Exam 3 - Cardio Flashcards
1
Q
The heart is composed of what 3 layers?
Inside to outside
A
Endocardium - lines inside of heart
myocardium - muscle fibers
epicardium - exterior
2
Q
The pericardial space hold how much fluid?
A
20mL which lubricates the surface of the heart
3
Q
What happens during diastole?
A
-All 4 chambers of the heart relax simultaneously
-Allows ventricles to fill
4
Q
What happens during systole?
A
-Contraction of artia and ventricles
-Not simultaneous
-Atrial contraction occurs first, then ventricle
*allows ventricles to fill completely prior to ejction of blood
5
Q
What artery is the only artery which carries deoxygenation blood?
A
Pulmonary artery
6
Q
What route does blood flow through heart?
Starting with Right Atrium
A
-R atrium gets unoxygenated blood via superior/inferior vena cava from body.
-R atrium drains into R ventricle, which is pumped through pulmonary arteries to lungs
-Lungs oxygenate blood & sends back to heart via L artium
-L atrium drains to L ventricle and pumped out aortic arch to body
7
Q
What position does the heart lie in the chest?
A
R ventricle lies anteriorly - just beneath sternum)
L ventricle is posteriorly
8
Q
Where is the PMI located?
A
intersection of midclavicular line of left chest wall, 5th intercostal space
9
Q
What do the AV valves do?
Where are they?
During diastole are they open or closed?
A
AV - separate atria from ventricles
Tricuspid - R atria/R ventricle
Mitral/bicuspid - L atria/L ventricle
Diastole - open, allowing blood to drain
10
Q
Where are the semilunar valves?
Open or closed during diastole?
A
R ventricle & pulmonary artery is pulmonic valve
L ventricle & aotra is aortic valve
Diastole - closed / forced open during systole and blood is ejected
11
Q
Where is the SA node located?
what is the firing impulses per min of SA node?
Impulses of AV node?
A
-Located junction of superior vena cava and R atrium
SA - 60-100bpm
AV - 40-60
30-40
12
Q
Explain cardiac action potential
A
Phase 0 - depolarization - NA+ ions influx into cell. 40+
Phase 1 - Early repolarization as P exits
Phase 2 - Plateau. Ca+ enter
Phase 3 - Repolarization / resting state Na + out
Phase 4 - Resting -80 (refractory)
13
Q
Each Cardiac cycle has what 3 events?
A
Diastole
atrial systole
ventricular systole
14
Q
Cardiac output refers to
A
total amount of blood ejected by 1 of ventriles in liters per minute
*resting adult is 4-6L/min
15
Q
Stroke volume
A
amount of blood ejected from one of ventricles per heartbeat
-60-130mL
16
Q
C/O is increased by both S/V and HR
Changes in HR are due to
PNS travel to SA via?
SN increase SA by?
A
HR - inhibition or stimulation of SA by para or sympathic
PNS - SA via vagus nerve to SLOW HR
SN - beta 1 receptor in SA to INCREASE DR
17
Q
Stroke volume is effected by what 3 factors?
