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what is blood flow?
Movement along a pressure gradient within the vascular beds.
What is turbulent blood flow? and how does it manifest?
- Is an interruption in the forward current of blood flow by crosswise flow.
- Turbulent flow may manifest as:
- Bruit: turbulent blood flow that can be auscultated.
- Thrill: Turbulent blood flow that can be palpated and auscultated.
- Thrombus Formation:
What is blood pressure?
Moving from higher pressure (arteries/arterioles) towards lower pressure (vein/venous); the greater the pressure difference, the greater the blood flow.
What is vessel resistance? and what determinants it?
- 3 determinants: length, diameter, and viscosity.
- opposing forces that deter blood flow; as resistance increases, blood flow decreases.
- Changes in diameter is the most important determinant for blood flow, since the length canon be change by the body.
- The more viscous the blood, the more the resistance, the slower the flow rate. High amout of RBCs or low amt of platelets cause this.
What is a Thrombus (thrombosis)?
it is a stationary blood clot formed within a vessel or a chamber of the heart.
What is the etiology of a thrombus? what is the difference b/t Arterial and venous thombus?
- When blood slows dramatically, becomes more turbulent, if there is a damage to intimal walls or drugs (oral contraceptives).
- Arterial thrombosis results in ischemia.
- venous thrombosis results in edema. Phlebitis: inflammation in a vein.
what is Thrombophlebitis?
Thrombophlebitis: Inflammation with a clot in a vein. It this breaks and becomes mobile can result in the right side of the heart causing an pulmonary embolism (PE)
Clinical Manifestation of a thrombus? both arterial and venous.
- arerial: Intermittent claudication (pain with activity) in affected limb that improves with rest. Cool, cyanotic, painful ulcer around one toe.
- Venous: None or life threading (Except PE) calf/groin tenderness, swelling, + human's sign (dorsiflexion of the ankle with pressure, if calf tenderness, means positive. avoid do this test on pregnant women.
What are the risk factors of a thombus? both arterial and venous.
- Hypercoagulable conditions, pump failure, Dysrhythmias, aging, trauma, drugs.
- Arterial: arteriosclerosis/artherosclerosis.
- Venous: Immobilization.
what is the treatment for a thrombus?
- Anticoagulant therapy is initiated to prevent clot enlargement.
- May need thrombolytic drugs.
- additional medical prophylactic interventions (antiembolic stockings or sequential, compression devices, ambulation as soon as possible)
- Surgery to remove thrombus.
what is an embolus? what is the difference if found in the Lt or Rt ventricle?
- Material that forms a clot within the bloodstream and travels (atrial fibrillation).
- Embolus leaving Lt ventricle = Ischemic stroke.
- Embolus leaving Rt ventricle = Pulmonary Embolus (comes from the vena cava)
What is a thromboembolus?
Embolus that began as a thrombus and was dislodged from the vessel intima.
What is the treatment for embolus?
Embolectomy (surgery removal) or filter (eliac vifertation—placed in the inferior vena cava, then enzymes destroy it)
what are the Clinical Manifestations of embolus?
- If lodge in the brain, it depends what part of the brain is blocked. Symptoms could include: Loss of cognitive function, motor changes, and different levels of sensory loss.
- If in the lungs, it could be asymptomatic or it could pressent dyspnea, increase RR, chest pain, it may cause sudden death.
what are other causes that can produce an embolus?
- fat emboli: Deposits of fats released into the bloodstream after trauma (maybe a broken bone).
- tumor emboli: Comes from a malignant neoplasma that can metastasize by various means, one which is in the blood as a neoplasm tumor.
- Collection of bacteria and infectious exudate: may break of (like in endocardatis) and becoming a bacteria emboli causing infection in other site.
- Air from the external environment: bubbles from a IV injection could be considered foreign and obstruct perfussion.
- Amniotic fluid: increase pressure in the abdomen after labor/delivery could cause amneotic fluid to go into the bloodstream. This case doesn't cause blockage, but immune response.
What are vasospasm?
- Sudden, involuntary constriction of arterial smooth muscle that results in an obstruction to flow (like a tourniquet)
- May be mediated by hormonal changes, food additives, or environmental factors.
What are the manifestation of a vasospasm?
- Angina (prinzemetal angina)
- Hemorrhagic stroke.
