Main Concepts for Chapter 30
Diseases of the Veins
Diseases of the Arteries
Hypertension
Hypotension
Atherosclerosis
Coronary Artery Disease (Ischemia, Angina and MI)
Disorders of the Valves (Stenosis & Regurgitation)
Heart Failure
Varicose veins
A vein in which blood has pooled
-- Distended, tortuous, and palpable veins
Cause: trauma or gradual venous distention
(asymptomatic, but esthetically unpleasing)
Chronic venous insufficiency
Inadequate venous return over a long period due to varicose veins, valvular incompetence
Venous stasis ulcers
Allows backflow of blood through faulty valves
Deep venous thrombosis (DVT)
the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the leg, known as post-thrombotic syndrome, or a life-threating pulomnary embolism (PE). (give heparin-IV loading d
Causes of DVT
One-way valves prevent the back-flow of blood between the contractions. (Blood is squeezed up the leg against gravity and the valves prevent it from flowing back to our feet.)
When the circulation of the blood slows down due to illness, injury or inactivi
Thrombus formation
Disease of the veins and arteries
Blood clot that remains attached to the vessel wall
Thrombo-embolus
Thrombophlebitis
Arterial thrombi
Venous thrombi
Aneurysm
Diseases of the Arteries
Due to weakening of blood vessel
Local dilation or outpouching of a vessel wall or cardiac chamber
Ruptured aneurysm = ER situation
True aneurysms: Fusiform aneurysms and Circumferential aneurysms
False aneurysms: Saccular aneurys
Arteriosclerosis
Disease of the arteries
Hardening of arteries
Chronic disease of the arterial system
Abnormal thickening and hardening of the vessel walls
Smooth muscle cells and collagen fibers migrate to the tunica intima
Embolism
Disease of the arteries
Bolus of matter that circulates in the bloodstream, then lodges, obstructing blood flow
Dislodged thrombus (often DVT), air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance
Many arterial embo
Atherosclerotic
Peripheral Artery Disease
disease of arteries that perfuse the limbs, especially lower extremities
Often asymptomatic
Intermittent claudication
Obstruction of arterial blood flow in the iliofemoral vessels resulting in pain with ambulation
Thromboangiitis obliterans (Buerger disease)
Peripheral Artery Disease
Thromboangiitis obliterans (Buerger disease)
Occurs mainly in young men who smoke
Inflammatory disease of peripheral arteries resulting in non-atherosclerotic lesions
Digital, tibial, plantar, ulnar, and palmar arteries
Obliterat
Raynaud phenomenon and Raynaud disease
Peripheral Artery Disease
Episodic vasospasm (ischemia) in arteries and arterioles of the fingers, less commonly the toes
Raynaud phenomenon is secondary to other systemic diseases or conditions: Collagen vascular disease (scleroderma), smoking, pulmonary
Hypertension
Prehypertension 120-139 (systolic)/80-90 (diastolic)
Hypertension
Sustained elevation of 140/90 or higher
Primary hypertension: Essential or idiopathic (cause unknown) hypertension, Genetic and environmental factors, and Affects 90% to 95% of individuals
Risk Factors for Hypertension
Family history
Advancing age (due to decreased elasticity of blood vessels)
Gender: female <55; male >74
Black race
Increased Na+
Glucose intolerance
Heavy alcohol use
Obesity
Cigarettes
decreased K+, Mg++, Ca++
Orthostatic (postural) hypotension
Decrease in systolic (by 20 mmHg or more) and diastolic (by 10 mmHg or more) blood pressure on standing
Lack of normal blood pressure compensation in response to gravitational changes on the circulation
Acute orthostatic hypotension
Chronic orthostatic hy
Atherosclerosis
An inflammatory disease; Form of arteriosclerosis
Thickening and hardening caused by accumulation of lipid-laden macrophages in the arterial wall
Plaque development
Process occurring throughout the body
Progression
Inflammation of endothelium
Cellular pro
Coronary Artery Disease and risk factors
Any vascular disorder that narrows or occludes the coronary arteries. Atherosclerosis is the most common cause.
