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Loeffler Ch 9 - Pathophysiology of the Vascular System
Terms in this set (90)
Explain how cardiac output and vascular tone relate to organ perfusion
Organ perfusion = Vascular tone + Cardiac output
What affects cardiac output and how?
Cardiac Output = Heart Rate x Stroke Volume
What influences the heart rate?
the central nervous system
What influences the stroke volume?
preload, afterload, and contractility
What influences vascular tone?
local mediators and the central nervous system
What is tissue perfusion determined by?
cardiac output and blood pressure
What is blood pressure determined by?
Describe vascular tone
resistance in the arterioles
What type of pressure is normally in the arteries?
What type of pressure is normally in the venous?
When does venous pressure increase?
What is capillary flow controlled by?
hydrostatic pressure, osmotic pressure, and integrity of endothelial cells
Describe what hydrostatic pressure does in capillaries
passes oxygen out of the blood stream
Describe what osmotic pressure does in capillaries
brings waste into the blood stream
List vascular diseases
Varicosities, Hypertension, Hypotension, Arteriosclerosis, Atherosclerosis, aneurysms, Dissection, Angiomas (Hemangioma, lymphangiomas), Vasculltis, Systemic Lupus Erythematosus, vasculitis of the temporal arteries, Raynaud's Phenomenon, Thrombophlebitis, Pulmonary embolism
Permanently dilated venous channels
What are anal varicosities called?
What is the only real issue patients with varicosities deal with?
they are quite painful
What do patients with varicosities have to be aware of?
they are predisposed for thrombi but it is normally a very low risk
increased afterload on the heart
What causes primary or idiopathic hypertension?
of unknown origin
What is the most common type of hypertension?
primary or idiopathic hypertension
What are some causes of secondary hypertension?
tumor on the adrenal gland, thyroid disease, renal disease, cardiovascular disease, neurological dysfunction
How is hypertension diagnosed?
after 3 elevated blood pressures are documented
What qualifies as an elevated blood pressure?
a systolic blood pressure of greater than 140 mmHg or a diastolic blood pressure of greater than 90 mmHg
What are the signs and symptoms of hypertension?
headache, visual changes (floaters), nosebleeds, dizziness
What is the treatment for hypertension?
drugs, stress reduction, lifestyle changes
What are the risk factors for developing hypertension?
ethnicity, genetics, high sodium diet, smoking, obesity, diabetes, sedentary lifestyle, high alcohol consumption, stress
What are long-term complications of hypertension?
stroke, renal failure, blindness, heart disease, and heart failure
Describe malignant hypertension
rapid severe hypertension with a systolic pressure of over 180 mmHg
What are signs and symptoms of malignant hypertension?
severe headache, seizures, rapid death (within months of onset)
How long can hypotension be tolerated by the body?
short term due to organ perfusion issues
What are signs and symptoms of hypotension?
dizziness, faintness, cold skin, chest pain, shortness of breath, seizure
Which age group is at a higher risk of hypotension?
what is hypotension due to positional change called?
everyone has some; "hardening of the arteries", thickening and stiffening associated with age and/or hypertension; process is not completely understood; has a chronic inflammatory component (stress impact); some ple never have any clinical issues
What are risk factors for Arteriosclerosis?
hyperlipidemia, hypertension, smoking, poorly controlled diabetes, hyperhomocysteinemia, age, gender, family history, activity level, psychosocial factors
Describe how smoking influences arteriosclerosis
doubles the rate of it developing
amino acid breakdown
What do high levels of amino acid break down cause?
increased risk of vessel inflammation
What psychosocial factors influence arteriosclerosis?
stress and depression
plaque in the intima
what is atherosclerosis made of?
lipid, calcium, and fibrous deposits
What can atherosclerosis lead to?
strokes, myocardial infarction, gastrointestinal infarction, peripheral vascular disease
Which vessels are more likely to thrombos?
When is the earliest we have evidence of these fatty streaks being laid down?
What type of issue is atherosclerosis?
life long issue that leads to a short term major problem
What is the clinical picture based on?
What are signs and symptoms of atherosclerosis?
angina pectoris, intermittent claudication, abdominal angina, Transient Ischemic Attack or Reversible Ischemic Neurological Deficit
What is the treatment for atherosclerosis?
surgical intervention, risk factor modification to prevent progression of disease, treat complications as they occur
What are the surgical interventions for atherosclerosis?
bypass or Endarterectomy
What is the most important component of risk factor modification?
loss of structural integrity due to damage to the vessel wall; the vessel wall can become thin enough to rupture causing a life threatening hemorrhage
Which vessels are more likely to develop aneurysm with plaque?
What is the treatment for a possible aneurysm?
layers shear apart; blood enters the media of large vessels through a tear in the intima
Where does dissection most commonly happen?
What vascular disease is dissection secondary to?
What happens if a rupture occurs?
it becomes rapidly fatal
What are the signs and symptoms of dissection?
ripping and tearing pain between the shoulder blades, chest pain, and difference in blood pressure between both arms.
List types of angiomas
hemangioma and lymphangioma
local proliferation of capillaries; blanchable; rarely cause problems; purely cosmetic; rarely bleed
What are hemangiomas also know as?
port wine stains
why are hemangiomas removed?
When do hemangiomas typically regress completely?
by the age of 5
dialated masses of lymphatics; uncommon
When do lymphangiomas usually regress?
if congenital, with age
uncommon; non-infectious, inflammatory disease of usually arteries and sometimes veins, blood under skin
What is the cause of vasculitis?
unknown, but thought to be autoimmune
What are some of the effects of vasculitis?
Aneurysms, infarction of tissue, pain
Describe systemic lupus erythematosus
collection of autoimmune diseases, Butterfly rash on face, wide variety of symptoms due to a variety of tissues or organs attached, most common type of vasculitis
What are the signs and symptoms of systemic lupus erythematosus?
renal disease, pleuritic chest pain, arthritis, fevers, hematologic changes, seizures, butterfly rash on face
Describe vasculitis of the temporal arteries
causes migraines, most common form of vasculitis in adults, affects arteries of temples
List signs and symptoms of vasculitis of the temporal arteries.
fever, pain, fatigue, headache, pain, weight loss, may develop sudden loss of vision
How is vasculitis of the temporal arteries treated?
Describe Raynaud's phenomenon
exaggerated response to cold in the small vessels of hands and feet
What is the cause of Raynaud's phenomenon?
usually idiopathic but can be secondary to lupus; stress can also cause it
What can make Raynaud's phenomenon worse?
smoking makes it way worse
an inflammed vein
What is thrombosis related to?
sluggish or turbulent blood flow, increased platelet concentration, venous injury
What can happen once a thrombi forms
can dislodge and travel to lungs
what is it called if a thrombi travels to the lungs?
What are the signs and symptoms of thrombophlebitis?
pain, edema, redness
Describe how to prevent a thrombi from forming
filters, avoid dehydration, get up and exercise
What must you do if DVT is noted?
blood clot in vessels walls; stable
pieces of thrombi break free and travel to pulmonary vasculature; mobile
What can pulmonary embolism lead to?
infarction of portions of the lung and eventual death
What are signs and symptoms of pulmonary embolism?
hypoxia, shortness of breath, chest pain
Describe saddle embolism
almost instant death
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