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
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
3
Q
Dyslipidemia is the imbalance of
A
Lipid components (triglycerides, phospholipids, cholesterol)
4
Q
Atherosclerosis is the
A
Hardening of the arteries
5
Q
Atherosclerosis is characterized by
A
The formation of fibrofatty lesions in the intimal lining of large and medium sized arteries
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
7
Q
How does smoking cause atherosclerosis?
A
By damaging the endothelial tissue of the blood stream causing inflammation - allows for plaque build-up
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
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
10
Q
List the three types of lesions associated with atherosclerosis
A
Fatty streak
Fibrous atheromatous plaque
Complicated lesion
11
Q
Fatty streaks are
A
Thin, flat, yellow lines that become thicker and slightly elevated
12
Q
Fatty streaks consist of
A
Macrophages and smooth muscle cells (SMCs) that have become distended with lipids to form foam cells
13
Q
Who do fatty streaks affect?
A
Everyone; they present in children and increase in number until 20 years of age
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
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
16
Q
Complicated atherosclerotic lesions are caused when
What is produced?
A
Fibrous plaque breaks open
Hemorrhage
Ulceration
Scar tissue deposits
17
Q
What is the most important complication of atherosclerosis?
A
Thrombosis (blood clot blocks vein or artery)
18
Q
Hyperlipidemia may also play a role in
A
Atherosclerotic lesions
19
Q
Activated macrophages release
A
Free radicals that oxidize LDL
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
21
Q
Endothelial cell injury is caused by
A
Smoking
Elevated LDL levels
Immune mechanisms
Mechanical stress associated with hypertension
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
23
Q
Lipid accumulation and SMC proliferation is due to
A
Growth factors
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
25
The plaque structure is vulnerable and can
This would lead to
Rupture
Ulcerate
Erode
Hemorrhaging to the plaque or thrombotic occlusion of the vessel lumen
26
Clinical manifestations of atherosclerosis
Manifestations depend onf
There are no symptoms until the artery is severely narrowed or totally obstructed
The vessels involved
the extend of vessel obstruction
27
What organs/tissues are most frequently involved in atherosclerosis?
Arteries supplying the heart, brain, kidneys, lower extremities, and small intestine
28
Acute arterial occlusion is the
Commonly caused by
Sudden interruption to blood flow
Thrombus - blood clot
29
Most emboli start in
The heart
30
Thrombi arise from
The erosion/rupture of a fibrous cap or an arteriosclerotic plaque
31
Clinical manifestations of acute arterial occlusion depend on
The artery involved and the adequacy of collateral circulation
32
What are the 7 P's of acute arterial occlusion?
```
Pistol shot (acute onset)
Pallor
Polar (cold)
Pulselessness
Pain
Paresthesia
Paralysis
```
33
Atherosclerotic occlusive disease is a
Caused by
Peripheral artery disease
Atherosclerosis
34
Atherosclerotic occlusive disease is common in the
Lower extremities
35
Symptoms of atherosclerotic occlusive disease show up
Symptoms occurs with
Gradually
50% narrowing
36
The primary symptom of atherosclerotic occlusive disease is
Intermittent claudication (muscle pain that occurs when you're active and stops when you rest)
37
Other signs of ischemia are
Atrophic changes (body tissue or organ atrophied)
Thinning of skin and subcutaneous tissues of the lower leg
Reduced size of leg muscles
38
Thromboangiitis is also called
Buerger disease
39
Thromboangiitis is an
Inflammatory arterial disorder that causes thrombus formation
40
What/where does thromboangiitis affect?
Medium sized arteries in the foot and lower leg
41
What is the cause of thromboangiitis?
Unclear
But smoking is involved (smoking causes everything)
42
What the symptoms of thromboangiitis?
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
43
Raynaud disease/phenomenon is the
Vasospasm of arteries and arterioles (usually fingers
44
What causes Raynaud disease?
Raynaud phenomenon?
No one knows
Due to other disorders/diseases
45
Raynaud disease is brought on by
The cold or strong emotions
46
What are manifestations of Raynaud disease/phenomenon?
Blanching of the extremities
> Primarily fingers
> Cold to the touch, can become red once spasm ends
47
An aneurysm is an
Abnormal localized dilation of a blood vessel
48
Aneurysms are most common in the
Aorta
49
What are the two kinds of aneurysms?
True and False
**aneurysms can be hipster too**
50
A true aneurysm is
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
A false aneurysm is 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
What is the most serious complication of an aortic aneurysm?
Rupture (then DEATH)
53
Causes of thoracic aortic aneurysm and abdominal aortic aneurysm
Atherosclerosis and degeneration of vessel media
Hypertension
Smoking
54
List symptoms of a thoracic aortic aneurysm
```
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
What are symptoms of an abdominal aortic aneurysm?
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
Most abdominal aortic aneurysms are
What can be the first sign?
Asymptomatic
Pulsating mass
57
Aortic dissection is chronic or acute?
Acute - life threatening condition
58
If you had a patient with an aortic dissection, what would you expect to see?
Hemorrhage into the vessel wall with tearing to form a blood filled pocket
*heart wall splits and blood pools between the layers*
59
What are the causes of aortic dissection?
Conditions that weaken the elastic and smooth muscle layers of the aorta
60
What are the 2 risk factors of aortic dissection?
Hypertension
| Degeneration of the medial layer of the vessel wall
61
You might see a patient with an aortic dissection as a complication of
Cardiac surgery
| Catheterization
62
What is the major symptom of aortic dissection?
