Week 3: Cardiovascular Flashcards
varicose veins
vein in which blood has pooled
distortion, leakage, increased intravascular hydrostatic pressure, and inflammation
varicose veins cause
incompetent valves, venous obstruction, muscle pump dysfunction, or combination
chronic venous insufficiency
persistent ambulatory lower extremity venous hypertension
chronic venous insufficieny treatment
- weight loss
- decrease time standing
- leg elevation, compression stocking, and physical exercise
- endovenous ablation or foam sclerotherapy
deep venous thrombosis
clot in large vein
obstruction of venous flow leading to increase in venous pressure
prevention of dvt
- mobilization after surgery, illness, injury
- prophylactic low molecular weight heparin or direct thrombin inhibitors
treatment of dvt
- low molecular weight heparin
- direct thrombin inhibitors
- aspirin therapy
- catheter directed thrombolytic therapy
superior vena cava syndrome
progressive occlusion of the SVC that leads to venous distention in the upper extremeties and head
leading cause of SVC syndrome
nonsmall cell lung cancer, small cell lung cancer, lymphoma
SVC syndrome clinical symptoms
- edema
- venous distension of face neck trunk or upper extremities
- cyanosis
- dyspnea, dysphagia, hoarseness, stridor, cough, and chest pain
- CNS changes
- respiratory distress
SVC symdrome treatment
radiation & chemo
primary hypertension
genetic and environmental factors
secondary hypertension
caused by altered hemodynamics from an underlying disease
systolic hypertension
affects entire cardiovascular system
most sig. in causing target organ damage
hypertension increased risk for
myocardial infarction, kidney disease, and stroke
hypertension risk factors
- Positive family history
- Advancing age
- Gender: female >70 years of age; male >55 years of age
- Race: black
- ↑Sodium (Na+) intake
- Glucose intolerance (diabetes mellitus)/insulin resistance
- Heavy alcohol use
- Obesity
- Cigarettes
- ↓Potassium (K+), magnesium (Mg++), calcium (Ca++)
hypertension caused by
increases in cardiac output or total peripheral resistance
complicated hypertension
hypertrophy and hyperplasia with assoc. fibrosis of the tunica intima and media in a process called vascular remodeling
malignant hypertension
rapidly progressive hypertension
diastolic pressure is usually > 140 mmHg
can lead to encephalopathy
hypertension dx
Measurement of blood pressure on at least two separate occasions averaging two readings at least 2 minutes apart with the individual seated, the arm supported at heart level, after 5 minutes of rest, with no smoking or caffeine intake in the past 30 minutes
hypertension tx
Reducing or eliminating risk factors
Dietary approaches to stop hypertension (DASH)
Cessation of smoking
Exercise program that promotes endurance and relaxation
hypertension pharmacologic tx
ace inhibitors
arbs
calcium channel blockers
thiazide diuretics & antihypertensives
othostatic hypotension
Decrease in the systolic and diastolic blood pressures on standing by 20 mmHg or more and by 10 mmHg or more, respectively
Lack of normal blood pressure compensation in response to gravitational changes on the circulation, leading to pooling and vasodilation
othostatic hypotension clinical manifestation
fainting upon standing
othostatic hypotension tx
Liberalize salt intake, raise the head of the bed, wear thigh-high stockings, expand volume with mineralocorticoids, and administer vasoconstrictors (midodrine)
true anuerysm
Involvement of all three layers of the arterial wall
Fusiform aneurysms
Circumferential aneurysms
false aneurysms
Leak between a vascular graft and a natural artery
Saccular aneurysms
clinical manifestations of aneurysm
Heart: Include dysrhythmias, heart failure, and embolism of clots to the brain or other vital organs
Aorta: Is asymptomatic until it ruptures, then it becomes painful
Thoracic: Dysphagia (difficulty in swallowing) and dyspnea (breathlessness) are caused by the pressure
Abdomen: Flow to an extremity is impaired, causing ischemia
aneurysm tx
Maintenance of low blood volume and low blood pressure to decrease the mechanical forces
Smoking cessation
β-Drenergic blockage
Surgery
aortic dissection
Is a devastating complication that involves the aorta (ascending, arch, or descending); can disrupt the flow through the arterial branches
Is a surgical emergency
arterial thrombus formation
Activation of the coagulation cascade: caused by roughening of the tunica intima by atherosclerosis
arterial thrombus formation tx
Heparin, warfarin derivatives, thrombin inhibitors, or thrombolytic agents
Balloon-tipped catheter used to remove or compress an arterial thrombus
Various combinations of drug and catheter therapies sometimes concurrently used
embolism
Bolus of matter circulates in the bloodstream and then lodges, obstructing blood flow.
