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how does gravity play a role in DVT?
gravity pulls blood down
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what are some risk factors for DVT?
immobility, age, L heart failure, venous stasis, trauma, IV meds, vein wall damage, pregnancy, oral contraceptives, malignancy, genetic coagulopathies, and hypercoagulation
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what are venous stasis ulcers?
cell death and necrosis - no O2 and cell dies
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what can chronic venous insufficiency cause?
hyperpigmentation of lower extremities
-
what happens with varicose veins?
blood pools, valves don't shut
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what could be some causes/risk factors for orthostatic hypotension?
anatomic variation with aging, antihypertensive and antidepressant therapy, fluid volume depletion, and venous pooling
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what is orthostatic or postural hypotension?
decrease in both systolic and diastolic arterial BP on standing from a reclining position
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what is malignant hypertension an adverse reaction to?
anesthesia
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what is malignant hypertension?
rapid progression in which diastolic is > 140
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what are some cerebrovascular complications of complicated hypertension?
transient ischemic attack (TIA), CVA, cerebral thrombosis, aneurysm, and hemorrhage
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what are some cardiovascular complications of complicated hypertension?
left ventricular hypertrophy, angina, CHF, CAD, MI, sudden death
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what are some renal complications of complicated hypertension?
parenchymal damage, renal arteriosclerosis, renal insufficiency and failure
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what is complicated HTN?
primary and secondary hypertension, damages walls of blood vessel
-
what are some neurologic disorders that cause secondary hypertension?
lesions requiring higher systolic BP to maintain perfusion
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what are some vascular diseases that cause secondary hypertension?
arteriosclerosis
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what are some endocrine disorders that cause secondary hypertension?
acromegaly, thyroid disturbances, adrenal disorders - estrogen, testosterone, and aldosterone
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what are renal disorders that cause secondary hypertension?
renovascular disease, renin-producing tumors, renal failure
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what causes secondary hypertension?
systemic disease that increases peripheral resistance in blood vessel or cardiac output
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what percentage of hypertensive cases are primary?
90-95%
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what is likely responsible for primary hypertension?
combination of genetic and environmental factors mediated by host of neurohumoral effects
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is there a specific cause identified for primary hypertension?
no
-
what is primary hypertension also called?
essential or idiopathic (unknown)
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when is hypertension diagnosed?
2 or more diastolic BP's on 2 or more consecutive visits of 90 or more back-to-back and average of 2 or more visits is > 140 systolic
-
what are two risk factors for Raynaud disease?
women who play piano and type of the computer a lot cause fingers need more O2 to function
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what is Raynaud phenomenon and Raynaud disease characterized by?
attacks of vasospasm in small arteries and arterioles of fingers and (less commonly) the toes
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is Raynaud phenomenon and Raynaud disease more common in men or women?
women
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what is a risk factors for Buerger's disease/thromboangiitis obliterans?
heavy smoking
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what is another name for thromboangiitis obliterans?
Buergers disease
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is thromboangiitis obliterans more common is men or women?
men
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what is PAD?
atherosclerotic disease that decreases perfusion to the limbs, especially lower extremities
-
name three different types of emboli:
- fat
- air
- foreign matter - IV catheter (don't retract IV needle and then reinsert cause slices off pieces of catheter)
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what is an embolus?
obstruction of vessel by an embolus or a bolus of matter that is circulating in bloodstream
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what is a thrombus?
clot that remains attached to vessel wall
-
describe the 3 different types of an aneurysm:
- sacular: looks like a berry grown on one side of arterial wall
- fusiform: all around arterial wall
- pseudoaneurysm: one layer of artery wall
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what is a true aneurysm?
weakening of vessel wall that involves three layers
-
what is an aneurysm?
localized dilation or outpouching of vessel wall or cardiac chamber
-
are aneurysms venous or artery disorders?
artery
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what symptoms do you see in someone with superior vena cava syndrome?
round head, upper body edema, JVD
-
what type of cell is injured during atherosclerosis?
endothelial cells
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what is atherogenesis?
begins with injury to endothelial cells of arteries that causes inflammation
-
what type of disease is atherosclerosis?
inflammatory disease
-
what is atherosclerosis?
it is a form of arteriosclerosis and is thickening caused by hardening of soft deposits of intra-arterial fat and fibrin that reduce lumen size
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what is the only difference between unstable ischemia and an MI?
