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Cardiovascular System > Session 8 - Special Circulations, Peripheral Arterial And Venous Disease > Flashcards

Session 8 - Special Circulations, Peripheral Arterial And Venous Disease Flashcards

1
Q

What is the pressure in the pulmonary artery?

A

12-15mmHg

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2
Q

What is the pressure in the pulmonary capillaries?

A

9-12mmHg

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3
Q

What is the pressure in the pulmonary veins?

A

5mmHg

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4
Q

What is ventilation perfusion matching in a pulmonary circulation?

A

Blood flow and air flow must be matched to allow effective exchange to occur

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5
Q

What is hypoxia pulmonary vasoconstriction?

A

Mechanism regulating pulmonary vascular tone

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6
Q

How does gravity affect pulmonary vessels?

A

In upright position, there is greater hydrostatic pressure on vessels in lower part of lung causing vessels to distend

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7
Q

What is the effect of exercise on pulmonary blood flow?

A

Increased cardiac output, small increase in pulmonary arterial pressure, opens apical capillaries and increased O2 uptake by lungs, reduced capillary transit time as blood flow increases

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8
Q

What is hydrostatic pressure?

A

Pushes fluid out of capillary

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9
Q

What is oncotic pressure?

A

Pressure exerted by large molecules such as plasma proteins, draws fluid into capillary

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10
Q

How does tissue fluid form?

A

Hydrostatic pressure is more than plasma oncotic pressure and forces water out,

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11
Q

What is the capillary hydrostatic pressure influenced by?

A

More by venous pressure

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12
Q

What are 2 conditions that result in pulmonary oedema?

A

Mitral valve stenosis and left ventricular failure

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13
Q

How does mitral valve stenosis cause pulmonary oedema?

A

Blood is unable to flow from left atrium to left ventricle to increase pressure in left atrium which increases pulmonary venous pressure, increasing capillary pressure and causing pulmonary oedema

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14
Q

How does left ventricular failure lead to pulmonary oedema?

A

Left ventricular fails, end diastolic volume increases, LA blood cannot flow to LV, leading to increased pressure in pulmonary veins, increasing capillary pressure, causing pulmonary oedema

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15
Q

What is the effect of pulmonary oedema?

A

Gas exchange is impaired, affected by posture

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16
Q

How to treat pulmonary oedema?

A

Use diuretics to relieve symptoms

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17
Q

What are 3 main features of cerebral circulation?

A

High capillary density - large surface area & reduced diffusion distance
High basal flow rate
High O2 extraction

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18
Q

Why is O2 supply to the brain vital?

A

Neurons are very sensitive to hypoxia and loss of consciousness occurs after a few seconds of cerebral ischaemia

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19
Q

What are 4 factors that ensures a secure blood supply to the brain?

A

Anastomoses between basilar and internal carotid arteries
Myogenic auto regulation maintains perfusion during hypotension
Metabolic factors control blood flow
Brain stem regulates other circulations

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20
Q

What is myogenic auto regulation of blood flow in the brain?

A

Cerebral resistance vessels have a well developed myogenic response to changes in transmural pressure to maintain cerebral blood flow when BP changes - when BP increases, vasoconstriction, when BP decreases, vasodilation

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21
Q

What is metabolic regulation of blood flow in the brain?

A

Cerebral vessels very sensitive to changes in arterial PCO2, if hypercapnia, vasodilation to meet demands and if hypocapnia, vasoconstriction

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22
Q

What are 4 changes when regional activity increases?

A

Areas with increased neuronal activity have increased blood flow, which increases pressure of CO2, [K+], adenosine and lower PO2

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23
Q

What is the effect of adenosine?

A

Vasodilator of cerebral arterioles

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24
Q

What is Cushing’s Reflex?

A

When there is an increase in intracranial pressure and cerebral blood flow is impaired, sympathetic vasomotor activity occurs which causes vasoconstriction throughout body to help maintain cerebral blood flow, which increases BP and causes reflex bradycardia

