Week 13- Cardiovascular System Flashcards
The cardiovascular system functions in coordination with the pulmonary system to…
Circulate oxygenated blood through the arterial system to all cells in the body
Leading risk factors for CVD include:
-Hypertension
-High serum cholesterol levels
-Physical inactivity
-Diabetes
-Suboptimal diet
-Being overweight/obese
-Smoking
-Risk factor reduction targeted towards an entire population through a focus on social and environmental conditions
-Such measures typically get promoted through laws and national policy
Primordial prevention
-Often aimed at children to decrease as much risk exposure as possible
Primordial prevention
-Improving access to an urban neighborhood to safe sidewalks to promote physical activity
Primordial prevention
-Reducing chances of the first adverse cardiovascular event in patients with no clinical apparent CVD
-Lifestyle and environmental changes
Primary prevention
-Decrease the recurrent cardiovascular events and reduce death resulting from CVD
Secondary prevention
Cardinal symptoms of cardiac disease usually include…
-Chest, neck, or arm pain or discomfort; angina, palpitations; dyspnea; syncope (fainting); fatigue; cough; and cyanosis
The most common symptoms of the vascular component of cardiovascular pathologic conditions
-Edema and leg pain (claudication)
Biomarkers of CVD
-BP, premature ventricular contraction, low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) etc.
True or false: Cardiovascular disease, especially coronary atherosclerosis, is the most common cause of hospitalization and death in the older population in the US
True
Cardiovascular disease is likely to be even more of a major health problem in the future, as it accounts for over ___% of cardiovascular deaths in people aged 65 years and older
80
True or false: The heart pumps more blood and does not work harder in aging
False
(less blood and works much harder)
Disease-independent changes in the aging heart associated with a reduction in function include the following…
-Reduction in the number of myocytes and cells within the conduction tissue
-The development of cardiac fibrosis
-A reduction in calcium transport across membranes
-Lower capillary density
-Decreases in the intracellular response to β-adrenergic stimulation (sometimes referred to as blunted β-adrenoceptor responsiveness)
-Impaired autonomic reflex control of heart rate
As the arteries age, increased collagen and calcium content and progressive deterioration of the arterial media combined with _____________ formation result in _________ arterial walls and __________ _________, increased systolic BP, and increased fatigue of arterial walls, all of which accelerate arterial damage, producing a self-perpetuating cycle
-Atherosclerotic plaque
-Stiff
-Narrowed lumen
The vasculature changes with aging as the arterial walls _________ with age and the aorta becomes ___________ and _____________
-Stiffen
-Dilated
-Elongated
Calcium deposition and changes in the amount of and loss of elasticity in _________ and _________ most often affect the larger and medium-sized vessels
-Elastin
-Collagen
True or false: Resting cardiac function (e.g., cardiac output, heart rate) shows minimal age-related changes
True
True or false: Changes in functional capacity are less apparent during exercise than when at rest
False
(more apparent)
True or false: The maximal heart rate or the highest heart rate during exercise does not decline with age
False
(it does decline)
What happens to oxygen uptake, heart rate, and maximal cardiac output in exercise?
