What disease is responsible for more morbidity and mortality than any other disease?
cardiovascular disease (heart disease), heart attack or stroke
what is the #2 cause of death?
What are the 3 vessel types?
1) large or elastic arteries 2) medium sized or muscular arteries 3)small arteries (arterioles)
What are large/elastic arteries
aortas and its branches and pulmunary arteries
What are medium or muscular arteries
coronary or renal arteries
What are small/arterioles arteries?
they are control points for constriction and pressure/velocity of blood flow. Vasocontriction/vasodialation
What are capillaries and what are their purpose?
they are one cell thick and designed for slow blood flow. They are responsible for exchange of diffusable substances
Describe venules and what can affect it?
Very thin walls, can be easily penetrated by tumors and inflammations
What are lymphatics and what are their purposes?
They have very thin walls. They drain excess interstitial fluid. Can transfort infection or tumor cells
What does Arteriosclerosis mean?
hardening of the walls. often due to hypertension
What are the three patterns of Arteriosclerosis?
1) Arteriolosclerosis 2)Monckeberg medial calcific sclerosis 3)atherosclerosis
What is arterioloscelorosis?
it is the disease of the arteries. The wall thickens and the lumen narrows. Can be related to diabetes and Hypertension and aging.
What is Monckenberg medial calcific sclerosis and how is it different of arteriolosclerosis?
It is a harderning of the muscular arteries. There is NO affect on the lumen. Occurs in pts +50yr old.
most frequent and clinically significant. Hardering of the arteries (intima) due to a plaque deposits, which may contain lipids and cholesterol. Prone to ulcers and calcification
What is the most common form of arteriosclerosis?
Where do the plaques form in atherosclerosis?
there is elevated cholesterol in the tunica intima, can also involved the tunica media.
What are the complications of atherosclerosis?
(OCUTESHA) occlusion of an artery, calcification/hardening, ulcerations, thrombosis, embolism, spasm, hemorrhages and aneurism
What are the NON controllable risk factors of atherosclerosis?
age 40-60year olds, premenopausal women are more protected than age matched men, diabetes, HTN and lipoprotein metabolism
What are the controllable risk factors of atherosclerosis?
hyperlipidemia (diet), HTN, diabetes, smoking, obesity, exercise, stress
Describe how Atherosclerosis develops
injury to the endothelial cells (toxins, virus), lipoprotein start to accumulate, monocytes (WBC) adhere to the endothelial cells, produce foam cells, platelets adhere, SMC production, lipid accumulation
Describe the symptoms of Hypertensive Vascular Disease
it is asymtopmatic until late into its course--essenstial hypertension
How do you calculate blood pressure
cardiac output X peripheral resistance
What affects cardiac output?
blood volume and sodium concentration (heart rate contractibility)
What affects peripheral resistance?
neural and hormonal inputs and local factors (ph)
What decreases BP?
What increase BP?
Aldosterone--cause an increase in NA absorption in the kidneys
What are the risk factors of hypertension?
Gender, Race, Age, Stress, Smoking, Physical inactivity, Obesity, Diet (sodium), Family history
What happens to the BP if you fit the cuff too loosely?
falsely low presure
What happens to the BP if you fit the cuff too tightly?
Falsely high pressure
What is normal BP and what is high BP?
120/80 and 140/90
What is stage 1 hypertension?
What is stage 2 HTN?
Describe the symptoms of hypertensive encephalopathy
restlessness, confusion, blurred vision, sleepiness, nausea, vomiting and headache
What are some agents that should be screened for that can be related to HTN?
hormonal contraceptives, steroids, caffeine, decongestants, amphetamines, and licorice!
What kind of laboratory tests can be done on a HTN patient?
Urinalysis, Blood glucose, Hematocrit, Lipid panel, Serum potassium, Creatinine, Thyroid, Calcium
90-95% of all HTN are what?
What are the tx of HTN?
change lifestyle first (diet, moderate drinking, sodium reduction, DASH eating) and then medications
What can secondary HTN cause?
renovascular disease, renal disease, phenochromocytoma, cushing syndrome, hyperaldosterone
What are some risk factors for heart disease?
smoking, hypercholesteremia, DM, family history of heart disease
What are some clinical signs of hypertensive emergency?
1)fundoscopic changes (hemorhages, exudates) 2)cardiovascular dysfunction (heart failure, fast heartbeat) 3)increased intracranial pressure (confusion, seizures)
What are some clinical symptoms of hypertensive emergency?
Encephalopathy, Headache, Malaise (weak/tired), Dizziness, Blurred vision, Chest pain, Palpitations, Shortness of breath
What is the BP for Malignant hypertension
What are some medications for HTN?
Diuretics (lower BP), Beta-blockers, ACE-inhibitors, ARB's, Calcium channel blockers
What is an aneurism?
It is a localized dialation of a blood vessel or the heart
What is a true aneurism?