peripheral vascular disease
Occurs mainly in smokers
Is an inflammatory disease of the peripheral arteries
Digital, tibial, plantar, ulnar, and palmar arteries
Obliterates the small- and medium-sized arteries
Pain and tenderness develop in the affected part.
Sluggish blood flow, rubor, and cyanosis result
peripheral vascular disease tx
Smoking cessation
Vasodilators, sympathectomy, exercise, immunomodulation, spinal cord stimulation, bone marrow transplantation
artherosclerosis
Form of arteriosclerosis
Thickening and hardening caused by the accumulation of lipid-laden macrophages in the arterial wall
Plaque development
Process that occurs throughout the body
Leading cause of coronary artery and cerebrovascular disease
artherosclerosis tx
Focuses on reducing risk factors, removing the initial causes of vessel damage, and preventing lesion progression
Exercising, smoking cessation, and controlling hypertension and diabetes when appropriate while reducing LDL cholesterol levels by diet or medications or both
peripheral artery disease
Atherosclerotic disease of arteries that perfuse limbs, especially lower extremities
Prevalent in people with diabetes or who smoke
Intermittent claudication- Obstruction of arterial blood flow in the iliofemoral vessels, resulting in pain with ambulation
peripheral artery disease tx
Vasodilators, antiplatelet or antithrombotic medications (e.g., aspirin, cilostazol, ticlopidine, clopidogrel), cholesterol-lowering medications, and exercise rehabilitation
coronary artery disease
any vascular disorder that narrows or occludes the coronary arteries
LDL
mainly cholesterol plus a carrier protein
Are responsible for the delivery of cholesterol to the tissues
HDL
mainly phospholipids plus a carrier protein
Are responsible for “reverse cholesterol transport,” which returns excess cholesterol from tissues to the liver, where it is eliminated as bile or converted to cholesterol-containing steroids
Can remove excess cholesterol from arterial walls
transient myocardial ischemia
Develops if the supply of coronary blood cannot meet the demand of the myocardium for oxygen and nutrients
stable angina
causes predictable chest pain
myocardial ischemia tx
Nitrates, β-adrenergic-receptor blockers, calcium channel blockers, statins, antithrombotics, sodium ion channel inhibitors
Percutaneous coronary intervention
Coronary artery bypass graft (CABG)
Minimally invasive direct coronary artery bypass (MIDCAB)
Gene and stem therapy for myocardial angiogenesis and spinal cord stimulation
MI manifestation
1st and classic is: sudden & severe chest pain
Heavy & crushing - not relieved by nitrates
Radiates to neck, jaw, back, shoulder, L. arm (referred pain)
N & V may occur (usually from pain), diaphoresis, cool clammy skin
MI dx
ECG, serial enzyme alterations, (CK, LDH, troponins), clinical findings
myocardial stunning
is the temporary loss of contractile function that persists for hours to days after perfusion has been restored
hibernating myocardium
tissue that is persistently ischemic undergoes metabolic adaptation to prolong myocyte survival
angiotensin II effects
Systemic effects: peripheral vasoconstriction and fluid retention
Local effects: growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; causes coronary artery spasms
two major types of MI
subendocardial
transmural
MI tx
Hospitalization
Immediate administration of supplemental oxygen and aspirin
Morphine sulfate
Bed rest
Cardiac medications: thrombolytic, antithrombotic, vasodilators
Percutaneous coronary intervention (PCI)
Surgery
MI complications
dysrhythmias, hf, cardiogenic shock, pericarditis, ventricular aneurysm
acute coronary syndromes
sudden coronary obstruction bc of thrombosis formation over a ruptured atherosclerotic plaque
unstable angina
reversible myocardial ischemia and a harbringer of impending infarction
unstable angina tx
- immediate hospitalization
- admin of nitrates, antithrombotics, and anticoagulants
