ACC Pathophysiology Unit 3

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  1. Blood: How many liters in an adult and composed of?
    5 liters of blood; composed of water and dissolved solutes = 55%, 45% composed of cells
  2. Define: Hematocrit
    proportion of cells [mainly RBC's]; indicates the viscosity of blood
  3. Define: Plasma
    clear yellowish fluid that remains after the cells have been removed [plasma proteins include albumin, globulins and fibrinogen]
  4. Define: Serum
    the fluid and solutes remaining after removal of the cells and fibrinogen
  5. Blood: Blood cells originated from?
    the red bone marrow
  6. Define: Hematopoiesis
    the process of formation and development of the various types of blood cells and other formed elements [e.g. platelets]
  7. Define: Pieuripotent Stem Cells
    lead to the formation of erythroblasts, myeioblasts, monoblasts, lymphoblasts, and megakaryoblasts
  8. Define: Erythroblasts
    lead to development of mature erythrocytes [ red blood cells; RBC's]
  9. Define: Myeloblasts
    lead to development of neutrophils, basophils, eosinophils [granulocytes]
  10. Define: Monoblasts
    lead to development of monocytes and macrophages [agranulocytes]
  11. Define: Lymphoblasts
    lead to the development of lymphocytes
  12. Define: Megakaryoblasts
    lead to the development of platelets
  13. Blood: Structure of Erythrocytes [RBC's]
    • biconcave flexible discs [pass through capillaries]
    • non-nucleated when mature
    • contain hemoglobin
  14. Define: Erythropoietin
    a hormone from kidney; stimulates bone marrow to produce erythrocytes
  15. Blood: Production of RBC's requires.....
    amino acids, iron, vitmain B12, B6 and folic acid
  16. Blood: Name two types of Hemoglobin. And what are they?
    • Oxyhemoglobin: oxygenated and bright red color
    • Deoxyhemoglobin: reduced or deoxygenated; pruplish-red, dark color
  17. Blood: Hemoglobin consists of.....
    • Globin portion: two pairs of amino acid chains [alpha and beta]
    • Four Home groups: each containing a ferrous iron atom to which oxygen can attach
    • Carbon Dioxide: carried primarily via the bicarbonate ion of the buffer pair; some is carried via carbaminohemoglobin
    • Carbon Monoxide: can displace oxygen from hemoglobin; can result in a fatal hypoxia
  18. Blood: Life Cycle of an Erythrocyte [RBC]
    • 120 days
    • RBC becomes rigid and fragile
    • Phagocytosis of old RBC's in spleen or liver
    • Broken down into globin and heme
    • Globin is recycled into amino acids
    • Heme is recycled into iron and bilirubin [excreted via bile]
    • Excess iron stored as Ferritin or Hemosiderin
  19. Define: Leukopoiesis
    production of Leukocytes [WBC]
  20. Blood: 3 Types of Granulocytes
    neutrophil, eosinophil, basophil
  21. Blood: 2 Types of Agranulocytes
    monocyte/macrophage, lymphocyte
  22. Blood: Leukopoiesis is stimulated by....
    Colony Stimulating Factors [CSFs]
  23. Blood: Lymphocytes comprised __% of WBC's
  24. Blood: What is the most common WBC [life span is 4 days]?
  25. Define: Basophils
    migrate from blood to tissue to form mast cells
  26. Define: Eosinophils
    control the release and effects of histamine
  27. Define: Monocytes
    Enter tissues to become macrophages
  28. Define: WBC Differential Count (aka. a diff)
    proportions of specific types of WBC's
  29. Define: Thrombocytes
  30. Blood: Purpose of Thrombocytes
    • Essential to blood clotting process
    • They are not cells; they are fragments of megakaryocytes; vary in size and shape but are small
    • Platelets stick to damaged tissue and to each other to form a platelet plug; aspirin interferes with the stickiness of platelets
  31. Define: Hemostasis
    blood clotting/Thrombus
  32. Blood: Process of Hemostasis (Blood Clotting)
    • Immediate response to blood vessels injury is vasoconstriction
    • Platelets adhere to the site and form a plug
    • Coagulation [clotting] mechanism is induced
    • Coagulation is a cascading events that result sin the formation of prothrombin activator [PTA]; this converts prothrombin into thrombin; finally fibrinogen is converted into firbin threads
  33. Blood: Fibrinolysis
    • Part of the delicate balance between the tendency of the blood to clot and form thrombi
    • Coagulation Inhibitors (antithrombin III; plasminogen; plasmin)
    • Drugs that can destroy clots- tPA [tissue plasiminogen activator] and streptokinase
