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RMC Patho Exam 2 > Disorders of Blood flow and BP > Flashcards

Disorders of Blood flow and BP Flashcards

1
Q

Ischemia is the

A

Reduction in arterial flow to a level that is insufficient to meet the oxygen demands of the tissue

inadequate blood supply

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2
Q

Infarction is an area of

A

Ischemic necrosis in an organ produced by occlusion of its arterial blood supply or venous drainage

obstruction of blood supply

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3
Q

Dyslipidemia is the imbalance of

A

Lipid components (triglycerides, phospholipids, cholesterol)

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4
Q

Atherosclerosis is the

A

Hardening of the arteries

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5
Q

Atherosclerosis is characterized by

A

The formation of fibrofatty lesions in the intimal lining of large and medium sized arteries

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6
Q

The risk factors of atherosclerosis are

A 
Hypercholesterolemia (elevations in LDL cholesterol) **This is the major risk factor** ^^^
Smoking
Obesity
Hypertension
Diabetes mellitus
Physical inactivity
Stressful life patterns
Blood levels of C-reactive protein (CRP)
Serum homocysteine levels
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7
Q

How does smoking cause atherosclerosis?

A

By damaging the endothelial tissue of the blood stream causing inflammation - allows for plaque build-up

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8
Q

What is CRP?

What does it implicate in atherosclerosis?

A

C-reactive protein is an acute-phase reactant protein of the inflammatory process

CRP has been noted within some atherosclerosis plaques - indicates inflammation in plaque formation

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9
Q

What is homocysteine?

How does it cause atherosclerosis?

A

It is an amino acid produced to break down proteins in the body

It inhibits elements of the anticoagulant cascade and is associated with endothelial damage leading to inflammation

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10
Q

List the three types of lesions associated with atherosclerosis

A

Fatty streak
Fibrous atheromatous plaque
Complicated lesion

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11
Q

Fatty streaks are

A

Thin, flat, yellow lines that become thicker and slightly elevated

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12
Q

Fatty streaks consist of

A

Macrophages and smooth muscle cells (SMCs) that have become distended with lipids to form foam cells

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13
Q

Who do fatty streaks affect?

A

Everyone; they present in children and increase in number until 20 years of age

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14
Q

Fibrous atheromatous plaque is gray to pearly white because

A

Macrophages ingest and oxidize accumulated lipoprotein

Over time, the fatty streaks grow and proliferate into the smooth muscle layer

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15
Q

What are the main three problems that fibrous atheromatous plaque causes

A

Can occlude the vessel
Can lead to a thrombus (blood clot)
Can reduce the blood flow

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16
Q

Complicated atherosclerotic lesions are caused when

What is produced?

A

Fibrous plaque breaks open

Hemorrhage
Ulceration
Scar tissue deposits

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17
Q

What is the most important complication of atherosclerosis?

A

Thrombosis (blood clot blocks vein or artery)

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18
Q

Hyperlipidemia may also play a role in

A

Atherosclerotic lesions

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19
Q

Activated macrophages release

A

Free radicals that oxidize LDL

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20
Q

The development of atherosclerotic lesions is a

It involves

A

Progressive process

Endothelial cell injury
Migration of inflammatory cells
SMC proliferation and lipid deposition
Gradual development of he atheromatous plaque with a lipid core

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21
Q

Endothelial cell injury is caused by

A

Smoking
Elevated LDL levels
Immune mechanisms
Mechanical stress associated with hypertension

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22
Q

In the migration of inflammatory cells, monocytes adhere to ___ then become ___ and then turn into ___

A

Endothelium
Macrophages that engulf lipoproteins
Foam cells

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23
Q

Lipid accumulation and SMC proliferation is due to

A

Growth factors

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24
Q

Within lipid accumulation and SMC proliferation, what happens to foam cell macrophages?

A

They die, depositing necrotic cellular debris an lipids within the vascular wall

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25
Q

The plaque structure is vulnerable and can

This would lead to

A

Rupture
Ulcerate
Erode

Hemorrhaging to the plaque or thrombotic occlusion of the vessel lumen

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26
Q

Clinical manifestations of atherosclerosis

Manifestations depend onf

A

There are no symptoms until the artery is severely narrowed or totally obstructed

The vessels involved
the extend of vessel obstruction

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27
Q

What organs/tissues are most frequently involved in atherosclerosis?

