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Pathophysiology - Diseases > Diseases of the Venous circulation > Flashcards

Diseases of the Venous circulation Flashcards

1
Q

What does the venous systems in the lower extremities consist of?

A

SUPERFICIAL (SAPHENOUS) VEINS AND NUMBER OF DEEPER VEINS

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2
Q

WHAT ARE VARICOSE VEINS, s/s and etiology?

A

dilated, distorted veins that develop in the superficial veins of the leg

the veins become swollen and painful and appear knotty under the skin (feeling of gatigue in leg, followed by continous dull ache, leg cramp at night, ankles may swell)

caysed by blood pooling withi nthe veins bc of decreased,stagnated blood flow,

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3
Q

risk factors for varicose veins?

A

pregnancy, seentary lifestyle, obesity and family histroy

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4
Q

why do varicose veins occur

A

leg muscle have valves that it squeezes blood up te vein (one valve open, blood goes in, valve closes, the valve above opens , etc.)

if this is isn’t happening blood exerts pressure on the closed valves and thin walls of veins

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5
Q

what are spider veins?

A

small, dense networks of veins that appear as red or blue discolorations on the skin

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6
Q

what are some complication of varicose veins + TREATMENTS?

A

ULCERS, INFECTION AND HEMORRHAGE

treatments include elastic band or support hose to increase circulation, walking, elevating legs when seated, losing weight, surgery

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7
Q

how to treat varicose veins?

A

elevate feet higher than heart

exercise, submerging legs in warm water, compression stockings

surgical vein stripping - removing veins and tying off the remaining open ends

compression sclerotherapy - strong saline solution is injected into specific sites of the varicose veins = infections -> scarrring of inner lining ->fusing veins shut

endovenous laser ablation procedure (destrooying incompetent veins, identify vein w/ ultrasonpgrahy, inject anesthetic and tissue rotecting agent, small incision, catheter into vein and section of vein r heated to destroy it)

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8
Q

What is chronic venous insufficiency

A

condition of poor venous blood returning to the heart

occurs most in middle age women and men 70+

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9
Q

risk factors for CVI

A

advancing age, family histroy of deep vein thrombosis (most common cause) , sedentary lifestyle, obesity and smoking

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10
Q

how to treat CVI

A

diet, exercise, use of compression stocking, valve repair, bypass and vein stripping

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11
Q

S/S of CVI

A

tissue edema, necrosis, skin atropy, pain during walking, venous stasis ulcers

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12
Q

how to diagnose CVI

A

ultrasound, venogrpahy, CT, MRI, blood test for D dimer

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13
Q

What is venous thrombosis + risk factors

A

a clot in superficial or deep veins of lower extremities

risks factors r venous stasis, vascular trauma, and condtions that promote blood clotting

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14
Q

s/s of venous thrmobosis

A

inflammation, pain, swelling and deep muscle tenderness

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15
Q

what are emboli?

A

clots (usually blood) that travel to vital organs such as the lungs

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16
Q

how to diagnose + treat venous thrombosis?

A

physical exam, history, ultrasound, venography, CT, MRI, and blood test for D dimer

Treatment - blood thinning med and surgery

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17
Q

what is coronary heart diease (CHD) ?

A

disease of reduced coronary blood flow (leading cause of death worldwide)

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18
Q

risk factors for CHD?

A

hypertension, family histroy, sedentary lifestyle, overweight , high blood lipid levels, atherosclerosis and smoking

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19
Q

More than ____% of persons with CHD have coronary atherosclerosis.

A

90

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20
Q

What is agina pectoris, s/s, etiology, diagnose and treat?

A

chest pain/pressure as a result of ischemia during or after exertion as result of redcued oxygen supply t o myocardium

s/s r sudden onset of left-sided chest pain during or shortly after exertion (may radiate to left arm or back), dyspnea, nitrogylcerin tablets may relieve pain, bp rise, arrhythmias

cause are atherosclerosis (exertion = more blood flow but cant), and spasms of coronoary arteries

diagnose w/ ECG and treat with cessation of strenous activit and nitroglycerin

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21
Q

symptoms of CHD

A

angina pectoris, palpitations, dizziness or fainting, weakness upon exertion or at rest, SOB, cardiac arrest or heart attack

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22
Q

symptoms of MI?