- Migraine headaches.
- vasodilatation following cerebral vasospasm.
How can inflammation cause an emboli? what is vasculitis? phlebitis? arteritis (angiitis)?
- Can increase risk of thrombotic process.
- Vasculitis: inflammation of the intima of an artery
- Phlebitis: Inflammation of the lining of a vein.
- Arteritis (angiitis): inflammatory process of autoimmune origin in arteries.
How can mechanical compression can cause an emboli?
- Obstruction of blood flow due to trauma, constriction, swelling.
- May lead to hypoxia, ischemia, or necrosis of tissue.
- External forces to the vascular system may result in partial or complete obstruction.
what can cause Mechanical compression emboli?
- Trauma could cause occlusion.
- Tight casts, dressings, or stockings.
- Compartment syndrome (compramasing circulation by a tight cast).
What is arteriosclerosis? what is atherosclerosis?
- Arteriosclerosis: is a generic term meaning “hardening of the arteries” which is characterized by thickening and lumen narrowing of small arteries.
- Atherosclerosis: affect intermediate-sized and large vessels in which lipids collect along the intimal surface producing a narrowing and reduction in blood flow/inflammatory response.
What are the etiologies of atherosclerosis?
- Cholestrol-rich foodstuffs.
- Begins in childhood and develops all the way to old age.
- Maybe accelerated by genetics and environmental factor (what we eat)
- it is the cause of 50% of all deaths.
What are the risk factors of atherosclerosis? which ones are modifiable and which ones are not?
- Modifiable: smoking, hypertension, glucose intolerance, hyperlipidemia, obesity, weight fluctuations, sedentary life-style, ineffective stress management.
- Nonmodifiable: family history, age, gender, ethnicity.
How does atherosclerosis occurs? and what can disease could cause?
- atherosclerosis: 1.Low-density serum lipoproteins breach intimal layer 2.Simultaneously, platelets aggregate at the site 3.Media smooth muscle cells, normally confined to the other tunicas, drawn to the intima where they proliferate 4.Result: atherosclerotic plaque, primarily composed of smooth muscle cells, lipoproteins, and inflammatory debris 5.Plaques slowly enlarge, the orifice of the artery is decreased and perfusion is diminished
- Diseases: Can lead to hypertension, cardiac (CAD) and renal disease, peripheral arterial disease, stroke and myocardial infarction
What are the clinical manifestations of artherosclerosis?
- Atherosclerosis is an abnormality of arterial blood vessels, it can affect almost any organ in the body.
- angina pectoris.
- myocardial infarction.
- thrombotic strokes.
- intermittent claudication.
What are the treatment for artherosclerosis?
- First: nonpharmacologic interventions (weight loss, smoking cessation, exercise, and low-fat diet.
- Second: If first is no successful, drug therapy added to reduce hypercholesterolemia.
- Third: surgery (balloon/ laser angioplasty, stents, CABG.
What is arteritis -- Thromboangitis obliterans (buerger disease)?
- Rare inflammatory condition affecting small and medium-size arteries and veins of upper and lower extremities resulting in varying degrees of obstruction.
- Associated with tobacco use and may be an autoimmune response to it.
- Seen in men less than 40 years of age, Jewish and Asian decent with history of heavy smoking.
- Known for periods of remission and exacerbations.
- Causes include genetic disposition, smoking, and immune response.
What is Raynaud syndrome?
- Red-white and blue syndrome.
- Extreme vasoconstrictive response of the arteries in the hands and fingers in response to cold and stress.
- Affect primarily young women---may be genetic tendency.
- Digital arteries go into spasm.
- Raynaud's phenomenon is diagnosed by history.
- The syndrome is defined as episodes of blue then white color changes in the digits induced by cold or emotional stimuli followed by red discoloration during the hyperemia recovery phase.
- Most patients describe only two of the three phases.
- Manifestations include throbbing, burning pain, erythema (red-white-blue disease).
What are aneurysms?
- they are localized arterial dilation, weakens until it bulges outward.
- Underlying cause is artherosclerosis changes in the vessels, trauma, congenital weakness, infection or inflammation.
- Frequently found in cerebral circulation an thoracic and abdominal aorta.
- Mortality is high.