  34. Blood: Name the blood types and which are universal and recipient. Imcompatible blood transfusion can lead to what?
    • O, A, B, AB
    • Universal Donor: O
    • Universal Recipient: AB
    • Incompatible blood transfusion leads to a transfusion reaction [aggulination and hemolysis of the recipients blood]
  35. Define: Blood Smear
    size, shape, uniformity, maturity of RBC's and WBC's
  36. Define: Complete Blood Count [CBC]
    • RBC's [hematocrit, hemoglobin, mean corpuscular volume, etc - morphology of red cells, i.e. size and shape]
    • WBC's [Leukocyte count with differential]
    • Leukocytosis: increased WBC's
    • Leukopenia: decreased WBC's
    • Eosinophilia: common in allergic reactions
  37. Define: Blood Clotting Disorders
    bleeding time; platelet count; prothrombin time [PT] and partial thromboplastin time [PTT]
  38. Define: Bone Marrow Function
    reticulocyte count [immature, non-nucleated RBC's]; bone marrow aspirate and bone marrow biopsy
  39. Blood: List of Blood Therapies
    • Whole blood
    • Packed RBC's
    • Packed Platelets
    • Plasma
    • Artificial blood products [Hemolink; Hemopure; Oxygent]
    • Epoetin alfa [Procrit; Eprex]- synthetic erythropoietin
  40. Define: Blood Dyscrasias
    diseased state of the blood
  41. Define: Polycythemia
    RBC's and hemoglobin above normal
  42. Define: Anemia
    RBC's and hemoglobin less than normal
  43. Blood: List of Anemias
    • Iron Deficiency Anemia
    • Pernicious Anemia [Vitamin B12 deficiency]
    • Aplastic Anemia
    • Sickle Cell Anemia
    • Thalassemia
  44. Define: Polycythemia vera
    primary polycythemia in which there is an increased production of RBC's; considered a neoplastic disorder presenting between ages 40 to 60 [marked by increased blood volume and vicosity; high BP; thromboses and infarctions; hepatosplenomegaly]
  45. Define: Secondy polycythemia
    increase in RBC's that occurs in response to prolonged hypoxia [e.g. in chronic lung and heart disease]
  46. Blood: Iron Deficiency Anemia - Pathophysiology
    • Most common type of anemia
    • Mild to severe; seen in all age groups
    • Insufficient iron
    • Frequently a sign of another underlying problem
    • RBC's are microcytic [small] and hypochromic [loss of color]
    • Serum ferritin and hemosiderin are also decreased
  47. Blood: Iron Deficiency Anemia - Etiology
    poor iron intake; chronic lood loss; malabsorption of iron [e.g. achlorhydria]; severe liver disease affects both iron storage and absorption
  48. Blood: Iron Deficiency Anemia - Signs & Symptoms
    pallor of the skin; fatigue; lethargy; cold intolerance; irritability; brittle hair; ridged nails; stomatitis and glossitis; delayed healing; tachycardia heart palpitations; dyspnea; syncope
  49. Blood: Iron Deficiency Anemia - Diagnosis
    physical signs and symptoms; laboratory tests showing low hemoglobin, hematocrit, ferritin, and serum iron; blood smear shows RBC's to be microcytic and hypochromic
  50. Blood: Iron Deficiency Anemia - Treatment
    Identify the underlying cause and treat it; prognosis depends on cause; iron supplements
  51. Blood: Pernicious Anemia - Pathophysiology
    • Vitamin B12 deficiency [B12 needed in bone marrow for RBC maturation]
    • Megaloblastic red cells [large and immature; nucleated]
    • Usually caused by malabsorption of Vitamin B12 owing to a lack of intrinsic factor [IF] in the stomach; IF must bind with B12 to enable absoprtion in the lower ileum
    • Decreased IF caused by an autoimmune disease against IF or the parietal cells that produce it
  52. Blood: Pernicious Anemia - Etiology
    dietary insufficiency of B12 is rare; malabsorption of B12 is most common due to autoimmune disease, chronic gastritis, or other gastric inflammatory conditions; gastrectomy; resection of the ileum
  53. Blood: Pernicious Anemia - Signs & Symptoms
    basic signs and symptoms of anemia; enlarged, red, sore tongue; parathesias in extremeties, loss of coordination and afaxia
  54. Blood: Pernicious Anemia - Diagnosis
    RBC's appear macrocytic or megaloblastic and are reduced in number on the smear and CBC; bone marrow is hyperactive; serum B12 levels are low; Schilling's test is abnormal [radioactive B12 given orally to measure GI absorption]
  55. Blood: Pernicious Anemia - Treatment
    administer B12 by injection; investigate chronic gastritis and treat it
  56. Blood: Aplastic Anemia - Pathophysiology
    Impairment or failure of the bone marrow function and loss of stem cells; bone marrow is hypocellular; pancytopenia is seen
  57. Blood: Aplastic Anemia - Etiology
    50% of cases in middle age and idiopathic; secondary causes are from myelotoxins to the bone marrow [radiation, industrial chemicals- benzene, and drugs, hepatitis C]
  58. Blood: Aplastic Anemia - Signs & Symptoms
    onset is indious; pallor, weakness, dyspnea; recurrent multiple infections from leukopenia; petechiae from thrombocytopenia; can see uncontrolled infection and hemorrage
  59. Blood: Aplastic Anemia - Diagnosis
    CBC shows pancytopenia; bone marrow biopsy confirms the diagnosis
  60. Blood: Aplastic Anemia - Treatment
    remove any bone marrow suppressants; blood transfusion; bone marrow transplantation; donor stem cell infusion [harvested from peripheral blood]
  61. Blood: Sickle Cell Anemia - Pathophysiology
    • Sickling is reversible with oxygenation for a few cycles but then becomes irreversible and hemolysis occurs
