Pc604 chapter 30 Flashcards
hypertension is an elevation in the ________blood pressure
arterial
what is considered primary hypertension/
140/90
what is considered pre-hypertension
120/80-139/89
What is the most prevelant type of hypertension
primary or essential hypertension
what is the cause of primary or essential hypertension?
genetics and environment
Primary essential hypertension is asymptomatic until
marked end organ damage
The most significant factor in high blood pressure
Systolic Pressure -because of the potential of the systolic pressure to cause organ damage
isolated systolic high blood pressure is when the
is when the systolic is greater than 140 and the diastolic is LESS THAN 90. (A WIDE PULSE PRESSURE)
what causes isolated systolic high blood pressure
Reduced vascular compliance or aortic stiffening related to atherosclerosis.
What age group is isolated systolic high blood pressure seen
usually over 65 years of age
Low blood pressure on standing is
Orthostatic Hypotension - a rapid change in position causes a dip in blood pressure
What are the causes of orthostatic hypotension?
altered body chemistry, prolonged immobility, venous pooling, starvation, exhaustion, drugs
What are the symptoms of orthostatic hypotension?
dizziness, syncope, blurred vision
A chronic disease of the arterial system is
Arteriosclersosis
Arteriosclersosis causes what in a blood vessel?
an abnormal thickening of the blood vessel walls
The most common form of arteriosclerosis is
atherosclerosis
What happens in atherosclerosis?
soft deposits of intra=arterial fat and fibrin that begin to harden over time are deposited in the vessel wall.
What is the overall significance of atherosclerosis?
A vascular problem that can affect all of the vascular tree.
Symptoms of atherosclerosis depend on
Depends on where the hardening occurs
Major clinical manifestation of atherosclerosis is
Ischemia,
______________initiates and causes the progression of atherosclerosis.
Inflammation
An injury to the endothelial wall initiates the __________process.
Inflammation
chronic endothelial injury can be caused by
hypertension smoking hyperlipidemia hyperhomocystinemia hemodynamic factors toxins viruses immune reactions
Name the layers of the blood vessel wall
Endothelium
Tunica Intima
Tunica Media
Tunica Advantitia
When there is damage to the epithelial wall, inflammation and____________occurs.
Progression occurs.
epithelial injury begins as a ____________
fatty streak on the vessel wall
In the second stage of the epithelial injury, a
lipid pool forms.
As a plaque in the vessel expands, what happens?
ischemia and necrosis occurs in the area
A ballooning or weakening
Area on an artery.
Aneurysm
Aneurysms in the chest cavity may cause the following symptoms as they tear
difficulty swallowing, shortness of air , or chest pain
when an aneurysm ruptures the layers of the artery
split
when atherosclerotic plaque occurs in the arteries of the legs it is called
peripheral artery or peripheral vascular disease.
PAD is highly prevelant among what disease group?
diabetics
A macrovascular event that causes damage in the diabetic patient.
Atherosclerosis
for the patient with PAD the patient complains of pain on exercise as the
artery is occluded
the exercising muscle does not get enough oxygen. This is called
Intermittent claudication
Because of the poor oxygen and nutrient flow to the lower leg, the leg will be
cool, hairless and diminished, esp in the feet.
NO SWELLING INVOLVED BUT THERE MAY BE RUBAR
Myocardial infarction occurs when a coronary artery is occluded by atherosclerotic
plaque or other embolism
when the coronary artery blood flow decreases, the heart muscle looses ______
oxygen and nutrients
when there is no oxygen to the heart muscle , the injury may be very
painful due to ischemia and infarction
Prior to a true MI the patient may experience
unstable angina
Reversible myocardial ischemia is
unstable angina
The plaque within the coronary artery has become _______when MI occurs
complicated
usually occurs at rest
comes and goes
worsening with each episode
patient is anxious, diaphoretic, and soa
what happens when unstable angina occurs.
unstable angina is most dangerous when it occurs at
rest
caused by a vasospasm of the blood vessel and is totally unpredictable
Prenzmetal angina
this kind of angina occurs almost exclusively at rest
Prenzmetal angina
This kind of angina occurs at night during rem sleep and awakens the patient
Prenzmetals angina
An immune response to group a beta hemolytic strep
Rheumatic heart disease
Stable angina is a
A recurrent predictable chest pain
Stable angina usually lasts how many minutes
3-5
usually occurs after exercise and is relieved by rest and nitrites
stable angina
stable angina is caused by
myocardial ischemia
Preceeds a strep throat infection
Rheumatic heart disease
An abnormal humeral cell mediated immune response to beta hemolytic strep antigen
Rheumatic heart disease
The immune response cross reacts with self antigens on the heart muscle brain and joints causing
an autoimmune response that inflames and
scars the heart tissue
Rheumatic heart disease can cause
Carditis
polyarthritis
chorea
erythemia marginatum (a skin lesion)
Blood comes to the heart from the
vena cava to the right atrium
From the right atrium blood goes to the
right ventricle
from the right ventricle blood goes to the
lungs
Right sided heart failure is
corpulmonale
If there is a blockage in the right ventricle we see
corpulmonale –blood will collect in the right ventricle.
