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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
Q

What are 2 signs of space occupying lesion in Brain?

A

Bradycardia

Acute hypertension

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26
Q

What are 3 features of coronary circulation?

A

High capillary density facilitates efficient O2 delivery
Small diffusion distance
Continuous production of NO by coronary endothelium maintains high basal flow

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27
Q

What is the effect of myocardial O2 demand on coronary blood flow?

A

Increase blood flow, almost linearly until very high O2 demand

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28
Q

What happens if coronary arteries are partially occluded?

A

Stable angina because when heart rate increases during exercise, diastole is reduced and blood flow through coronary arteries is reduced

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29
Q

What happens when coronary arteries are fully occluded?

A

Myocardial infarction

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30
Q

What are the 4 factors influencing skeletal muscle circulation?

A

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

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31
Q

What are 6 agents that act as vasodilator?

A 
Increase in K
Increase osmolarity
Inorganic phosphates 
Adenosine 
Adrenaline
Increase in H+
32
Q

How does adrenaline act as vasodilator?

A

Acts through beta2 receptors

33
Q

What is the special role of cutaneous circulation?

A

Temperature regulation

34
Q

What are the 2 types of skin?

A

Apical

Non apical

35
Q

What kind of structures is in apical skin that regulates temperature?

A

Artereovenous anastomoses

36
Q

How does AVAs work?

A

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
Q

How does non apical skin regulate temperature?

A

Sympathetic cholinergic fibres activate sweat glands that release vasodilator like bradykinin

38
Q

What are 3 problems associated with cutaneous circulation?

A

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
Q

How does blood flow in veins in the lower limb?

A

From superficial to deep veins

40
Q

What is the role of calf muscle pump?

A

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
Q

What is varicose veins?

A

When walls of veins weaken, varicosities develop and valve cusps separate, becoming incompetent

42
Q

Why do varicose veins occur?

A

Ineffective valves and slow blood movement, or reversed saphenous veins

43
Q

What are 4 symptoms of peripheral venous disease?

A

Leg cramps
Ankle swelling
Varicose eczema
Haemorrhage

44
Q

What are 5 risk factors of peripheral venous disease?

A 
Age
Family history 
Female sex
Number of births
Occupation standing a lot
45
Q

What is superficial vein thrombophlebitis?

A

Inflammatory processes resulting from a clot in the vein causing painful erythematous, increases risk of deep vein thrombosis

46
Q

What is chronic venous insufficiency?

A

More advanced version of peripheral venous disease

47
Q

What are 3 symptoms of chronic venous insufficiency?

A

Lipodermatosclerosis
Haemosiderin staining - brawny oedema
Venous ulceration

48
Q

What is lipodermatosclerosis?

A

Inflammation and thickening of fat layer under skin

49
Q

What is venous eczema?

A

Chronic, itchy red and swollen thigh - hard to touch compared to other fatty tissues above or below

50
Q

When does calf muscle pump fail?

A

When no proper use of calf muscles, no plantar flexion of the ankle joint during walking

51
Q

What causes arterial thrombosis?

A

Atheroma - platelets aggregate and forms plaque

52
Q

What causes venous thrombosis?

A

Stasis and usually another factor (trauma, medication, dehydration, chemotherapy, inflammation, pregnancy)

Fibrin rich

53
Q

What is deep vein thrombosis?

A

Clotting of blood in a deep vein, impairing venous return and hypercoagulability

54
Q

What are 6 symptoms of deep vein thrombosis?

A 
Calf tenderness
Warmth 
Distended and visible superficial veins 
Oedema
Pyrexia with no other obvious cause 
Asymmetry
55
Q

How to test for deep vein thrombosis?

A

Use Wells’ score

56
Q

What are 3 prophylaxis for DVT?

A

Anticoagulant agents
Physical activity
Gradient stockings

57
Q

What is a fatal consequence of DVT?

A

Pulmonary embolism

58
Q

What is acute limb ischaemia?

A

Sudden occlusion of artery within minutes or days so no collateral circulation developed

59
Q

What are 3 causes of acute limb ischaemia?

A

Atrial fibrillation
Popliteal artery aneurysm
Rupture of atherosclerotic plaque

60
Q

What are the 6P symptoms of leg ischaemia?

A 
Pain 
Pallor
Perishing with cold 
Pulseless
Paraesthesia
Paralysis
61
Q

What are 4 ways to treat acute limb ischaemia?

A

Angioplasty
Thrombectomy
Thrombolysis
Amputation

62
Q

What is chronic peripheral arterial disease?

A

Intermittent claudication of lower limb

63
Q

What is claudication?

A

Cramping pain in leg induced by exercise, not present during rest

64
Q

What are 5 ways to manage chronic peripheral arterial disease?

A 
Exercise
Smoking cessation
Antiplatelet drugs
Angioplasty
Bypass graft
65
Q

What are 4 steps of how the ankle brachial index cuff works?

A

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
Q

How to calculate ABI?

A

Divide ankle systolic over brachial systolic, if <0.9, there is peripheral artery disease

67
Q

What is the symptoms of chronic peripheral arterial disease?

A

Pain is exercise induced, like stable angina, goes away upon rest

68
Q

What is critical limb ischaemia?

A

Progression of chronic peripheral vascular disease

69
Q

What is the symptoms of critical limb ischaemia?

A

Rest pain, unstable angina, can have ulcers and gangrene

70
Q

What are the 4 lower limb pulses?

A

Femoral
Popliteal
Posterior tibial
Dorsalis pedis

71
Q

How to palpate femoral pulse?

A

Mid inguinal point midway between anterior superior iliac spine and pubic symphysis

72
Q

How to palpate popliteal pulse?

A

Deep in popliteal fossa

73
Q

How to palpate dorsalis pedis pulse?

A

Lateral to extensor hallucis longus tendon

74
Q

How to palpate posterior tibial pulse?

A

Behind the medial malleolus

75
Q

How does Doppler ultrasonography work?

A

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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