    • Sickle cells obstruct small blood vessels and cause thrombus and repeated infarctions throughout the body
    • Sickle Cell Crisis: occurs when there is lung infection, dehydration, or any tim ebasic oxygen levels are reduced
    • Hemolysis leads to hyperbilirubinemia and jaundice
  62. Blood: Sickle Cell Anemia - Etiology
    • the gene for HbS is recessive; very common in African and African-American population
    • In carriers [heterozygous] less than half the hemoglobin is HbS; this condition is called Sickle Cell Trait
    • Carriers are somewhat protected from malaria
  63. Blood: Sickle Cell Anemia - Signs & Symptoms
    • begin after 12 months of age when fetal hemoglobin is replaced by HbS; severe anemia, pallor, weakness, tachycardia, dyspnea
    • hyperbilirubinemia with jaundice; splenomegaly in younger people; small, fibrotic spleen in older adults due to infarction; vascular occulusions and infarctions lead to painful crises and permanent damage to organs and tissue [e.g. ulcers on legs and feet]; seizures, stroke; delayed development and growth; Congestive heart disease; frequent infections
  64. Blood: Sickle Cell Anemia - Diagnosis
    DNA analysis; blood smear, CBC; presence of HbS
  65. Blood: Sickle Cell Anemia - Treatment
    Hydroxyurea to reduce sickling and frequency of crises; aoidance of strenuous activity; avoid high altitudes; prevent dehydration; treat crises aggressively with hydration, oxygen, pain meds
  66. Blood: Thalassemia - Pathophysiology
    • Genetic defect that interferes with the production of the globin chains and therefore, the amount of hemoglobin synthesized and the number of RBC's produced
    • Thalassemia alpha: reduction in alpha globin chains
    • Thalassemia beta: reduction in beta globin chains
    • Homozygotes have Thalassemia major; heterozygotes have Thalassemia minor
  67. Blood: Thalassemia - Etiology
    Common in people from the Mediterranean; Thalassemia beta is more common; six genes are involved with many possible gene mutations [effects the range of severity of the anemia]
  68. Blood: Thalassemia - Signs & Symptoms
    usual signs of anemia; increased hemolysis; impaired growth and development; heptatomegaly; splenomegaly; hyperbilirubinemia with possible jaundice; hyperactivity in bone marrow; heart failure
  69. Blood: Thalassemia - Diagnosis
    RBC's are microcytic on smear and vary in size and shape; RBC's are hypochromic; reduced hematocrit and hemoglobin; iron overload; increased erythropoietin
  70. Blood: Thalassemia - Treatment
    Blood transfusions
  71. Define: Thrombocytopenia
    defective platelet function [e.g. with uremia in end stage kidney disease]; Vitamin K deficiency; liver disease; inherited defects causing a deficiency in clotting factors; hemorrhagic fever viruses; anticoagulent drugs
  72. Blood: Blood Clotting Disorders - Signs
    Bleeding from the gums; petechiae; purpura and ecchymoses [bruising]; excessive bleeding from trauma; bleeding into a joint [hemarthroses]; hemoptysis; hematemesis; etc
  73. Blood: Hemophilia A - Pathophysiology
    deficit or abnormality of clotting factor VIII; most common inherited blood clotting idsorder; this is an X-linekd recessive trait [carried by females; manifest in males]; an affected man and a carrier female could produced an affected female child; can be a spontaneous gene mutation with no previous family history [rare]; varying degrees of severity depending on the amount of clotting factor present
  74. Blood: Hemophilia A - Signs & Symptoms
    prolonged or severe hemorrhage following minor trauma; prolonged oozing of blood; hematomas; hemarthrosis; hernaturia; blood in stool
  75. Blood: Hemophilia A - Diagnosis
    PTT is abnormal; bleeding time and PT are normal; serum levels of factor VIII are low
  76. Blood: Hemophilia A - Treatment
    Take all relevant precautions; replacement therapy for factor VIII [cryoprecipitate] periodically and with all surgical or dental procedures
  77. Define: Leukemia
    a group of neoplastic disorders involving the white blood cells; one or more of the leukocytes are present and undifferentiated, immature, and nonfunctional; these cells multiply rapidly and uncontrollably with large numbers in the general circulation leukemic cells infiltrate the spleen, liver, brain and other organs; leukocyte function is impaired; incidence of infection high
  78. Blood: Acute Leukemia - Pathophysiology
    • Diagnosed and differentiated by primary cell type
    • High proportion of immature, nonfunctional blast cells in the bone marrow and peripheral circulation
    • Proliferation of leukemic cells in bone marrow suppresses the production of other cell lines leading to anemia, thrombocytopenia and lack of normal functioning white blood cells
  79. Blood: Acute Leukemia - Signs & Symptoms
    Acute onset of symptoms; multiple infections; excessive bleeding; anemia; bone pain; weight loss; fatigue; fever; lymphadenopathy; splenomegaly; hepatomegaly; headache; visual disturbances; hemorrhage - brain and GI tract
  80. Blood: Acute Leukemia - Diagnosis
    CBC shows very high WBC; smear shows immature leukocytes; anemia and thrombocytopenia; bone marrow aspirate confirms the diagnosis; flow cytometry and cytogenetics for classification
  81. Blood: Acute Leukemia - Treatment
    Chemotherapy [Induction and Consolidation]; Bone marrow transplantation; transfusion; supportive measures; infection control
  82. Blood: Types of Acute Leukemia