a collection of blood in the right ventricle or corpulmonale will cause
dependent edema
jugular venous distention
hepatomegaly
ascities
An infarction in the right side of the heart will cause the same symptoms as
corpulmonale
from the right ventricle the blood goes into the
lung
In the lung, the blood is
oxygenated through a complex exchange at the capillary alveolar membrane
oxygenated blood goes to the
left atrium
from the left atrium blood goes to the
left ventricle
The left ventricle then gives the final big push to push the blood into the
periphery
if there is left sided failure within the heart and the volume increases the back flow is to the
lung
Left means
LUNG
WHEN BACKFLOW HAPPENS ON THE left side, WE SEE
Pulmonary edema
pulmonary edema happens on the left side of the heart when
the fluid volume in the arteriole is pushed back to the alveoli
Manifestations of pulmonary edema (or left sided heart failure) are
pulmonary edema-pink frothy sputum.
soa, fatigue
Pulmonary edema (or left sided heart failure)can happen in
in response to MI, change within the myocytes of the left side of the left ventricle.
Also seen in HTN.
.Pulmonary edema (or left sided heart failure) associated with hypertension occurs because
because the left ventricle is pushing blood against vascular resistance.
Hypertension is about
vascular resistance or increased fluid volume
vascular resistance or the pushing against the resistance
increases afterload
An increased volume in the system would be a
preload problem
Burger’ s disease
Thromboangiitis obliterans
Occurs in young men who are heavy cigarette smokers.
Burger’s disease
the pathogenesis of Burger’s disease is
unknown
Shows evidence of T-cell activation, autoimmunity, and inflammation
Burger’s disease
Leads to thrombi, vasospasm and occlusion of arterioles in the hands and feet
Burger’s disease
The most important part of treatment for burger’s disease is to
Stop Smoking
Raynaud’s disease is
arterial vasospasm
Cause of Raynaud’s disease is
unknown
Raynaud’s disease causes
endothelial damage with an imbalance in the endothelium-derived vasodialtors and vasoconstrictors.
Clinical manifestations of Raynaud’s disease are
Changes in skin color and sensation secondary to ischemia
Varicose veins
Distended, tortuous, palpable vein
Chronic venous insufficiency
Inadequate venous return over a long period of time
Tapenade
blockage or compression of a body part
Dysrhythmia
Disturbance in cardiac rhythm
Preload
Volume of blood in ventricle after atrial contraction and ventricle filling
After load
Tension or pressure at must be generated by the ventricle of the heart in order to eject blood
Deep vein thrombosis
Blood clot that adheres to a deep vein
Thromboembolism
Detached thrombus
Orthostatic hypotension
A drop in systolic and diastolic arterial blood pressure on standing
Aneurysm
Localized dilatation or out pouching of a vessel wall
Embolism
Obstruction of a vessel by a bonus of matter in circulation
Pericarditis
An inflammation of the pericardial sack
Pericardial effusion
Accumulation of fluid in the pericardial sack
RAYNAUDS PHENOMENON IS DIFFERENTTHAN RAYNAUD’S DISEASE!!
YES IT IS :) !
Secondary to systemic disease such as scleraderma OR RHEUMATOID ARTHRITIS.
RAYNAUD’S PHENOMENEN
Primary vasospastic disease of unknown origin.
Raynaud’s DISEASE
Both cause a change in skin color and sensation due to the ischemia that occurs
Raynaud’s disease and Raynaud’s Phenomenen
Pallor, numbness in finger’s and toes due to vasospasm is seen in both
Raynaud’s disease and Raynaud’s Phenomenen
A disease of the veins
Venous insufficiency
Arises from venous insufficiency
Venus stasis ulcer (and other venous diseases)
Inadequate venous return leads to
Venous hypertension, stasis, tissue hypoxia
Tissue hypoxia (related to venous disease) leads to
Inflammatory reaction in the vessel
Inflammatory reaction in the vessel (related to venous disease) leads to
fibrosclerotic remodeling of the skin and ulceration
Mitral valve prolapse is the most common cause of
mixamotis degeneration of the leaflet where the cusps are redundant and thickened.
Most common valve disorder in the United States
Mitral Valve Prolapse
Mitral Valve prolapse is seen most often in what population?
Young women
There may be an autosomal ______
in the inheritance of the disorder.
dominant factor
Environmental insult to the fetus in the 5th or 6th week of development may be the cause of ____________
Mitral Valve prolapse
When the left ventricle empties, then there is a billowing up of the ____ into the ____ during _____.
leaflets
atrium
systole
What kind of murmer can occur with Mitral Valve Prolpse?
a regurgitation type murmer.
What sound is heard with mitral valve prolapse?
a CLICK
A MID-SYSTOLIC CLICK
Do people have symptoms with mitral valve prolapse?
many do not
MVP can mimmick symptoms of a
panic attack (causes tachycardia and anxiety)
Symptoms of MVP may include
palpitations,dysrhythmias, tachycardia, sycope,, fatigue, lethargy, dyspnea, chest tightness, anxiety, panic attacks, depression and atypical chest pain.
