Patho Ch 18

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Patho Ch 18
2014-10-31 01:19:59
Exam #4 Disorders of Blood Flow and Blood Pressure
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  1. Blood Pressure

    What is blood pressure?
    Systolic and Diastolic number?
    What is pulse pressure?
    Force that blood exerts on the walls of blood vessels

    Reflects the how hard the heart is working

    Represented as a fraction

    • -Systolic – top number; cardiac work phase
    • -Diastolic – bottom number; cardiac rest phase

    Pulse pressure (~40)-difference between the two numbers

    -Reflects force of each contraction
  2. Influences on Blood Pressure

    What factors effect blood pressure? What effect those (3 each)?
    What is afterload; preload?
    Hormones associated (2)?
    BP = CO x PVR

    Cardiac output (CO)

    • -CO = SV x HR
    • -Stroke volume (SV)
    • -Heart rate (HR)

    Peripheral vascular resistance (PVR)

    • -Sympathetic nervous system
    • -Parasympathetic nervous system
    • -Arterial elasticity


    Afterload – pressure needed to eject the blood

    • -Blood viscosity
    • -PVR

    Preload – amount of blood returning

    • -Blood volume
    • -Venous return


    • -Antidiuretic hormone
    • -Renin-angiotensin-aldosterone system
  3. Blood Vessels

    Three different types of vessels?
    What are the three layers of each vessel?
    Arteries – carry blood away

    Veins – carry blood back

    Capillaries – site of exchange

    Three layers

    • 1.Tunica intima – inner layer (endothelium)
    • 2.Tunica media – middle muscular layer (smooth muscle)
    • 3.Tunica adventitia – outer elastic layer (collagen and elastic fibers)
  4. Lymphatic System

    What does the lymphatic system do? What role does it play?
    What organs does it include (4)?
    Works to return excess interstitial fluid (lymph) to the circulation

    Plays a role in immunity

    Includes lymph nodes, the spleen, the thymus, and the tonsils
  5. Vascular Endothelium

    What pass into tissues?
    What pass from tissues into blood?
    What function is of the smooth lining of the blood vessels?
    Food and O2 pass into tissues

    Wastes and CO2 pass from tissues into blood

    Creates compounds that cause vasodilation or vasoconstriction

    Creates growth factors that can stimulate smooth muscle

    Forms a smooth lining of the blood vessels that resists clot formation

    Creates compounds to promote clot formation in injured areas
  6. Dyslipidemias

    What is it?
    What does it increase risk for?
    Where do lipids come from?
    High levels of lipids in the blood

    Increases risk for many chronic diseases

    Lipids come for dietary sources and liver production

    Dietary sources

    • -Cholesterol – animal products
    • -Triglycerides – saturated fats
  7. Lipid Transport in the Body

    What are chylomicrons? 
    What are IDLs?
    Dietary lipids absorbed as chylomicrons

    Adipose and muscle cells take up lipids from chylomicrons

    Chylomicron remnants are intermediate-density lipoproteins


    IDLs become low-density lipoproteins (“bad cholesterol”)

    These can deliver fat to the liver and by other tissues

    LDL receptors are necessary for the liver to take them up

    Some LDLs are taken up by scavenger cells like macrophages
  8. Lipoproteins

    What are the relations between density, proteins, and lipids?
    The more protein, the higher the density

    The more lipid, the lower the density
  9. Dyslipidemia disorder

    Classified by what and based off of what?
    Signs and symptoms?
    • •Classified based on density, which is
    • based on the amount of triglycerides (low density) and protein (high density)

    • –Very-low density lipoproteins
    • –Low density lipoproteins – AKA “bad
    • cholesterol
    • –High density lipoproteins – AKA “good
    • cholesterol

    • •S/Sx:
    • asymptomatic until it develops into other diseases

    • •DX: cholesterol screening and lipid
    • panels

    • •TX dietary changes, weight reduction,
    • routine exercise, tobacco cessation, lipid-lowering agents, and complication
    • management
  10. Hypercholesteremia

    What is it?
    What are the optimal levels of LDL, Total Cholesterol, and HDL
    What are Xanthomas?
    What are some secondary causes (4)?
    • Increased levels of cholesterol in the
    • blood

    • LDL optimal level: <100
    • Total cholesterol desirable: <200
    • HDL high >=60

    •Xanthomas: cholesterol deposits along tendons, atherosclerosis can appear.

    •May be genetic

    • •Secondary causes obesity with
    • high-caloric intake, sedentary lifestyle, diabetes mellitus.
  11. Atherosclerosis
    •Lipids get into the vascular endothelium

    •Inflammatory process is triggered by vessel wall injury.