    • Acute Lymphocytic Leukemia [ALL]
    • Acute Myelogenous Leukemia [AML]
    • Acute Monocytic Leukemia
    • Hairy Cell Leukemia [B Lymphocytes]
  83. Blood: Acute Myelogenous Leukemia [AML] - Statistics
    Constitutes 80% of adult onset leukemia; 50-80% achieve complete remission with induction chemotherapy
  84. Blood: Acute Lymphocytic Leukemia [ALL]
    Predominantly a disease of childhood with onset between ages 2 to 6; only 25% of cases > age 15
  85. Blood: Hairy Cell Leukemia
    represents 2-3% of all adult leukemias
  86. Blood: Chronic Leukemia - Pathophysiology
    more insidious onset; milder signs and symptoms; may be diagnosed on a routine blood check [CBC with smear]
  87. Blood: Chronic Lymphocytic Leukemia [CLL]
    presents with lymphocytosis, lymphadenopathy, and splenomegaly; cells resemble mature lymphocytes; treatment with chemotherapy; median survival 6-8 years
  88. Blood: Chronic Myelogenous Leukemia [CML]
    presents with leukocytosis and splenomegaly; elevated platelet counts are seen [thrombocytosis]; diagnosis is confirmed by the presence of the Philadelphia chromosome [#22]; stable phase of disease can be controlled for years with oral hydroxyurea; most patients are relatively asymptomatic; acute leukemic transformation [blast phase] is inevitable and unpredictable; median time to transformation is 5-7 years; blast phase highly resistant to treatment; bone marrow transplant is an option
  89. Blood: Lymphomas - Pathophysiology
    • Malignant neoplasms involving lymphocyte proliferation int he lymph nodes
    • Staging is organized into 4 categories:
    • 1) localized into a single lymph node
    • 2) more than one lymph node group but confined to one side of the diaphragm
    • 3) lymph nodes and spleen and both sides of diaphragm
    • 4) disease involving liver, lung, skin or bone marrow
    • B symptoms: fever above 38.5C; nightsweats; 10% weight loss over 6 months
  90. Blood: Name 2 Types of Lymphoma
    Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma
  91. Blood: Hodgkin's Lymphoma - Pathophysiology
    Presents with cervical adenopathy and spreads in a predictable manner along lymph node groups; treatment is based on stage; diagnosis with LN biospy, CT of chest, abdomen, and pelvis; bilateral bone marrow biopsies; treatment with radiation or a combination of radiation and chemotherapy; surgery can be involved; most common chemo regimen is ABVD
  92. Blood: Non-Hodgkin's Lymphoma - Pathophysiology
    • Classified as low, intermediate, or high grade base on histologic type; same staging as Hodgkin's
    • Less predictable pattern of spread; advanced stage disease is very common
  93. Blood: Non-Hodgkin's Lymphoma - Grades
    • Low grade lymphoma: often involves the bone marrow at diagnosis but the disease has an indolent course; doesn't respond well to chemo; radiation can be used to ameliorate symptoms
    • Intermediate grade lymphoma: has a more aggressive course, usually does not involve the bone marrow at diagnosis, and can be cured with chemotherapy; complete response rates > 80%
    • High grade lymphoma: [Burkitt's or lymphoblastic] includes the most aggressive subtypes and has a high frequency of CNS and bone marrow involvement; combination chemotherapy is the mainstay of therapy
  94. Blood: Multiple Myeloma [Plasma Cell Myeloma] - Pathophysiology
    • Neoplastic disease of uknown etiology that occurs in older adults
    • Malignant plasma cells [mature B lymphocytes] replace the bone marrow and erode the bone
    • Blood cell and antibody production is impaired
    • Multiple tumors with bone destruction develop in the vertebrae, ribs, pelvis and skull
    • Pathologic or spontaneous fractures are common
    • Hypercalcemia develops
    • Tumor cells and spread to lymph nodes and infiltrate other organs
  95. Blood: Multiple Myeloma - Signs & Symptoms
    • Onset is insidious
    • Frequent infections
    • Bone pain
    • Anemia and bleeding
    • Kidney function affected [proteinuria and kidney failure]
  96. Blood: Multiple Myeloma - Diagnosis
    radiographic bone survey; bone marrow aspiration and biopsy; serum and urine electrophoresis looking for an associated paraprotein
  97. Blood: Multiple Myeloma - Treatment
    • Chemotherapy is used to induce remissions; local radiation to reduce bone pain; Thalidomide is effective in treatment
    • Median survival is three
  98. Cardiovascular: Normal Flow of Blood
    • One Way
    • Inferior Vena Cava > Right Atrium > Tricuspid Valve > Right Ventricle > Pulmonary Valve > Pulmonary Artery > Pulmonary Arterial System > Pulmonary Venous System > Left Atrium > Mitral Valve > Left Ventricle > Aortic Valve > Aorta....
  99. Cardiovascular: Name the 2 Semilunar Valves
    • Pulmonary valve [three cusps]
    • Aortic valve [three cusps]
  100. Cardiovascular: Name the 2 Atrioventricular Valves
    • Tricuspid valve [three leaflets]
    • Mitral valve, aka Bicuspid Valve [two leaflets or cusps]
  101. Cardiovascular: Cardiac Conduction System
    • Electrical impulses are conducted by specialized myocardial fibers; no nerves are present in cardiac tissue
    • Intercalated diss at the junction between myocardial fibers allow for all muscle fibers of the atria and ventricles to contract together
  102. Cardiovascular: Details on the 2 Conduction Pathway
    • Sinoatrial [SA] node: right atrium; pacemarker of the heart; generates basic sinus rhythm; can be latered by vagus nerve and epinephrine