- Aneurysm causes by degenerative etiologies enlarge over years. However, aneurysm caused by infections only take days.
how are aneurysms classified? explain. Subtypes? explain
- True and false.
- True: means that all 3 layers of the vessels are involved.
- False: means that only on layer of the vessels in unaffected.
What are the 2 types of true aneurysms?
- Saccular true: means that weaking confined to one side of the vessel wall.
- Fusiform true aneurysm: means that the weaking is in both sides of the vessel wall.
What is a dissecting aneurysm?
It is a tear in the vessel wall that creates a channel of blood flow b/t the layers of the vessel.
what are arteriovenous fistulas?
- It is an abnormal communication b/t arteries and veins.
- usually congenital in origen.
- Symptoms depend on size and location of the fistula.
- May result in alterations in O2 to the involved tissues.
What is acute arterial occlusion?
- Absence of arterial circulation.
- Embolism lodges in a major artery with followed by decreased circulation to the extremity.
- Due to thrombus, embolus, trauma, vasospasm.
- Usually a surgical emergency.
What are the Clinical Manifestations of an acute arterial occlusion?
The 6 "Ps": 1) pallor (unhealthy pale), 2)paraesthesia (tingling or pricking abnormal sensation), 3)paralysis, 4)pain, 5) polar (skin cold to touch), 6) pulselessness.
What are the treatments for acute arterial occlusion?
- Loosen tight dressing.
- Cut cast.
- Anticoagulant therapy.
- Thrombolytic therapy.
- Bypass surgery.
what are the risks of vascular insufficiency? both for arterial and venous.
- Arterial: smoking, atherosclerosis, inflammatory:Buergers, trauma, DIC, emboli from LV, vasospasm, diabetes mellitus.
- venous: stasis of blood flow (immobility, Rt heart failure, prolonged standing, obesity, pregnancy) trauma, hypercoagulable (high platelets and high hematocrit)
What are the alteration in venous flow? explain.
- Varicose veins, chronic venous insufficiency, and deep venous thrombosis (DVT).
- Incompetent valves (obesity, pregnancy, Rt hear failure, prolonged standing) producing varicose veins, chronic venous insufficiency, and obstruction by deep vein thrombosis.
- Accompanied by edema, venous stasis, ulcers, and pain.
- Deep vein thrombosis (DVT) can be life threating.
What are the causes of valvular incompetence?
- Intimal folds of veins that forms valves can be damaged interfering with blood flow in the venous system.
- Overstretching of the valves owing to excessive venous pressures resulting in backflow of blood.
What are varicose veins? primary and secondary varicose? what cause them?
- Superficial veins that are darkened, raised, twisted and enlarged, cause edemas.
- Veins that have lost their elasticity of the vein wall and incompetent valves.
- Venular ulcera may develop.
- Primary varicosities may be familial, often first appearing during pregnancy.
- Secondary causes of varicosities include extrinsic venous compression, prior DVT, congenital lesions, arteriovenous fistulas.
what are the etiologies of Chronic Venous Insufficiency?
- Results when valvular incompetence or blockage within the venous system advances to involve deep veins.
- Skin pigmentation becomes brown, venous stasis ulcers may develop, aching and cramping in legs.
- High risk of PE.
- Poor blood flow, nothing heals.
What are Deep Vein Thrombosis?
- Acute venous obstruction due to a thrombus, trauma, thermal injury, septic state and is most common sees in the lower extremity.
- Emboli may break away and travel to pulmonary circulation causing a PE (most common cause of PE).
- Injury to the lining of the vein causes decreased circulation and stimulates the aggregation of platelets which will occlude the vessel.
what do the lymphatic system do?
- Transport volume approx equal to plasma volume per day.
- Returns 25%-50% of the total circulating blood proteins per day.
- Located primarily in subcutaneous tissues and submucosa.
what is lymphodema? manifestations? Primary lymphodema? secondary?
- Lymphedema is an abnormal buildup of lymphatic fluid in the dermal and subcutaneous tissues.
- Lymphatic flow is altered due to impairment in the circulation of lymph.
- Manifestations include regional edema and thickened subcutaneous.
- Primary lymphedema is congenital.
- Secondary lymphedema is more common caused by trauma, recurrent infections, obstructive mass, infiltrative processes, and radiation can cause lymphatic vessel damage.