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Patho > Lectures 11 & 12 - Vascular disorders and circulatory shock > Flashcards

Lectures 11 & 12 - Vascular disorders and circulatory shock Flashcards

1
Q

what is essential hypertension?

A

no underlying cause

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2
Q

what is secondary hypertension?

A

kidney disease, renovascular disease, alcoholism

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3
Q

what are the four theories of underlying disease development of HTN?

A
  1. excessive SNS activity
  2. overactive renin-angiotensin-aldosterone system
  3. altered neurohormonal control
  4. metabolic disturbances
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4
Q

what are lifestyle management options to control HTN?

A

physical activity
dietary modification
relaxation techniques
salt restriction
decrease dietary fat
decrease alcohol intake
stop smoking
weight control

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5
Q

what are the short term responses to stress?

A
  1. Increased HR
  2. Increased BP
  3. Glycogen converted to glucose and released in blood
  4. Dilation of bronchioles
  5. Changes in blood flow patterns = decreased digestive activity and reduced urine output
  6. Increased metabolic rate
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6
Q

what are long term stress responses when mineralocorticoids are involved?

A
  1. Retention of sodium and water by kidneys
  2. Increased blood volume and BP
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7
Q

what are long term stress responses when glucocorticoids are involved?

A
  1. Proteins and fats converted to glucose or broken down for energy
  2. Increased blood glucose
  3. Suppression of immune system
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8
Q

What are common medications for HTN

A
  • Diuretics
  • Beta blockers
  • ACE inhibitors
  • ARBS
  • Calcium channel blockers
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9
Q

how do diuretics work to lower BP?

A

Thiazide diuretics block reabsorption of Na and H2O and lower BV hence lowering BP, but also cause excretion of K

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10
Q

how do beta blockers work to lower BP?

A

slow down heart by blocking hormones such as adrenaline

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11
Q

how do ACE inhibitors work to lower BP?

A
  • Used for HTN in heart failure
  • Side effects include dry cough
  • stop angiotensin 2 thus lower BP
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12
Q

how do ARBS work to lower BP?

A

angiotensin receptor blocking drugs – blocks angiotensin 2

Alternative to ACE inhibitors if side effects are not tolerated

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13
Q

how do CCBs work to lower BP?

A

By blocking calcium they allow blood vessels to relax and open

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14
Q

how do CCBs work to lower BP?

A

By blocking calcium they allow blood vessels to relax and open

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15
Q

what is peripheral vascular disease?

A

disruption of peripheral perfusion due to obstruction of blood vessels and increased blood clot formation

can affect both veins and arteries

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16
Q

what are the main causes of peropheral vascular disease?

A

thromboangititis or Raynaud’s disease

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17
Q

what can result from peripheral vascular disease?

A

reduces perfusion in peripheries leading to ischemia and tissue necrosis

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18
Q

How is peripheral vascular disease diagnosed?

A

Dopplers to listen to blood flow
angiogram
venogram

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19
Q

how is peripheral vascular disease treated?

A

angioplasty
endarterectomy
bypass grafts
medications (platelet inhibitors)

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20
Q

What are arterial manifestation of PVD?

A
  • Diminished or absent pulses
  • Smooth, shiny, dry skin, no hair
  • No oedema
  • Round, painful ulcers on distal foot or toes
  • Dependent rubour
  • Pallor and pain when legs elevated – fighting gravity to get blood to tissues
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21
Q

what are venous manifestations of PVD?

A
  • Normal pulses
  • Brown patches of discolouration on lower legs
  • Dependent oedema
  • Irregular shaped, painless ulcers on lower legs and ankles
  • Pain relief when legs elevated
  • No intermittent claudication
  • Normal nails
  • Basically getting good oxygen to areas but not returning it as well
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22
Q

what is DVT and how is it caused?

A

clot that forms in deep veins
caused from pooling blood, platelets gather, clot forms and breaks off which may head to heart or brain

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23
Q

how is a DVT diagnosed?

A

ultrasound
if found pt not to move as clot may break off

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24
Q

how is a DVT treated?

A

Heprine - breaks down clots
warfarin - stop clotting cascade
may need prophylactic treatment like clexane after to stop another DVT

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25
Q

what is circulatory shock?

A

Failure of circulation
result in poor tissue perfusion and therefore cellular metabolism

26
Q

what are the 5 types of circulatory shock?

A

cardiogenic shock
neurogenic shock
anaphylaxis
hypovolemic
septic shock

27
Q

what is cardiogenic shock?

A

MI
HF
poorly controlled dysrhythmias
angina
infection or tension pneumothorax

28
Q

what is neurogenic shock?