    • SA node > atrial conduction pathways > contraction of both atria
    • Atrioventricular [AV] node: floor of the right atrium; slight delay in conduction to the node to allow for ventricular filling; AV node > bundle of his [AV bundle] > right and left branches > Purkinje network of fibers > simultaneous contraction of the ventricles
  103. Define: Electrocardiogram and the waves involved
    • tracing of the electrical impulses as they depolarize the heart in preparation for contraction
    • P Wave: depolarization of the atria
    • QRS complex: depolarization of the ventricles
    • T Wave: repolarization of the ventricles [recovery phase]
  104. Cardiovascular: Control of the Heart Rate and Force of Contraction details
    • Cardiac Control Center: medulla of the brain
    • Baroreceptors in the walls of the aorta and internal carotid arteries
    • Sympathetic nervous system acts via Beta 1 adrenergic recaptors in the heart [increases heart rate, i.e. tachycardia and contractility]
    • Parasympathetic nervous system acts via the vagus nerve fibers [decreases heart rate = bradycardia]
  105. Cardiovascular: Factors that increase heart rate
    Elevated body temperature; exercise; stress; infection; smoking; stimulants; dehydration

    Dysrhythmias due to conduction system abnormalities or electrolyte imbalances, or congenital defects in the conduction system
  106. Cardiovascular: Factors that decrease heart rate
    • Relaxation
    • Sleep
    • Dysrhythmias
    • Drugs [e.g. beta-blockers]
  107. Cardiovascular: Coronary Circulation
    • Main coronary artery branches off the aorta immediately above the aortic valve
    • Main coronary artery > right and left coronary arteries
    • Left coronary artery> Left anterior descendary artery and left circumflex artery

    • Right coronary artery> Right marginal artery and the posterior interventricular artery
    • Collateral channels exist throughout the myocardium
    • Right Coronary Artery: supplies the right side of the heart and the inferior portion of the left ventricle, and the posterior interventricular septum
    • Left Coronary Artery: supplies the anterior walls of both ventricles, the anterior septum, the bundle branches, and the left atrium and lateral and posterior walls of the left ventricle
    • Coronary veins: drain into the coronary sinus and then into the right atrium
  108. Define: Diastole
    • relaxation and filling stage
    • right atrium fills with blood from the seruprior and inferior vena cava; left atrium fills with blood from the pulmonary veins; pressure in the filling atria open the AV valves and blood flows into the relaxed ventricles
  109. Define: Systole
    • contraction and pumping stage
    • the atria relax; the two ventricles begin to contract; the AV valves close; the semilunar valves open; blood is forced into the aorta via the aortic valve and into the pulmonary artery via the pulmonary valve
    • at the end of the cycle the atria begint o fill again as the ventricles relax; this closes the semilunar valves
  110. Define: Heart Sounds
    "Lubb- dupp"
  111. Define: "Lubb"
    Closure of the AV valves at the beginning of ventricular systole
  112. Define: "Dupp"
    closure of the semilunar valves with ventricular diastole
  113. Define: Heart murmurs
    unusual turbulence in the blood flow producing an abnormal sound in the cardiac cycle
  114. Define: Cardiac Output [CO]
    • the volume of blood ejected by a ventricle in 1 minute
    • CO = Heart Rate x Stroke Volume in 1 minute
  115. Define: Heart Rate [HR]
    beats per minute
  116. Define: Stroke Volume [SV]
    volume pumped from one ventricle in one contraction
  117. Define: Cardiac Output at rest
    the heart pumps into the system an amount of blood equal to the total blood volume in the body every minute
  118. Define: Cardiac Reserve
    the ability of the heart to increase output in response to increased demand [a normal heart can increase cardiac output by 4-5 times normal]
  119. Cardiovascular: Name the two separate circulations
    • Pulmonary circulation
    • Systemic circulation
  120. Cardiovascular: Three layers of blood vessels
    • Tunica intima: inner layer; endothelium
    • Tunica media: layer of smooth muscle that controls the diameter and lumen size of the vessel
    • Tunica adventitia or externa [outer connective tissue layer; contains elastic and collagen fibers]
  121. Define: Vasa vasorum
    tiny blood vessels that supply the tissues of the vessel walls
  122. Cardiovascular: Blood Vessels - General Knowledge
    • Arteries: highly elastic to adjust to large changes in blood volume
    • Veins have thinner walls than arteries and less smooth muscle tissue; they also have valves to prevent backflow; veins are capcitance vessels
    • Arterioles are autoregulated for vasoconstriction and vasodilation
    • Capillaries and Venules consist of a single endothelial layer
  123. Cardiovascular: Blood Pressure - General Knowledge
    • The pressure of blood exerted against the systemic arterial walls
    • Normal BP ranges but an average is 120/75mm Hg at rest
    • Systolic pressure [left ventricle in full contraction] is the top number; diastolic pressure [ventricles are relaxed] is the bottom number
    • Blood pressure depends on cardiac output and peripheral resistance [the force opposing blood flow];
    • The Sympathetic nervous system innervated the blood vessels; the parasympathetic system does not