Abrupt excruciating pain (described as tearing or ripping)
63
In the early stages of an aortic dissection, BP is typically
Moderately or markedly elevated
64
In the later stages of an aortic dissection, BP and PR become
Unobtainable in on or both arms
65
Other manifestations of aortic dissection are
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
Veins move ___ from the body to the ___
Deoxygenated blood
Right side of the heart
67
What are the two mechanisms that prevent retrograde flow?
Valves and action of leg muscles
68
Varicose veins are
Dilated, tortuous veins of the lower extremities
69
What is the most common cause of varicose veins?
DVT (deep vein thrombosus)
70
You're most likely to see varicose veins in ___ patients.
Female
71
There is a higher incidence of varicose veins in people who
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
Clinical manifestations of varicose veins are
Aching in lower extremities and edema
73
In regards to varicose veins, prolonged exposure to increased pressure causes venous valves to
```
Become incompetent (no longer close properly)
> reflux of blood causes further venous enlargement , pulling the valve leaflet apart
```
74
Chronic venous insufficiency is
Persistent venous hypertension in lower extremities
75
The causes of chronic venous insufficiency are
```
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
Chronic venous insufficiency presents with
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
Venous thrombosis is
Thrombus plus inflammation
78
Venous thrombosis is most common in
Lower extremities
79
Venous thrombosis can cause a
Pulmonary embolism
80
How can a DVT cause a PE?
By throwing a clot to the heart
81
Are DVT or SVT more common?
DVT
82
Venous thrombosis is associated with
Stasis of blood
Increased blood coagulability
Vessel wall injury
**Virchow Triad**
83
Examples of stasis of blood
Impaired cardiac function
Acute MI and congestive heart failure
Long airplane travel/extended sittin
84
Examples of increased blood coagulability
State of increased clot formation
Inherited disorders of factor V Leiden and prothrombin
Smoking
Birth control
85
Examples of vessel wall injury
Trauma and surgery
Infection or inflammation
Venous catheters
86
Many cases of venous thrombosis appear without
Symptoms
87
Venous thrombosis symptoms are related to
List symptoms
Inflammation
```
Pain
Swelling
Deep muscle tenderness
Fever
Malaise
Elevated WBC
Erythrocyte sedimentation
```
88
BP is closely regulated to ensure
Body tissues are perfused
| Arteries don't get damaged
89
Hypertensions is
Elevated BP
90
What are the two types of hypertension?
Primary - "essential" (no evidence of other diseases)
Secondary (due to another disease condition)
91
Non-modifiable risk factors of hypertension are
```
Age
Gender
Race
Family history
Genetics
```
92
Modifiable risk facts of hypertension are
```
Diet
Levels of blood lipids
Smoking and alcohol consumption
Fitness and activity level
Overweight/obesity
Blood glucose control
```
93
Clinical manifestations of primary hypertension
Typically asymptomatic until long term effects on target-organ systems (kidneys, heart, eyes, blood vessels)
94
Secondary hypertension has 5 big causes
Renal hypertension
Disorders of adrenocortical hormones
Pheochromocytoma
Coarctation of the aorta
Oral contraceptive drugs
95
Which of the big 5 is the largest cause of secondary hypertension?
Renal hypertension
96
Renal hypertension is caused by
Reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism
97
Disorders of adrenocortical hormones is
Hormonally induced renal retention of salt and water
98
Pheochromocytoma is a
Tumor of chromaffin tissue
| > Contains sympathetic nerve cells that release catecholamine (most commonly located in the adrenal medulla)
99
Coarctation of the aorta is a
Congenital condition in which there is narrowing in the area of the arch of the aorta
100
Oral contraceptive drugs cause is
Largely unknown
| > Probably cause is volume expansion
101
Increased perfusion pressure leads to
Damage of target organs
102
Increased intravascular pressure leads to
Damage of endothelial cells in vessels - increases the risk for atherosclerosis
103
Hypertension is a big risk factor for atherosclerosis because
It promotes plaque formation and rupture
104
Hypertension predisposes to
Coronary heart disease
Heart failure
Stroke
PAD
105
Hypertension causes increased workload of the
Left ventricle (heart pumps against high pressure in arteries)
106
Chronic hypertension can lead to
Nephrosclerosis (hardening of the walls of the small arteries of the kidney)
>> Glomerular perfusion is decreased
107
People with hypertension are more likely to experience what in regards to the brain
Dementia and cognitive impairment
| Stroke
108
Hypertension can lead to what eye changes?
Microvascular changes in retina (retinopathy)
109
Orthostatic hypertension is when
BP drops after a person stands after sitting or lying down
Systolic BP drop of 20mmHg and/or diastolic BP drop of 10mmHg
110
With the BP of a patient with orthostatic hypertension, you'd expect to see what in regards to systolic and diastolic?
Systolic BP drop of 20mmHg and/or diastolic BP drop of 10mmHg
111
A patient with orthostatic hypertension would present with
May be asymptomatic or have dizziness and syncope
112
What causes orthostatic hypertension?
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
Contributing factors of orthostatic hypertension are
```
Effects of aging
Reduced blood volume
Bed rest and impaired mobility
Drug induced hypotension
Disorders of autonomic nervous system
```
114
Why do the effects of aging contribute to orthostatic hypertension?
There is increased arterial pressure instability and deficiencies in circulatory system
115
Why does reduced blood volume contribute to orthostatic hypertension?
There is just not enough blood circulating around (not enough oxygen when the person stands)
116
Why does bed rest and impaired mobility contribute to orthostatic hypertension?
Reduced plasma volume
Decreased venous tone
Failed peripheral vasoconstriction
Weakness of skeletal muscles that support veins
117
Why does drug induced hypotension contribute to orthostatic hypertension?
Antihypertensives
| Antipsychotics
118
Why do disorders of the autonomic nervous system contribute to orthostatic hypertension?
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.