It involves all three layers of the arterial wall (intima, media and adventitia)
What causes a true aneurism cause?
atherosclerosis, syphilitic, congenitial aneurism and trauma
What is a false aneurism?
there is a damage to the vascular wall, which leads to a hematoma (an accumulation of blood outside of the vessel wall)
What is an arterial disection?
It is when blood enters thru the arterial walls
What kind of complications can an aneurism cause?
can cause: hemorrhages, emboli, pressure on adjacent structures, aortic disection
Where do aneurism usually occur?
thoracic aneurism, abdominal aortic aneurism, berry aneurism and syphillic aneurism
Where do where atherosclerotic aneurysms occur most frequently?
in the abdominal aortic aneurism (AAA)
What is vasculitis?
an inflammation of the blood vessel wall
What is the most common vasculitis?
giant cell (temporal) arteritis
What do giant cell (temporal) arteritis affect?
mostly infects the temporal arteries of the head, as well as vertebral and the opthalmic arteries of the aorta
Describe the manifestation of the giant cell(temporal) arteritis
it is granulomous in nature. can occlude vessels and cause vision loss
What are some clinical and ocular symptoms of giant cell (temporal) arteritis?
fever, fatique, unilateral headchaes and pain in jaw when chewing. Ocular symptoms: amaurosis fugax (loss of vision in 1 eye due to lack of blood flow to the retina), diplopia and blindness
What are the ways to dx giant cell (temporal) arteritis?
1) look at clinical symptoms 2) elevated erythrocyte sedimentation rate 3)biopsy of the temporal arteries
What are the ways to tx giant cell (temporal) arteritis?
what are the 4 common lymphatic disorders?
1)varicose veins 2)thrombophlebitis 3)lymphangitis 4)lymphedema
What is the cause of varicose vein?
high intralumal pressure and a weak vessel walls-->causes veins to be abnormally dialated and twisted
Varicose veins are more common in which areas of the body?
lowe extremities--superficial vein
What are some complications of varicose veins?
pain, edema, thrombosis, embolization, stasis dermatitis and ulcers
Give 2 examples of varicose veins?
Esophageal varices (dialated veins of the esophagus) and Hemorrhoids (swelling of veins around the anus)
What is Thrombophlebitis?
A type of varicose vein inflammation. It is a vein inflammation related to a blood clot or a thrombus (blood clot that breaks apart)
What are the causes of Thrombophlebitis?
congestive heart failure, neoplasia, pregnancy, obesity, postoperative state, prolonged bed rest, immobilization
What are the clincal signs of Thrombophlebitis?
heat, tenderness, redness, swelling, pain; or no signs
What is homan's sign?
it is a sign for deep vein thrombosis (DVT)--pain in the calf, when the ptn dorsiflex his feet at the ankle
What is Lymphangitis?
it is a type of varicose vein inflammation. it is an inflammation of the lymph system from an infection. These systems will become inflamed and can obstruct the lymph node and swells.
What is the most common cause of lymphangitis?
What is Lymphedema?
It is a type of varicose vein inflammation. There is an obstruction in the lymph nodes-->causing build up of interstitial fluid
What causes Lymphedema?
cancer, trauma, inflammation and scarring
What are the four tumors of the blood vessles?
1)congential hemangiomas 2)karposi sarcoma 3) Cutaneous Hemangioma and 4)Cherry Hemangioma
what is the most common tumor of the blood vessle?
Describe Congenital hemangiomas and where is it found?
it is the most common and benign tumor of the blood vessel. Found on the skin and the mucous membrane. "Wad of capillaries" Increase # of vessels filled with blood.
What is Cherry Hemangioma
it is a type of blood tumor. Small cherry spots on the skin that increase with age
What is karposi sarcoma?
it is a malignant blood tumor - caused by HHV-8. Found in ptn with AIDs
What is Telangiectasia?
it is an abnormal dialation of pre-existing small vessels in the skin or mucous membrane
What can cause Telangiectasia
Congenital, liver disease, atrophic skin, surface of basal cell carcinoma, or pregnancy
What is a common sign of Telangiectasia?
Port Wine Stain
What is port wine stain?
it is a sign of Telangiectasia. Purple and reddish discoloration of the skin due to dialated capilaries
What are the two major causes of heart disease?
1) arrthymia due to ischemia 2)loss of myocardial muscle mass
What is Conjestive Heart Failure?
conjestion of the blood, because blood does not pump out fast enough (low cardiac output), so when the venous blood returns to the heart, it backs up. Leading to conjestion!
What causes CHF?
systolic dysfunction - heart cannot contract due to ischemia or hypertension
What happens during diastolic failure?
This occurs during CHF. What happens is that there is an abnormal relaxation phase. It usually occurs in older patients and ptns with HTN or DM
Describe the left side heart failure
blood backs up into lungs (causes pulmunary edema)-->decreased oxygenation (more failure)-->decreased blood flow to the kidneys-->kidney will increase blood volume
What cuases left side heart failure?