  124. Cardiovascular: BP is elevated by...
    sympathetic nervous system activity
  125. Cardiovascular: other hormones contribute to the control of BP....
    • Antidiuretic hormone [ADH]
    • Aldosterone
    • Renin-angiotensin-aldosterone system in the kidneys
  126. Cardiovascular: List of Common Heart Diseases
    • Congenital heart defects
    • Hypertensive heart disease
    • Coronary Artery disease
    • Cardiac Dysrhythmias
    • Congestive heart disesase [failure]
  127. Cardiovascular: General Diagnostic Tests for Cardiovascular Function
    • HIstory and PHysical Exam [auscultation of heart sounds with stethoscope]
    • Electrocardiogram [ECG]; Holter Monitor Test
    • Echocardiography; Chest-x-ray; Exercise stress test; Nuclear imaging [thallium]; Cardiac catheterization with coronary angiography; Doppler studies in the peripheral vessels
  128. Cardiovascular: General Recommendations for a Healthy Heart
    • Dietary modifications [low fat diet]
    • Regular exercise and stress reduction
    • Cessation of cigarette smoking
    • Screen and monitor Blood Pressure; treat when necessary
    • Screen and monitor triglycerides and cholesterol; treat when necessary
  129. Cardiovascular: Coronary Artery Disease [CAD]; aka Ischemic Heart Disease [IHD] - General Knowledge
    • Angina pectoris: temporary cardiac ischemia [can be stable or unstable]
    • Myocarial Infarction or heart attack [acute coronary syndromes]: permanent damage to part of the heart muscle
    • CAD may lead to congestive heart disease, serious dysrhythmias and sudden death
  130. Define: Arteriosclerosis
    general term for all types of arterial changes; degenerative changes and loss of elasticity [hardening of the arteries with age]; walls become thick and hard and lumen narrows
  131. Define: Atherosclerosis
    specific term used for the presence of atheromas in the intima [plaques consisting of lipids, fibrin, fibrosis, and calcification]
  132. Cardiovascular: Role of Lipids
    • Lipids are carried in the blood by proteins [lipoproteins]
    • Cholesterol and Triglycerides are essential lipids in the body and are synthesized and regulated by the liver
    • Triglycerides are an independent risk factor for CAD
    • when values exceed 200 mg/dl [normal range is 75 to 160 mg/dl]
  133. Cardiovascular: Types of Cholesterol
    • LDL: Low Density Lipoprotein [high cholesterol content; transports cholesterol from the liver to the cells]; promotes formation of atheromas; aka "bad cholesterol"
    • HDL: High Density Lipoprotein [low cholesterol content; transports cholesterol from peripheral cells to the liver]; known as "good cholesterol"
    • Total Cholesterol [product of HDL, LDL, VLDL, etc]
  134. Cardiovascular: Ideal Range for the Types of Cholesterol
    • LDL Cholesterol: <180 mg/dl; if CAD is present then ideal LDL is less than or equal to 100 mg/dl
    • HDL Cholesterol: >40 mg/dl
    • Total Cholesterol: 200 mg/dl or less
  135. Cardiovascular: Atherosclerosis - Pathophysiology
    • Endothelial injury in the artery [can begin at an early age]
    • Cells and Lipids accumulate in the intima and the media of the artery wall
    • A plaque forms and platelets adhere
    • Lipids continue to build up
    • Fibrous tissue also forms
    • Inflammation ensues with more platelet aggregation
    • Finally a thrombus can form at the site totally obstructing blood flow which results in a myocardial infarction [heart attack]
  136. Cardiovascular: Development of an Atheroma
    Fatty Streak > Plaque > Narrowed arterial lumen > Necrosis and Calcification of the arterial wall > Eventual formation of thrombus and total obstruction or occlusion of the vessel
  137. Cardiovascular: Risk Factors for CAD - Factors that cannot be changed
    • Age [more common after age 40]
    • Gender [more common in males until females reach menopause and lose the protective effects of estrogen; i.e. a high HDL]; overall, CAD kills as many women as men
    • Genetic of Familial factors on serum lipid levels [familial hypercholesterolemia; serum lipid levels and metabolism]
  138. Cardiovascular: Risk Factors for CAD - Factors that can be modified
    • Weight
    • Serum lipid levels [diet, exercise, medication]
    • Cigarette smoking
    • Sedentary life style
    • Diabetes mellitus: control the disease well
    • Hypertension
  139. Cardiovascular: Diagnostic Tests for CAD
    • History and Physical exam; ECG; Chest X-ray
    • Consider Holter monitor test and Exercise stress
    • test
    • Echocardiography can be helpful
    • MRI with contrast is an excellent technique
    • Coronary angiography may be necessary
    • Examine lipid levels, blood glucose, thyroid, kidney and liver function
  140. Cardiovascular: Treatment of CAD
    • Life style changes [diet and exercise]
    • Control primary disorders of HTN and Diabetes
    • Cease smoking
    • Low fat and low salt diet
    • Lipid lowering agents when necessary
    • Daily dose of aspirin [baby aspirin 81 mg]
    • Surgical intervention when necessary [Angioplasty; Stent placement; CABG]
  141. Cardiovascular: Acute Coronary Syndrome [ACS] - General Knowledge
    • US: 1,680,000 unique events of CAS in 2001
    • Definition: myocardial ischemia due to imbalance between supply and demand of myocardial O2
    • ACS includes: unstable angina; non ST segment elevation MI; ST segment elevation MI
    • Rare causes: spontaneous or cocaine induced coronary artery dissection: other causes of coronary artery dissection [Marfan's syndrome; Kawasaki disease; cystic medial necrosis with aortic root dilation; aneurysm and dissection]
  142. Cardiovascular: Angina Pectoris - General Knowledge
    • Chest pain due to narrowed coronary arteries or vasospasm; increased demand for oxygen cannot be met
    • Can occur at rest or with exertion; many triggers
    • Recurrent, intermittent brief episodes of substernal chest pain [can be triggered by stress or exertion]
    • Treat with rest, oxygen, nitroglycerin, observation
  143. Cardiovascular: Myocardial Infarction [MI]