A
preload - degree of stretch of ventricle muscle at end of diastole (bigger stretch bigger contraction)
afterload - resistance to ejection
contractility- force generated by contracting myocardium
18
Q
ejection fraction
A
% of end diastolic blood volume that is ejected with each heart beat
55% - 65%
>40% likely requires treatement for HF
19
Q
ANGINE PECTORIS
Symptoms
Duration
Aggravating factors
Alleviating factors
A
Uncomfortable pressure, squeezing in chest - can radiate to arms, hands, jaw/ numbness, tingle, achy
-5-15min
-Excersice, emotional upset, large meal, extreme temps
-rest, nitroglycerin, oxygen
20
Q
PERICARDITIS
Symptoms
Duration
Aggravating factors
Alleviating factors
A
Sharp, severe substernal/epigastric pain. Can radiate to neck, arms, back. Fever, malaise, dyspnea, cough, nausea, dizziness, palpitations
-Intermittent
-SUdden onset, increases with inspiration, swalling, coughing, rotation
-Sitting upright, analgesia, antiinflammatory
21
Q
PULMONARY DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors
pneumonia, pulmonary embolism
A
Sharp, severe substernal or epigastric pain arise from inferior pluera, maybe able to localize pain
->30mins
-infectious or noninfectious process (MI, cardiac surgery, cancer). increases with inspiration, coughing, movement, supine, inconjunction with CAP or HAP
-Treatment of underlying cause
22
Q
ESOPHAGEAL DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors
A
Substernal pain, sharp, burning, heavy, Often mimic angina, Can radiate to neck, arm, shoulders
-5-60min
-Cold liquids, exercise
-Food or antacid, nitroglycerin
23
Q
ANXIETY / PANIC DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors
A
Stabbing to dull ache. Palpitations, SOB, tingling, fear, unreal
less than 3o mins
-anytime including during sleep, assoc by a specific trigger
-Removal of stimulus, relaxation, medications
24
Q
MUSCULOSKELETAL DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors
A
Sharp or stabbing pain localized in anterior chest. Unilateral, radiate across chest or back
hours to days
-Follows respiratory tract infection, coughing, vigorous exercise or posttrauma, idiopathic, exacerbated by deep breathing, coughing, sneezing, movement
-Rest, ice, heat, analgesic, antiinflammatory
25
Managing diet are important for managing what 3 major cardio risks?
hyperlipidemia
hypertension
diabetes
26
Screening for bloody urine or stools should be done in patients taking what 3 types of meds?
Antiplatelets
Platelet aggregation inhibitors
anticoagulants
27
What are the 6 P's for obstruction of arterial blood flow of extremities?
Pain
Pallor
Pulselessness
paresthesia
poikilothermia (coldness)
paralysis
28
What does prolonged cap refill indicate?
inadequate arterial perfusion to extremities
29
What does clubbing of fingers indicate?
chronic hemoglobin desaturation
Assoc with congenital heart disease
30
What are the 2 stages of htn
Stage 1 - systolic 130-139 or diastolic 80-89
STage 2 - systolic over 140 or diastolic over 90
31
What is pulse pressure
Narrow?
Wide?
Difference between systolic and diastolic pressure
*normal 40 mmhg
-Narrow >18 mmhg occurs vasoconstriction conpensating for low stroke volume (shock, HF,hypovolemia
-Wide <50mmHg (anxiety, exercise, bradycardia or vasodialtion (fever, septic shock)
32
What are normal postural responses when a person stands up
HR increase of 5-20bpm
unchanged systolic or decrease of 10mmHG
Slight increase in diastolic 5 mmhg
33
Orthostatic hypotension
sustained decrease of at least 20 mmhg in systolic BP or 10mmhg in diastolic within 3 mins of standing up
34
What is pulse deficit
disturbances of rythym resulting in difference between apical and radial pulse rates
*commonly occur with atrial fibrillation, flutter, premature ventriclur contractions
35
What does it mean if apical impulse is palipable 2 or more adjacent intercostal spaces?
An apical impulse below the 5th intercostal means?
If apical impulse can be felt in 2 distinct locations?
Broad or forceful impulse is?
-left intercostal enlargement
-left ventriclur enlargement from HF
-ventricular aneurysm
-left ventricular heave or lift
36
What creates the S1 sound?
Where is it heard the loudest?
Tricuspid and Mitral valve closure
Apical area
37
Intensity of S1 increases during
Tachycardias or mital stenosis
38
What creates the S2 sound?
Where is it the loudest
Closure of pumonic and aortic valves
loudest over aortic/pumonic areas
39
When are S3 and S4 gallop sounds heard?
during diastole
40
WHat causes S3 sound
Normal / abnormal
rapid ventricular filling
*normal finding in children up to 35-40yrs old
**Older adults -suggest HF
41
Summation gallop
Durning tachycardia all 4 sounds (s1,s2,s3,s4) combine
42
Opening snaps
abnormal diastolic sounds heard during opening of AV valve
*mitral stenosis
43
Systolic click
result of the opening of rigid and calcified aortic or pulmonic valve during ventricular contractions
44
Murmurs are created by
Turbulant blood flow
*could be narrowed valve, malfunctioning valve, defect in vent wall, increased blood flow
45
Friction rub
a harsh grating sound that can be heard in both systole and diastole
*Caused by abrasion of inflammed pericardial surfaces form pericarditis
46
What is a cardiac biomarker analysis?