Ischemic heart disease, Systemic hypertension, Aortic and mitral valve disease, Diseases of the myocardium
What are the symptoms of left side heart failure?
Dyspnea (hard to breathe), orthopnea, paroxysmal nocturnal dyspnea (abrupt awakening to gather breath), cough, fatigue, confusion
What are some clinical signs of left side heart failure?
fast heart rate (tachycardia), clicking at lung base and edema
Describe right side heart failure
a lung disease that decreases pulmonary vascular bed-->causes pulmunary hypertension and Cor pulmonale
What is the most common cause of right side heart failure
left side heart failure
What are some clinical symptoms of righ side heart failure?
fatique, and very few respiratory symptoms
What are some clinical signs of right side heart failure?
edema, (ascites) fluid in the abdomen, pleural effusion in the chest cavities
Describe left-to right shunt
A shut is an abnormal communication btwn chambers or vessels. Blood flows from high pressure to low pressure side (going the wrong way). A non cyanotic heart disease
What is the most common cardiac malformatoin?
Describe right-to-left shunt
a Cyanotic heart disease - blood bypasses lungs and goes into systemic circulation. Poorly oxygenated blood from right side mixes with left side oxygenated blood. Non oxygenated blood goes to the organs!
What is mitral valve prolapse?
the mitral valve flops back into the left atrium
What are the symptoms of a mitral valve prolapse?
can cause chest pains, arrythmia, palpitations, headaches and anxiety
If you hear a midsystolic click on auscultation, what does the ptn have?
mitral valve prolapse
Patients with mitral Valve Prolapse have increased risk for what?
infective endocarditis, ventricular arrythmias, stroke, and systemic infection
What is Ischemic Heart Disease?
Imbalance of oxygen supply to meet the muscle demand in the heart
What is ischemia caused by?
increased heart rate, HTN, not enough o2 to meet demand of increased heart rate, due to anemia, co2 poisoning, coronary artery disease (reduction in coronary artery blood flow)
What are the 4 Clinical Syndromes of ischemia?
1) Angina pectoris 2)acute myocardial infarction (MI) 3)Chronic ischemic heart disease 4)Sudden cardiac death
What is Angina pectoris?
It is one of the syndromes of ischemia. it is Intermittent chest pain caused by transient, reversible myocardial ischemia
What are the symtoms of angina pectoris?
chest pains, that can radiate to jaw/neck.
what is Acute myocardial infarction (MI)?
It is one of the syndromes of ischemia. it is cardiac muscle death.
what causes angina pectoris?
excercise, pain, anger, emotions
What can relieve angina pectoris?
rest, o2 and nitroglycerin
What are the three types of angina pectoris?
1) typical (stable-due to increased 02 demand)
2) prinzmetal variant (occurs at rest due to coronary artery spasm)
3)unstable (pre-infarction angina)
is Acute myocardial infarction (MI) deadly?
yes, it is a common cause of death. arrythmias can occur within the first 24 hours
What can cause acute myocardial infarction (MI)
coronary artery occlusion (plaque forms and adhere to endothelial cells, vasospasm and further coagulation-->thrombus forms)
What are the symptoms of myocardial infarction (MI)?
Like angina but worse, Chest pain, nausea, vomiting, diaphoresis (profuse sweat), dyspnea (difficulty breathing)
What is Chronic ischemic Heart disease?
Progressive heart disease due to ischemic myocardial damage. Causes pump failure
What is Sudden cardiac death
lethal arrhythmia following myocardial ischemia. unexpected death from cardiac causes without symptoms or within 24 hrs of symptoms
what causes Sudden cardiac death
in what popluation can sudden cardiac death be seen in
world class athletes
Describe Hypertensive Heart Disease
enlargement of the ventricle due to hypertension ONLY. if it occurs on the left side (systemic hypertension), if it occurs on the right side (pulmunary hypertension-cor pulmonle)
Describe Rheumatic Valvular Disease
inflammation of valves, myocardium or pericardium
what causes Rheumatic Valvular Disease
occurs 2-3 weeks after a group A beta-hemolytic streptococcus pharyngitis = strep throat
Rheumatic Valvular Disease is common in what population?
How do you diagnose Rheumatic Valvular Disease
1) Serological evidence of previous streptococcal infection 2) jones criteria (2 more more)
What is Jones criteria?
used to dx Rheumatic Valvular Disease.
1) Carditis 2) Migratory polyarthritis of large joints
3) Subcutaneous nodules 4) Erythema marginatum of the skin = red rings 5) Sydenham chorea
what is a Heart Murmur?
Anything that interferes with blood flow and creates turbulence and therefore makes a noise
What are some causes for heart murmurs?
Valvular disease, Vessel stenosis, Congenital abnormalities, Metabolic rate (Pregnancy, Thyroid --> Both increase HR)