exam 3: chapter 26

Question 1

define varicose veins and what causes it

Answer 1

○ Varicose veins:
■ A vein in which blood has pooled
■ Caused by trauma or gradual venous distention

Question 2

risk factors for varicose veins

Answer 2

Age, female, family history, obesity, pregnancy, DVT, prior leg injury

Question 3

define thrombus

Answer 3

■ blood clot that remains attached to the vessel wall
■ Obstruction of venous flow leading to increased venous pressure
■ More common in veins due to lower pressure (hold more)

Question 4

thrombus risk factors

Answer 4

■ Triad virchow
● Venous stasis
● Venous endothelial damage
● Hypercoagulability:
○ Certain medications/ Afib (irregular rhythm)/ clotting
■ Contraceptives

Question 5

what is the biggest concern for a thrombus?

Answer 5

Detaching and becoming a thromboembolism

Question 6

what is the difference between primary and secondary hypertension?

Answer 6

○ Primary:
■ Idiopathic (unknown)
○ Secondary:
■ Known cause (raises peripheral vascular resistance and cardiac output)

Question 7

describe the pathophysiology of a thrombus

Answer 7

Localized platelet aggregation and fibrin entrap RBCs, WBCs, and more platelets to form a thrombus. A frequent site of thrombus formation is the valve cusps of veins, where venous stasis occurs. As a thrombus enlarges, increased numbers of blood cells and fibrin collect behind it. This makes a larger clot with a “tail” that eventually blocks the lumen of the vein.

Question 8

A venous thrombus can travel to ______

Answer 8

the lungs

Question 9

an arterial thrombus can travel to ________

Answer 9

brain and heart

Question 10

define thromboangitis obliterans (Buerger disease)

Answer 10

○ Thromboangiitis obliterans (Buerger disease)
● Thrombus: plaque
● Angiitis: pain
● Obliterans: inflammation
■ Inflammatory disease of the peripheral arteries
■ Strongly associated with smoking
■ Can lead to gangrenous lesions and amputations
■ Intermittent claudication
● Pain with walking

Question 11

signs and symptoms of thromboangiitis obliterans (Buerger disease)

Answer 11

● Pain, tenderness (hands/feet)
● Slow sluggish blood flow
■ Can lead to gangrenous lesions and amputations
■ Intermittent claudication
● Pain with walking

Question 12

what is Raynaud’s disease/phenomenon

Answer 12

○ Episodic vasospasm in arteries and arterioles of the fingers, less commonly in toes
○ White (ischemia) then blue (hypoxia) then red as blood flow returns
○ Triggered by cold temperatures, anxiety, or stress

Question 13

define atherosclerosis

Answer 13

thickening and hardening of the vessel wall

Question 14

atherosclerosis risk factors

Answer 14

■ Diabetes, smoking, hyperlipidemia/dyslipidemia, HTN
○ Results in - inadequate perfusion, ischemia, necrosis

Question 15

when does angina pectoris occur and what is the most common cause for it?

Answer 15

Chest pain or discomfort that occurs when the heart muscle does not receive enough blood or oxygen.

The most common cause is coronary artery disease (CAD), which is narrowing or blockage of the arteries that supply blood to the heart

Question 16

stable angina is described as

Answer 16

Chest pain is caused by gradual luminal narrowing and hardening of the arterial walls (associated inflammation, endothelial cell dysfunction and a decrease in endogenous vasodilators) that produces myocardial ischemia (heart attack)

Gets better with rest

Question 17

unstable angina is

Answer 17

○ Unstable angina: Acute coronary syndromes
■ Reversible myocardial ischemia
■ Unpredictable, often occurs at rest

Question 18

define MI, MI manifestations and complications

Answer 18

○ MI: Acute coronary syndrome
■ Sudden and extended obstruction of the myocardial blood supply
■ Cell injury -> cellular death
■ Supply and demand issue
■ Results in structural and functional changes
■ Manifestations
● Sudden severe chest pain; may radiate
● N/V
● Diaphoresis (sweating)
● Dyspnea (SOB)
■ Complications
● Sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability

Question 19

define pericarditits

Answer 19

■ Swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium)
■ Pain
■ Exudate
● Serous -> pericardial effusion
● Fibrous -> friction rub; adhesions
■ ECG change

Question 20

what is pericardial effusion?

Answer 20

■ Fluid accumulation in the pericardial space
■ Cause: injury or inflammation from trauma, cardiac surgery, cancer, cardiac rupture
■ Composed of blood or pus

Question 21

what is rheumatic heart disease

Answer 21

○ Rheumatic fever:
■ Systemic inflammatory disease caused by a delayed immune response to pharyngeal infection by the group A B-hemolytic streptococci
■ Febrile illness
● Inflammation of the joints, skin, nervous system, and heart
■ If left untreated, rheumatic fever may cause rheumatic heart disease

Question 22

what are some clinical manifestations of rheumatic heart disease?

Answer 22

○ Manifestations: Diagnosis based on Jones Criteria
■ Common:
● n/v
● Tachycardia
● Fever
● Abdominal pain

■ Major:
● Carditis (inflammation of the heart)
● Polyarthritis (joints)
● Chorea (involuntary spasms of limbs)
● Erythema marginatum (rash)

Question 23

what is endocarditis?

Answer 23

inflammation of the endocardium

Question 24

endocarditis manifestations

Answer 24

fever, cardiac murmur, petechial (round spots) of the skin, oral mucosa

characteristics: Osler nodes (painful erythematous nodules on the pads of the fingers and toes

other: weight loss, back pain, neck pain, night sweats, HF

Question 25

what is the difference between left-sided HF and right-sided HF

Answer 25

○ Left-sided HF:
■ Result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation
■ Dyspnea, orthopnea (dif. Breathing while laying flat), fatigue, decrease urine output, edema, cough of frothy sputum
———
Right-sided heart failure occurs when the right side of the heart is unable to effectively pump blood to the lungs to pick up oxygen. This can be caused by conditions that affect the right side of the heart, such as chronic lung diseases like chronic obstructive pulmonary disease (COPD), pulmonary hypertension, or conditions that cause increased pressure in the right side of the heart, such as tricuspid valve disease or right ventricular infarction (a heart attack affecting the right ventricle). Symptoms of right-sided heart failure can include swelling in the legs and ankles (edema), a bloated abdomen, and an enlarged liver.

On the other hand, left-sided heart failure occurs when the left side of the heart is unable to effectively pump oxygenated blood to the rest of the body. This can be caused by conditions that affect the left side of the heart, such as coronary artery disease, high blood pressure (hypertension), or conditions that weaken the left ventricle, such as myocardial infarction (heart attack), dilated cardiomyopathy, or hypertrophic cardiomyopathy. Symptoms of left-sided heart failure can include shortness of breath, fatigue, fluid retention, and a reduced ability to exercise.

Question 26

what are the different types of shock, their pathophysiology, and related clinical manifestations?

Answer 26

○ Patho:
■ Cardiovascular system fails to perfuse the tissues adequately
■ Leads to impaired cellular metabolism
● Impaired oxygen use
● Impaired glucose use

○ Cardiogenic:
■ Decrease cardiac output -> MI

○ Hypovolemic:
■ Decreased intravascular volume -> impaired cellular metabolism

○ Neurogenic:
■ Imbalance between sympathetic and parasympathetic stimulation -> impaired cellular metabolism

○ Anaphylactic:
■ Antigen (allergen) -> Impaired cellular metabolism

○ Septic:
■ Gram positive/negative organism -> multiple organ dysfunction