripheral arteries
- Coronary arteries
- Cerebral arteries
- Aorta (makes it at risk for forming aneurysms)
Pathophysiology Endothelial injury - Smoking - Hypertension - Diabetes Inflammation - Monocytes/macrophages - Free radicals Dyslipidemia
Risk Factors Non modifiable - Age - Genetics - Gender (male) - Ethnicity - African American Modifiable - Smoking - Hypertension - Dyslipidemia - Diabetes/insulin resistance
Steps to Atherosclerosis
- Endothelium is injuried; LDL enters injured area
- LDL is oxidized by free radicals
- Macrophages engulf oxidized LDL
- They now turn into foam cells. foam cells are macrophages that engulf LDL
- Build up of foam cells- lipid pool, forms, fatty streaks. As the lipid pool grows, they develop fatty streaks
Dyslipidemia
Abnormal amount of fats in the bloodstream
Low-density lipoprotein cholesterol (LDL-c) bad cholesterol
- Deliverer of cholesterol
- Elevated LDL-c is a strong risk for atherosclerosis
- Genetic and dietary factors
High-density Lipoprotein- cholesterol (HDL-c)
- Takes cholesterol from the tissue back to the liver
- HL-c is a protective lipoprotein
- Genetics, dietary and exercise factors
- More exercise = more HDL
- Imbalance of the ratio between LDL-HDL
Peripheral Artery Disease
Atherosclerotic disease of arteries that perfuse lower limbs
Risk factors Modifiable - Hypertension - Dyslipidemia - Smoking - Diabetes Non modifiable - Age - Genetics - Gender (male) - Ethnicity - African American
Manifestations Intermittent claudication - Leg pain that occurs with exercise and resolves with rest - Weaker pulses in the feet - Pale or cyanotic - Cooler temperature - Numbness Rubor - Red feet
Complications:
- Arterial ulcer: not enough blood flow, round deep and clean edge
- Amputations: gangrene can occur in feet or toes (no circulation), serial amputations
Varicose Veins
Varicose veins - chronic venous insufficiencies - venous stasis ulcers
- Distended tortuous (twisted) and palpable veins
- Caused by age, genetics, trauma, prolonged retrograde pressure (long periods of time standing)
- Can lead to chronic venous insufficiency
Treatment
- Elevating legs, avoiding standing for long periods of
- Compression stockings
- Sclerotherapy (injection of chemical and thats he vein) / laser
- Surgery (removal fo the vein, less common)
Chronic Venous Insufficiency
- Inadequate venous return over a long period due to varicose veins or valvular incompetence
- Can lead to venous stasis ulcer. Uneven edges, shallow. Can have a bluish tinge
Affects signs and symptoms
- Elevating the legs
- Wearing support/compressive stockings
- Sitting with legs crossed at knees
- Increasing physical exercise
Deep Vein Thrombosis
- Also known as venous thromboembolism (VTE)
- Primarily in lower extremities
Virchow’s triad of risk factors
- Stasis of blood flow
- Vessel wall injury (knee, hip, pelvis injury, or surgery)
- Hypercoagulability (increased clotting)
- 5 signs of inflammation
- Untreated DVT associated with a high risk of embolization.
- Embolus is a piece of a clot that breaks off and travels
- Tends to go to the lungs
Pulmonary Embolus
- Commonly occurs secondary to a clot in the deep veins of the legs (DVT)
- Can also be due to tissue fragments, fats and air
- Can cause alveolar deadspace
- Increased heart rate, respiratory rate, chest pain, hypoxemia
Prevention is key
- Ambulation, anti-embolic stockings, pneumatic stockings, prophylactic, anticoagulation