- -Unstable ischemia does not have enzymes
- -MI does have enzymes
-
why does someone get an MI?
coronary arteries cannot compensate for lack of O2
-
do you have positive or negative enzymes with stable and unstable ischemia/angina?
negative enzymes for both
-
what happens to an EKG in stable and unstable ischemia/angina?
STABLE: normal EKG
UNSTABLE: normal transient ST depression and T wave inversion
-
what is the difference with NTG (nitroglycerine) with stable and unstable angina/ischemia?
STABLE: NTG is effective
UNSTABLE: NTG is not effective
-
when does angina occur in stable and unstable ischemia?
STABLE: on exertion, vessels cant dilate in response to demand
UNSTABLE: occurs at rest
-
what is the difference with ischemia between stable and unstable angina?
STABLE: temporary ischemia
UNSTABELE: advanced but irreversible ischemia
-
what are the two different types of ischemia?
stable and unstable
-
1. Can you have angina and not have ischemia?
2. Can you have ischemia and not have angina?
1. No - if you have angina you always have ischemia
2. Yes
-
what is the most common cause of myocardial ischemia and infarction?
atherosclerosis
-
list the main symptoms that go with PAD and CAD that help distinguish the two:
- PAD: increased BP
- CAD: increased BP AND chest pain
-
when adiponectin is decreased, what are people at risk for?
cardiovascular risk
-
what is the purpose of adiponectin in CAD?
antiatherogenic hormone - tries to protect tissue
-
In CAD, which of these two hormones is the good and bad hormone?
Adipokines is the bad hormone
Adiponectin is the good hormone
-
in obese people who have CAD, which of these two hormones are increased or decreased?
Adipokines are increased
Adiponectin is decreased
-
in CAD, where does adipokines come from?
adipose tissue
-
what are the two hormones involved with CAD?
adiponectin and adipokines
-
when you have ischemia or a clot in CAD, what eventually happens?
infarction of death of deprived myocardial cells/tissues
-
what causes diminished blood flow to the myocardium in CAD?
persistent ischemia (atherosclerosis), or complete occlusion by a clot
-
what happens to blood flow in CAD?
diminishes to the myocardium
-
if you have PAD, are you guaranteed to have CAD?
yes
-
whats the difference between CAD and PAD?
PAD is in the periphery and CAD is in the heart
-
with atherosclerosis, what develops if systemic vascular resistance elevates?
hypertension
-
what type of MI is happening with marked elevation in ST segments on EKG, non-stemi or stemi?
stemi
-
what type of MI does stemi go with?
transmural MI
-
what type of MI does non-stemi go with?
subendocardial MI
-
what type of MI does someone have if there is no ST segment, there's T depression and no Q wave, non-stemi or stemi?
non-stemi
-
what indicates severity in an MI?
CPK-MB, LDH, SGOT, troponins I and T indicate severity
-
what ultimately results in aortic stenosis?
left ventricular failure
-
what symptoms occur with aortic stenosis?
dyspnea and angina
-
what can cause aortic stenosis?
rheumatic heart disease, congenital malformation and calcification
-
valve leaflets or cusps fail to close completely; blood flow continues when valve should be closed, what is this?
valvular regurgitation/insufficiency/incompetence
-
what is it when the valvular orifice is constricted or narrowed?
valvular stenosis
-
the myocardium is infiltrated with amyloid, hemosiderin or glycogen deposits and the AV valve is incompetent, what is it?
restrictive cardiomyopathy
-
why cant the left ventricle squeeze good in restrictive cardiomyopathy?
it is hardened and stiff
-
why is there decreased chamber volume in hypertrophic cardiomyopathy?
there is not enough room for blood in left ventricle
-
there is hypertropthy of the left ventricle and interventricular septum, chamber volume is normal or decreased and mitral valve is incompetent, what is it?