A

Crushing pain in the chest (substernal or left-sided chest pain)
shortness of breath
left or right arm, back or jaw
irregular heartbeat
dyspnea
diaphoresis
nausea
pallor
weakness
faintness

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23
Q

how to diagnose coronary heart disease?

A

physical exam, patient medical history, and
an electrocardiogram (ECG) and possible echocardiograms, stress tests, nuclear imaging, and angiography

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24
Q

How to treat CHD?

A

meds - bp lowering agents, blood thinners, diuretics (increases exertion of water), nitrates like nitroglycerin to stop chest pain, lifestyle changes (healthy, low-salt diet and exercise)

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25
Q

wat is angioplasty?

A

procedure to open a partly occluded artery and insert a ballon topped catheter into the femoral artery before guiding it to the heart and into the narrowed coronary artery

the balloon expands against vessel walls to open lumen and with it the stent (cylindrical wire mesh of stainless steel or other allow) and the balloon is removed but the stent is stuck in place to keep the lumen again

stents r coated with drugs to prevent restenosis (vessels commonly become occluded

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26
Q

what is coronary bypass surgery?

A

reroute blood flow aroudn the clogged arteries to improve blood flow and oxygen by grafting or attaching a healtyh bv from another part of the body from the aorta to the cornary artery

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27
Q

what is myocarditis + etiology?

A

inflammatory disease of the heart muscle that is asociated with other diseases

frequently viral, bacterial, fungal, protozoal infection or complication of other diseases such as influenza, diphtheria, mumps and rheumatic fever, MI, lithium, cocaine, chronic alcholosim, radiation, chemical poisoning

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28
Q

what diseases r risk factors for myocarditis ?

A

Coxsackie virus,
parvovirus, adenovirus, and echovirus. HIV/AIDS, Lyme disease, streptococcal and staphylococcal infections, and illegal drug use

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29
Q

s/s of myocarditis

A

flu-like illness, fatigue, fever, chest pain that may feel like
a heart attack, shortness of breath, and tachycardia, palpations, dyspnea, arrhythmias, tenderness in chest

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30
Q

how to diagnose and treat myocardial disease?

A

ECG, MRI, CT, chest x-ray, echocardiogram,
and cardiac catheterization + blood culture a d blood test (elevated WBC, increased ESR, elevated cardiac enzyme levels, ventricular enlargement on chest radiographs, abn ECG readings,, myocardial bopsy)

treatment = antibiotic or antivral med for underlying infections, analgesics, antiinflammatory agents, ACE inhibitors, oxygen, med to reduce bp and heart workload

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31
Q

What is cardiomyopathy?

A

disorder where the heart becomes weakened, enlarged or rigid

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32
Q

what r risk factors for cardiomyopathy

A

hypertension, myocarditis, and viral or bacterial infections

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33
Q

what are the 3 types of cardiomyopathy?

A

Dilated cardiomyopathy - most common, dilation of the ventrile, contractile dysfunction and symptoms of congestive heart failure

Hypertrophic cardiomyopathy - ventricular hypertrophy, most common cause of sudden cardiac death among youngins

Restrictive cardiomyopathy - least common, reducing filling of heart and endocardial scarringin the ventricle

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34
Q

S/S of cardiomyopathy + treatment

A

shortness of breath, weakness, fatigue, ascites, and peripheral edema, dyspnea, tachycardia, palpations, chest pain, hepatic congestions, syncope, cardiac murmurs

treatment = heart transplantation, medication, rest (mostly depends on type and unerlying causes)

35
Q

What is endocarditis?

A

infection of the endocardium and the heart valve most prevanelnt in people with heart valve disorders or other heart disorders (doesnt affect healthy heart)

36
Q

what are the risk factors for endocarditis?

A

rheumatic heart disease, herat valve disease, degenerative heart disease, congential heart disease and IV drug abuse

37
Q

how bacteria and fungi cause endocarditis?

