Patho Chapter 10 & 11

6. What is cardiac output and how is it calculated?

Cardiac output (CO)= *Blood ejected by a ventricle in one minute* -depends on heart rate and stroke volume Calculated by: CO = *SV (stroke volume) × HR (heart rate)*

What are the signs/symptoms? *Remember, the progression of non-Hodgkins lymphoma is disorderly and unpredictable*

Clinical signs, staging, and treatment of the disease are similar to Hodgkins Lymphoma *Early Signs/Symptoms* -large, painless, non tender enlarged lymph node often in the neck *Later Signs/Symptoms* -enlarged spleen and multiple enlarged lymph nodes *Advanced Signs/Symptoms* -weight loss, fever, fatigue, night sweats -Skin itches and infections are common due to decreased lymphocyte function.

What are the risks that CAN be modified?

Those that can be modified include: -Obesity or diets high in cholesterol and animal fats which elevate lipid levels -Sedentary lifestyle which predisposes a sluggish blood flow Also . . . Cigarette smoking whereby the risk associated is directly related to the amount of cigarettes smoked per day. Smoking decreases HDL, increases LDL and promote platelet adhesion, clot formation, and vasoconstriction.

Those that CAN'T be modified...

Those that cannot be modified include: Age (more common after 40 years, particularly in men) -Gender (women are protected by higher HDL levels until after menopause -Genetic or familial factors (have an influence on lipid levels

17. What is multiple myeloma?

(another type of Neoplastic Disorder of *Leukocytes*) *an increased number of malignant plasma cells replace the bone marrow and erode the bone* a neoplastic disease of unknown etiology occurring in older adults and involving the *plasma cells* (mature B lymphocytes involved in production of antibodies)

What are the characteristics of the two ACUTE leukemias? (disease onset, type of proliferating cell, complications, disease progression) Table 10-3 may be helpful

(see next flashcard)

Systole

*Contraction* of myocardium provides increase in pressure to *eject blood*

What blood cell proliferates in Hodgkins Lymphoma?

-*T-Lymphocytes are defective* and the *lymphocyte count is decreased* -The atypical cell used as a marker for diagnosis is the *Reed-Sternberg cell*, a giant cell present in the lymph node

How is leukemia diagnosed?

-*blood tests* showing increased immature leukocytes, abnormal WBCs -*bone marrow biopsy* confirms diagnosis

What cell proliferates in this disorder?

*malignant plasma cells* (mature B lymphocytes involved in production of antibodies) -that *replace the bone marrow*, and aggregate into tumors masses throughout the skeletal system

7. What is polycythemia?

*results from an increased level of circulating red blood cells in the bloodstream* -increased production of erythrocytes and other cells in the bone marrow *a type of Neoplastic Disorder of Erythrocytes*

What do tarry stools indicate?

*warning sign of excessive bleeding and possible sign of a blood-clotting disorder* Bleeding that takes place in the *esophagus, stomach, or the first part of the small intestine* most often causes the stool to appear black or tarry. Bleeding in the upper part of the *GI tract* will most often cause black stools due to: Abnormal blood vessels stool can appear black (tarry) or occult (hidden)

How is leukemia treated?

-*Chemotherapy* -*Bone marrow transplant* -*Drugs:* the more rapid response to drugs, the better prognosis

How is polycythemia treated?

-*Drug therapy* -*Radiation* to suppress bone marrow activity -*Periodic phlebotomy* will relieve congestion in blood vessels temporarily and minimize the possibility of thrombosis (local coagulation or clotting of the blood)

What does the bone marrow look like?

-*Hypercellular bone marrow* -bone marrow can become *fibrotic* in some patients

10. How are leukemias classified?

-*Lympho* - leukemia involving the *lymphoid tissue and the lymphatic system* -*Myelo* - leukemia of the *bone marrow* -*Blastic and acute* - leukemias involving *immature* cells -*Cytic and chronic* - leukemias involving *mature* cells

How is Hodgkins Lymphoma treated?