- beta blockers & ace inhibitors
- emergent PCI
acute pericarditis
acute inflammation of the pericardium
acute pericarditis clinical manifestations
fever, myalgias, and malaise, followed by sudden onset of severe chest pain
acute pericarditis tx
rest, salicylates, and nonsteroidal anti inflammatory drugs, combined nonsteroidals and colchicine
pericardial effusion
accumulation of fluid in the pericardial cavity
constrictive pericarditis
fibrous scarring with occasiunal calcification of the pericardium causes the visceral and parietal pericardial layers to adhere
cardiomyopathies
effects of neurohumoral responses to ischemic heart disease or hypertensino on the heart muscle cause remodling
dilated cardiomyopathy
impaired systolic function, leading to increases in intracardiac volume, ventricular dilation, and systolic heart failure
hypertrophic cardiomyopathy
Hypertrophic obstructive cardiomyopathy
Hypertensive or valvular hypertrophic cardiomyopathy
hypertrophic obstructive cardiomyopathy
common inherited heart defect of thick septal wall
hypertensive or valvular hypertrophic cardiomyopathy
Hypertrophy of the myocytes: attempts to compensate for increased myocardial workload
restrictive cardiomyopathy
Myocardium becomes rigid and noncompliant, impeding ventricular filling and raising filling pressures during diastole.
valvular dysfunction
Stimulates chamber dilation and/or myocardial hypertrophy
valvular stenosis
valve orifice is constricted and narrowed
valvular regurgitation
valve fails to shut completely
is also called insufficiency or incompetence
aortic stenosis
orifice of the aortic semilunar valve narrows causing diminished blood flow from the left ventricle into the aorta
aortic stenosis clinical manifestations
angina, syncope, and heart failure
mitral stenosis
impairment of blood flow from the left atrium to the left ventricle
mitral stenosis cause
acute rheumatic fever
aortic regurgitation
inability of the aortic valve leaflets to close properly during diastole
aortic regurgitation manifestations
widened pulse pressure as a result of increased stroke volume. and diastolic
mitral regurgitation common cause
mitral valve prolapse, rheumatic heart disease, infective endocarditis, MI, connective tissue disease, dilated cardiomyopathy
tricuspid regurgitation
leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure
mitral valve prolapse syndrome
anterior and posterior cuscps of the mitral valve billow upward into the atrium during systole
rheumatic fever
is a diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic streptococci
rheumatic fever is the abnormal immune resopnse to
the M proteins that cross react with normal tissues
rheumatic fever clinical manifestations
carditis, polyarthritis, subq nodules, chorea, eythema marginatum
infective endocarditis clinical manifestations
Fever
New or changed cardiac murmur
Petechial lesions of the skin, conjunctiva, and oral mucosa
osler nodes
painful erythematous nodules on the pads of the fingers and toes
janeway lesions
nonpainful hemorrhagic lesions on the palms and soles
infective endocarditis tx
Antibiotics
Antimicrobial therapy is generally administered for
several weeks.
Surgery to repair or replace the valve, as prescribed
heart failure is a
pathophysiologic condition in which the heart is unable to generate adequate cardiac output, resulting in an inadequate perfusion of tissues or an increased diastolic filling pressure of the left ventricle, or both
systolic hf clinical manifestations
dyspnea, orthopnea, cough of frothy sputum, fatigue, decreased urine output and edema
diastolic hf clinical manifestations
dyspnea on exertion and fatigue
right hf clinical manifestations
jugular venous distension, peripheral edema, hepatosplenomegaly
systolic hf is associated with the activation of the
- parasympathetic ns
- hypothalamic pituitary adrenal axis
- renin angiotensin aldosterone system
- antidiuretic hormone vasopressin aldosterone system