A

Arteries supplying the heart, brain, kidneys, lower extremities, and small intestine

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28
Q

Acute arterial occlusion is the

Commonly caused by

A

Sudden interruption to blood flow

Thrombus - blood clot

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29
Q

Most emboli start in

A

The heart

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30
Q

Thrombi arise from

A

The erosion/rupture of a fibrous cap or an arteriosclerotic plaque

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31
Q

Clinical manifestations of acute arterial occlusion depend on

A

The artery involved and the adequacy of collateral circulation

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32
Q

What are the 7 P’s of acute arterial occlusion?

A 
Pistol shot (acute onset)
Pallor
Polar (cold)
Pulselessness
Pain
Paresthesia
Paralysis
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33
Q

Atherosclerotic occlusive disease is a

Caused by

A

Peripheral artery disease

Atherosclerosis

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34
Q

Atherosclerotic occlusive disease is common in the

A

Lower extremities

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35
Q

Symptoms of atherosclerotic occlusive disease show up

Symptoms occurs with

A

Gradually

50% narrowing

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36
Q

The primary symptom of atherosclerotic occlusive disease is

A

Intermittent claudication (muscle pain that occurs when you’re active and stops when you rest)

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37
Q

Other signs of ischemia are

A

Atrophic changes (body tissue or organ atrophied)
Thinning of skin and subcutaneous tissues of the lower leg
Reduced size of leg muscles

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38
Q

Thromboangiitis is also called

A

Buerger disease

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39
Q

Thromboangiitis is an

A

Inflammatory arterial disorder that causes thrombus formation

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40
Q

What/where does thromboangiitis affect?

A

Medium sized arteries in the foot and lower leg

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41
Q

What is the cause of thromboangiitis?

A

Unclear

But smoking is involved (smoking causes everything)

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42
Q

What the symptoms of thromboangiitis?

A

Pain (even present at rest in severe cases)

Intermittent claudication in arch of foot/digits

Increased sensitivity to cold

Cyanotic extremities in dependent position (can be reddish/blue in nondependent positions)

Skin becomes thin, shiny, suffered hair growth and nutrition

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43
Q

Raynaud disease/phenomenon is the

A

Vasospasm of arteries and arterioles (usually fingers

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44
Q

What causes Raynaud disease?

Raynaud phenomenon?

A

No one knows

Due to other disorders/diseases

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45
Q

Raynaud disease is brought on by

A

The cold or strong emotions

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46
Q

What are manifestations of Raynaud disease/phenomenon?

A

Blanching of the extremities
> Primarily fingers
> Cold to the touch, can become red once spasm ends

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47
Q

An aneurysm is an

A

Abnormal localized dilation of a blood vessel

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48
Q

Aneurysms are most common in the

A

Aorta

49
Q

What are the two kinds of aneurysms?

A

True and False

aneurysms can be hipster too

50
Q

A true aneurysm is

A

Bounded by a complete vessel wall
> Blood remains within the vascular compartment

an abnormal dilation of an artery due to a weakened vessel wall

51
Q

A false aneurysm is a

A

Localized dissection/tear in the inner wall of the artery with formation of an extravascular hematoma that causes vessel enlargement

when a blood vessel wall is injured and the leaking blood collects in the surrounding tissue

52
Q

What is the most serious complication of an aortic aneurysm?

A

Rupture (then DEATH)

53
Q

Causes of thoracic aortic aneurysm and abdominal aortic aneurysm

A

Atherosclerosis and degeneration of vessel media
Hypertension
Smoking

54
Q

List symptoms of a thoracic aortic aneurysm

A 
Substernal, back, and neck pain
Dyspnea
Stridor or brassy cough
Hoarseness
Distention of neck veins
Edema of the face and neck

may be asymptomatic until rupture

55
Q

What are symptoms of an abdominal aortic aneurysm?

A

Calcification
Pain (varies from mild mid-abdominal or lumbar discomfort to severe abdominal and back pain)
> pain from lower back to back of the legs
Erosion of vertebrae

56
Q

Most abdominal aortic aneurysms are

What can be the first sign?

A

Asymptomatic

Pulsating mass

57
Q

Aortic dissection is chronic or acute?