Myocardial cells that become necrotic release specific enzymes **(creatin kinase CK), (CK-MB), myoglobin and troponin. **
47
BUN
Normal level
indicates?
-End products of protein metabolism excreted by kidneys
8-20mg/dL
**-Elevated indictates reduced renal perfusion from decreased cardiac output or fluid volume deficit as a result of dehydration or diuretics **
48
Calcium
Normal range
Necessary for?
8.8-10.4
Blood coagulation, neuromuscluar activity, automaticity of nodal cells
49
Hypocalcemia
Hypercalcemia
Hypo- slows nodal function and impair contractility
Hyper - increased contractility, increased heart block and sudden death from ventricular fibrillation
*HYPER Can occur with thiazide diuretics bc reduce renal excretion of Ca
50
CREATININE
Normal level
increased level indicates?
Male 0.6-1.2 / female 0.4-1.0
Increased indicates renal impairment
51
Magnesium
normal level
Necessary for
1.8-2.6
absorption of calcium, maintenance of postassium, metaboloism of adenosine triphosphate/ major role in protein and carb synthesis and muscular contraction
52
Hypomagnesia
Hypermagnesia
Hypo - enhanced renal excretion of mag from due of diuretic or digitalis therapy. Predisose pts to atrial or ventricular tachycardias
Hyper - caused by the use of cathartics or antacids containing magnesium. Depress contractility and excitability of myocardium, causing heart block and asystole
53
Potassium
normal level
Necessary for
3.5 - 5
Major role in cardiac electrophysiologic function
54
Hypokalemia
Hyperkalemia
Hypo - Due to postassium-excreting diuretics can cause arrythmias, ventricular tachycardia, vent fibrillation
Hyper - increased intake of potassium, decreased renal excretion of pot, or use of pot sparing diuretics. Heart block, asystole, ventricular arrhythmias
55
Hyponatremia
Hypernatremia
Hypo - indicate fluid excess, can be caused by heart failure or admin of thiazide diuretics
Hyper - fluid deficits and can result from decreased water intake or loss of water through excessive sweating or diarrhea
56
Activated partial thromboplastin time (aPTT)
lower limit of normal
measures?
21-35s
activity of intrinsic pathway, used to assess affects of unfractionated heparin.
*Therapeutic range is 1.5-2.5X baseline value
57
Prothrombin time (PT)
Lower limit of normal
measures?
11-13s
extrinsic pathway and used to monitor level of anticoagulation with warfarin
58
International normalized ratio
(INR)
Normal range
used for
0.8-1.2
used to monitor effectiveness of warfarin
Therapeutic range is 2-3.5
59
Hematocrit
Normal %
Represents
Male 42-52% / Female 36-48%
represents % if red blood cells found in 100mL of whole blood.
60
Hemoglobin
Normal range
Measures
Male 14-17.4 / Female 12-16
Measures amount of oxygenation saturation
61
Platelets
Normal range
140,000-400,000
62
WBC
Normal levels
4500-11,000
63
What is the harmful effect of LDL
Primary transport of cholestrol and triglycerides into the cell
deposition of these into arterial vessels
64
What is the protective effect of HDL
Carries cholestrol and triglyercides away from tissues/cells to liver for excretion
65
What is Brain natriurtic peptide
(BNP)
neurohoromone that helps regulate BP adn fluid volume
-Secreted from ventricles in response to increased preload with resulting elevated vent pressure
*level of BNP increases as vent walls expand
**occur in conditions PE, MI, ventricular hypertrophy, HF
| BNP GREATER than 100pg/ml is suggestive of CONGESTIVE HF
66
C-reactive protein
CRP
Produced by liver in response to systemic inflammation
*ppl with high crp levels may be at risk for CVD complications
67
Homocysteine
an amino acid, linked to develop of atherosclerosis bc it can damage endothelial lining of arteries and promote thrombus formation
*Elevated blood level of homocysteine indicates high risk for CAD, stroke, peripheral vascular disease
*genetic factors, diet low in folate, vit b6, vitb12 are assoc with eleveled homo levels
68
Hardwire cardiac monitoring
used to continuously observe heart for arrythmias using 1 or 2 leads
69
Central venous pressure monitoring
measurement of pressure in vena cava or right atrium
70
Pulmonary artery pressure monitoring
assessing left vent function, diagnosing etiology of shock, patients response to medical interventions
71
Artherosclerosis
abnormal accumulation of lipid or fatty substances and fibrous tissue in lining of arterial blood vessels. These substances block and narrow coronary vessels which reduces blood flow to myocardium
*involves a reptitious inflam response
72
What is the patho of atherosclerosis?