-*Radiation* -*Chemotherapy* High doses of chemotherapy wipes out the immune system including the bone marrow that produces RBCs so these patients may need a bone marrow transplant -*Surgery*

What is the pathophysiology of Hodgkins lymphoma?

-*T Lymphocytes are defective*, and *lymphocyte count is decreased* -initial involvement of a *single lymph node, often cervical*- neck area -Cancer *then spread to adjacent lymph nodes* in an *ORDERLY* fashion -and then *spreads to organs* via the lymphatics -*lymphadenopathy* (enlarged lymph nodes) -*splenomegaly* (enlarged spleen) -*hepatomegaly* (enlarged liver) -Is accompanied by anemia, fever and if untreated at an early stage, death

In general, what are the signs/symptoms of leukemia?

-*frequent infections* that resist resolution -*excessive bleeding* -*bone pain* -*weight loss* -*fatigue* -*enlarged lymph nodes and spleen* -If there is CNS involvement, one may see *headaches, visual disturbances, drowsiness, vomiting* *Complications of leukemia include:* -Opportunistic infections, including pneumonia -Sepsis -Congestive heart failure -Hemorrhage -Liver failure -Renal failure -CNS depression and coma

8. What are the signs/symptoms of polycythemia?

-Distended (swollen) blood vessels -sluggish blood flow -Increased blood pressure -Hypertrophied heart -Hepatomegaly (enlarged liver) -Splenomegaly (enlarged spleen) -Thromboses and infarctions -Deep bluish-red tone of the skin resulting from engorged blood vessels -Enlarged liver and spleen (from blood circulating through. -Itching -Increased BP -Bounding pulse -Dyspnea -Headaches -Visual disturbances *Diagnostic tests*: -Increased cell counts -Increased hemoglobin and hematocrit values -Hypercellular bone marrow -Hyperuricemia (high uric acid)

*Acute lymphocytic leukemia* (ALL) -*B-Lymphocytes* YOUNGER CHILDREN and *Acute myelogenous leukemia* (AML) -*Granulocytic Stem Cells* ADULTS (Both are acute, so same characteristics, but note the different proliferating cell and age group!)

-High proportion of *immature nonfunctional cells* in bone marrow and peripheral circulation -Onset usually *abrupt* -*marked signs* of complications

13. What are signs and symptoms of an angina attack?

-Intermittent episodes of substernal chest pain -Tightness or pressure in the chest that may radiate to the neck -Pallor (pale skin), diaphoresis (sweating, especially to an unusual degree as a symptom of disease) -Nausea ♥ Pain: Onset: *Transient* or *gradual* Properties: *Dull, heavy, "tightness," "squeezing"* Location: *Substernal, precordial, radiating* Responds to treatment: -Rest -Medication *(nitroglycerin)* ♥ Duration: *15 min. or less* ♥ Myocardial tissues are *not permanently injured*

What are the signs and symptoms?

-Sudden severe chest pain -Pain is not relieved by nitrates -Described as heavy or crushing Various cardiovascular changes are found on PE: -Low blood pressure -Increased HR -Abnormal extra heard sounds -Friction rub from membranes rubbing against one another

Endocardium

-The endocardium (THINK: en="in") is the innermost layer or the internal lining of the myocardium. -It is comprised of connective tissue and squamous cells

Myocardium

-The middle and thickest layer of the heart wall (THINK: "M" for middle) composed of cardiac muscle -The thickness of the myocardium is related to how much resistance the heart must overcome to pump from the heart chambers

What tissue is affected?

-initially involves a single lymph node (frequently in cervical/neck area) -then spreads to adjacent nodes -then to ORGANS via the lymphatics (lymph nodes, spleen, liver)

What is the pathophysiology of multiple myeloma?