A

it causes acute endocarditis by formic nodules or vegetation that consist of infectious organisms and cellular debris all in a fibrous clot

this clot can break up and lodge itself in small bv of skin or other organs and cause the blood vessels to rupture

common infecting organims r Staphylococcus aureus, group A beta-hemolytic streptococci, Escheria coli (more likely for IV drug users, damaged cardaic valves from rheumatic disease)

38
Q

symptoms of infective endocarditis?

A

fever, chills, change in the sound or character of an existing heart murmur, evidence for emobilzation of the vegetative lesions

39
Q

How to diagnose and treat endocarditis?

A

echocardiograms, CT, ECG to diagnose

treat with antibiotics, surgery for heart valve damage

prevent by only treating heart disease and valve diseases and avoid illegal IV drug use

40
Q

What is rheumatic fever + risk factors?

A

systemic inflammatory and automimmune disease of heart tissue and heart valve as well as joints

v rare in US, risk factors r age (5-15), infection with group A hemolytic streptococci (causes antibodies to attack body’s own cells and intitatie an inflammatory reaction which migrate to endocardium and mitral (sometimes aortic valves) where vegetations form - joint pain and fever)

41
Q

s/s pf rheumatic fever

A
  • usually follows sore throat caused by group A beta-hemolytic Streptococcus
  • fever
  • polyarthritis (joint pain, edema, redness, limited range of moiton in finger, knee and ankle joints)
  • carditis
  • cardiac murmurs
  • cardiomegaly
  • CHF
  • weakness
    -maliase
  • anorexia
  • wt loss
  • rash on trunk
  • abd pain
  • development of small nodules on tendon shealths in knoees, knuckles and elbows
42
Q

what does blood clots on cusp of inflamed valves lead to?

A

forms nodular structures call vegetations which makes fnormally flexivible cusps thicken and adhere to each other which allows fibrous tissue to form (has tendency to contract), which may narrow valve openings, nmeaning the mitral valve becomes stenotic

43
Q

How to diagnose and treat rheumatic fever?

A

phyiscal exam, histroy of streptococcal infection, elevated antistreptolysin O titer, ECG, echocardiogram, WBC count, ESR, cardiac enzyme levels

treat using antibiotics (penicillin), antipyretics, and anti-inflammatores, may give meds to control invol muscle contractions, bed rest, pediatric autoimmune neuropsychaitric dissorders associated with streptococcal infections can be result of untreated beta-hemolytic streptococcal infections

44
Q

What is stenosis?

A

narrowing of the valve opening and failure of the valve to open normally

causes heart chamber that empties blood through disease valve to swell which impaires the filling of the chamber that recieves blood

45
Q

hat is valvular insufficiency

A

aka regurgitation, refers to valve that allows backward flow of blood within the heart

46
Q

risk factors of valve disorders

A

increasing age, family history of valve disorders, and
history of rheumatic fever

47
Q

most common valve disorders

A

mitral valve stenosis
mitral valve insufficiency (prolapse)
aortic valve stenosis
aortic valve insufficiency (prolapse)

48
Q

s/s of valve disorders

A

may be absent excpet for presence of characterisitc heart sounds

advace disease causes hypertrophy and weaking of the heart muscle, SOB, and cyanosis

complications include congestive heart failure

49
Q

how to diagnose and treat valve disorders?

A

listening to heart murmurs with a stethoscope
imaging with echocardiogram
transesophageal echocardiogram
ECG
cardiac catheterization

no treatment needed usually but serious valve damage may require surgical valve replacement or repair

50
Q

what are cardiac arrythmias + types?

A

abn heart rhythms that develop from irregularity in impulse generation and impulse conduction

2 types - supraventricular and ventricular

51
Q

what are supraventricular arrythmias?

A

those created by electrical abn in sinoatrial (SA) node, atria, atrioventricular (AV) node, and junctional tissue in the heart

52
Q

what are ventricular arrhythmias?

A

include those that are generated in the ventricular conduction system and in the ventricle

since ventricles pump blood from heart ventricular arrythmias r seriosu and potentially life threatening

53
Q

risk factors of arrythmias?

