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DHHD 6005 - Exam 2 > Huber 2 > Flashcards

Huber 2 Flashcards

1
Q

Vascular Diseases have frequent coexistence with _________.

A

Cardiac disease

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2
Q

Describe Peripheral Artery Disease

A
  • Affects up to 15% of patients > 60 years of age
  • 50% of CAD also have PAD
  • Atherosclerosis most common etiology
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3
Q

Outcomes of Periperhal Artery Disease

A
  • Many asymptomatic
  • Claudication
    • Aching or cramping on exertion
    • Relieved by rest
    • 5 year mortality rate of 30%, amputation rate of 5%
  • Acute arterial occlusion
  • Thromboangiitis obliterans (Buerger’s disease)
    • Inflammation/blockage of small vessels in extremities
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4
Q

Managmenet of Peripheral Artery Disease

A
  • Tailored to severity of disease
  • Control modifiable risk factors (smoking, weight control, diabetes)
  • Exercise regimen
  • Avoid vasoconstricting medications
  • Pharmacotherapy
    • Pentoxifylline ( Increases vasodilation, decreases aggregation and blood viscosity)
  • Resection/revascularization/stents
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5
Q

Describe Aneurysmal Vascular Disease

A
  • Affects up to 3% of patients > 50 years old
  • Common occurrence with CAD
  • Atherosclerosis most common etiology
  • Marfan Syndrome
  • Family history
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6
Q

Outcomes of Aneurysmal Vascular Disease

A
  • Most are asymptomatic
  • Concern for catastrophic rupture
  • Compression against surrounding tissues
  • Embolization of atherosclerotic debris or clot
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7
Q

Management of Aneurysmal Vascular Disease

A
  • Monitor for change/symptoms
  • Surgical correction
  • Prosthetic grafts
  • Stents
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8
Q

Describe Aortic Dissection

A

Tear in the aortic intima leading to blood dissecting between the intima and media

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9
Q

Pre-disposing factors and Management of Aortic Dissection

A
  1. Hypertension, Marfan Syndrome
  2. B-blockers, Surgical repair/Endovascular stent
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10
Q

Describe Giant Cell Arteritis

A

Involvement of extracranial branches of carotid artery (temporal arteritis) in patient over 65

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11
Q

Signs & Symptoms and Managment of Giant Cell Arteritis

A
  • Headache, temporal artery tenderness, visual loss, jaw claudication, weight loss, fever, markedly elevated erythrocyte sedimentation rate.
  • Managed with coticosteroids
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12
Q

Describe the location, risk factors, risks, and management of Deep Vein Thrombosis

A
  1. Most commonly affects veins of lower extremities (i.e. femoral, iliac, calf)
  2. Risk factors: Venous stasis, hypercoagulability, vein injury (Virchow’s triad)
  3. Risk for embolic complications such as pulmonary embolism (proximal > distal)
  4. Managed with anticoagulation regimen
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13
Q

Describe Pulmonary Embolism and it’s causes

A
  • 250,000 hospitalization annually
  • 3 month mortality rate up to 15%
  • Usually result of venous thromboemboli
    • Deep veins of thigh
  • Other causes
    • Marrow fat from orthopedic surgery
    • Air from central venous catheters
    • Amniotic fluid from labor
    • Sickled red blood cells
    • Blood borne parasites
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14
Q

Predisposing factors, signs & symptoms, and management of Pulmonary Embolism

A
  1. Prominent predisposing factor is Virchow’s triad
  2. Dyspnea, pleuritic chest plain, tachypnea
  3. Managed with anticoagulant therapy: Inferior vena cava filter if there is recurrent risk of lower limb DVTs
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15
Q

Define Hypertension and it’s categories. What is the impact of the new hypertension guidelines?

A

Persistent elevated systemic and local blood pressure. 46% of adults have HTN.

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16
Q
  1. Increased BP is a function of _____.
  2. Systolic BP _______ throughout life and is a more important cardiac risk factor ______ the age of 50.
  3. Diastolic BP tends to ______ around age 50 and is a more important cardiac risk factor ______ the age of 50.
A
  1. Aging
  2. Increases; After
  3. Stabilize and begin to drop; Before
17
Q

The relationship between any BP above normal and ________ is linear. An increase of 20 mmHg systolic and 10 mmHg diastolic ______ the risk of death from stroke, heart disease, or other vascular disease.

A
  1. The morbidity and mortality of stroke or coronary heart disease
  2. Doubles
18
Q

Prevalence of HTN by race and ethnicity

A

Non-Hispanic blacks > Non-Hispanic whites > Hispanics > Non-Hispanic Asians

19
Q

HTN is called “the silent killer” becuase it is usually _______. HTN can lead to eventual ________.

A
  1. Asymptomatic
  2. End organ damage
20
Q

Primary or essential HTN accounts for _____ of cases (etiology poorly understood). Secondary HTN accounts for _____.

A
  • 95%
  • 5%
21
Q

Causes of Secondary HTN

A
22
Q

What are the critical roles of the kidneys?

A
  1. Renin-angiotensin system
  2. Release of vascular relaxing substances (nitric oxide, prostaglandins): Action is to counterbalance the vasopressor effects of angiotensin
  3. Influence of GFR
  4. Natriuretic factors
23
Q

Function of Renin

A
  • Proteolytic enzyme produced by renal juxtaglomerular cells in response to:
    • Low BP in afferent arterioles
    • Elevated catecholamines levels
    • Low sodium levels in distal convoluted renal tubules
24
Q

Describe the Renin-Angiotensin System

A
  • Renin cleaves plasma angiotensinogen to angiotensin I, which in turn in converted to angiotensin II by angiotenin-converting enzyme (ACE) in the periphery. Angiotensin II raises blood pressure by:
    • Inducing vascular SMC contraction
    • Stimulating aldosterone secretion by the adrenal gland
    • Increasing tubular sodium resorption
25
Q

Describe the function of Aldosterone

A
  • Increases blood pressure by its effect on volume
    • Increases sodium resorption (and thus water) in the distal convoluted and collecting tubules
    • Increases potassium excretion into the urine
26
Q

Describe the function of Natriuretic Peptides

A
  • Myocardial natriuretic peptides are released from atrial and ventricular myocardium in response to volume expansion
    • Inhibit sodium resorption in the distal renal tubules, thus leading to sodium excretion and diuresis
    • Induce systemic vasodilation
27
Q

Describe End-Organ Damage of Heart

A
  • About 50% of hypertensive patients die of coronary artery disease
    • Coronary insufficiency
    • Myocardial infarction
    • Congestive heart failure
28
Q

Describe End-Organ Damage of the Brain

A

About 30% of hypertensive patients die of stroke

29
Q

Describe End-Organ Damage of the Vessels

A

Hypertension accelerates atherogenesis and degenerative changes affecting vessel walls

30
Q

Describe End-Organ Damage of the Kidney

A
  • HTN is the second leading cause of kidney failure
  • Arteriosclerotic changes lead to impaired glomerular function
    • Reduced ability to filter blood
    • Reduced ability to regulate the fluid, hormones, acids, and salts in the body
    • Damaged kidney may release more renin contributing to a downward spiral
31
Q

Describe End-Organ Damage of the Eye

A
  • Arteriosclerotic damage
    • Retinopathy
      • Vision impairment/loss
    • Optic nerve neuropathy
      • Vision impairment/loss
    • Choroidopathy - fluid buildup under the retina
      • Distorted vision/scarring
32
Q
A

DHHD 6005 - Exam 2 (2 decks)

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