-neoplastic disease of unknown etiology -characterized by the proliferation of malignant plasma cells that replace the bone marrow, and aggregate into tumors masses throughout the skeletal system -typically occurs in older adults and involves the plasma cells -*increased number of plasma cells replace bone marrow and erode the bone* -*Blood cell production is impaired* -*Production of antibodies are impaired* -*Multiple tumors with bone destruction develop* in the vertebrae, ribs, pelvis, and skull -The *tumor cells can spread through the body*, into lymph nodes and infiltrate the organs -*Pathological fractures* are common -*Hypercalcemia* develops as the bone is broken down

What is the pathophysiology of leukemia?

-one or more of the leukocyte (WBC) types are present as undifferentiated, immature, nonfuntional cells that *multiply uncontrollably in the bone marrow* and suppress other cell types -large quantities are released as such into the general circulation -as the numbers of leukemic cells increase, they begin to *infiltrate:* lymph nodes spleen liver brain other organs The crowding of the bone marrow causes severe pain owing to pressure on the nerves. The increased number of leukemic cells cause congestion and enlargement of lymphoid tissue.

What are the membranes of the heart? Pericardium

-the outermost layer and is a doubled walled membranous sac that encloses the heart and -prevents displacement of the heart during acceleration or deceleration; -a physical barrier that protects the heart against infection from the lungs and pleural space -Contains pain receptors that elicit changes in blood pressure and heart rate *Layers of Pericardium*= -*Fibrous Pericardium* -*Parietal Layer of Serous Pericardium* -*Pericardial Cavity* -*Visceral Layer of Serous Pericardium (EPICARDIUM)*

11. What are the two acute leukemias discussed in class?

1. *Acute lymphocytic leukemia* (*ALL*-B lymphocytes) 2. *Acute myelogenous leukemia* (*AML*- granulocytic stem cells)

How is hemophilia treated?

1. *DDAVP* (Desmopressin) 2. *Replacement therapy with factor VIII* -replacement therapy for Factor VIII is available for intravenous administration at regular intervals, and especially before any surgical or dental procedures

What are the two lymphomas discussed in class?

1. Hodgkin's Lymphoma 2. Non-Hodgkins Lymphoma

What are some activities that can precipitate an angina attack?

When precipitating factors play a role In angina attacks, they are *related to activities that increase the demands on the heart*, such as: -Running up the stairs -Getting angry -Respiratory infection with fever -Exposure to cold weather

Why does hemorrhage occur in DIC?

When underlying cause of DIC (i.e. burns, trauma, sepsis, obstetric complications) occur, *clotting may be induced* by the release of *tissue thromboplastin* or by *injury to the endothelial cells*, causing platelet adhesion. The process causes multiple thromboses and infarctions, but also consumes the available clotting factors and platelets and stimulates the* fibrinolytic process (enzymatic breakdown of the fibrin in blood clots)...* *The resulting consumption of clotting factors and fibrinolysis then leads to hemorrhage and eventually to hypotension or shock*

What is *art*eriosclerosis?

a GENERAL TERM of all types of arterial changes -is a chronic disease of the arterial system characterized by: -abnormal thickening, narrowing and hardening of vessel walls Common in: -people>50 -diabetics

What cell is increased?

a non malignant increase in *RBCs*

What age group is most vulnerable to Hodgkins Lymphoma?

adults, 20-40 years equal numbers in men & women *a second peak occurrence is found in those 50+ but primarily in men

When are the aortic and pulmonary (semilunar) valves open?

during *VENTRICLE systole* and *ATRIAL diastole*

What are 3 forces influencing blood pressure?

Blood pressure (BP) is altered by: -cardiac output -blood volume -peripheral resistance to blood flow

7. What is preload?

-amount of blood delivered TO heart by venous return -refers to the mechanical state of the heart at the end of diastole with the ventricles at their MAXIMUM volume

11. What are the possible consequences of atherosclerosis? text and Figure 12-12

-as the *atheromas increases in size* and the *coronary arteries* are *partially obstructed*, ANGINA (temporary myocardial ischemia) MAY OCCUR! -a *total obstruction* leads to *MYOCARDIAL INFARCTION!* -artheromas are also a common cause of strokes, renal damamge, and peripheral vascular disease, which affects the legs and feet

Neoplastic Disorders of leukocytes...