A

family history, atherosclerosis, coronary artery disease,
smoking, and alcohol and drug abuse

54
Q

etiology of arrythmias?

A

history of coronary heart disease
heart valve disease
myocardial infarction
hypertension
atherosclerosis
metabolic diseases
smoking
drug abuse
could be caused by pacemaker (SA node), AV node, bundle branches and Purkinje fibers
ischemia

55
Q

Types of rhythm disorders?

A

• Tachycardia - sustained heart rate greater than 100 beats per minute
• Bradycardia - abnormally low heart rate less than 50 beats per minute
• Atrial fibrillation - disorganized, uncoordinated contraction of atria (most common)
• Ventricular fibrillation - disorganized, uncoordinated contraction of ventricles (life-threatening, form of cardiac arrest)
• Heart block - atria and ventricles contract independent of each other

56
Q

S/s and treatment of cardiac rhythm disorders?

A

s/s - syncope or lightheadedness, edema, or SOB, abn heartbeat, tachycardia, bradycardia, skipped heartbeats, fatigue

treatment -
med (change physiological properties of the heart conduction system)
electro cardioversion (external device or internal pacemaker)
catheter ablation (insert catheter in diseased area of the heart and direct to area of heart causign abn heart rhythm where it severs the connecting pathway)

57
Q

what is an AED

A

automated external defibrillator that delivers electrical shocks and is used to reestablish normal heart rhythm

58
Q

What is Myocardial infarction?

A
  • death of myocardial tissue caused by development of ischemia
  • caused by insufficient oxygen supplu as can occur when a coronary artery is occluded by artherosclerotic plaque, thrombus, myocardial muscle spasm
59
Q

how to diagnose and treat myocardial infarction?

A

diagonse - through history, ECG, chest radiographic studies, lab tests for cardiac enzyme levels (indicated death of cardiac tissue and included creatin phospokinase (CPK) and troponin, which are elevated in first 6 to 24 hrs after MI, lactate dehydrogenase (LDH), which peaks at 48 ours after MI, aspartate aminotransferase (AST)

treat - oxygen, morphine, aspirin, vasodilation w/ nitroglycerin drop, lidocaine or aminodarone, thrombolytic drugs, within 6 hr window attempt to open occlusion and to restore blood flow to area through angioplasty or CABG, stent

60
Q

etiology of cardiact myopathy

A
  • primary causes r mostly unkown
  • dilated cardiomyopathy can be result of crhonic alcholism, autoimmune process or viral infection (diffuse degeneration of myocardial fibers)
  • hypertropic cardiomyopathy r thought ot be genetic and r considered idiopathic
  • restrictive cardiomyopathy is rare where any infiltrative process of heart causes fibrosis and thickening of myocardium, resulting in walls of ventricles becoming stiff
  • muscle stiffens = not fillign properly = harder to fill ventricles with adequate blood and for ventricles to pump blood to heart
61
Q

how to diagnose and treat cardiac myopathy?

A

diagnose - thorough pt history and complete physical exam, cardiomegaly, chest radiographs to confirm cardiomegaly, ECG reveals rate ad rhythm abn, ECG and cardiac catheterization, biopsy

treat - for dilated treat w. antiarrhythmic agents, digitalis, anticoagulants, limit activies, bed rest, for hypertrophic cardiomyopathy reduce workload of hear w/ beta-adrenergic blockers to reduce myocardial contractility, heart rate and conductivity, CCBs to reduce bp and relax heart muscle, ACE inhibitors to relax bv, treat restrictive same as hypertrophic

62
Q

s/s of endocarditis?

A
  • usually secondary to infeciton elsewhere in body, result of preexisting heart disease, abn immunologic reaction
  • fevere, chills, night sweats, weakness, anorexia, fatigue
  • characterized by vegetattive growth on cardaic valves that may be released in bloodstream in form of emboli which can lodge in vessels and cause symptoms of ischemi, dysfunction of valves and which may not close effectibilty = cardaic murmur heard on ausculation, serious obstruction or regurgitaiton of blood flow throgh heart
63
Q

What is sinus tachycardia?

