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Pathophysiology > Disorders of Blood Vessels > Flashcards

Disorders of Blood Vessels Flashcards

1
Q

Describe the sounds heard in BP

A
  • First sound is systolic number

* After you stop hearing is diastolic

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2
Q

Define hypertension

A

a systolic BP greater than 140 and/or diastolic blood pressure over 90

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3
Q

What happens to BP as we age?

A
  • As we age we are not as elastic- increase in stiffening in arteries- increases resistance and it naturally elevated
  • 150/90 for older patients
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4
Q

What are the 4 types of arteries?

A
  • Elastic
  • Muscular
  • Small Arteries
  • Arteriole
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5
Q

Describe elastic arteries

A
  • Large and include the aorta and initial branches, and the pulmonary artery
  • Elastic and this makes them springy
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6
Q

Describe muscular arteries

A
  • Middle size and include the renal and coronary arteries
  • Has encircling smooth muscle cells
  • Regional flow and pressure are regulated by lumen size
  • Contract to narrow the lumen (Vasoconstriction)
  • Relax to enlarge it (Vasodilation)
  • Vasoconstriction and vasodilation are controlled by the autonomic nervous system (hormones, local metabolic factors)
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7
Q

Describe small arteries

A
  • Less than 2 mm in diameter

- Retinal Arteries

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8
Q

Describe Arterioles

A
  • Tiny pre-capillary arteries
  • Less than 0.1 mm
  • Wrapped in a thin layer of smooth muscle
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9
Q

Describe veins

A
  • Carry low pressure, non-pulsing blood to the heart
  • Larger diameter compared to arteries, larger lumen, and thinner wall
  • Pliable and expand easily (to accommodate the changes in volume with little pressure change)
  • 2/3 of blood is in the veins
  • One way venous valves (prevent back flow)
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10
Q

Describe capillaries

A
  • Smallest of vessels, lie in tissues and join the arterial network to the venous network
  • Composed of only endothelial cells resting on the basement membrane
  • Promote free exchange of gases and fluids
  • As blood flows down the arterial tree, the cross sectional area of each vessel becomes smaller, the total cross sectional area becomes larger
  • Most numerous
  • Flow rate is very slow
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11
Q

What are the 3 layers of large vessels

A 
o	Adventura
	Supporting fibrous tissue
o	Media
	Composed of mainly smooth muscle
o	Intima 
	A single layer of endothelial cells
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12
Q

What are the 2 functions of endothelial cells?

A

o Control diffusion of substances across the wall to adjacent tissues
o In constant contact with blood and keep blood in a smooth, unclotted state

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13
Q

What is the equation for BP?

A

• Blood pressure= Cardiac output * vascular resistance

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14
Q

Define CO

A

the volume of blood per unit of time ejected from the left ventricle into the aorta

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15
Q

What is the equation for CO

A

o Cardiac output= SV and HR

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16
Q

Define vascular resistance

A

the resistance to the flow that must be overcome for blood to flow though the circulatory system

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17
Q

What kind of relationship do resistance and flow have?

A

Inverse

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18
Q

What regulates flow

A

Peripheral arterioles

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19
Q

sense blood pressure and act to change peripheral resistance and blood volume

A

Kidneys

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20
Q

What 2 things does the kidney do to regulate BP

A

o It decreases the amount of blood passing through the kidney
o Renin

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21
Q

Describe the effect of vasoconstriction

A

o It decreases the amount of blood passing through the kidney
 Lowers urine output
 Preserves water
 Increases blood volume

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22
Q

Describe the effects of renin

A

 Causes peripheral and renal vasoconstriction
 Stimulates aldosterone
 Expands blood volume
 Increases CO and BP

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23
Q

Lipids that are attached to plasma proteins

A

Lipoproteins

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24
Q

plasma proteins that makes lipid soluble in the blood

A

Apoprotein

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25
Q

Describe High Density Lipoproteins

A

o Half protein, half lipid
o Lipid is phospholipid and cholesterol
o “Good Cholesterol”
o Like a garbage truck- it gets the bad stuff out

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26
Q

Normal values for HDL

A

o Normal levels Men- greater than 40, women above 50

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27
Q

This is associated with less risk of atherosclerosis

A

HDL

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28
Q

Describe LDL

A

o 22% protein
o Most of the lipid is cholesterol
o Smaller amounts of phospholipid and cholesterol
o “Bad” builds up in your arteries and is plaque

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29
Q

Normal values of low density lipoproteins

A
  • Normal levels= less than 130
  • If you are diabetic- less than 100
  • Heart disease- less than 70
30
Q

Characteristics of LDL

A
  • High levels promote atherosclerosis
  • Diet in saturated fat
  • Trans fats
31
Q

Describe VLDL

A

o Only 10% proteins
o “Very bad”- not really used in clinic
o Most of lipids are triglycerides
o Small amounts of phospholipid and cholesterol

32
Q

Describe cohort score

A

o 10 year risk would be to have a cardiovascular event (stroke, MI)
o Helps guide treatment

33
Q

When your score is ___ or mre, you should be put on a statin

A

7.5

34
Q

What is the effect of a statin?

A

o Statins lower cholesterol and have an anti-inflammatory infect and reduce risk of cardiovascular event

35
Q

What is includes in a cohort score?