...

What are the steps in the development of an atheroma? (text and slide)

-The process appears to begin with endothelial injury in the artery, often at a very young age. Endothelial injury causes inflammation in the area, leading to elevated C-reactive protein (CPR) levels. -WBCs, particularly monocytes and macrophages, and lipids accumulate in the intima, or inner lining, of the artery and in the media, or muscle layer. -Smooth muscle cells proliferate or multiply -Thus, a plaque forms and inflammation persists -Platelets adhere to the rough, damaged surface of the arterial wall, forming a thrombus and partial obstruction of the artery -Lipids continue to build up at the site of arterial injury, along with fibrous tissue -Platelets adhere and release prostaglandins, which precipitate inflammation and vasospasm -this draws more platelets to aggregate at the site, enlarging the thrombus. -Arterial flow becomes more turbulent, again promoting thrombus formation -A vicious cycle persists--blood flow pregressively decreases as lumen narrows -at some point, the plaque may ulcerate and break open -this may precipitate more inflammation or a thrombus may form at this site, resulting in total obstruction in a very short time (this may be the precipitating factor for myocardial infarction) -the artheroma also damages the arterial wall, weakening the structure and decreasing its elasticity -in time, artheromas may calcify, causing further rigidity of the wall -initially, the artheroma manifests as a yellowish fatty streak on the wall --it becomes progressively larger, eventually becoming a large, firm projecting mass with an irregular surface on which a thrombus easily forms -as the atheromas increases in size and the coronary arteries are partially obstructed, angina (temporary myocardial ischemia) may occur; a total obstruction leads to myocardial infarction artheromas are also a common cause of strokes, renal damamge, and peripheral vascular disease, which affects the legs and feet

What cell proliferates in non-Hodgkins?

About 80% of the cases involve B-Lymphocytes

What factors increase afterload? (slides)

Afterload is increased by: -high diastolic pressure resulting from excessive vasoconstriction -Hypertension (High BP) -Vasoconstriction an increased afterload= increased cardiac workload

What factors increase preload?

Preload is increased in: -Hypervolemia -Regurgitation of cardiac valves -Heart failure

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1. What are the warning signs of blood clotting disorders? (Box p201 and slides 4-6).

Spontaneous bleeding or excessive bleeding following minor tissue trauma indicates a blood-clotting disorder -*Persistent bleeding from gums* (around teeth) -*Repeated epistaxis* (nosebleeds -*Petechiae* (pinpoint, flat, red spots on skin and mucous membrane) -*Frequent purpura and ecchymosis* (large, purplish-red or greenish areas on skin) -*More than normal bleeding in trauma* -*Bleeding into joint—hemarthroses* (Swollen, red, painful) -*Hemoptysis* Coughing up blood-(bright red flecks in sputum) -*Hematemesis*-coarse brown particles (coffee ground emesis) -*Blood in feces*- often black (tarry) or occult (hidden) -*Feeling faint and anxious, low blood pressure, rapid pulse* -*Anemia*

6. What are signs and symptoms of disseminated intravascular coagulation (DIC)?

Whether hemorrhage (bleeding) or thrombosis (clotting) dominates, the clinical effects depend somewhat on underlying cause... *Integumentary system:* (skin, hair, nails, glands, and nerves) : -*Hemorrhage* -*vascular lesions* -*oozing* *Central nervous system:* -*Subarachnoid hemorrhage* -*coma* *Gastrointestinal system:* -*Abdominal distention* (occurs when substances or fluid accumulate in the abdomen causing its outward expansion beyond the normal girth of the stomach and waist) -*weakness* *Pulmonary system:* -*ARDS* (acute respiratory distress syndrome) -*infarctions* (tissue death due to lack of blood supply) -*cyanosis* (the bluish or purplish discolouration of the skin or mucous membranes due to the tissues near the skin surface having low oxygen saturation) *Renal system:* -Renal failure