A

change in CNS control is vasoconstriction/vasodilation balance

vasovagal syncope
drugs that lower SNS
brain/spinal cord damage

29
Q

what is anaphylactic shock?

A

allergic reaction.

Widespread vasodilation peripheral blood pooling
poor tissue perfusion
oedema

30
Q

what is hypovolaemic shock?

A

reduced blood volume

31
Q

what is septic shock?

A

Due to bacterial infections

32
Q

what are the 3 types of angina?

A

stable angina
unstable angina
variant angina

33
Q

what is stable angina

A

Blood flow is adequate at rest but compromised when the person experts themselves

34
Q

what is unstable angina

A

Compromised blood flow at rest, leading to chest pain without exertion

can experience nausea, SOB etc

35
Q

what is variant angina?

A

Unexplained vasospasms (not atherosclerosis like the others). Occurs with ST elevation in ECG.

36
Q

what are the 5 types of myocardial infarction?

A
  1. Spontaneous
  2. Secondary to ischemic imbalance
  3. resulting in death when biomarker values are unavailable
    4A. Related to percutaneous stent thrombosis
    4B. Related to percutaneous stent thrombosis
  4. Related to coronary artery bypass grafting
37
Q

what is Type 1 – spontaneous MI?

A

Most common type of MI.
Caused by the rupture, ulceration or erosion of atherosclerotic plaque

38
Q

what is Type 2 (secondary to an ischaemic imbalance) MI?

A

Occurs because of an imbalance between oxygen supply and oxygen demand

39
Q

what is Type 2 (secondary to an ischaemic imbalance) MI?

A

Occurs because of an imbalance between oxygen supply and oxygen demand

40
Q

What is Type 3 MI?

A

perfusion results in death

41
Q

What is type 4A MI?

A

Occurs from the iatrogenic effects of an angiogram, angioplasty or stent

42
Q

What is type 4B MI?

A

Occurs from the development of a clot on a previously inserted stent

43
Q

what is type 5 MI?

A

occurs as a result of coronary artery bypass grafting

44
Q

what is cardiomyopathy?

A

A disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body, can lead to heart failure.

45
Q

what are the 3 types of cardiomyopathy?

A

Dilated
Hypertrophic
Restrictive

46
Q

what is dilated cardiomyopathy

A

loss of elasticity of myocardium and overstretched
flaccid ventricular muscle mass

47
Q

what are the causes of dilated cardiomyopathy?

A

chemo
alcohol
pregnancy
infections

48
Q

what is hypertrophic cardiomyopathy?

A

increased size of ventricular muscle
sub valvular hypertrophy can occur (muscle below valve enlarged) and is exacerbated by exercise

49
Q

what is restrictive cardiomyopathy?

A

scar tissue formation post MI causes myocardium to stiffen and inhibits contraction and relaxation

50
Q

what are the three main causes of valve defects?

A

congenital
acquired
rheumatic heart disease

51
Q

what are the two classifications of valve defects?

A

regurgitation - affected heart chamber experiences volume overload either due to failure to eject right amount of blood or because volume returns to chamber

stenosis (hardening) - cause wall tension that contributes to hypertrophy = cycle of heart failure

52
Q

what are the S&S of valve defects?

A

presyncope - feeling of being about to faint
extra heart sounds
dysrhythmias

53
Q

how are valve defects diagnosed?

A

ECG
echo
baseline obs
history

54
Q

what is the treatment for heart defects?

A

surgical repair
valve replacement (tissue of mechanical)

55
Q

what are the signs and symptoms of L&R sided heart failure?

A

chronic tiredness
decreased physical ability
SOB

decrease in cardiac output causes:
muscle fatigue
urinary retention
restlessness
confusion
anxitey
irritability

56
Q

what is left sided heart failure related to?

A

Lungs - causes fluid build up in the lungs

57
Q

what is right sided heart failure related to?

A

rest of body - causes an increase in hydrostatic pressure in the periphery and therefore peropheral oedema

58
Q

what is the purpose of the renin-angiotensin system/pathway?

A

associated with blood pressure regulation by modulating blood volume, sodium reabsorption, potassium secretion, water reabsorption, and vascular tone

increased renin = increased angiotensin 2 = vasoconstriction = hypertension

increased renin = increased angiotensin 2 = increased aldosterone = increased BV = hypertension

59
Q

what is the most potent vasodilator?

A

Nirtic oxide

60
Q

what is the most potent vasconstrictor?

A

angiotensin 2

61
Q

what is claudication?

A

Cramping pain in the lower limbs while walking or exercising, due to vascular or neurogenic causes.

Patho (10 decks)

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