They decline
True or false: Exercise can reverse some of the age-associated changes in the heart at least partially, supporting the hypothesis that age-related cardiovascular changes are simply the result of inactivity or deconditioning
True
Female hearts not only are _________ than male hearts but also are constructed differently and respond to age and hypertrophic stimuli differently
Smaller
Structural differences in the mitral valve may explain why women are more prone to ____________ than are men
Mitral valve prolapse
Women also have a three times greater risk of potentially fatal ____________ from some cardiac and psychotropic medications
Arrhythmias
Women also tend to have a higher incidence of bleeding episodes from ____________ agents
Thrombolytic
Diseases affecting the heart muscle
-Ischemic Heart Disease, Coronary -Heart Disease, Coronary Artery -Disease
-Angina Pectoris
-Hypertensive Cardiovascular Disease
-Myocardial Infarction
-Heart Failure
-Orthostatic (postural) hypotension
Any _____ of _____ components constitute a diagnosis of metabolic syndrome
3
5
Components that constitute a diagnosis of metabolic syndrome
-Elevated waist circumference (in the US: waist size of more than 40 inches [102 cm] in men and 35 inches [88 cm] in women; lower values are recommended for Asian, Middle Eastern, South American, and African groups)
-Reduced levels of HDL (good or “healthy” cholesterol): less than 40 mg/dL in men and 50 mg/dL in women
-Increased blood pressure of 130/85 mm Hg or greater
-Elevated fasting blood glucose level of 100 mg/dL or greater
-Elevated serum triglyceride levels of 150 mg/dL or greater
True or false: Elevated total serum cholesterol levels does not place a person at greater risk for heart disease
False
(it does)
The disorder of the myocardium owing to insufficient blood supply
Ischemic heart disease
Ischemic heart disease is also referred to as…
Coronary heart disease or Coronary artery disease
A group of diseases characterized by thickening and loss of elasticity of the arterial walls, often referred to as hardening of the arteries
Arteriosclerosis
Athero mas (plaques of fatty deposits) form in the inner layer (intima) of the arteries
Atherosclerosis
Involving the middle layer of the arteries with destruction of muscle and elastic fibers and formation of calcium deposits
Mönckeberg arteriosclerosis
Characterized by thickening of the walls of small arteries (arterioles)
Arteriolosclerosis or arteriolar sclerosis
True or false: All three forms of arteriosclerosis may be present in the same person but in different blood vessels
True
Surgical management of atherosclerosis of the coronary arteries may include…
-Percutaneous coronary intervention (PCI)
-Coronary artery bypass graft (CABG)
-Coronary stents
Can open an occluded coronary artery without opening the chest, an important advantage over bypass surgery
Percutaneous coronary intervention (PCI)
This procedure involves taking a portion of a vein or artery from the leg, chest, or arm and grafting it onto the coronary artery
Coronary artery bypass graft (CABG)
Medical management of cardiovascular conditions
-Lifestyle changes
-Prescriptive exercise
-Medications
-Surgery
True or false: As blood vessels become obstructed by the formation of atherosclerotic plaque, the blood supply to tissues supplied by these vessels becomes restricted
True
When the cardiac workload exceeds the oxygen supply to myocardial tissue, ischemia occurs, causing temporary chest pain or discomfort, called _____________
Angina pectoris
Causes of myocardia pectoris
-Decreased oxygen supply
-Increased oxygen demand
SLIDE 29
Also known as idiopathic hypertension and accounts for 90% to 95% of all cases of hypertension
Primary (or essential) hypertension
Accounts for only 5% to 10% of cases and results from an identifiable cause
Secondary hypertension
A syndrome of markedly elevated blood pressure (DBP > 125mmHg) with target organ damage
Malignant hypertension
Modifiable risk factors of primary hypertension
-High sodium intake (causes water retention, increasing blood volume)
-Obesity (associated with increased intravascular volume)
-Insulin resistance and metabolic abnormalities
-Diabetes mellitus
-Hypercholesterolemia and increased serum triglyceride levels
-Smoking (nicotine restricts blood vessels)
-Long-term abuse of alcohol (increases plasma catecholamines)
-Continuous emotional stress (stimulates sympathetic nervous system)
-Personality traits (hostility, sense of hopelessness)
-Sedentary lifestyle
-White coat hypertension (see explanation in text)
-Hormonal status (menopause, especially before age 40 years and without HRT; hysterectomy/oophorectomy)
Nonmodifiable risk factors of primary hypertension