3. What are the components of the cardiac conduction system?

https://www.youtube.com/watch?v=TJR2AfxVHsM The continuous rhythmic repetition of the cardiac cycle (*systole and diastole*) depends on the transmission of *electrical impulses* through the *myocardium*. The myocardium also contains its own conduction system and these cells are concentrated at certain sites in the myocardium called *nodes* The conduction pathway *originates* in the *sinus atria node or SA node*, considered the pacemaker of the heart. The SA node *automatically generates impulses at the basic rate*. This is where the term "sinus rhythm" originates from. *From the SA node*, impulses then spread through the *atrial conduction pathways* resulting in *contraction of both atria*. Next, the impulse is concentrated at the *AV node*, in the *right atrium* near the septum, where it *pauses while ventricles fill with blood*. Finally, the impulse reaches the *Bundle of His*, the *left & right bundle branches*, and the *purkinje* network of fibers to cause *simultaneous contraction of both ventricles*.

What are some disorders that can cause disseminated intravascular coagulation (DIC)?

is a complication of many primary problems: -*Obstetrical complications*, such as abruptio placentae -*Infections* -*Carcinomas* -*Severe trauma*, especially to the brain -*Infectious disease* (sepsis is the most common) -*Solid tumors or hematological cancers* (Treatment is focused on removing underlying cause such as infection or severe trauma and supporting the patient until coagulation balance is restored)

What population is most vulnerable to multiple myeloma?

older adults

16. How does non-Hodgkin's lymphoma differ from Hodgkin's lymphoma?

***Reminder: key words - multiple nodes, non organized*** Clinical signs, staging, and treatment are similar to one another -*Non-Hodgkin's lymphoma* is distinguished by *MULTIPLE NODE* involvement scattered throughout the body and a *NONORGANIZED* pattern of widespread metastases (Hodgkin's is organized) -Non-Hodgkin's is a condition of the lymphoid tissue that mimics Hodgkins disease but does not produce the cell characteristics of Hodgkins disease -Involves multiple peripheral nodes -Does not have a definitive cause -intestinal nodes and organs are frequently involved in the early stage Lymphomas are differentiated by lymph node biopsy

What is DDAVP and what does it do?

*Desmopressin* -this drug *stimulates the endothelium that lines blood vessels to release stored Factor VIII* -may raise clotting factors in some clients

15. What are the signs/symptoms of Hodgkin's lymphoma?

*Early Signs/Symptoms:* -The first indicator is usually a lymph node, often cervical (neck), that is: -large, painless, NONtender *Later Signs/Symptoms:* -Later, splenomegaly and enlarged lymph nodes at other locations may cause pressure effects; for example, enlarged mediastinal nodes may compress the esophagus *Advanced Signs/Symptoms:* -General signs of cancer, such as: -weight loss -anemia -fever -fatigue -night sweats -generalized pruritus (itching) -recurrent infections are common due to decreased lymphocyte function/abnormal lymphocytes interfere with immune response

What are the effects on blood vessels and blood flow, blood pressure and the myocardium?

*Effect on blood vessels:* -blood vessel distension (swell up) *Effect on blood flow:* -blood pressure is elevated -increased blood volume and viscosity (SLUDGY BLOOD) -blood flow sluggish -frequent thrombosis and infarctions throughout the body -hemorrhage *Effect on myocardium*: Heart is HYPERTROPHIED (thickening of heart walls)

How is this disorder staged? (check out figure 11-9)

*Extensive testing is required to stage lymphomas accurately* Various Staging Systems are available. Staging for Hodgkin's lymphoma *uses the diaphragm as the differential landmark*. The Ann Arbor staging system generally defines the following stages as: *Stage 1 cancer:* affecting a *single* lymph node or region *Stage II:* affecting *two or more* lymph node regions on the *same side* of the diaphragm or in a relatively localized area *Stage III:* involves nodes on *both sides* of the diaphragm and the *spleen* *Stage IV:* represents diffuse extralymphatic, *widespread* involvement such as bone, lung, or liver