Risk factors: Dyslipidemia, Hypertension, Cigarette smoking,
Diabetes mellitus, Obesity/sedentary lifestyle, Defect in the production of precur
Lipid action in Coronary Artery Disease
Lipids: Strong link between lipoproteins and coronary artery disease
Fat metabolism
Dietary fat packaged into chylomicrons for absorption in small intestine
Triglycerides: in chylomicrons
VLDL: mainly triglycerides + carrier protein
LDL: mainly cholestero
Myocardial Ischemia
-Coronary Artery Disease
-Local, temporary deprivation of the coronary blood supply
-Stable angina
-Prinzmetal angina: (variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at
Acute coronary syndromes
Transient ischemia
Unstable angina
Sustained ischemia
MI
Myocardial inflammation and necrosis
Myocardial infarction
Sudden and extended obstruction of the myocardial blood supply
Subendocardial infarction
Transmural infarction
The MI individuals usually have marked elevations in the ST segments on electrocardiogram (ECG) and are categorized as having STEMI. (ST Elevati
Disorders of the Valves
Valvular stenosis
-Aortic stenosis: The classic manifestations of aortic stenosis are angina, syncope, and heart failure.
-Mitral stenosis: refers to narrowing of the mitral valve orifice, resulting in impedance of filling of the left ventricle in diastol
Heart Failure
General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients
Systolic heart failure
Inability of the heart to generate adequate cardiac output to perfuse tissues.
Activation of the renin-angiotensin-aldosterone system (RAAS) causes not only increases in preload and afterload but also direct toxicity to the myocardium.
Diastolic heart failure
Pulmonary congestion despite normal stroke volume and cardiac output.
Diastolic failure occurs because a normal LVEDV is associated with an increased left ventricular end-diastolic pressure (LVEDP), which is then reflected back into the pulmonary circulat
Right heart failure
Commonly caused by a diffuse hypoxic pulmonary disease
Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation
High-output failure
Inability of the heart to supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility
Dysrhythmias
Disturbance of the heart rhythm
Range from occasional "missed" or rapid beats to severe disturbances that affect the pumping ability of the heart
Can be caused by an abnormal rate of impulse generation or abnormal impulse conduction. May occur due to Digo
Ectopic Focus
is an impulse originating outside the SA node and can develop as a result of electrolyte disturbances, ischemia, excessive myocardial fiber stretch, drugs, or toxins also lead to impulse formation abnormalities.
Atrial Flutter
(Saw-tooth Ps) can induce rapid atrial rates > 300 bpm with only every second or third atrial impulse being conducted to the ventricles, giving rise to a ventricular rate of 100-150
Atrial Fibrillation
is an uncoordinated and "out-of-control" impulse conduction. Afib. results from quivering, uncoordinated atrial activity, which produces an irregular ventricular rhythm.
Ventricular Fibrillation
results from chaotic ventricular activity depicted by bizarre and uncoordinated ECG traces.
Ventricular premature beats (PVCs)
are characterized as ventricular contractions not coupled to an atrial impulse and occur prior to the next expected normal SA-initiated QRS response.
Heart Block
is a delayed or interruption in the normal impulse conduction between the atria and the ventricles.
What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?
It causes smooth muscle proliferation and activate further immune and inflammatory responses due to their toxicity to endothelial cells.
What is the primary mechanism of atherogenesis?
The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs)
What alteration occurs in injured endothelial cells that contributes to atherosclerosis?
They are unable to make the normal amount of vasodilating cytokines.
What factor is responsible for the hypertrophy of the myocardium associated with hypertension?
Angiotensin II
What pathologic change occurs to the kidney's glomeruli as a result of hypertension?
In the kidney vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and preglomerular arteriopathy.