    •White blood cells try to clear them away à foam cells; WBCs and vascular endothelium release growth factors that promote plaque formation

    •Plaques/lesions develop on the vessels wall, calcify over time,  block the arteries

    • •Chronic inflammatory disease characterized by thickening and hardening of the arterial
    • wall.

    •Leads to vessel obstruction, platelet aggregation, and vasoconstriction

    •Complications: peripheral vascular disease, coronary artery disease, thrombi, hypertension, and stroke

    •Manifestations: asymptomatic until complications develop


    •Atherosclerosis develops because scavenger cells encounter the fatty deposits in the artery lining and

    –Try to destroy the fats by oxidizing them

    ºOxidized fats injure the endothelium

    ºClots form and release growth factors

    ºSmooth muscle grows over the fatty core

    –Try to remove the fats by eating them

    •Become “foam cells” in the core of the plaque


    •Important to  identify contributing factors and complications

    •Treatment: similar to dyslipidemia with the addition of angioplasty, bypass, laser procedures, and artherectomy
  12. Stable Plaques

    Thick or thin fibrous caps?
    Does it completely block vessel?
    Does it form clots/emboli?
    Have thick fibrous caps

    Partially block vessels

    Do not tend to form clots or emboli
  13. Unstable Plaques

    Thick or thin fibrous caps?
    Does it completely block vessel?
    Does it form clots/emboli?
    Have thin fibrous caps

    Plaque can rupture and cause a clot to form

    May completely block the artery

    The clot may break free and become an embolus
  14. Peripheral Vascular Disease

    Diseases or conditions associated
    Signs and symptoms
    Narrowing of the peripheral vessels

    •Causes: atherosclerosis, thrombus, inflammation, and vasospasms

    •Thromboangiitis obliterans – an inflammatory condition of the arteries

    •Raynaud’s disease – vasospasms of arteries, usually in the hands, because of sympathetic stimulation

    –Raynaud’s phenomenon – associated with an autoimmune condition

    •S/Sx: pain, intermittent claudication, numbness, burning, non-healing wounds, skin color changes, hair loss, and impotency

    •DX: history, physical examination, ankle/brachial index, treadmill exercise test, angiography, ultrasounds, and magnetic resonance imaging

    •TX: reducing contributing factors, angioplasty, bypass procedures, laser procedures, atherectomy, antiplatelet agents, anticoagulants, thrombolytics, and lipid-lowering agents
  15. Coronary Artery Disease

    What is Angina and what types are there?
    What is Infarction?
    Signs and Symptoms
    Atherosclerotic changes of the coronary arteries; Impairs myocardial tissue perfusion

    Angina – intermittent chest pain resulting from myocardium ischemia

    • –Stable
    • – goes away with demand reduction

    • –Unstable
    • – increased intensity or frequency, does not go away with demand reduction, or occurs at rest

    • Infarction
    • – necrotic damage to myocardium

    •Causes: atherosclerosis, vasospasms, thrombus (blood clots) & cardiomyopathy

    •Complications: myocardial infarction, heart failure, dysrhythmias, & sudden death

    •S/Sx: angina, indigestion-like sensation, nausea, vomiting, clammy extremities, diaphoresis, and fatigue

    •DX: history, exam, contributing factors?, stress test, echocardiogram, ECG

    •TX: similar to dyslipidemia/ atherosclerosis, but add meds to help reduce workload on the heart) and manage BP & dysrhythmias, & O2.
  16. Aneurysms

    What are aneurysms?
    Where are they common?
    What can happen?
    What are some risks?
    Signs and symptoms
    •Weakening of an artery

    •Can occur in an artery

    • –Common in the abdominal aorta, thoracic
    • aorta, and the cerebral, femoral, and popliteal arteries

    Can rupture – exsanguination (bleeding)

    •Risk factors: congenital defect, atherosclerosis, hypertension, dyslipidemia, diabetes mellitus, tobacco, advanced age, trauma, and infection 


    • –Depend on location and size
    • –May be asymptomatic
    • –May include: pulsating mass, pain, respiratory difficulty, and neurologic decline

    • •DX: exam,  X-ray, echocardiogram, CT, MRI,
    • and arteriograph  

    •TX:  eliminating or managing cause and surgery


    •Wall of artery weakens and stretches

    •Risk of rupture and hemorrhage

    •Risk of clot formation
  17. Types of Aneurysms

    Two types of aneurysms and how does it affect all three layers of the vessel?
    True aneurysms – affect all three vessel layers

