Cardiac - Disorders of Blood Flow and Pressure

What describes:
- Carries lipids in plasma b/c they're insoluble
- Hydrophobic core + Shell made out of soluble phospholipid & nonesterified cholesterol
- There's 5 types?

Lipoproteins

What are the 5 classes of lipoproteins?

- VLDL's - triglycerides
- LDL's - cholesterol
- HDL's
- IDL - intermediate density lipoproteins
- Chylomicrons

What are 2 pathways involved in the generation and transport of lipoproteins?

1) Exogenous intestinal
2) Endogenous hepatic

What pathway of Lipoprotin transport:
- Invovles CHYLOMICRONS transporting dietary tryglyceride + cholesterol from intestines to liver?

Exogenous pathway

What pathway of Lipoprotin transport:
- Liver is central site of handling lipid
- Synthesize triglycerides from chylomicrons
- Synthesize VLDL from esterified cholesterol and triglyceride
- VLDL will carry their tryiglycerides to fat and muscle cells to b

Endogenous pathway

What lipoprotein:
- Largest of the lipoprotein
- Synthesized in wall of small intestines
- Used to carry dietary tryglyceride to peripheral tissues like adipose and skeletal muscles
- Transport from intestines to liver in Exogenous pathway if any remains

Chylomicrons

What lipoprotein:
- Made in liver
- Carry triglycerides to fat and muscle cells to be stored
- Will form IDL which will go back to liver to be recycled into ___ or converted to LDL?

VLDL

What lipoprotein:
- Less triglyceride, More cholesterol compared to VLDL
- Is made after VLDL carry triglycerides to fat and muscle cells to be stored
- Goes back to liver to be recycled into VLDL or converted to LDL?

IDL

What lipoprotein:
- Main carrier of cholesterol
- Cholesterol is deposited in the intima layer of the coronary arteries and other arteries as a "fatty streak"
- High levels = CORONARY ARTERY RISK
- "Bad cholesterol"?

LDL

What lipoprotein:
- Synthesized in the liver; increases with exercise
- Higher level in women than in men until menopause
- Transport cholesterol FROM peripheral tissues and atherosclerotic plaques in BLOOD VESSELS, back to the liver where it is excreted

HDL

What type of Hypertriglyceridemia:
- Has an unknown genetic basis?

Type 4 Endogenous hypertriglyceridemia

What type of Hypertriglyceridemia:
- Mutation in apolipoprotein CII gene
- Person also has high cholesterol levels?

Type 5 Mixed hypertriglyceridemia

What are the Etiologies of Hyperlipidemia?

- Genetics (Primary hyperlipidemia)
- Lack of LDL receptors
- Increased dietary sensitivity to dietary cholesterol

What are Metabolic syndromes for Hyperlipidemia; how many of these are needed to be diagnosed with hyperlipidemia?

3/5 needed for dx:
- Obesity (BMI >30)
- Hypertension (Stage 1 >140/90, Stage 2 >160/100)
- Low HDL (<35)
- Insulin resistance (Diabetes Type II)
- Hyperglycemia (>110 mg/dL)

What are risk factors for Hyperlipidemia; asided from the 5 Metabolic syndromes used for diagnosis?

- Increased Homocysteine levels
- Smoking
- Increased Age
- Total high cholesterol level
- C-Reactive Protein (CRP)

What is the desirable range for:
- Total cholesterol?

<200

What is the desirable range for:
- LDL?

- <100
- <70 for those with diabetes and heart disease

What is the desirable range for:
- Triglyceride?

<150

What is the desirable range for:
- HDL?

>60
(<40 is considered low)

What are some Therapeutic Lifestyle Changes for those with High LDL (>100)?

- Diet
- Weight control
- Exercise
- Smoking cessation

What describes:
- Cholesterol LOWERING Drug (NOT FOR TRIGLYCERIDE)
- Used to treat high LDL
- Inhibits HMG-coenzyme A essential to hepatic production of cholesterol
- Increases LDL receptors, thus increasing LDL uptake and catabolism?

Statins

What describes:
- A hypersensitve reaction to Statin
- Muscle aches and pains = drug is destroying the tissues
- To get rid of tissue debris, the body circulates it to the kidney = Damaging the kidney ? Renal failure?