    • occurs when a coronary artery is totally obstructed leading to prolonged ischemia and myocardial cell death, i.e. infarction
    • obstruction of the coronary arteries is most commonly due to atherosclerosis and thrombus formation; a thromus can embolize and move downstream to cause infarction; vasospasm can occur to such an extent that infarction ensues [e.g. cocaine use]
  144. Cardiovascular: Differential Diagnosis of Chest Pain
    • Cardiac
    • Pulmonary
    • Musculoskeletal
    • Gastrointestinal
    • Assume the worst until proven otherwise
  145. Cardiovascular: Myocardial Infarction - Signs & Symptoms
    • Chest pain - sudden or gardual onset; heaviness, pressure/crushing or burning; can be severe; can radiate into neck and arms
    • Silent MI can occur [no pain or pain associated with GI tract]; most common in people with advanced DM
    • Pallor, sweating [diaphoresis], nausea, dizziness, weakness, dyspnea [shortness of breath], anxiety
    • Hypotension, near syncope or syncope [fainting]
    • Cardiac arrest with or without pulmonary arrest
  146. Cardiovascular: Myocardial Infarction - Diagnosis
    • Acute history and past history
    • ECG
    • serum enzymes and isoenzymes released from necrotic cells [CK-MB; troponin, myosin]
    • Other laboratory tests - liver enzymes, electrolytes, glucose, CBC, C-reactive protein [marker of inflammation], arterial blood gas
  147. Cardiovascular: Myocardial Infarction - Complications
    • Dysrhythmias: ventricular tachycardia, ventricular fibrilation, asystole, cardiac arrest and sudden death
    • Heart block [infarcted conduction fibers]
    • Premature ventricular contractions [PVC's]
    • Cardiogenic shock
    • Congestive Heart Failure
    • Rupture of necrotic heart tissue; valvular rupture
    • Thromboembolism from a mural thrombus in the heart
  148. Cardiovascular: Myocardial Infarction - Acute Treatment
    • Assess ABC's
    • Give an spirin; rest, oxygen, nitro, get emergency help
    • Initiate thrombolytic treatment ASAP with TPA [tissue plasminogen activator], Streptokinase; unless contraindicated
    • Defibrilation for V-fib [ventricular fibrilation]
    • Pacemaking for heart block
    • Revascularization with angioplasty or CABG
    • Medical therapy for stunned heart and decreased cardiac output
  149. Define: Cardiac dysrhythmias
    alterations in rate or rhythm or both
  150. Cardiovascular: Sinus Node Abnormalities
    • Bradycardia
    • Tachycardia
    • Sick Sinus Syndrome [alternating bradycardia and tachycardia]; may require a pacemaker
  151. Cardiovascular: Atrial Conduction Abnormalities
    • Premature atrial contractions [PAC's]
    • Atrial Flutter [regular, fast, 160-350 beats/minute]
    • Atrial Fibrilation [irregular; fast; rate over 350 beats/minute]
    • AV node controls conduction to the ventricles so that the ventricular rate is slowed
  152. Cardiovascular: Atrioventricular Node Abnormalities - Heart Block
    • Heart block occurs when conduction is excessively delayed or stopped at the AV node or bundle of His
    • First Degree Block: prolonged PR interval on ECG
    • Second Degree Block: longer delay leads to missed ventricular beats
    • Third Degree Block: no transmission of impulses from atria to ventricles; ventricles contract spontaneously at a slow rate of 30 to 45 beats/minute
  153. Cardiovascular: Ventricular Conduction Abnormalities
    • Bundle Branch Block: wide QRS wave
    • Ventricular tachycardia: cardiac output decreased
    • Ventricular fibrilation: ineffective contraction and no meaningful cardiac output
    • Premature Ventricular Contractions [PVC's]: additional beats arising from a ventricular muscle cell
  154. Cardiovascular: Congestive Heart Disease [CHD] - General Knowledge
    • Heart is unable to pump sufficient blood to meet metabolic needs
    • CHD is usually due to a secondary disorder [e.g. myocardial infarction, aortic stenosis, hypertension, hyperthyroidism]
    • May be left or right sided or both; left sided is most common
    • Can be an acute and reversible condition
    • Is most likely to be a chronic condition
    • Chambers of the heart dilate [enlarge] and cardiac muscle hypertrophies resulting in cardiomegaly
    • Compensatory mechanisms make the problem worse; e.g. the renin-angiotensin system
  155. Cardiovascular: Two Basic Effects of CHD
    • Cardiac output or stroke volume decreases: less blood reaching the organs; demands for oxygen not met; leads to fatigue, dyspnea, mild metabolic acidosis
    • Congestion develops in the circulation behind the affected ventricle: the output from the ventricle is less than the inflow; left ventricle backs up into the lungs [pulmonary congestion and pulmonary edema]; right ventricle backs up into the legs, feet and eventually the liver and GI tract [lower extremity edema and hepatomegaly with ascites]
  156. Cardiovascular: CHD Etiology
    • left sided CHD- MI; hypertension; aortic stenosis; idiopathic cardiomyopathies
    • right sided CHD- Pulmonary disease such as pulmonary artery stenosis, pulmonary emboli, etc [referred to as cor pulmonale]
  157. Cardiovascular: CHD - Signs & Symptoms - Left Sided
    • General hypoxia
    • Fatigue, lethargy, dyspnea, exercise intolerance
    • Pulmonary congestion: dyspnea; orthopnea; cough; pulmonary edema; paroxysmal nocturnal dyspnea
    • Pulmonary edema produces a pink [blood stained] frothy sputum and rales on exam
  158. Cardiovascular: CHD - Signs & Symptoms - Right sided
    • Fatigue, weakness, dyspnea, exercise intolerance, general hypoxia
    • Dependent edema in the feet or legs or buttocks
    • Hepatomegaly and Splenomegaly
    • Digestive tract edema
    • Ascites [fluid in the abdomen]
    • Acute right sided heart failure [distended neck veins, headache, visual disturbances]
  159. Cardiovascular: Congenital Heart Defects - General Knowledge
    • Arise during the first 8 weeks of life
    • A structure may be altered or missing
    • Valvular defects, septal defects, shunts, abnormal positioning or shape of aorta and pulmonary artery