    –Saccular aneurysm – bulge on the side

    –Fusiform aneurysm – occurs the entire circumference

    False aneurysm – does not affect all three layers of the vessel

    –Dissecting aneurysms - occurs in the inner layers
  18. Varicose Veins

    What is it?
    Where is it most common?
    What can it cause?
    Risk factors?
    Signs and Symptoms
    Engorged veins resulting from valve incompetency

    •Most common in the legs

    •May also occur as esophageal varices and hemorrhoids

    •Can cause stasis pigmentation, subcutaneous induration, dermatitis, and thrombophlebitis

    •Risk factors: genetic predisposition, pregnancy, obesity, prolonged sitting or standing, alcohol abuse and liver disorders (esophageal varices), and constipation (hemorrhoids)


    • –Irregular, purplish, bulging veins
    • –Pedal edema
    • –Fatigue
    • –Aching in the legs
    • –Shiny, pigmented, hairless skin on the
    • legs and feet
    • –Skin ulcer formation

    •DX: exam, Doppler ultrasound, and venogram

    •TX: elevate affected leg, compression stockings, avoid prolonged standing or sitting, exercise, sclerotherapy, and surgical removal
  19. Venous Thrombosis

    What is it?
    What is Virchow's Triad?
    What can an embolus be?
    Signs and symptoms
    •Stationary blood clot

    • Virchow’s Triad – endothelial injury,
    • sluggish blood flow, and increased viscosity

    •Emboli – traveling body

    • –May be a thrombus, air, fat, tissue,
    • bacteria, amniotic fluid, tumor cells, and foreign substances
    • –Can become lodged in places like the
    • lungs, brain, and heart

    •S/Sx: Depends on location

    •DX: arteriography, ultrasound, echocardiogram, MRI

    •Prevention: increasing mobility, hydration, antiembolism hose, sequential compression devices, antiplatelet agents, and anticoagulants

    •TX: thrombolytic agents and embolectomy
  20. Hypertension
    •Prolonged elevation in blood pressure

    •Excessive cardiac workload due to increased afterload and vasoconstriction

    •Risk factors: advancing age, ethnicity, family history, being overweight or obese, physical inactive, tobacco use, high-sodium diet, low-potassium diet, high vitamin D intake, excessive alcohol intake, stress, and other chronic conditions

    “Silent killer”

    • S/Sx include: Include: fatigue, headache,
    • malaise, and dizziness

    Early detection and management is essential to prevent complications

    •Complications: atherosclerosis, aneurysms, heart failure, stroke, hypertensive crisis, renal damage, vision loss, metabolic syndrome, memory problems

    •Lifestyle modification has been shown to reduce BP; wt reduction, regular exercise, reduce salt, smoking cessation, reduce alcohol


    •Primary hypertension

    • –Most common form
    • –Develops gradually over time

    •Secondary hypertension

    –Tends to be more sudden and severe

    –Causes: renal disease, adrenal gland tumors, certain congenital heart defects, certain medications, and illegal drugs
  21. Hypertensive Crisis/Malignant Hypertension
    An accelerated or severe form; may not respond as well to treatment.

    •Situations in which a markedly elevated BP is accompanied by progressive or impending target-organ damage.

    •Often associated with secondary hypertension

    •Traditionally defined as diastolic BP >120.

    •Severe hypertension = SBP>180/DBP >110.

    •Hypertensive Urgency = DBP>110 and HA or dyspnea

    •Hypertensive Emergency = DBP >120 and rapidly progressing damage/symptoms.
  22. Pregnancy-induced hypertension
    –Hypertension first seen in pregnancy

    –S/Sx: high blood pressure, proteinuria, edema

    –Risk factors: history of pregnancy-induced hypertension, renal disease, diabetes mellitus, multiple fetuses, and maternal age less than 20 years or greater than 40 years

    –May cause seizures, miscarriages, poor fetal development, and placental abruption

    –TX: bed rest and magnesium sulfate
  23. Pheochromocytoma
    •Tumor of chromaffin tissue that contain sympathetic nerve cells that stain with chromium salts.

    •Most commonly in adrenal medulla

    •Can cause serious hypertension

    •Tumor cells secrete epinephrine and norepinephrine.

    •Hypertension is from massive release of catecholamines.

    •Periodic episodes of headache, excessive sweating, palpitations, nervousness, tremor, pallor, weakness, fatigue

    May have sustained or intermittent HTN.
  24. Coarctation of the Aorta
    •Narrowing of the aorta.

    •Results in increase in systolic BP and blood flow to upper body; Blood pressure in lower extremities may be normal or low.

    •Need to take BP in both arms and one leg!

    •Maintenance of blood pressure to lower body probably a result of renin-angiotensin-aldosterone system activated by decreased renal blood flow.

    TX: surgical repair or balloon angioplasty