4. What are the steps of the cardiac cycle?

*NOTE:* The *two atrioventricular (AV) valves*, the *mitral valve (bicuspid valve), and the tricuspid valve*, which are between the upper chambers (atria) and the lower chambers (ventricles). The *two semilunar (SL) valves*, the *aortic valve and the pulmonary valve*, which are in the arteries leaving the heart. The cardiac cycle refers to the alternating sequence of DIASTOLE (the relaxation phase of cardiac activity) and SYSTOLE (the contraction phase) which is coordinated by the conduction system for maximum efficiency 1. The cycle begins with the two atria relaxed and filling with blood (from inferior and superior vena cavae into the right atrium, and from the pulmonary veins into the left atrium) 2. The AV valves open as the pressure of blood in the atria increases and the ventricles are relaxed 3. Blood flows into the ventricles, almost emptying the atria. 4. The conduction system stimulates the atrial muscle to contract, forcing any remaining blood into the ventricles 5. The atria relax. 6. The two ventricles begin to contract, and pressure increases in the ventricles 7. The AV valves close. 8. For a brief moment, all valves are closed, the ventricular myocardium continues to contract, building up pressure in this isovolumetric phase (no change in blood volume in the ventricles) 9. Then the increasing pressure opens the semilunar valves; blood is forced into the pulmonary artery and aorta. Note that the muscle contraction must be strong enough to overcome the opposing pressure in the artery to force the valve open. This is significant, particularly in the left ventricle, in which the pressure must be greater than the diastolic pressure in the aorta. Because the pulmonary circulation is a low-pressure system, the right ventricle does not have to exert as much pressure to pump blood into the pulmonary circulation. 10. At the end of the cycle, the atria begin to fill again, the ventricles relax, the aortic and pulmonary valves close to prevent backflow of blood, and the cycle repeats The same volume of blood is pumped from the right to the left sides of the heart during each cycle. This is important to ensure that blood flow through the systemic and pulmonary circulations is consistently balanced.

9. What are atheromas? What is contained in an atheroma?

*PLAQUES* consisting of lipids, cells, fibrin, and cell debris, often with attached thrombi, which form inside the walls of large arteries *-artheromas are present in atherosclerosis*

Diastole

*Relaxation* of myocardium required for *filling chambers*

9. What is leukemia?

*The leukemias are a group of neoplastic disorders involving the leukocytes* (THINK: "LEUKemias= LEUKocytes= white blood cells) -*Uncontrolled WBC production in bone or lymph nodes* -a malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leukocytes. These suppress the production of normal blood cells, leading to anemia and other symptoms-(*other hemopoietic (relating to blood or blood cells) tissues are reduced*) -*One or more types of leukocytes are undifferentiated, immature, and nonfunctional* -Large numbers released into general circulation -Infiltrate lymph nodes, spleen, liver, brain, other organs

17. What are the warning signs of a myocardial infarction?

*Warning signs of a heart attack* -Feeling pressure, heaviness or burning in the chest, especially with increased activity -Shortness of breath -sweating -weakness -fatigue -Nausea, indigestion -Anxiety, fear

15. What is myocardial infarction?

*a heart attack* Book: occurs when a *coronary artery is totally obstructed*, leading to *PROLONGED ischemia* and cell death, or infarction, of the heart wall Slides: Myocardial infarction is the acute onset in which muscle tissue dies because of lack of blood flow This results in varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting and sometimes loss of consciousness.

5. What is the primary event that initiates this disorder (DIC)?

*activation of the clotting process in systemic microcirculation* (the circulation of the blood in the smallest blood vessels) (See figure)

Are other blood cells increased as well?

*granulocytes* *platelets*

1. What is lymphoma?

*malignant neoplasms involving lymphocyte proliferation in the lymph nodes* (a group of blood cancers that develop in the lymphatic system)

2. What is the basic abnormality in Hemophilia A?

Deficit or abnormality of factor VIII (8)

When are the AV (tricuspid and mitral) valves open?