    • Acyanotic conditions vs Cyanotic conditions
    • Problems present at birth
  160. Cardiovascular: Congenital Heart Defects Examples
    • Ventircular septal defect
    • Atrial septal defect
    • Valvular defects [stenosis or incompetence]
    • Pulmonary artery stenosis
    • Tetralogy of Fallot [pulmonary stenosis; ventricular septal defect [VSD]; right ventricular hypertrophy; dextroposition of the aorta over the VSD
    • Totally anamolous pulmonary venous return
  161. Cardiovascular: Rheumatic Fever and Rheumatic Heart Disease - General Knowledge
    • Acute inflammatory condition of childhood usually due to a streptococcus infection
    • Abnormal immune reaction occurs in untreated cases [strep antibodies react with connective tissue in skin, joints, brain, heart.... Leads to scar tissue formation in the heart]
    • May cause pericarditis, myocarditis, or endocarditis
    • Mitral valve is most frequently affected
  162. Cardiovascular: Infective Endocarditis - General Knowledge
    • Bacterial endocarditis: subacute and acute
    • Subacute: defective heart valves are invaded by oraganisms of low virulence [Strep viridans]
    • Acute: normal heart valves are infected by highly virulent organisms [Staph aureus]
    • Inflammation and formation of vegetations on the cusps of the valves; valvular dysfunction; infective emboli
  163. Cardiovascular: Pericarditis - General Knowledge
    • presents with chest pain, dyspnea, cough, fever and tachycardia
    • may be acute or chronic: [Acute: causes open heart surgery; MI; Rheumatic fever; Lupus; cancer; renal failure; trauma; viral infection] [Chronic causes: Tuberculosis; Radiation treatment]
    • Pericardial effusion may occur: Paracentesis to analyze the fluid or remove excess fluid prevent cardiac tamponade
  164. Cardiovascular: Vascular Disorders - General Knowledge
    • Hypertension
    • Peripheral vascular disease
    • Intermittent Claudication
    • Aortic aneurysms
    • Varicose veins
    • Thrombophlebitis and Thromboembolism
  165. Cardiovascular: Hypertension - General Knowledge
    • Primary vs Secondary vs Malignant
    • Primary cause is unknown [idiopathic]; also called Essential Hypertension
    • Secondary causes include renal artery stenosis, pheochromocytoma, Cushing's syndrome, primary hyperaldosteronism
    • Malignant HTN: uncontrollable, severe, and rapidly progressive form with many complications
  166. Cardiovascular: Primary or Essential Hypertension - General Knowledge
    • Characterized by a BP of over 140/90 on multiple readings at rest
    • Affects an estimated 50 million Americans
    • Causes end organ damage: kidneys, brain, retina, heart, arterial vessel walls
    • For individuals 55-65, the lifetime probability of development of hypertension is 90%
  167. Cardiovascular: Primary Hypertension - Predisposing Factor
    age, family history, gender [males>females], alcoholism, obesity, stress
  168. Cardiovascular: Primary Hypertension - Signs & Symptoms
    usually absent in early stages; may cause headache, fatigue, malaise in later stages
  169. Cardiovascular: Primary Hypertension - Treatment
    with life style changes, weight reduction, control of underlying diseases, drugs
  170. Cardiovascular: Primary Hypertension - Aneurysms
    • localized dilatation in an arterial wall
    • most common in the thracic and abdominal aorta
    • also seen in the brain
    • causes include congenital defects, atherosclerosis, trauma, syphilis
    • vary in shape and size
    • defect is in the medial layer; dissection occurs when there is a tear in the intimal layer
  171. Cardiovascular: Peripheral Vascular Disease [PVD] - General Knowledge
    • Atherosclerosis can affect any artery or arteriole
    • Peripheral arteries of the lower extremities may be affected; claudication is the main presenting symptom; weak, or decreased peripheral pulses are a common sign
    • PVD impairs sensory function; injury and ulceration may result from lack of sensation
  172. Cardiovascular: Shock [Pathologic Hypotension] List
    • Hypovolemic
    • Cardiogenic
    • Neurogenic or Vasogenic
    • Septid [endotoxic]
  173. Define: Highly vascular mucosa
    warms air and filters foreign material [mucous secretions; hairs]; pseudostratified columnar epithelium
  174. Define: Goblet cells
    secrete mucous
  175. Define: Cilia
    sweep mucous blanket up and out of respiratory system
  176. Respiratory: Anatomy of the Upper Respiratory Tract
    • Nasal passages
    • Conches [Turbinates]
    • Paranasal sinuses [4 pairs: frontal, ethmoid, aphenoid, maxillary]
    • Nasopharynx [palatine tonsils; pharynxgeal tonsils: adenoids; eustachian tubes]
    • Oropharynx
    • Larynx
    • Trachea
  177. Define: Pharynx
    where the nasopharynx joins the oropharynx; common passage of both food and water and air untilt he separation between the trachea and the esophagus
  178. Define: Larynx
    protected by the epiglottis which opens and closes [made of cartilage]; contains the vocal cords [false cords: upper; true cords: glottis]
  179. Respiratory: Lower Respiratory Tract - General Knowledge
    • Trachea [cartilaginous rings; smooth muscle; elastic tissue]
    • Right mainstem bronchus [larger and straighter]
    • Left mainstem bronchus
    • Bronchi [cartilaginous rings, smooth muscle, elastic tissue]
    • Bronchioles [smooth muscle and elastic tissue]
    • Alveolus [alveolar duct, alveolar sacs]
  180. Respiratory: Gas exchange occurs at...
    the alveoli via diffusion through a single layer of squamous epithelial tissue
  181. Define: Respiratory Membrane
    combined alveolar and capillary wall; very thin
  182. Respiratory: Millions of alveoli produce....
    a very large surface area for ventilation
  183. Define: Surfactant
    fluid produced in the alveoli that reduces surface tension and allows expansion of the alveoli
Card Set:
ACC Pathophysiology Unit 3
2012-04-02 20:14:01
acc patho pathophysiology unit review

Austin Community College Pathophysiology Unit 3
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