A

Acute - life threatening condition

58
Q

If you had a patient with an aortic dissection, what would you expect to see?

A

Hemorrhage into the vessel wall with tearing to form a blood filled pocket

heart wall splits and blood pools between the layers

59
Q

What are the causes of aortic dissection?

A

Conditions that weaken the elastic and smooth muscle layers of the aorta

60
Q

What are the 2 risk factors of aortic dissection?

A

Hypertension

Degeneration of the medial layer of the vessel wall

61
Q

You might see a patient with an aortic dissection as a complication of

A

Cardiac surgery

Catheterization

62
Q

What is the major symptom of aortic dissection?

A

Abrupt excruciating pain (described as tearing or ripping)

63
Q

In the early stages of an aortic dissection, BP is typically

A

Moderately or markedly elevated

64
Q

In the later stages of an aortic dissection, BP and PR become

A

Unobtainable in on or both arms

65
Q

Other manifestations of aortic dissection are

A

Syncope (fainting, LOC)
Hemiplegia (paralysis of one side of the body)
Paralysis of the lower extremities
Heart failure - when the aortic valve in involved

66
Q

Veins move ___ from the body to the ___

A

Deoxygenated blood

Right side of the heart

67
Q

What are the two mechanisms that prevent retrograde flow?

A

Valves and action of leg muscles

68
Q

Varicose veins are

A

Dilated, tortuous veins of the lower extremities

69
Q

What is the most common cause of varicose veins?

A

DVT (deep vein thrombosus)

70
Q

You’re most likely to see varicose veins in ___ patients.

A

Female

71
Q

There is a higher incidence of varicose veins in people who

A

Are obese or pregnant
> Increase intra-abdominal pressure which puts stress on saphenofemoral junction

Stand for long periods of time
> standing increases venous pressure and causes dilation/stretching of vessel wall

72
Q

Clinical manifestations of varicose veins are

A

Aching in lower extremities and edema

73
Q

In regards to varicose veins, prolonged exposure to increased pressure causes venous valves to

A 
Become incompetent (no longer close properly)
> reflux of blood causes further venous enlargement , pulling the valve leaflet apart
74
Q

Chronic venous insufficiency is

A

Persistent venous hypertension in lower extremities

75
Q

The causes of chronic venous insufficiency are

A 
Increased venous hydrostatic pressure
Incompetent valves in veins
Deep vein obstructions
Decreased skeletal muscle pump function
Inflammatory processes
Endothelian dysfunction 
Ineffective blood flow
Retrograde blood flow
76
Q

Chronic venous insufficiency presents with

A

Tissue congestion
Edema
Impaired tissue nutrition
Necrosis of subQ fat deposits - skin atrophy
Brown pigmentation of skin (due to hemosiderin deposits resulting from the breakdown of RBC)

Advanced stages:
Stasis dermatitis (shiny, bluish brown skin, poor healing)
Ulcers

77
Q

Venous thrombosis is

A

Thrombus plus inflammation

78
Q

Venous thrombosis is most common in

A

Lower extremities

79
Q

Venous thrombosis can cause a

A

Pulmonary embolism

80
Q

How can a DVT cause a PE?

A

By throwing a clot to the heart

81
Q

Are DVT or SVT more common?

A

DVT

82
Q

Venous thrombosis is associated with

A

Stasis of blood
Increased blood coagulability
Vessel wall injury

Virchow Triad

83
Q

Examples of stasis of blood

A

Impaired cardiac function
Acute MI and congestive heart failure
Long airplane travel/extended sittin

84
Q

Examples of increased blood coagulability

A

State of increased clot formation
Inherited disorders of factor V Leiden and prothrombin
Smoking
Birth control

85
Q

Examples of vessel wall injury

A

Trauma and surgery
Infection or inflammation
Venous catheters

86
Q

Many cases of venous thrombosis appear without

A

Symptoms

87
Q

Venous thrombosis symptoms are related to

List symptoms

A

Inflammation

Pain
Swelling
Deep muscle tenderness
Fever
Malaise
Elevated WBC
Erythrocyte sedimentation
88
Q

BP is closely regulated to ensure

A

Body tissues are perfused

Arteries don’t get damaged

89
Q

Hypertensions is

A

Elevated BP

90
Q

What are the two types of hypertension?