A

sustained heart rate greater than 100 beats per minute
rapid impulse originating in SA node, conduction is normal
treat with beta blockers, CCB, may need ICD

64
Q

What is sinus bradycardia?

A

abnormally low heart rate less than 50 beats per minute
caused by slow impulse originating in SA node
treat with atropine

65
Q

What is premature atrial contraction/

A

extra heartbeats that begin in one of your heart’s two upper chambers (atria)
rate depends on underlying rhyhtm
caused irritable atrium, single ectopic beat the arises prematures
diagnose with irregular heartbeat and ECG
usually no treatment, may need antiarrythmic drugs

66
Q

What is atrial tachycardia?

A

rate of 150-250 bpm
caused irritable atrium, firing at rapid rates
diagnose w/ rapid rate with atrial and ventricular rates identical, + ECG
treat with reflex vagal stimulation, CCBs, may be canadate for ICD or ablation

67
Q

What is atrial fibrillation?

A

disorganized, uncoordinated contraction of atria (most common)
atrial rate over 350 bpm and ventricular less than 100 bpm (controlled) or over 100 bpm (rapid ventricular response)
- caused by actrial ectopic foci dischargin at too rapid and chaotic rate for muscle to respond and conrtal
diagnose w/ ECG that shows grossly irregular ventricular rate
treat with IV verapamil, procainamide, cardioversion, amy be candidate for ICD or ablation

68
Q

What is first-degree heart block?

A

atria and ventricles contract independent of each other
rate depends
rate depends on rate of underlying rhythm
caused by delay at AV node
diagnose w/ ECG show P-R interval > 0.2 second
treat with atropine or artificial pacemaker insertion

69
Q

What is Wenckebach heart block

A

varying failure of conduction through the AV node occurs, such that some P waves may not be followed by a QRS complex.
intermittent block with progressively loner delay in condiction until 1 beat is blcoked (atrial rate normal, ventricular rate slwoer than normal)
caused by SA node initiaes impulse but conduction through AV node is blocked intermittently
ECG show normal P waves but some P waves not followed by ORS complex (P-R intervals progressively longer)
mild = no treatment severe = artificial pacemaker

70
Q

What is classic second-degree heart block

A

disturbance, delay, or interruption of atrial impulse conduction to the ventricles through the atrioventricular node (AVN) and bundle of His.
ventricular rate slow (1/2, 1/3 or 1/4) of atrial rate, P wavs normal, ORS complex dropped every second, third, or fourth beat
SA intitiates impulse conduction through AV node is blocked
ECG shows P waves present, QRS blocked every second, third or fourth impulse
treat with artifical pacemaker

71
Q

What is third-degree heart block

A

complete loss of communication between the atria and the ventricles
atrial normal, no relationship btwn P wave and QRS complex
SA node intitate impulse but is compleyely blocked from conduction, causing atria and ventricles to beat indep
diagnoe w/ ECG (shows P waves and QRS with no relationship)
treat with artifical pacemaker

72
Q

What is premature ventricular contraction?

A

single ectopic beat, arises from ventricle, followed by compensatory pause
ectopic beat originates in irritable ventricle
ECG show wide, bizarre QR cmoplex > 0.12 sec
if less than 6/min and single focus
make be candidate for ICD or ablation

73
Q

What is multifocal arryhtmia?

A

4 types: coupling (2 in row), Bigeminy (every other beat), trigeminy (every 3rd beat), quadrigeminy (every fourth beat)
rate depends on underlying rhythm, P wave avsnet before ectopic beat
ectopic beat originates in irritable ventricle
diagnose with ECG show wide, bizarre QRS complex
no treatment if <6/min and single focus

74
Q

What is ventricular tachycardia ?

A

rate of 150-250 bpm
rhythm usually egular
focus of pacemaker normally single
pt experiences palpitations, dyspnea, anxiety
cause is 4 or more rapid PVC at rapid rate caused by advanced irritabiltiy of myocardium
ECG show 4 or more PVC
treat with IV lidocain, cardioversion, procainamide, bretylium, ICD, ablation

75
Q

What is ventricular fibrillation?