hypertrophic cardiomyopathy
-
why do you hear a murmur in dilated cardiomyopathy?
cause excess fluid regurgitates into atrium
-
what can cause dilated cardiomyopathy?
alcoholism, pregnancy, and infection
-
left chamber volume and size increases and theres mitral valve incompetence, what is it?
dilated cardiomyopathy
-
what are 3 complications of cardiomyopathies?
ischemic disorders, HTN, and valvular dysfunction
-
what are cardiomyopathies?
diverse group of diseases that affect myocardium
-
what can happen to the sac in cardiac tamponade?
rupture
-
why is it easier for fluid to accumulate around right atrium and right ventricle in cardiac tamponade?
decreased pressure
-
in cardiac tamponade, what are the first structures of the heart to be affected?
right atrium and right ventricle where diastolic pressure are normally lowest
-
what is pressure from fluid that causes cardiac compression? (squeezing in on heart)
cardiac tamponade
-
what can cause pericarditis, but not all the time?
inflammation of sac
-
it is a connective tissue disease and there's pericardial effusion... what is it?
pericarditis
-
can radiation cause pericarditis?
yes
-
what is pericarditis commonly seen with?
infections
-
do we know what causes pericarditis?
no (idiopathic)
-
what do you hear in pericarditis?
friction rub
-
in pericarditis, what happens in the pericardial cavity?
fluid accumulates
-
what are 2 symptoms of mitral stenosis?
orthopnea and pulmonary HTN
-
what fails in mitral stenosis?
right ventricular failure
-
what hypertrophies in the heart in mitral stenosis?
left atrium and right ventricle
-
in tricuspid regurgitation, what causes right sided heart failure?
pulmonary HTN
-
what causes mitral regurgitation?
rheumatic heart disease, mitral valve prolapse, and CAD which causes LHF
-
what are symptoms in mitral regurgitation?
pulmonary HTN, dyspnea
-
what are some symptoms/conditions seen in high-output failure?
anemia, septicemia causes systemic vasodilation and fever, hyperthyroidism
-
what is inability of the heart to adequately supply blood with nutrients, despite adequate blood and normal myocardial activity?
high-output failure
-
what are some symptoms seen in right sided heart failure?
GI disorders, JVD, dependent edema, and ascites
-
what happens in right sided heart failure (the process)?
L failure, decreased RV emptying, increased volume and pressure in RA, increased volume in distensible organs, causing edema and serous effusion
-
what are symptoms seen in left sided heart failure?
orthopnea, decreased cardiac output and urinary output, S3 gallop, and blood-tinged sputum
-
why do you get pulmonary edema with left sided heart failure?
fluid is transferred from capillaries to alveoli causing pulmonary edema
-
what happens in left sided heart failure?
LV fails, increased pressure and volume in LA
-
what symptoms do you see with infective endocarditis?
fever, murmur, petechial lesions of skin and mucosa, bacteremia, Osler's nodes
-
what happens to valves in infective endocarditis?
blood-borne microbes colonize damaged valve and vegetate
-
in infective endocarditis, what leads to thrombotic endocarditis?
prior damage to valves
-
what causes infective endocarditis?
staphylococcus aureus, viruses, and fungi
-
for rheumatic heart disease, what diagnostic blood test is used?
ant-streptolysi o titer (ASO)
-
what question do you ask someone if you suspect rheumatic heart disease?
have you had a Hx of strep throat
-
what effects/causes does rheumatic heart disease have on the heart?
causes carditis of all 3 layers of the heart wall, endocaridal inflammation and vegetative growth on valves
-
what causes rheumatic heart disease?
sequel to pharyngeal infection with group A beta-hemolytic streptococci (strep throat)
-
in right sided heart failure do you have symptoms in the body or lungs?
body
-
in left sided heart failure do you have symptoms in the body or lungs?
lungs
-
is tricuspid regurgitation left or right sided heart failure?
right
-
is mitral regurgitation left or right sided heart failure?
left
-
is mitral stenosis left or right sided heart failure?
left
-
what are some symptoms of tricuspid regurgitation?
peripheral edema and ascites
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