Systemic Final

• Increased fluid volume passes through the kidney -> impairment of filtration (microalbuimuria, hypertensive nephrosclerosis) -> reduction of BP will give improved renal function
• -Higher risk in DM and chronic renal disease Px

• The insufficient tissue perfusion of extremities (lower extremities affected more than upper) due to existing atherosclerosis
• -Sxs: pulseless, paralysis, parethesia, pain, pallor

• Elevated BP (>140/90 due to vasoconstriction and changed endothelial function) leading to target organ damage
• (>130/80 for DM or chronic kidney disease Px)
• -Optic nerve swelling, hemorrhages, exudates/cotton wool spots, macular star (malignant hypertension)

Thiazide Diuretics, ACEi (Angiotensin conversting enzyme inhibitor), ARB (Angiotensin receptor blockers)

Calcium channel blockers, beta blockers (BB)

• The number 1 killer in NA that affects men more than women. Is the accumulation of atheromatous plaques w/i artery walls of the myocardium -> less blood and O2 supply -> ischemia in myocardium
• -asymptomatic until >70% blocked (dyspnea, angina, palpitations, light-headed, faint, nausea)
• -Sxs increased by 4 Es: exertion, eating, excitement (stress), exposure to cold

• -hypercholesterolemia (elevated serum LDL esp)
• -smoking
• -hypertension
• -hyperglycemia (DM)
• -hereditary factors

• -cholesterol lowering meds
• -anticoagulants and aspirin (prevents clots)
• -thrombolytics (dissolve clots)
• -ACEi, BB, Calcium channel blockers (lower BP and heart workload)
• -nitroglycerin (vasodilators)

• Cholesterol emboli that is normally dislodge from the carotid arteries and is trapped in a retinal artery
• -could have transient vision loss (~20mins) that will return when the vessel is unobstructed
• -A sign of severe atherosclerosis
• -could be a warning sign for stroke or TIA

• -chest pain caused by coronary artery disease or myocardial
• ischemia. Pain results from myocardial cells switching from aerobic to anaerobic metabolism-exacerbated with 4Es: exertion, eating, excitement (stress), exposure to cold -Sxs subside with rest and/or nitro
• -Tx: nitroglycerin to lower BP, alter diet, cease smoking, treat HT, DM, obesity, hyperlipidemia, Aspirin, BB (lower HR and contractility)

• -heart attack caused by coronary artery blockage and occlusion for >4-6 hrs -> irreversible myocardial necrosis (reperfusion may reverse some damage)
• -heart is dying
• -Sxs: chest pain, respiratory difficulty, anxiety, shock (lightheadedness, diaphoresis/sweating), nausea
• -50% do NOT display classic Sxs (older ppl, women, DM Px)
• -MONA: morphine, O2, nitro, aspirin

• -is a congenital defect in which the aorta b/t upper and lower body is narrow -> hypotension in legs and hypertension in arms and head, heart is stressed and damaged
• -Sxs: HA (high BP in upper body), leg pain (not enough blood)

• -is a congenital defect in which the pulmonary valve is narrower so the R ventricle works harder and hyptertophies but the lungs do not receive as much blood -> cyanosis (blue baby) and dyspnea
• -Tx: balloon valvuloplasty to enlarge the valve

• -ductus arteriosus stays open 72 hrs after birth -> O2 rich and poor blood mix and the lungs have large blood volume load
• -Sxs: pulmonary hypertension, dyspnea, fatigue, poor feeding
• -Tx: PDA may spontaneously close, Indomethacin stimulates PDA closure, good nutrition, Surgery

• -4 congential heart defects (pulmonary stenosis and R ventricular hypertrophy, ventricular septal defect, over-riding aorta)
• -most common cause of blue baby syndrome

• The valves are affected so that their is stenosis (less blood flow) or regurgitation (backflow)
• -left side valves are more commonly affected (mitral and aortic)
• -Sxs: none, weakness, fatigue, syncope, tachycardia, chest discomfort, dypsnea, heart murmurs, swelling feet, pulmonary edema

• inflammation of the endocardium (inner membrane of the heart muscle and valves) due to bacteria pooling
• -Sxs: stroke, gangrene, roth spots, conjunctival petechiae, chronic renal failure, hemorrhagic lesions

• The chronic heart valve damage that occurs after Rheumatic Fever that could eventually lead to heart failure
• Polyarthritis, carditis, skin lesions, Syndenham's chorea due to stroptococcal infection (strep throat in upper respiratory), pancarditis (esp for the heart valves, mitral valve)
• -Tx: Ab, steroids, Aspirin (anti-inflam), digitalis and diuretics if heart failure occurs, valve surgery

• inflammation of the pericardium due to infection, RA, lupus, truama, MI, tumor or radiation or idiopathic
• Sxs: chest pain (worsened when lying down, coughing or swallowing and relieved by sitting forward), cardiac tamponade (heart compression), fever
• Tx: NSAIDs, steriods (pain and inflammation), Ab (for infective causes)

