Huber 2 Flashcards
Vascular Diseases have frequent coexistence with _________.
Cardiac disease
Describe Peripheral Artery Disease
- Affects up to 15% of patients > 60 years of age
- 50% of CAD also have PAD
- Atherosclerosis most common etiology
Outcomes of Periperhal Artery Disease
- 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
Managmenet of Peripheral Artery Disease
- 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
Describe Aneurysmal Vascular Disease
- Affects up to 3% of patients > 50 years old
- Common occurrence with CAD
- Atherosclerosis most common etiology
- Marfan Syndrome
- Family history
Outcomes of Aneurysmal Vascular Disease
- Most are asymptomatic
- Concern for catastrophic rupture
- Compression against surrounding tissues
- Embolization of atherosclerotic debris or clot
Management of Aneurysmal Vascular Disease
- Monitor for change/symptoms
- Surgical correction
- Prosthetic grafts
- Stents
Describe Aortic Dissection
Tear in the aortic intima leading to blood dissecting between the intima and media
Pre-disposing factors and Management of Aortic Dissection
- Hypertension, Marfan Syndrome
- B-blockers, Surgical repair/Endovascular stent
Describe Giant Cell Arteritis
Involvement of extracranial branches of carotid artery (temporal arteritis) in patient over 65
Signs & Symptoms and Managment of Giant Cell Arteritis
- Headache, temporal artery tenderness, visual loss, jaw claudication, weight loss, fever, markedly elevated erythrocyte sedimentation rate.
- Managed with coticosteroids
Describe the location, risk factors, risks, and management of Deep Vein Thrombosis
- Most commonly affects veins of lower extremities (i.e. femoral, iliac, calf)
- Risk factors: Venous stasis, hypercoagulability, vein injury (Virchow’s triad)
- Risk for embolic complications such as pulmonary embolism (proximal > distal)
- Managed with anticoagulation regimen
Describe Pulmonary Embolism and it’s causes
- 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
Predisposing factors, signs & symptoms, and management of Pulmonary Embolism
- Prominent predisposing factor is Virchow’s triad
- Dyspnea, pleuritic chest plain, tachypnea
- Managed with anticoagulant therapy: Inferior vena cava filter if there is recurrent risk of lower limb DVTs
Define Hypertension and it’s categories. What is the impact of the new hypertension guidelines?
Persistent elevated systemic and local blood pressure. 46% of adults have HTN.
- Increased BP is a function of _____.
- Systolic BP _______ throughout life and is a more important cardiac risk factor ______ the age of 50.
- Diastolic BP tends to ______ around age 50 and is a more important cardiac risk factor ______ the age of 50.
- Aging
- Increases; After
- Stabilize and begin to drop; Before
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.
- The morbidity and mortality of stroke or coronary heart disease
- Doubles
Prevalence of HTN by race and ethnicity
Non-Hispanic blacks > Non-Hispanic whites > Hispanics > Non-Hispanic Asians
HTN is called “the silent killer” becuase it is usually _______. HTN can lead to eventual ________.
- Asymptomatic
- End organ damage
Primary or essential HTN accounts for _____ of cases (etiology poorly understood). Secondary HTN accounts for _____.
- 95%
- 5%
Causes of Secondary HTN
What are the critical roles of the kidneys?
- Renin-angiotensin system
- Release of vascular relaxing substances (nitric oxide, prostaglandins): Action is to counterbalance the vasopressor effects of angiotensin
- Influence of GFR
- Natriuretic factors
Function of Renin
- 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
Describe the Renin-Angiotensin System
- 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
Describe the function of Aldosterone
- 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
Describe the function of Natriuretic Peptides
- 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
Describe End-Organ Damage of Heart
- About 50% of hypertensive patients die of coronary artery disease
- Coronary insufficiency
- Myocardial infarction
- Congestive heart failure
Describe End-Organ Damage of the Brain
About 30% of hypertensive patients die of stroke
Describe End-Organ Damage of the Vessels
Hypertension accelerates atherogenesis and degenerative changes affecting vessel walls
Describe End-Organ Damage of the Kidney
- 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
Describe End-Organ Damage of the Eye
- Arteriosclerotic damage
- Retinopathy
- Vision impairment/loss
- Optic nerve neuropathy
- Vision impairment/loss
- Choroidopathy - fluid buildup under the retina
- Distorted vision/scarring
- Retinopathy