Rhabdomyolysis

What describes:
- Cholesterol BLOCKING Drugs
- Used to treat high LDL
- Stops Cholesterol from being absorbed through the GI tract?

Ezetimibe

At what age should pt consider starting an annual cholesterol test?

>20

What is the limit of how much cholesterol can be consumed per day?

No more than 300 mg per day

What are the 3 layers of arteries and veins?

- Tunica externa (collagen fibers, anchors + protects)
- Tunica media (smooth muscle layer + elastin)
- Tunica intima (endothelial layer)

What chemicals does the Endothelium produce that:
- Inhibits platelet aggregation & cause VASODILATION
- Released from stress on endothelium that results in inc in blood flow or bp?

- Nitric oxide
- Prostacyclin

What chemical does the Endothelium produce that:
- Vasoconstrict = Increases vascular resistance
- Also stimulate release of aldosterone from adrenal cortex = increase the reabsorption of Na and H2O
- All of this increases bp?

Angiotensin II

What describes:
- Produced by platelets
- Causes VASOCONSTRICTION and increases aggregation
- Blocked by ASPIRIN?

Thromboxane A2

If we believe a pt is having a MI, what should be given and why?

81mg/day Aspirin, this blocks the platelet's response to aggregate.

What does arterial blood pressure represent?

- The rhythmic ejection of blood from the left ventricle to the aorta during systole
- Also means the amount of pressure exerted against the walls of the blood vessels
- Determines by Arterial pressure regulation + Systolic + Diastolic pressure

What describes:
- The amount of blood (Stroke volume) that is ejected from the heart with each beat
- The rate and force with which the blood is ejected
- The elasticity or compliance of the aorta and large arteries
- INCREASES WITH AGING b/c aorta and la

Systolic pressure

What describes:
- The closure of aortic valve (Onset)
- The energy that has been stored in the elastic fibers of the large arteries during systole (helps move blood forward even when heart's not pumping)
- The resistance to flow through the arterioles int

Diastolic pressure

What describes:
- The difference between systolic and diastolic pressure
- ~40 mmHg (decreases with age)
- ? when ?stroke volume
- ? when ?resistance to outflow (remember bp equation)?

Pulse pressure

What describes:
- The average pressure in the arterial system during ventricular contracction and relaxation
- = 1/3 Sys + 2/3 Dia pressure
- Good indicator of tissue perfusion
- ~90 mmHg (pressure in the venous system and vena cava is ~0, right atrium as

Mean arterial pressure

What is the equation for blood pressure?

- BP = CO x total peripheral resistance (TPR)
- Remember that CO = SV x hr
- TPR depends change in radius of ARTERIOLES (not venules) & viscosity of blood

What are short-term mechanisms for the regulation of blood pressure; controls bp over seconds, minutes and hours?
What is the Long term mechanism?

- Neural (Baroreceptors + chemoreceptors) & Humoral mechanism (via Renin-angiotensin-aldosterone system + ADH / Vasopressin)
- Renal and fluid body system (can be damaged by Hypertension and Diabetes)

What nerve does the Cardiovascular center in the brain stem use the ANS to control the heart?

Vagus nerve

What describes:
- Receptors classified as high-pressure and low-pressure receptors
- High-pressure receptors are located in aorta and carotids arteries; between heart and brain
- Respond to changes in the stretch of the vessel wall by sending impulses to

Baroreceptors

How does a High-pressure baroreceptor respond to a person standing up from a supine position?
How would Low-pressure baroreceptor handle changes in bp?

- The ?bp from position change ? ?Stretch in baroreceptors ? Induce ?heart rate and vasoconstriction to ?peripheral vascular resistance (prevent orthostatic hypotension)
- Moderate ADH secretion for retention of water

What describes:
- Located in 2 common carotid arteries and aorta
- Sensitive to changes in Oxygen, carbon dioxide and hydrogen ion content of the blood
- Main function is to regulate ventilation
- Can communicate with brain stem for system-wide vasoconstr

Chemoreceptors

How would the Chemoreceptors respond to drop in arterial blood pressure?