A
  • pt loses consciousness immediatley, no peripheral pulse, heart sound or bp
  • ventricular fibers twitch rather than contract
  • ECG show rapid, repetitive chaotic waves originating in ventricle
    treat with defbrillation, ICD or ablation
76
Q

What is shock?

A
  • collapse of CB system, including vasodilation and fluid shift, accompanied by inefficient carduac output
  • caused by anaphylaxis, hemorrhage, spesis, respiratory distress, heart failure, neurologic failure, emotional catastrophe, severe metabolic insult, rapid loss of blood or fluid, hypovolemia, failure of heart to pump, vascular collapse w/ subsequet massive dialtion or contrsiction of vessels
  • amt of blood that is circulating in body is reduced so vital organs dont receive sufficient oxyven and nutrients
77
Q

s/s of schock

A
  • causes inadequate perfusion of organs and tissue, pt has pale, cold, and clammy skin, rapid, weak and thready pulse, rapid breathing, altered level of consciousness, bp drops, pt may be anxious, irritable or restless, feel impending doom, dizziness, extreme thirst, profuse sweating, dilated pupil, eyes become dull and lusterless
    shaking and trembling
78
Q

how to diagnose and treat shock?

A

diagnose - history of precipating event, inadequate cellular perfusion, respiratory distess, varying levels of consciousness

treat - CABs (compression, airway, breathing), control visible bleeding, surgical intervention, supin position, warm, monitor vital signs, volume replacement with IV, supplemental oxygen

79
Q

What is cardiogenic shock

A
  • inadequate output of blood by heart
  • myocardium fails to pump effectibely (preceded by MI, severe heart failure, certain arrhythmas, acute valve failure)
  • diagnose w/ clinical picture and history of major cardiac insult, ECG
    treat w/ meds to increase efficiency of myocardium, improve blood supply to vital organs, intraaortic balloon pump
80
Q

What is cardiac tamponade?

A
  • aka cardiac compression
  • compression of heart muscle and restriciton of heart movement by blood or fluid trapped in pericadial sac (coronary, epicardial or pericardial or myocardium breaks) which contricts heart, thus restricting heart movmeent and less blood can enter heart chmbers
  • severe dyspnea, rapidly falling bp, weak, thready, rapid pulse, cyanotic
  • diagnose based on clinical picture and history of traumatic event
    treat by inserting needle into pericardial space and withdray blood (surgery to fix leak)
81
Q

s/s of emboli?

A
  • depends on location of occluded vessel and magintude of area of tissue served by vessel
  • initial symptom is severe pain, pale, numbness, cold, absence of arterial pulse, N&V, fainting, shock in area blocked off
82
Q

how to diagnose and treat emboli?

A

diagnose w/ clinical picture, history of bed rest, physical inactivity, heart failure, arrhythmias, any condition that has put pressure on or decreased flow in veins of legs or pelvis

treat based on area of involvement: reestablish blood flow to affeced part ny lowering limb, wraping it to maintain warmth, reating any constriction of bv, heparin or enoxaparin to prevent further clot formation and antispasmoodic for vascular spasms, surgical interveontion, thrombolytic drug

83
Q

What is thromboangiitis obliterans?

A
  • aka buerger disease
  • inflammation of peripheral arteries and veins of extremities along w/ clot formation
  • s/s r itense pain in affected area, usually legs or instep of foot (can cause atrophy, ulcers and even gangrene)
  • primary cause is long-term smoking (inflammation and resulting clot fomration advance until entrie vessel is obliterated)
84
Q

how to diagnose and treat buerger disease?

A
  • diagnose w/ intense pain in leg or instep, arteriography, ultrasonography (identify sitre of clot or obliteration), ulcers on skin, long term smoking of tobacco
  • treat w/ cessation of smoking, reduce inflammation and restore parttial circulation, prasugrel or clopidogrel to improve circulation, buerger-allen exercises, elevate legs by 45-90 degrees until skin blanches than lower leg to lower below rest of body utnil skin reddens then rest in supin position, finaly is surgical intervention

Pathophysiology - Diseases (22 decks)

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