Atherosclerosis causes an aneurysm by:
eroding the vessel wall
What is the usual source of pulmonary emboli?
Deep venous thrombosis
The differences between healthy vessel walls and those that promote clot formation is that there is _____ of the endothelium of the vein.
roughening of the endothelium of the artery and inflammation
Which statement best describes thromboangitis obliterans (Buerger disease)?
An inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands
Which of the following statements best describes Raynaud disease?
A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly, the toes
What changes in veins occur to create varicose veins?
Damage to the valves within veins
The risk of developing coronary artery disease is increased up to threefold by:
hypertension
Which of the following can trigger an immune response within the bloodstream that can result in an embolus?
Amniotic fluid
Superior vena cava syndrome is a progressive _____ of the superior vena cava that leads to venous distention of the upper extremities and head.
occlusion
A local state in which cells are temporarily deprived of blood supply is defined as:
ischemia
Nicotine increases atherosclerosis by the release of:
epinephrine
Which of the following is manufactured by the liver and primarily contains cholesterol and protein?
Low-density lipoproteins (LDLs)
Which elevated value may be protective of the
development of atherosclerosis?
High-density lipoproteins (HDLs)
Which lab test is an indirect measure of
atherosclerotic plaque?
Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and is an indirect measure of atherosclerotic plaque-related inflammation.
Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?
20 minutes
The scar tissue that is formed after a myocardial infarction (MI) is most vulnerable to injury between days:
10 to 14 days
What is the expected electrocardiogram pattern for a person when a thrombus in a coronary artery lodges permanently in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
These individuals usually have marked elevations in the ST segments on electrocardiogram (ECG) and are categorized as having STEMI.
Angiotensin II increases the workload of the heart after a myocardial infarction by:
increasing the peripheral vascular resistance
Which of the following are clinical manifestations of aortic stenosis?
angina, syncope, and heart failure
Aortic and mitral regurgitation as well as mitral stenosis are caused by:
rheumatic fever
A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures may result from this condition?
Right heart failure
Ventricular remodeling is a result of:
myocardial ischemia
In systolic heart failure, what effect does angiotensin II have on stroke volume?
Increases preload and increases afterload
Match the descriptions with the corresponding terms:
Aortic stenosis - Impairs flow from the left ventricle
Aortic regurgitation - Backflow into left ventricle
Mitral stenosis - Impairs flow from left atrium to left ventricle
Tricuspid regurgitation - Backflow into right atrium
Mitral regurgitation - Backfl
If a person is taking an angiotensin-converting enzyme (ACE) inhibitor to treat primary hypertension, does that mean a person has too much of the enzyme?
The cause of their high blood pressure is most likely not known. It is not related to another disorder. Without knowing the specific cause of the high blood pressure, alternative physiologic mechanisms have to be targeted to minimize damage from chronic b
How does regular exercise reduce the risk of heart disease?
With exercise, HDL is increased and LDL and triglycerides are decreased, both helping decrease the risk of atherosclerosis. Good laminar blood flow also reduces the risk of intravascular clotting.
Explain the progressive pathophysiologic relationship between a myocardial infarction (MI) and the development of left ventricular (LV) failure. What factors affect the severity of LV failure?
An MI is caused by irreversible hypoxia that leads to cellular death and necrosis. In the zone of hypoxic injury and zone of ischemia, the injured myofibrils are oxygen deprived. Although not irreversibly damaged, they are unable to function normally. Thi
Describe the functional differences between valvular stenosis and valvular regurgitation.
Valvular Stenosis - Forward flow of blood is impeded, resulting in increased workload for the chamber trying to pump blood through the valve.
Valvular Regurgitation - Failure of the valve cusps to shut completely to prevent back flow of blood. Blood flows
Describe the current recommended approach in treating hypertension.
The first step is to initiate lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical activity, reduction of sodium intake, and smoking cessation.
The second step is medication: Diuretics or beta-blockers are us