During *ATRIAL systole* and *VENTRICLE diastole*

How is Hemophilia A transmitted?

Transmitted as an X-Linked recessive trait

What is Hemophilia A?

A coagulation disorder -caused by defect or deficiency in clotting factors -inherited disorder

4. What is disseminated intravascular coagulation (DIC)?

A coagulation disorder (Hemophilia A is the other type); -Involves both excessive *bleeding and clotting* -*Excessive clotting in circulation* -abnormal clumps of thickened blood (clots) form inside blood vessels. These *abnormal clots use up the blood's clotting factors, (which can lead to massive bleeding in other places*) -*Thrombi* (blood clot) and *infarcts* (small localized area of dead tissue due to lack of blood supply) occur -*Clotting factors are reduced to a dangerous level* -Widespread, uncontrollable *hemorrhage* results Very poor prognosis, with high fatality rate!

16. What are 3 ways in which a myocardial infaction can develop?

An infarction may develop in three ways: 1. A *thrombus* may build up and *obstruct* the artery (i.e. atherosclerosis); 2. *Vasospasm* with partial occlusion leading to total obstruction; or 3. *Part of a thrombus may break away, forming an embolus* that flows through the coronary artery until it lodges in a smaller branch blocking that vessel

12. What is angina?

Angina is *chest pain* caused by a myocardial ischemia -It occurs when there is deficient oxygen for the heart muscle -It is a reversible ischemia -The discomfort can last from 3 - 5 minutes -If blood flow is restored, there is no permanent damage

What causes angina?

Angina occurs: -When the blood supply to the myocardium is impaired (*i.e. atherosclerosis*) -When the heart is working harder than usual and needs more oxygen -When a combination of these factors occur

What is *ath*erosclerosis?

Atherosclerosis is the *MOST COMMON FORM of arteriosclerosis!* Differentiated by the presence of *atheromas* *atheromas*= plaques consisting of lipids, cells, fibrin, and cell debris, often with attached thrombi, which form inside the walls of large arteries. -*arteries are hardened and narrowed as a result of plaque that has built up along the inside of the artery walls* -Atherosclerosis can occur in any artery in the body

Where do tumors appear in multiple myloma?

Bone-destroying tumors in: -*Vertebrae* -*Ribs* -*Pelvis* -*Skull* -The tumor cells can spread through the body, into lymph nodes and infiltrate the organs

(Hemophilia A): Which sex is the carrier? Which sex manifests the disease?

CARRIED by WOMEN (who are asymptomatic) but MANIFESTED in MEN (think: MANifested= men)

How does an atheroma lead to development of an embolus and arterial occlusion? (text and slide)

Clinical Manifestations: -Presents with signs and symptoms that result from inadequate perfusion of tissues because of obstruction of vessels. -Partial obstruction may lead to a transient ischemic event. -As the lesion becomes complicated a thrombosis may result in tissue infarction. -Obstruction of vessels can cause significant pain and disability. Atherosclerotic obstruction of the vessels supplying the brain can cause a stroke. -CAD caused by arthrosclerosis is the major cause of myocardial ischemia.

10. What are the modifiable risks of atherosclerosis?

Etiology of atherosclerosis: Appears to be multifactoral There are 2 groups of risk factors: -One can be modified -One cannot be modified

5. What is systolic pressure?

Exerted when blood is ejected from ventricles (high)

What clotting factor is replaced in treating Hemophilia A?

Factor VIII

What is afterload?

Force required to eject blood from ventricles -Determined by peripheral resistance in arteries

What are the characteristic of the pain associated with this event?

Pain Onset: *Sudden* Properties: *Severe, "heavy," "crushing"* Location: *Chest, often radiating to jaw, arms, neck, shoulder, back* Unrelieved by rest or nitroglycerin ♥ Duration: Lasts *30 minutes or more* ♥ Related symptoms: *diaphoresis, cold/clammy skin, hypotension, nausea, vomiting, indigestion, dyspnea, gray, ashen color, anxiety, restlessness* ♥ *May be "silent" (no pain)*, yet have related symptoms

What are petechiae?