• Heart rate is irrgular/fluctation
• -tachycardia (>100 beats/min)
• -bradycardia (<60 beats/min)

• -atria quiver instead of beating effectively -> blood isn't pumped completely out of atria -> may pool and clot -> risk of stroke
• -tx: reassurance for minor cases, drugs, defibrillator, coumadin (anticoagulant), digoxin (stimulates L ventricle contraction, Verapamil (CCB slows HR), Lopressro (BB slows HR,vasodilation), pacemaker

• Ventricles quiver due to electrocution, drowing or MI -> heart pumps little blood
• -more serious heart arrrhythmia, death in minutes

• primary benign cardiac tumor
• -Tx: monitor if small and no Sxs, Surgery if flow problems and arrhthmias

• primary malignany cardia tumor
• -Tx: open heart surgery

• when the heart pumping is insufficient to supply enough blood/O2 to the body -> fluid build up in lungs and tissues  and heart enlarges and beats faster
• -most commonly due to CAD
• -L sided heart failure -> pressure builds in lungs, pulmonary edema, dypsnea, cough and fatigue
• -R sided heart failure -> pressure builds in veins -> edema in organs, nauseated, no appetite, renal failure
• -exertion increases Sxs

• -stop smoking, limit alcohol, limit fluid intake**, maintain good diet, control HT, manage DM
• -diuretics (for edema), digitalis (inotropic makes heart contrat stronger and slows HR), nitroglycerin (vasodilator), CCB BB ACEi ANGIIblockers (decrease BP)

-helps decrease arrhythmias

-slows HR and dilates vessels

helps keep vessels open

helps keep vessels open

anticoagulant

• Inflammation of the large and medium vessels (esp temporal artery) that impairs blood flow and increases the risk of embolis
• -Dx: elevated ESR, temporal artery biopsy
• -Sxs: HA, scalp tenderness, Jaw claudication pain, pain and stiffness worst in MORNING, Arteritic anterior ischemic optic neuropathy

• bilateral vision loss that is due to giant cell arteritis causing damage to the blood vessels supplying the optic nerve, leading to ischemia and death of the nerve
• -optic disc is swollen, pale and Px has flame-shaped hemorrhages, cotton-wool exudates, GCA Sxs (HA, jaw claudication, temporal tenderness, stiffness worse in morning)
• Tx: treat GCA with prednisone (corticosteroid that will reduce inflammation) and Plavix (blood thinners)

• Unilateral vision loss and optic disc changes that are due to atherosclerosis, HT, DM, MI
• -the optic nerve is spared

• -temporary focal brain or retinal ischemia leading to temporary loss of function
• -warning that a full-on stroke may occur
• -Sxs: diplopia, vision loss, vestibular dysfunction, motor (weak, uncoordinated), sensory (numb, tingling), speech and cognitive dysfunction
• -Mx: blood tests, ECG, imaging w/i hours

• -atherosclerosis
• -embolisms
• -arterial dissection
• -Giant cell arteritis
• -sympathomimetic drugs (cocaine)
• -mass lesions

• disruption of blood supply to or w/i brain causing death of brain cells (caused by cerebral thrombosis, embolism, arterial stenosis, hemorrhage)
• -Sxs: can't do STRoke (Smile, Talk, Raise both arms)
• -Tx: tPA clot buster (contraindicated for hemorrhagic CVA), surgery, treat underlying disease, rehab

• An abnormal bulge in a blood vessel wall (most common are thoracic and abdominal) that could lead to atherosclerotic plaque, thrombi and emboli, pain, aneurysm rupture (fatal)
• -Risk: HT, atherosclerosis, smoking, male, obesity, sedentary

• the incompetent valves allow blood to flow away from the heart leads to the formation of dilated, tortuous superficial veins -> risk of leg ulcers, CHF, DM
• -Sxs: asymptomatic, dull ache, warm to touch, edema, itch, heavy leg sensation leg fatigue

• inflammation of superifical leg veins with thrombus
• -Risk factors: abnormal veins, blood clotting, stasis of blood
• -Sxs: vein is painful and tender to touch, firm and swollen, surround is warm and red

• thrombus in deep vein that could more easily break off than superficial vein thrombosis
• -Sxs: none, calf swelling, calf pain (noticable or worse when standing or walking)

• anticoagulant (heparin, warfarin)
• foot elevation
• thrombolytic
• analgesisc (pain)

the conversion of soluble fibrinogen into insoluble fibrin via the intrinsic (plasma) and extrinsic (tissue) pathways that convert inactive proteins into catalytically active proteases

• excess free bilirubin in the blood leading to jaundice, abdominal pain, poor appetite, fatigue and weakness
• Tx: none, phenobarbital to reduce bilirubin if severe

• formed from the destruction of old rbcs and transported to the liver were it is excreted in the bile (for fat digestion) or urine (for excretion of waste)
• It is bad to have bilirubin not transported to the liver (indirect bilirubin that is non-functional)