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25
What are 2 signs of space occupying lesion in Brain?
Bradycardia | Acute hypertension
26
What are 3 features of coronary circulation?
High capillary density facilitates efficient O2 delivery Small diffusion distance Continuous production of NO by coronary endothelium maintains high basal flow
27
What is the effect of myocardial O2 demand on coronary blood flow?
Increase blood flow, almost linearly until very high O2 demand
28
What happens if coronary arteries are partially occluded?
Stable angina because when heart rate increases during exercise, diastole is reduced and blood flow through coronary arteries is reduced
29
What happens when coronary arteries are fully occluded?
Myocardial infarction
30
What are the 4 factors influencing skeletal muscle circulation?
Capillary density Very high vascular tone to permit lots of dilatation so flow can increase Only half of capillaries are perfumed at rest to allow for increased recruitment Opening of precapillary sphincters allows more capillaries to be perfused to increase blood flow and reduce diffusion distance
31
What are 6 agents that act as vasodilator?
``` Increase in K Increase osmolarity Inorganic phosphates Adenosine Adrenaline Increase in H+ ```
32
How does adrenaline act as vasodilator?
Acts through beta2 receptors
33
What is the special role of cutaneous circulation?
Temperature regulation
34
What are the 2 types of skin?
Apical | Non apical
35
What kind of structures is in apical skin that regulates temperature?
Artereovenous anastomoses
36
How does AVAs work?
When core temperature decreases, it increases sympathetic tone in AVAs and decreases blood flow to apical skin When core temperature increases, reduced vasomotor drive to AVA and allows them to dilate, diverting blood to veins near surface
37
How does non apical skin regulate temperature?
Sympathetic cholinergic fibres activate sweat glands that release vasodilator like bradykinin
38
What are 3 problems associated with cutaneous circulation?
Decreased blood flow due to pressure - pressure ulcers Raynaud’s - excessive vasoconstriction in response to cold Excessive vasodilation in response to heat can cause postural hypotension
39
How does blood flow in veins in the lower limb?
From superficial to deep veins
40
What is the role of calf muscle pump?
Soleus and gastrocnemius muscle pushes blood against gravity to the heart, valves open, blood pushed to deep veins and then valves close to prevent retrograde movement,
41
What is varicose veins?
When walls of veins weaken, varicosities develop and valve cusps separate, becoming incompetent
42
Why do varicose veins occur?
Ineffective valves and slow blood movement, or reversed saphenous veins
43
What are 4 symptoms of peripheral venous disease?
Leg cramps Ankle swelling Varicose eczema Haemorrhage
44
What are 5 risk factors of peripheral venous disease?
``` Age Family history Female sex Number of births Occupation standing a lot ```
45
What is superficial vein thrombophlebitis?
Inflammatory processes resulting from a clot in the vein causing painful erythematous, increases risk of deep vein thrombosis
46
What is chronic venous insufficiency?
More advanced version of peripheral venous disease
47
What are 3 symptoms of chronic venous insufficiency?
Lipodermatosclerosis Haemosiderin staining - brawny oedema Venous ulceration
48
What is lipodermatosclerosis?
Inflammation and thickening of fat layer under skin
49
What is venous eczema?
Chronic, itchy red and swollen thigh - hard to touch compared to other fatty tissues above or below
50
When does calf muscle pump fail?
When no proper use of calf muscles, no plantar flexion of the ankle joint during walking
51
What causes arterial thrombosis?
Atheroma - platelets aggregate and forms plaque
52
What causes venous thrombosis?
Stasis and usually another factor (trauma, medication, dehydration, chemotherapy, inflammation, pregnancy) Fibrin rich
53
What is deep vein thrombosis?
Clotting of blood in a deep vein, impairing venous return and hypercoagulability
54
What are 6 symptoms of deep vein thrombosis?
``` Calf tenderness Warmth Distended and visible superficial veins Oedema Pyrexia with no other obvious cause Asymmetry ```
55
How to test for deep vein thrombosis?
Use Wells’ score
56
What are 3 prophylaxis for DVT?
Anticoagulant agents Physical activity Gradient stockings
57
What is a fatal consequence of DVT?
Pulmonary embolism
58
What is acute limb ischaemia?
Sudden occlusion of artery within minutes or days so no collateral circulation developed
59
What are 3 causes of acute limb ischaemia?
Atrial fibrillation Popliteal artery aneurysm Rupture of atherosclerotic plaque
60
What are the 6P symptoms of leg ischaemia?
``` Pain Pallor Perishing with cold Pulseless Paraesthesia Paralysis ```
61
What are 4 ways to treat acute limb ischaemia?
Angioplasty Thrombectomy Thrombolysis Amputation
62
What is chronic peripheral arterial disease?
Intermittent claudication of lower limb
63
What is claudication?
Cramping pain in leg induced by exercise, not present during rest
64
What are 5 ways to manage chronic peripheral arterial disease?
``` Exercise Smoking cessation Antiplatelet drugs Angioplasty Bypass graft ```
65
What are 4 steps of how the ankle brachial index cuff works?
Ultrasound device amplifies the sound of arterial blood flow Systolic pressure recorded in brachial artery of arm Sound of arterial blood flow located in ankle Systolic pressure recorded in arteries of the ankle after flow is located
66
How to calculate ABI?
Divide ankle systolic over brachial systolic, if <0.9, there is peripheral artery disease
67
What is the symptoms of chronic peripheral arterial disease?
Pain is exercise induced, like stable angina, goes away upon rest
68
What is critical limb ischaemia?
Progression of chronic peripheral vascular disease
69
What is the symptoms of critical limb ischaemia?
Rest pain, unstable angina, can have ulcers and gangrene
70
What are the 4 lower limb pulses?
Femoral Popliteal Posterior tibial Dorsalis pedis
71
How to palpate femoral pulse?
Mid inguinal point midway between anterior superior iliac spine and pubic symphysis
72
How to palpate popliteal pulse?
Deep in popliteal fossa
73
How to palpate dorsalis pedis pulse?
Lateral to extensor hallucis longus tendon
74
How to palpate posterior tibial pulse?
Behind the medial malleolus
75
How does Doppler ultrasonography work?
Use ultrasound and Doppler effect to measure flow and velocity, sound produced from moving blood is detected and then computed

Cardiovascular System (11 decks)

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