-Injury to vascular endothelium (smoking, HTN, etc)
-Inflam cells ingest lipids becoming FOAM CELLS that transport lipids into arteral wall creating fatty streaks
-Macrophages release chems that further damage arterial wall = oxidized LDL = more damage
-smooth muscle forms fibrous cap over a core filled with lipid called **ATHEROMAS** which protrude into lumen and narrow
| a vulnerable plaque may rupture and cause thrombus
73
What characterized metabolic syndrome
3 of 5 of the below
-Enlarged waist circumference
-Elevated triglycerides
-Reduced HDL
-Hypertension
-Elevated fasting glucose
74
a fasting lipid profile should demonstrate the following values
LDL - less than 100mg/dl
Total cholestrol less than 200 mg/dl
HDL greater than 40 mg/dl
Triglycerides less than 150 mg/dl
75
What are the medications given to lower lipids
Statins
Fibrates
Bile acid sequestrants
Cholesterol absoprtion inhibitor
PCSK9
76
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HMG-CoA Reductase inhibitors (Statins)
Therapeutic effects
Considerations
*inhibit enzyme involved with lipid synthesis
Decrease total cholesterol, LDL, TGs / increase DHL
Consideration - myalgia/arthralgia are common side effects/ contraindicated in liver disease
77
FIBRIC ACIDS
Therapeutic effects
Considerations
Increase HDL/ decrease TGs, synthsis of TG
-COnsiderations - adverse diarrhea, flatuence, rash, myalgia/ pancreatitis, hepatotoxicity, rhabdomylysis/
contraindicated in severe kidney and liver disease
78
BILE ACID SEQUESTRANTS
Therapeutic effects
Considerations
Decrease LDL, slight ^ HDL, cholestrol into bile acids
Side effects - constipation, ab pain, GI bleed
Take before meals
79
CHOLESTEROL ABSORPTION INHIBITOR
Therapeutic effects
Considerations
Decrease LDL, inhibits absoprtion of cholestrol in sm, intestine
Side effects: ab pain, arthralgia, myalgia
Contraindicated in liver disease
80
PCSK9
Therapeutic effects
Considerations
Promotes clearance of cholestrol, decrease LDL, MI & stroke, need for stent or CABG
ONly admin subq
Side effects - rhinitis, sore throat, flulike symptoms, muscle pain, diarrhea, redness, pain, brusing
81
ANGIA PECTORIS
Patho
Symptoms
Management
Episodes of pain or pressure anterior chest
**Patho** - insufficient coronary blood flow caused by obstruction
**Symptoms** - poorly localized, may radiate. Tightness, SOB, pallor, dizzy, nausea, vomit
**Management** - Subsized with REST. Nitroglycerin, betablockers, Calcium ion antagoinsts, antiplatelet, anticoags
82
Unstable angina
attacks that increase in freq and severity and are not relieved by rest and nitroglycerin
83
Nitroglycerin
MOA
Vasodilator that improves blood flow to the heart muscle and relieves pain
Causes veinous pooling = less blood return to heart and filling pressure is reduced
Decreased BP and Decreased afterload
84
Beta-adrenergic blockers
MOA
Blocks beta-adrenergic sympathic stimulation
Reduced HR, BP and contractilty
*helps control chest pain, delays onset of ischemia during work or excersice
Side effects: hypotension, bradycardia, acute heart failure, bronchoconstriction
| Metroprolol & atenolol
85
Calcium Channel blockers
MOA
Decrease SA and AV node conduction = slower HR and weaker contraction
Dilate smooth muscle wall of coronary arteries
*also prescribed for HTN
| Amlodipine & diltiazem
86
What are the antiplatelets meds?