A

Primary - “essential” (no evidence of other diseases)

Secondary (due to another disease condition)

91
Q

Non-modifiable risk factors of hypertension are

A 
Age 
Gender
Race
Family history
Genetics
92
Q

Modifiable risk facts of hypertension are

A 
Diet
Levels of blood lipids
Smoking and alcohol consumption
Fitness and activity level
Overweight/obesity
Blood glucose control
93
Q

Clinical manifestations of primary hypertension

A

Typically asymptomatic until long term effects on target-organ systems (kidneys, heart, eyes, blood vessels)

94
Q

Secondary hypertension has 5 big causes

A

Renal hypertension

Disorders of adrenocortical hormones

Pheochromocytoma

Coarctation of the aorta

Oral contraceptive drugs

95
Q

Which of the big 5 is the largest cause of secondary hypertension?

A

Renal hypertension

96
Q

Renal hypertension is caused by

A

Reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism

97
Q

Disorders of adrenocortical hormones is

A

Hormonally induced renal retention of salt and water

98
Q

Pheochromocytoma is a

A

Tumor of chromaffin tissue

> Contains sympathetic nerve cells that release catecholamine (most commonly located in the adrenal medulla)

99
Q

Coarctation of the aorta is a

A

Congenital condition in which there is narrowing in the area of the arch of the aorta

100
Q

Oral contraceptive drugs cause is

A

Largely unknown

> Probably cause is volume expansion

101
Q

Increased perfusion pressure leads to

A

Damage of target organs

102
Q

Increased intravascular pressure leads to

A

Damage of endothelial cells in vessels - increases the risk for atherosclerosis

103
Q

Hypertension is a big risk factor for atherosclerosis because

A

It promotes plaque formation and rupture

104
Q

Hypertension predisposes to

A

Coronary heart disease
Heart failure
Stroke
PAD

105
Q

Hypertension causes increased workload of the

A

Left ventricle (heart pumps against high pressure in arteries)

106
Q

Chronic hypertension can lead to

A

Nephrosclerosis (hardening of the walls of the small arteries of the kidney)

> > Glomerular perfusion is decreased

107
Q

People with hypertension are more likely to experience what in regards to the brain

A

Dementia and cognitive impairment

Stroke

108
Q

Hypertension can lead to what eye changes?

A

Microvascular changes in retina (retinopathy)

109
Q

Orthostatic hypertension is when

A

BP drops after a person stands after sitting or lying down

Systolic BP drop of 20mmHg and/or diastolic BP drop of 10mmHg

110
Q

With the BP of a patient with orthostatic hypertension, you’d expect to see what in regards to systolic and diastolic?

A

Systolic BP drop of 20mmHg and/or diastolic BP drop of 10mmHg

111
Q

A patient with orthostatic hypertension would present with

A

May be asymptomatic or have dizziness and syncope

112
Q

What causes orthostatic hypertension?

A

When moving to standing position, 500-700 ml shifts to lower part of body

> > Several normal body responses act to maintain blood pressure with this shift - Without those responses

Blood pools in lower extremities, meaning inadequate blood flow to brain, which causes symptoms

113
Q

Contributing factors of orthostatic hypertension are

A 
Effects of aging 
Reduced blood volume 
Bed rest and impaired mobility
Drug induced hypotension 
Disorders of autonomic nervous system
114
Q

Why do the effects of aging contribute to orthostatic hypertension?

A

There is increased arterial pressure instability and deficiencies in circulatory system

115
Q

Why does reduced blood volume contribute to orthostatic hypertension?

A

There is just not enough blood circulating around (not enough oxygen when the person stands)

116
Q

Why does bed rest and impaired mobility contribute to orthostatic hypertension?

A

Reduced plasma volume
Decreased venous tone
Failed peripheral vasoconstriction
Weakness of skeletal muscles that support veins

117
Q

Why does drug induced hypotension contribute to orthostatic hypertension?

A

Antihypertensives

Antipsychotics

118
Q

Why do disorders of the autonomic nervous system contribute to orthostatic hypertension?

A

Sympathetic stimulation increases heart rate and cardiac contractility, which causes constriction of peripheral arterioles and veins
» Diabetes mellitus and spinal cord injury puts people at risk.

RMC Patho Exam 2 (6 decks)

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