-Positive family history of cardiovascular disease
-Age (>55 years)
-Gender (male <55 years; female >55 years)
-Ethnicity (African American, a Hispanic)
Myocardial cell death due to prolonged ischemia
Myocardial infarction
Caused by CAD and is triggered by the atherosclerotic plaque disruption (rupture or erosion)
MI type 1
Develops due to a mismatch between oxygen supply and demand by myocardial tissue; no atherosclerotic plaque disruption occurs
MI type 2
A complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood
Heart failure
True or false: Regarding heart failure, the heart is able to pump sufficient blood to supply the body’s needs
False
(unable to pump)
A decrease of 20 mm Hg or greater in SBP or a drop of 10 mm Hg or more in both systolic and diastolic arterial blood pressure with a concomitant pulse increase of 15 beats/min or more on standing from a supine or sitting position
Orthostatic (postural) hypotension
Orthostatic (postural) hypotension occurs frequently in older adults and occurs in more than one half of all ____________, contributing significantly to morbidity from _______ , ________, vital organ ischemia (e.g., MI, transient ischemic attacks), and mortality among older adults with diabetic hypertension
-Frail older adults
-Syncope
-Falls
A disturbance of heart rate or rhythm caused by an abnormal rate of electrical impulse generation by the sinoatrial (SA) node or the abnormal conduction of impulses
Arrhythmia
Echocardiograms are used to see…
-The size and shape of heart, the size, thickness and movement of the heart’s walls
-How the heart moves during heartbeats
-The heart’s pumping strength
If the heart valves are working correctly
-If blood is leaking backwards through the heart valves (regurgitation)
-If the heart valves are too narrow (stenosis)
-If a tumor or infectious growth is around your heart valves
-Problems with the outer lining of the heart (the pericardium)
-Problems with the large blood vessels that enter and leave the heart
-Blood clots in the chambers of the heart
-Abnormal holes between the chambers of the heart
The pericardium consists of ___ layers: the __________ layer, which is attached to the epicardium, and an __________ layer
-2
-Inner visceral
-Outer parietal
The ___________ stabilizes the heart in its anatomic position despite changes in body position and reduces excess friction between the heart and surrounding structures
Pericardium
Inflammation of the pericardium
Pericarditis
An abnormal stretching (dilation) in the wall of an artery, a vein, or the heart with a diameter that is at least 50% greater than normal
Aneurysm
Aneurysms are named according to the…
Specific site of formation
These aneurysms are the most common type
Abdominal aortic aneurysms
Venous diseases
-Deep vein thrombosis and pulmonary embolism
-Varicose veins
Swelling of a vein because of vein wall inflammation (phlebitis) occurring as a result of thrombus (blood clot) deposition in the vein
Thrombophlebitis
Two different types of thrombophlebitis
-Deep vein thrombosis (DVT)
-Superficial thrombophlebitis
A partial occlusion (mural thrombus) or complete occlusion (occlusive thrombus) of a vein by a thrombus (clot) with secondary inflammatory reaction in the wall of the vein (thrombophlebitis)
Vein thrombosis
Intravascular collection of fibrin network, platelets, erythrocytes, and leukocytes, the end result of the activation of the clotting cascade with the potential to produce significant morbidity and mortality
Venous thrombus
Risk factors for DVT
-Immobility (venous stasis)
-Trauma (venous damage)
-Lifestyle
-Hypercoagulation and other
Can occur when part of a thrombus (embolus) in a DVT breaks loose and travels through the right side of the heart into the pulmonary artery
Pulmonary embolism
True or false: An embolus lodged in a pulmonary artery or one of its branches occludes blood flow to that part of the lung, damaging the lung and impairing gas exchange
True
True or false: PEs, most often from the large, deep veins of the pelvis and legs, are the most devastating complication of DVT and can occur without apparent warning, ending in sudden death
True
DVT and PE are referred to as…
Venous thromboembolism (VTE)
_____ is the most common reason for hospital readmission and death after total hip and total knee arthroplasty
VTE
__________ can be formed of other substances besides a blood clot; air bubbles, fat droplets, amniotic fluid, clumps of parasites, or tumor cells can lead to a VTE
Emboli
An abnormal dilation of veins, usually the saphenous veins of the lower extremities, leading to tortuosity (twisting and turning) of the vessel, incompetence of the valves, and a propensity to thrombosis
Varicose veins