A 
	Male or female
	Age
	Total cholesterol
•	Bad and good collected together
•	Less than 200 is normal 
•	Liver synthesizes this
•	Need it in cells
	HGL
	BP (systolic)
	Smoker 
	Diabetic
	Treated for hypertension
36
Q

Describe primary hypertension

A

o 95% of hypertension is unknown

o Not associated with any identified cause

37
Q

Describe secondary hypertension

A

o Where there is something causing the hypertension

o Many causes and if you treat the problem the high BP will go away

38
Q

Examples of things that cause secondary hypertension

A
  • Renal Artery Stenosis
  • Obstructive Sleep Apnea
  • Pheochromacytoma
  • Tumors of the Adrenal cortex
  • Drugs
  • Beta agonists
39
Q

Describe the effects of Renal Artery Stenosis

A
  • Narrowing of the renal arteries
  • Decreased profusion
  • Increase Renin
  • Starts RAA system
  • Seen in young patients with high blood pressure
  • Most common cause of surgery correctible hypertension
40
Q

Describe the effects of obstructive sleep apnea

A
  • Uncontrolled sleep apnea can lead into hypertension
  • Keeps airways open, body isn’t in stress mode, and your body goes back to normal
  • Hypoxic mode and increases sympathetic act
41
Q

Describe the effects of pheochromacytoma

A
  • Very rare adrenal tumors that secrete a ton of catecholamine’s (norep and ep- fight and flight response)
  • Sweating and always anxious
42
Q

Describe the effects of Tumors of the Adrenal cortex

A

• High Aldosterone or cortisol

o See low potassium if high aldosterone

43
Q

Describe the effects of drugs

A

• Any kind of stimulants
• Aderol, rinalin, nicotine
-Increases BP

44
Q

Describe the effects of Beta agonists

A

• Increases HR and increases BP

45
Q

What can uncontrolled hypertension cause?

A

• Causes problems in eyes and kidney

46
Q

Describe hypertensive kidney disease

A

o High pressure destroys commonly afferent arterioles (bc high hemodynamic pressure)
o If you slice the walls of the kidneys you can see…
o Hyaline Arteriolosclerosis
o Hyperplastic Arteriosclerosis

47
Q

Describe hyaline Arteriosclerosis

A

 Fingerprint of hypertension
 Narrowing of the arteriolar lumen and waxy (hyaline) degenerative changes of the arteriolar walls
 Glassy appearance
 Increased elastic because of increased pressure
 Can cause atrophy and damage of glomeruli and kidney

48
Q

Describe Hyperplastic Arteriosclerosis

A
  • Severe hypertension
  • Concentric layers of hyperplastic cells (like onion skinning)
  • Increasing arteriole wall thickness
49
Q

Where does Atherosclerosis start?

A

The crib- begins when you are young and processes due to out habits
-Starts by vascular endothelial cell injury or damage- some sort of inflammation

50
Q

What things contribute to atherosclerosis

A

o Smoking- little injuries stimulate inflammatory response
o Hypertension- increased pressure can damage lining
o Hypergylcemia- leads into development of plaques
o Diabetes can accelerate this

51
Q

What is the Leading etiology for aneurisms

A

atherosclerosis

52
Q

What are some risk factors for atherosclerosis

A
  • Age
  • Gender
  • Genetics
  • Hypertension
  • Smoking
  • Diabetes
  • Cholesterol
  • Homosystein
  • C-reactive protein
53
Q

Describe the effect of Age

A

Increases atheriosclerosis by -40-60 increases MI by 5 times

54
Q

Describe the effect of gender

A
  • Men are more at risk
  • Women have an increased risk after menopause
  • Because cause estrogen protects us
55
Q

Describe the effect of genetics

A

 Familial hypercholesterolemia
 Causes hyperlipidemia
 Family cardiac disease
• Male in your family over 50 with MI is significant and same with woman

56
Q

Describe the effects of smoking

A

 Smoking also lowers HDL levels

57
Q

Describe the effects of hypergylcemia

A

 High sugars and high cholesterol

58
Q

What are the effects of cholesterol

A

 Increased LDL or low HDL increased risk

59
Q

What are the effects of homosystein

A 
	Toxic to endothelial cells
	Causes platelet aggregation 
	Genetic predisposition have strokes and MI in their 20s 
•	Aspirin- life of a platelet
•	Folic Acids
60
Q

What are the effects of C- reactive protein

A

Indicated of inflammation

61
Q

What are the 2 kinds of atheromas?

A
  • Young

- Old

62
Q

Describe young atheromas

A

o Squishy and spontaneous

63
Q

Describe old atheromas

A

o Calcified and stuck

64
Q

This is a loss of integrity of the blood vessels

-Abnormal dilation of blood vessels

A

Aneurysms

65
Q

Characteristics of aneurysm

A
  • Most common place is the circle of Willis
  • Get weakness, traumatic, and infection
  • Increasing radius increases the wall tension
  • Start getting ballooning
66
Q

Describe ruptured aneurysms

A

high pressure and you bleed out
o NEVER GOOD
o Only symptom is a rupture
o Asymptomatic until they rupture

67
Q

Describe cerebral aneurysms

A 
o	Maybe dizziness
o	Pain- headache
o	Large hemorrhage
o	Family history  you have to be screened MRA- every 5 years
o	High mortality rates
68
Q

Describe aortic aneurysm

A

o Smoking increases risk (with hypertension or hyperlipidemia)
o Can have back or abdominal pain
o Ultrasound screening- looking at caliber of the aorta
o High rate of rupture greater than 5 years

69
Q

What is the goal of a coronary catherization?

A

-See narrowing of the lumen and put a stent in

70
Q

What can a hematoma cause?

A

False Lumen

Pathophysiology (18 decks)

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