• GI (appetite, ascites, ab pain, dark urine, stool)
• Aching joints and emaciation (build up of waste)
• pruritis in skin, spicer angiomas (infection and bvs break down)

• Viral inflammation of the liver
• -travels through contaminated food or H2O
• -at risk during traveling, sex
• -Tx: avoid stressing liver (alcohol)

• Viral inflammation of the liver
• -travels through infected blood
• -at risk during child birth, health care workers, hemodialysis, sex

• Viral inflammation of liver
• -through direct contact with blood
• -at risk during child birth, health care workers, hemodialysis, sex
• -no vaccine

• viral inflammation of the liver
• -only in ppl already infected with Hep B
• -at risk Px with Hep B or hemodialysis
• -get Hep B vaccine

• viral inflammation of liver
• -through contaminated food or H2O
• -no vaccine, but resolves on its own in several weeks to months

• Inflammation of the liver due to virus, alcochol, or autoimmune causes
• -Sxs: fatigue, HA, jaundice, ascites, pain, low grade fever, loss of appetite, nausea, vomitting diarrhea

• widespread nodules and fibrosis of liver due to hepatitis, chronic alcoholism, drugs, toxins, infections, Wilson's, galactosemia, hemochromatosis, glycogen storage diseases, congestive heart failure
• -leads to edema, ascites, bruisng and bleeding, jaundice, pruritis, gallstones, toxins in blood or brain, sensitivity to meds, portal hypertension

• genetic disease that increases copper absorption and decreases copper excretion
• -Sxs: liver (jaundice hepatitis, cirrhosis), CNS (tremors, coordination), blood and bones (anemia, osteoarthritis), kidneys (pee out lots of nutrients), Kayser-Fleischer ring
• -Tx: D-penicillamine/trientine hydrochloride (remove copper), zinc acetate (copper excretion), Vit B-6, low copper diet, liver surgery

• Auto-immune disease of the CNS (specifically the myelin)
• -Demyelination -> scar tissure (sclerosis)
• -Optic nerve commonly affected! MS disrupts conduction from eye to brain
• -Sxs: Vision, speech, constinence, STM, paralysis depression, anxiety
• -Tx: no cure, interferon Beta 1 drugs (slow progression), steroids (decrease relapse)

• Median longitduinal fasciculus lesion -> supranueclear gaze palsy -> horizontal dysconjugate eye mov'ts (pursuits and saccades affected, poor adduction, poor abduction
• -Sxs: diplopia

• Free radical build up, triggers, and genertics -> progressive neurodegenerative CNS disease, loss of dopamine-producing cells in the substantia nigra -> mov't disorder, paralysis, shaking
• -Sxs: tremors, rigidity, bradykinesia, impaired coordination, dry eye, poor saccade convergence pursuits, reduced CSF
• -Tx: levodopa

• AD inheritance (chromosome 4) of basal ganglia degeneration -> protein build-up, reduction of ACh and GABA, overaction of dopamine
• -No cure

• fatal, progressive motor neuron disease
• -> upper (tight, stiff, hyperreflexia) and lower  (cramps, twitches, weakness, fasciculations) motor neuron damage
• -ALS could be due to excess glutamate, autosomal dominant
• -No cure, riluzole (decreases glutamate, only slows progression)

• Neuromuscular junction disease where antibodies destory, alter, block AChR -> muscle weakness during periods of activity and improves after rest
• -Sxs: Diplopia, ptosis, facial expression, chewing, talking, swallowing
• -Dx: Blood test (AChR antibody), CT scan (EOM, thymus), Edrophonium chloride (blocks ACh breakdown temporarily)
• -Tx: Neostigmine (anti AChase), Prednisone (immunosuppressive, inhibits abnormal antibodies), thymectomy (remove thymus producing abnormal antibodies), plasmapheresis (remove abnormal antibodies)

• skeletal muscle degeneration due to defective dystrophin protein that normally keeps muscle cells intact
• -Sxs: muscle weakness, loss, deformities, contracture, pseudohypertrophy, cardiac and respiratory arrest

• -inborn problem with protein metabolism (mutation in gene fibrillin-1)
• -elongation of bones, arachnodactyly, scoliosis
• -ectopia lentis, glaucoma, retinal detachement, blue sclera

• -inborn problem with converting galactose into glucose
• -galactose-free diet
• -hypoglycemia, bilateral cataract, cognitive dysfunction, renal and hepatic dysfunction

• -inborn error of glycogen metabolism
• -hypoglycemia, elevated cholesterol, stunted growth and osteoporosis, clotting problems
• -Tx: provide glucose source, liver transplant

• -most common inborn error of metabolism where phenylalanine is not metabolised because lack of phenylalanin hydroxylase (PAH) -> CNS damage, mental retardation
• -TX: low phenylalanine diet

• -inborn error of lipid metabolism (absent Hex-A enzyme)
• -progressive CNS destruction (blindness, cognitive delay, demetia, deafness)
• -constricted fields (startle effect), and macular cherry red spot (pale, no vasculature)
• -fatal <5years
• -TX: none