Pinpoint, flat, red spots on skin and mucous membrane *warning sign of excessive bleeding and possible sign of a blood-clotting disorder*

What are the signs and symptoms of hemophilia?

Varying degrees of severity... -*Prolonged bleeding* after minor tissue trauma -*Persistent oozing* after minor injuries -*hematomas* (a solid swelling of clotted blood within the tissues) -*Spontaneous bleeding/hemorrhage into joints* -*blood in feces* or -in *urine* (blood may appear in the urine because of bleeding into the kidneys)

What is coffee ground emesis (*hematemesis*)?

Vomiting up blood- that looks like coarse brown particles (coffee ground emesis) *warning sign of excessive bleeding and possible sign of a blood-clotting disorder*

What is the pathophysiology of polycythemia?

Polycythemia stems from problems with the bone marrow. Bone marrow is found in the center of most bones and normally produces all red blood cells and platelets and most white blood cells. When this process breaks down, production of cells is no longer orderly and conditions such as polycythemia can result... *Primary polycythemia*—polycythemia vera -Increased production of erythrocytes and other cells in the bone marrow -Neoplastic disorder -Serum erythropoietin levels are low *Secondary polycythemia*—erythrocytosis -Increase in RBCs in response to prolonged hypoxia -Increased erythropoietin secretion -Compensation mechanism to provide increased oxygen transport -*A non malignant increase in RBCs* -*Often increased granulocytes and platelets* -*increased blood volume and viscosity* -*blood vessel distension* (swell up) -*blood flow sluggish* VISCOUS, SLUDGY BLOOD! -*frequent thrombosis* (local coagulation or clotting of the blood in a part of the circulatory system) and *infarctions* throughout the body -*blood pressure is elevated* -*hemorrhage*

14. How is an angina attack treated (what is the medication used and how is it administered?)

Quickly relieved by rest and the administration of medications such as *vasodilators (nitroglycerin)* Book: Angina occurs as recurrent, intermittent brief episodes of substantial chest pain, usually triggered by a physical or emotional stress that increases the demand by the heart for oxygen. -Many patients carry nitroglycerin (in the correct dosage) with them at all times to be *administered sublingually* in an emergency (tablet is not swallowed but dissolves under the tongue and enters the blood directly for instant effect). -if chest pain persists following treatment, it is important to seek hospital care because pain may indicate presence of myocardial infarction

What is stroke volume?

Stroke volume (SV)= *Volume of blood pumped out of ventricle/contraction*

What is diastolic pressure?

Sustained pressure when ventricles *relax* (lower) THINK: "Relax, I'm on a DIet"

What are the signs/ symptoms of multiple myeloma?

The FIRST sign is usually *infection* due to decreased antibody production Later signs include: -*bone pain* -*pathologic fractures* -*anemia* -*hemorrhage* -*impaired kidney function* -*kidney failure* (Treatment involves chemotherapy, analgesics for bone pain, and bone marrow transplant)

What are the layers of the heart wall?

The heart consists of three layers: Pericardium Myocardium Endocardium

1. Know the anatomy of the heart.

The heart has four chambers: -Left atrium -Right atrium -Left ventricle -Right ventricle The atria is smaller than the ventricles and have thinner walls.

The circulatory system review...

The heart= -is a pump for circulatory blood -is located in the mediastinum -is enclosed in a double-walled pericardial sac -is the size of a fist, weighs a pound The heart pumps blood through two separate circulatory systems: 1. *Lungs* (pulmonary) 2. *Systemic* -*right* side heart pumps through the *pulmonary circulation* -*left* side of the heart pumps blood throughout the *systemic* circulation supplying blood to all of the body *except the lungs*

How does myocardial infarction differ from angina?

This *prolonged ischemia* (reduction in blood supply) cause *IRREVERSIBLE DAMAGE* to the heart muscle, --->whereas ANGINA is REVERSIBLE