Patho Exam 3 - Cardiovascular
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Patho Exam 3 - Cardiovascular
how does gravity play a role in DVT?
gravity pulls blood down
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
what are venous stasis ulcers?
cell death and necrosis - no O
and cell dies
what can chronic venous insufficiency cause?
hyperpigmentation of lower extremities
what happens with varicose veins?
blood pools, valves don't shut
what could be some causes/risk factors for orthostatic hypotension?
anatomic variation with aging, antihypertensive and antidepressant therapy, fluid volume depletion, and venous pooling
what is orthostatic or postural hypotension?
decrease in both systolic and diastolic arterial BP on standing from a reclining position
what is malignant hypertension an adverse reaction to?
what is malignant hypertension?
rapid progression in which diastolic is > 140
what are some cerebrovascular complications of complicated hypertension?
transient ischemic attack (TIA), CVA, cerebral thrombosis, aneurysm, and hemorrhage
what are some cardiovascular complications of complicated hypertension?
left ventricular hypertrophy, angina, CHF, CAD, MI, sudden death
what are some renal complications of complicated hypertension?
parenchymal damage, renal arteriosclerosis, renal insufficiency and failure
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
what are some vascular diseases that cause secondary hypertension?
what are some endocrine disorders that cause secondary hypertension?
acromegaly, thyroid disturbances, adrenal disorders - estrogen, testosterone, and aldosterone
what are renal disorders that cause secondary hypertension?
renovascular disease, renin-producing tumors, renal failure
what causes secondary hypertension?
systemic disease that increases peripheral resistance in blood vessel or cardiac output
what percentage of hypertensive cases are primary?
what is likely responsible for primary hypertension?
combination of genetic and environmental factors mediated by host of neurohumoral effects
is there a specific cause identified for primary hypertension?
what is primary hypertension also called?
essential or idiopathic (unknown)
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 O
what is Raynaud phenomenon and Raynaud disease characterized by?
attacks of vasospasm in small arteries and arterioles of fingers and (less commonly) the toes
is Raynaud phenomenon and Raynaud disease more common in men or women?
what is a risk factors for Buerger's disease/thromboangiitis obliterans?
what is another name for thromboangiitis obliterans?
is thromboangiitis obliterans more common is men or women?
what is PAD?
atherosclerotic disease that decreases perfusion to the limbs, especially lower extremities
name three different types of emboli:
foreign matter - IV catheter (don't retract IV needle and then reinsert cause slices off pieces of catheter)
what is an embolus?
obstruction of vessel by an embolus or a bolus of matter that is circulating in bloodstream
what is a thrombus?
clot that remains attached to vessel wall
describe the 3 different types of an aneurysm:
: looks like a berry grown on one side of arterial wall
: all around arterial wall
: one layer of artery wall
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?
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?
what is atherogenesis?
begins with injury to endothelial cells of arteries that causes inflammation
what type of disease is atherosclerosis?
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
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 O
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
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
what is the most common cause of myocardial ischemia and infarction?
list the main symptoms that go with PAD and CAD that help distinguish the two:
: increased BP
: increased BP AND chest pain
when adiponectin is decreased, what are people at risk for?
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
Adiponectin is the
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?
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?
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?
what type of MI is happening with marked elevation in ST segments on EKG, non-stemi or stemi?
what type of MI does stemi go with?
what type of MI does non-stemi go with?
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?
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?
what is it when the valvular orifice is constricted or narrowed?
the myocardium is infiltrated with amyloid, hemosiderin or glycogen deposits and the AV valve is incompetent, what is it?
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?
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?
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?
why is it easier for fluid to accumulate around right atrium and right ventricle in cardiac tamponade?
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)
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?
can radiation cause pericarditis?
what is pericarditis commonly seen with?
do we know what causes pericarditis?
what do you hear in pericarditis?
in pericarditis, what happens in the pericardial cavity?
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?
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?
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?
in left sided heart failure do you have symptoms in the body or lungs?
is tricuspid regurgitation left or right sided heart failure?
is mitral regurgitation left or right sided heart failure?
is mitral stenosis left or right sided heart failure?
what are some symptoms of tricuspid regurgitation?
peripheral edema and ascites