Asprin
Clopidogrel
Prasugrel
Ticagrelor
87
What does heparin do
Prevent formation of new blood clots
* a decrease in platelet count may indicate heparin induced thrombocytopenia, an antibody mediated reaction to heparin that may result in thrombosis
88
Acute Coronary syndrome (ACS)
an emergent situation by an onset of myocardial ischemia that results in myocardial death
Spectrum includes: unstable angine, NSTEMI, ST-segment elevation myocardial infarction
89
Patho of ACS
In unstable angina?
In MI?
Unstable angina - reduced blood flow due to rupture of atherosclerotic plaque
In MI, plaque rupture and thrombus result in complete occulusion of artery
90
Clinical manifestations of ACS
Chest pain that occurs suddenly and continues despite rest and medication
91
The first ECG signs of an acute MI are usually seen in what waves?
T wave and ST segment
*appearance of abnormal Q wave is also an indication of MI
92
What would indicate an old MI
abnormal Q wave without ST segment and T wave changes
93
How are patients diagnosed with ACS
Unstable angina
STEMI
NSTEMI
**Unstable** - symptoms of coronary ischemia but ECG and BIOmarkers show no evidence
**STEMI** - ECG evidence of MI with evidence in 2 continous leads on 12 lead. Damange to myocardium
**NSTEMI** - Elevated biomarkers (troponin) but not ECG evidence
94
Troponin
Protein found in myocardial cells, regulates myocardial contractil process
*reliable markers of myocardial injury
95
Patient with suspected MI should immediately recieve what
Supplemental oxygen
aspirin
nitrogycerin
morphine
96
Percutaneous coronary interventions
**Percutaneous transluminal coronary angioplasty **- balloon tipped cath to open blocked artery
**Coronary artery stent **- metal mesh
97
Coronary artery bypass graft
surgery in which a blood vessel is grafted into a occluded coronary artery so that blood can flow beyond occulusion
for ppl who:
Angina cannot be controlled with meds
left main artery stenosis & mulivessel CAD
Prevent MI, arrhythmias, HF
complications from unsuccessful PCI
98
Heart failure
Clincal syndrome resulting from cardiac disorders so that the heart is unable to pump enough blood to meet the bodies demands
99
Systolic heart failure
Aka heart failure with reduced ejection fraction
results in decreased blood ejected from the ventricle
*sensed by baroreceptors which stims SNS to release epinephrine and NE = increased HR and contractility
Continued response = **vasoconstriction** of skin, GI, kidneys = **decrease in renal perfusion** = increased fluid volume overload = **increased cardiac workload**
100
Diastolic heart failure
Heart failure with preserved ejection fraction
from increasing workload ^
heart compensates by increasing muscle and cells become dysfunctional and die, and the heart becomes fibrotic = a stiff ventricle resists filling and less blood = less Co2
*low CO leads to mechanisms which make heart work harder = vicious cycle
101
Left sided heart failure
when left ventricle can not effectively pump blood out of ventricle into aorta and systemic circualtion
pulmonary venous blood volumn and pressure increase in lungs **forcing fluid from capilaries into tissues and alveoli** causing edema and impaired gas exchange
**Dyspnea, cough, pulmonary crackles, and low oxygen, s3 may be detected, cough with secreations frothy pink or tan**
102
Right sided heart failure
when right vent fails the congestion peripheral tissues increases = increased JVD
**edema, hepatomegaly, ascites, weight gain
103
Congestive heart failure
When R and L sides fail causing swelling in body, abdomen, gi, liver
104
Pulmonary edema
Actue event, following an mI or chronic HF
When left side fails and blood backs up into pulmonary circulation
105
Ejection fraction
measure of ventricular contractility; % of end diastolic blood volume that is ejected with each heartbeat
Normal is 55%-65%
106
Heart failure with reduced ejection fraction
systolic heart failure
*left vent loses ability to contract effectively = less than 40% reflecting decreased CO and pump failure
107
Heart failure wtih preserved ejection fraction
Diastolic heart failure
left vent function measures greater than 50% yet ventricle loses ability to relax