?bp = ?O2 + ?CO2 + ?H ions ? Stimulate vasoconstriction

What describes:
- Made and stored in the juxtaglomerular cells of the kidneys
- Responds to ?bp, sympathtic stimulation, or ?extracellular Na
- Converts angiotensiogen to angiotensin I which goes to the LUNGS to be converted to angiotensin II by ACE (angi

Renin

What describes:
- Strong vasoconstrictor
- Stimulates aldosterone ? Salt and water retention
- Converted from angiotensin I in the lungs by by ACE (angiotensin converting enzyme)?

Angiotensin II

What describes:
- Released from the POSTERIOR pituitary, made in hypothalamus
- Responds to ?blood volume and blood pressure, ?osmolality of body fluids
- Causes VASOCONSTRICTION; short-term action?

ADH (Vasopressin)

Fill in the blank:
When the body contains too much extracellular fluid, the arterial pressure __(1)__ and the rate at which water and sodium are excreted by the kidney __(2)__ (and vice versa). When bp returns to its equilibrium point, water and sodium ex

1) increase
2) increased
3) normalize
4) higher

Autoregulation is the ability of tissues to regulate their own blood flow. So what would happen if a tissue is receiving excessive blood flow?

The local vessels would constrict; if the flow was deficient, then the vessels would dilate.
If the entire body would receive an ?flow from ?extracellular fluid volume (?CO), then there will be ?peripheral vascular resistance and ?bp.

What are 2 general mechanisms that would increase bp from an increase in fluid volume?

- Increasing cardiac output
- Autoregulation

Fill in the blank:
If person's hypotension is due to a lack of fluid, then blood pressure __(1)__, excretion of water and sodium also occurs.
If hypotension is not due to lack of water, then blood pressure __(2)__ despite water intake and sodium retention

1) rises
2) remains low

Which of the followings are risk factors for Hypertension:
1) Younger men or younger women?
2) Whites or Blacks?
3) Lower or higher socioeconomic group?
4) Younger or Older person?
5) High K diet or High Na diet?
6) Hypo or Hyperinsulinemia?
7) Family his

1) Younger men
2) Blacks
3) Lower
4) Older
5) High Na diet (K flushes out Na = good)
6) Hyperinsulinemia (activates sympathetic system and ?peripheral vascular resistance)
7) Before age 55
8) Central obesity (can also be hereditary)
9) >3 drinks
10) Takin

How does hypertension associate with:
- Headache?

Uncommon but occurs in the back of the head and person wakes up with it

How does hypertension affect:
- Brain?

CVA / stroke
<The main complication for Hypertension>

How does hypertension affect:
- Kidneys?

Loss of ability to concentrate urine

How does hypertension affect:
- Heart?

- Heart failure
- CAD
- Sudden death

How does hypertension affect:
- Circulatory?

Peripheral vascular disease

What Pharmacologic treatment for Hypertension is a:
- Diuretic?

Furosemide

What Pharmacologic treatment for Hypertension is a:
- Beta-adrenergic blocker?

Metoprolol

What Pharmacologic treatment for Hypertension is a:
- ACE inhibitor?

Captopril

What Pharmacologic treatment for Hypertension is a:
- Alpha-1 blocker?

Prazosin

What Pharmacologic treatment for Hypertension is a:
- Calcium channel blocker?

Nifedipine

What Pharmacologic treatment for Hypertension is a:
- Angiotensin II receptor blocker?

Losartan

What's the difference between:
- Atherosclerosis
- Arteriosclerosis?

- Athero = Formation of plaque build up on the inside of blood vessel walls
- Arterio = Chronic disease of the arteries that lead to abdominal thickening & hardening of artery walls

What's the difference between:
- Primary hypertension
- Secondary hypertension?

- Primary = No cause identified; "silent killer"
- Secondary = Elevation in bp due to disease condition like Renal, Adrenocortical hormone disorder, or narrowing of Aorta

What describes:
- The decrease in sytolic blood pressure of 20 mmHg or diastolic blood pressure of 10 mmHg within 3 minutes of standing
- Sign of reduced blood volume
- Can be caused by antihypertensive or psychotropic durgs
- Aging & prolonged bed rest a

Orthostatic / Postural hypotension