Review of CVS issues

Question 1

What can go wrong with the cardiovascular system?

Answer 1

Cardiovascular Overview
* A large and complex system with many pathophysiological possibilities
* Underpinning all is the failure of circulation around and/or oxygenation of tissues
* Disorders fall into broadly four categories:

Issues with pressure:
* Hypertension
* Hypotension
* Heart failure - pressure on the heart to compensate
* Pre-eclampsia

Issues with rhythm:
* Tachycardia - too fast
* Bradycardia - too slow
* POTS - excessive elevation on standing up
* Cardiac arrest - heart stops
* Atrial fibrillation - turbulent blood flow can lead to clotting

Issues with coagulation:
* Embolism - of any kind eg thrombosis. Thrombus is a still clot, and embolism is a moving clot
* Clot
* Stroke - TIA or full stroke
* Haemophilia
* Anaemias

Issues with circulation:
* Venous insufficiency
* Raynauds
* Varicose veins
* CAD - coronary artery disease/ vessels on the heart itself
* Intermittent claudication - cramps

Question 2

What are causes and processes of issues with the CVS?

Answer 2

Causes
* Genes
* Diet
* Lifestyle – smoking, sedentary
* Underlying conditions – diabetes, hypertension
* Ageing
* Inflammation – links to diet

Causes can trigger Processes
* Inflammation
* Hypertension
* Atherosclerosis – formation of fatty plaques within vessels

Question 3

What are the issues of pressure?

Answer 3

Hyper and hypotension
* Excessive or insufficient intravascular pressure
* Causing vessel and organ damage if excessive
* Hypertension is silent and so monitoring is essential

Heart failure
* Compensatory mechanisms due to inadequacy of circulation
* Increased heart rate, hypertrophy of heart muscle, arrhythmia from excessive
calcium release

Question 4

What are the issues of rhythm?

Answer 4

Electrical function recap
* Sinoatrial node fires…
* Triggers atrioventricular
node to fire…
* Travels down the bundle branches and through Purkinje fibres

Arrhythmias
* Palpitation vs genuine arrhythmia
* Be aware of dangerous or red plag presentations - Dizziness or loss of consciousness, unexplained blackout or collapse, associated chest pain, known history of heart disease, family history of arrhythmia or sudden death

Question 5

What are the issues with blood?

Answer 5

Be clear on Formation
* Plasma, formed elements, haemoglobin (carries oxygen)
* Lipids, amino acids, glucose, iron, copper, zinc, B vitamins
* RBC lifecycle 120 days from erythropoiesis in
bone marrow to macrophage destruction and removal.

Bleeding and clotting
* What are the stages of haemostasis (arrest of bleeding)– vasoconstriction, platelet plug formation, coagulation, and clot then dealth with at the end
* Hypocoagulability – does not clot - haemophilia, thrombocytopaenia, liver disease etc.
* Hypercoagulability – too much clot - inherited thrombophilia or acquired e.g. surgery, oral contraceptive pill
* Clot risk – stroke (perm) and TIA (temporary stroke as the clot moves on)

Anaemias
* Deficiency anaemias – iron, or pernicious or B12 anaemia (megaloblastic)
* Intrinsic or extrinsic haemolytic destruction - cells rupture
* Aplastic e.g. autoimmune
* Anaemia of chronic disease e.g.
inflammation, malignancy

Question 6

What are the issues with circulation?

Answer 6

Several mechanisms whereby circulation may become impaired
1. Abnormality of or damage to vessels
2. Abnormality of or damage to valves
3. Inappropriate vasospasm or vasodilation
4. Occlusion of vessels due to atherosclerosis
Problems arise as a result of tissue hypoxia and direct damage to adjacent tissues from inflammation and pressure

Then hypoxia can lead to tissue necrosis etc - risk to limbs and life