108
Heart failure with midrange ejection fraction
Efs with 40-49%
109
# 1.
What is Stage A heart failure
Patient characteristics
Treatment
-HTN, Atherolsclerotic disease, diabetes, metabolic syndrome
-Heart healthy lifestyle / risk factor control
110
What is stage B heart failure
Patient characteristics
Treatment
-History of MI, Left vent hypertrophy, low ejection fraction
-Stage A treament plus ACE, beta or statin
111
What is stage C heart failure
Patient characteristics
Treatment
-SOB, fatigue, decreased excersice tolerance
-A and B plus diuretics, aldosterone antagonist, sodium restriction, implantable defibrillator, cardiac resynchronization therapy
112
What is Stage D heart failure
Patient characteristics
Treatment
-Symptoms despite max medical therapy, Recurrent hospitaliations
-A,B,C plus Fluid restriction, end of life care, inotropes, cardiac transplant, mechanical support
113
DIURETICS
Therapeutic effects
Key considerations
| Heart failure
Decrease fluid overload, decrease signs of HF
-observe for electrolyte imbalances, renal dysfunction, decreased bp. Carefully monitor I&O, daily weight.
**observe for increase K+ and decrease Na+
114
Angiotensin system blockers
Therapeutic effects
Key considerations
| Heart failure
Decrease BP, afterload, signs of HF
**observe for decrease bp, increase K, cough and worsening renal functions
115
Beta-Adrenergic-blocking agents
Therapeutic effects
key considerations
| Heart failure
Dilated blood vessels and decrease afterload, decrease signs of HF, improve excersice capacity
**observe for decreased HR, BP, dizziness, fatique
116
IVABRADINE
Therapeutic effect
Key considerations
| heart failure
Decreases rate of contraction through SA node
-Observe for decreased HR, BP, dizziness, fatigue
117
Hydralazine-isosobidedinitrate
Therapeutic effect
Key considerations
| HEart failure
Dilated blood vessels, decrease BP & afterload
-Observe for decrease in BP
118
Digitalis
Therapeutic effect
Key considerations
| heart failure
Improves cardiac contractility, decreases signs of HF
-observe for decrease HR and digitalis toxicity
119
Dopamine
Dobutamine
Milrinone
| Heart failure
Dopamine - vasopressor - increase BP and myocardial contractility
Dobutamine - stims beta 1 to increase contractility and renul perfusion
Milrinone - increased intracellular calcium increasing contractility
120
Cardiogenic shock
When decreased CO leads to inadequate tissue perfusion and initiation of shock syndrome
121
Thromboembolism
Intracardiac thrombi can form in pts with atrial fibrillation bc atria do not contract forcefully, resulting in slow flow increasing likelyhood of thrombus
122
Pericardial effusion
accumulation of fluid in pericardial sac
*chest pain, tachypnea, dyspnea,
*pulsus paradoxus - systolic pressure lower during inhalation
123
Pericardiotcentesis
Pericardiotomy
Pericardiotcentesis - puncture of pericardial sac to aspirate fluid
Pericardiotomy- portion of pericardium is excised to permit fluid to drain into lympatic system
124
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Cardiac arrest
Heart unable to pump and circulate blood to the bodys organs
*often caused by arrhythmia, progressive bradycardia or asystole
**conciousness, pulse, bp are lost, breathing ceases, respiratory gasping, pupils dilate in less than minute and seizures may occur. Pallor and cyanosis
125
Pulseless electrical activity
electrical activity is present but cardiac contractions are ineffective
126
Arteries carry blood to or from heart?
Thick walled vessels carry blood FROM the heart to Tissues
127
Approx how much of total blood volume is in veins?
about 75%
128
Flow rate =
Pressure difference /resistance
129
Blood flow becomes turblant when
flow rate increases, blood vicosity increases, diameter of vessels increases, or segments of vessel are narrowed = this creates an abnormal sound called a bruit
130
What are potent vasodilators
nitric oxide
prostacyclin
histamine
bradykinin
prostaglandin
certain muscle metabolites
131
Heart failure with left ventricular ejection fraction causes accumulation of blood where?
in lungs and a reduction in cardiac output which results in inadequate flow to tissues
132
Heart failure with preserved left ventricluar ejection fraction causes blood to go where
systemic venous congestion
133
Signs of arterial insufficency
symptoms
ulcer signs
Relief with rest
Diminished or absent pulses
Cool skin, loss of hair, nails thickened, pallor of foot, dry shiny skin
Ulcer - Pressure points, painful, deep, circular, pale to black, minimal edema
134
Signs of venous insufficiency
symptoms
ulcer signs
Aching, throbbing, cramping. Pulses present but difficult due to edema, Skin red. better with movement
Ulcer - SUperficial, irregular border, granulation tissue (beefy red to yellow), moderate to severed edema
135
Intermittent claudication
muscular cramp-type pain, discomfort or fatigue in extremeities consistently reproduced with same degree of activity and relieved by rest in patients with peripheral arterial insufficiency
136
Rubor
a reddish-blue discoloration of extremities 20 sec to 2 mins after extremity is places in dependent postiion.
*suggests severe peripheral arterial damage
137
What does the ankle-brachial index measure?
ratio of systolic blood pressure in akle to systolic pressue in arm
138
What does Computed tomography (CT) show
cross sectional images of soft tissue and visualized the area of volume changes to an extremity
139
Arteriosclerosis
hardening of the arteries
140
Atherosclerosis
affecting intima of large and medium sized arteries
*accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue referred to as **atheromas** or **plaques**
141
Fatty streaks are
yellow and smooth, protrude slightly into lumen of artery and composed of lipids and elongated smooth muscle cells
142
Fibrous plaques are
composed of smooth muscle cells, collagen fibers, plasma componenets and lipids. White to yello and protrude, sometimes obstructing.
*found in abdominal aorta, coronary, popliteal and internal carotid arteries.
143
Endovascular therapy
procedures that use a puncture or small incision to place catheters inside a blood vessel to repair or insert a device
144
Symptoms of intermittent claudication
aching, cramping, fatigue, weakness that occurs with activity, relieved with rest
*sensation of coldness or numbness in extremeities, skin and nail changes, ulceration, gangrene, bruits, peripheral pulses diminishes
**Cilostazol - direct vasodilator that inhibits platelet aggregration
145
Venous thromboembolism
cause
DVT and PE collectively
Virchow triad - endothelial damage, venous stasis, altered coagulation
146
Venous stasis
occurs when blood flow is reduced; when veins are dilated and when skeletal muscle is reduced.
147
Pulmonary embolism
obstruction of the pulmonary artery or one of its branches by a thrombus
*dislodged or fragment of DVT
148
Chronic venous insufficiency/postthrombotic syndrome
obstruction of venous valves in the legs or a reflux of blood through valves
*edema, altered pigmentation, pain, stasis dermatitis, less symptoms in morning more in evening.
149
Hyperbaric oxygenation
beneficial as adjunct treatment in pt siwth diabetes and no signs of wound healing after 30 days of standard treatment.
*chamber increases barometric pressue while patient is breahting 100% oxygen
150
Negative pressure wound therapy
using vaccum assisted closure devices decreases time to healing in complex wounds that have not healed in 3 weeks
151
Varicose veins
abnormally dilated, tortuous, superficial veins caused by incompetent venous valves
*dull aches, muscle cramps, increased fatgiue in lower extremities, edema, heaviness, nocturnal cramp
151
152
Difference between primary htn and secondary
Primary - no identifiable cause
Secondary - with underlying cause
153
What is patho for HTN
result from increases in cardiac output and increases in peripheral resistance or both
-Increased SNS activity
-Increased renal reabsorption of sodium, chloride and water
-Increased activity of RAAS
-decreased vasodilation of arteries
-Resistance to insulin
-Immune system dysfuntion leading to inflammation
154
What are clinical manifestations of HTN
Retinal changes
angia & mI
Changes in kidneys
155
Resistant HTN
pt takes at least 3 antihypertensives from different classes including a diuretic and bp is still not controlled (not less than 130/80)
156
What is a hypertensive emergency
severe BP elevation wiht new or worsening target organ damage
