Alteration in Arterial/Vascular Function
What are the three things adequate blood supply to the body's organs depends on?
1. A heart strong enough to pump 2. Arteries and veins that can constrict or squeeze 3. Enough blood and fluid within the vessels
How does elevated salt intake cause hypertension?
1. It increases osmotic pressure and thus vascular volume 2. The heart works harder to pump out extra fluid causing hypertension
How does hypertension cause hematuria and proteinuria?
1. Kidneys sense poor blood flow 2. Fluid is retained 3. Kidneys become enflamed and build up toxins 4. Blood cells and proteins permeate the kidneys due to inflammation 5. Urine excretion takes blood cells and proteins with it
Why does pulmonary edema occur with hypertension?
1. Left side of the heart begins to fail 2. Fluid backs up into the lungs 3. Increased hydrostatic pressure pushes fluids out into the lungs
How does lung disease cause hypertension?
1. Left side work of the heart increases 2. Pulmonary edema forms from backward congested flow 3. Right side of the heart gets congested 4. Work of total heart increases and blood flow decreases
How do the kidneys cause hypertension?
1. Sense decreased blood flow 2. Secrete renin 3. Retain fluid volume 4. Increased fluid volume increases work of heart 5. Blood pressure increases
What are the steps of arterial thrombus formation?
1. There is injury to the intima 2. LDL attaches to the damaged area of the vessels 3. Macrophages engulf the LDL with foam cells 4. Foam cells combine with additional lipids 5. Fatty streaks form 6. Fatty streaks become fibrous plaques 7. Fibrous plaques accumulate at the sites of injury 8. Platelet caps cover fibrous plaques
How does smoking cause hypertension?
1. Toxins cause atherosclerosis in arteries 2. Nicotine causes constriction of vessels 3. Resistance and work of the heart increase 4. Blood pressure increases
Why can smoking lead to atherosclerosis?
1. Toxins enter the bloodstream and irritate the intima 2. Nicotine constricts the vessels further
What is Virchow's triad?
1. Vessel wall damage 2. Excessive clotting 3. Alterations in blood flow, such as turbulence or sluggish blood movement
How do fractures lead to fatty particle embolisms?
1. When fractures occur, they release fatty particles 2. Inflammation occurs at the fractures, opening up the vessels 3. Fatty particles cross over to the vessels and move to the lungs 4. The lungs vessels are too small for fatty particles and embolisms occur
What is prehypertension?
120-139/80-89
What is the diastolic pressure above with malignant or resistant hypertension?
140 mmHg
What is stage 1 hypertension?
140-159/90-99
What is stage 2 hypertension?
>159/>99
What is a saccular aneurysm?
A bulge on one side of vessel
What is peripheral artery disease (PAD)?
A disease in arteries outside the heart
What is orthostatic hypotension?
A drop in blood pressure due to a sudden change of posture
What is primary hypertension?
A multifactorial disease that has both genetic and environmental triggers
What is it called if a clot goes straight to the lungs?
A pulmonary embolism
What is it called if a clot goes straight to the brain?
A stroke
What is the difference between a thrombus and an embolism?
A thrombus is a blood clot that forms in a vessel; an embolism is a clot that travels to a new site from where it is formed
What is a DVT?
A thrombus that forms in the deep, larger veins, usually in the legs
What are the most common sites for PAD to occur?
Abdominal aorta Carotid arteries Femoral and iliac arteries
What are the complications of shock?
Acute renal failure Acute respiratory distress syndrome Hepatic failure Paralytic ileus Stress or hemorrhagic ulcers Infection Depression of cardiac function
What do the foam cells attach to in thrombus formation?
Additional lipids and triglycerides on top of the damaged vessel wall
What are the layers of a blood vessel from outside to inside?
Adventitia Media Intima
When is there an inherent risk for blood clotting?
After giving birth or post surgery
When does malignant or resistant hypertension occur?
After trauma or surgery
What are the major determinants of atherosclerosis?
Age Diet Obesity Smoking Lack of exercise High blood pressure Diabetes Genetic influence
What is encephalopathy?
Altered brain function
What are the early manifestations of shock?
Anxiety Tachycardia Pallor Light-headedness Syncope Sweating Oliguria
What is an embolism?
Any particle that can float in the blood stream
What three areas are at a higher risk for aneurysms?
Areas of turbulent blood flow Bifurcation areas Area where an atheroma has formed
How are arteries and veins different in flexibility?
Arteries are firm, veins are pliable
What are common causes of aneurysms?
Atherosclerosis Trauma Syphilis Congenital defects Hypertension
What is the difference between atherosclerosis and arteriolosclerosis?
Atherosclerosis occurs in the arteries; arteriolosclerosis occurs in the arterioles
What is statis dermatitis?
Atrophy of the skin due to insufficient oxygenation
What are the types of embolisms?
Blood clots Fatty particles Amniotic fluid Fibrous plaques
What happens if there is edema and inflammation in a vessel?
Blood flow is decreased and the heart has to work harder
What happens if there is atherosclerosis in the carotid arteries?
Blood flow to the brain is decreased and the workload on the heart increases
What is septicemia?
Blood poisoning from bacteria that occurs as a result of shock
How can left-sided heart failure cause a stroke?
Blood pools in the left atrium causing a clot to be sent out to the brain
Who is usually seen with Raynaud's Disease?
Both males and females
What is atherosclerosis?
Buildup of plaque that decreases the lumens of the arteries
Why does acidosis form with shock?
Cell metabolism is diminished and waste is removed, lowering pH
What is angina?
Chest pain caused by oxygen depletion to the heart muscle
What is vasculitis?
Chronic inflammation of blood vessels
How does hypertension cause aneurysms in the aorta?
Constant high pressure on the aorta causes atheroma growth and then aneurysms
What is the cause of cardiogenic shock?
Decreased pumping capability of the heart
What disease raises the risk of PAD?
Diabetes
What does arteriolosclerosis lead to?
Diffuse ischemia and necrosis in the kidneys, brain, or heart
What type of medications have an effect on orthostatic hypotension?
Diuretics and antihypertensive drugs
What are the signs and symptoms of orthostatic hypotension?
Dizziness/Syncope Pallor Sweating Tachycardia
What happens as a result of inflammation at the intima of a vessel?
Edema fills the lumen
What is secondary hypertension?
Elevated blood pressure caused by an underlying disease
What is malignant or resistant hypertension?
Elevated blood pressure that does not respond to most medications or interventions
What causes the heart to eventually fail when working against vessel resistance?
Enlargement of heart Lack of oxygen to heart
To what extent does edema occur with a DVT?
Everything below the DVT will become edematous
What is the only way to increase HCL?
Exercise
What is an atheroma?
Fibrous plaques that accumulate at the site of a vessel injury
Which type of aneurysm is the most deadly?
Fusiform
Which two aneurysms are seen in the abdominal cavity?
Fusiform and dissecting
What is C-Reactive protein a sign of?
General inflammation
How is vasculitis caused?
Glucose irritates the intima and causes widespread inflammation and edema on the arterial side
What is the key to arterial/vascular function?
Good circulation
What are the signs and symptoms of hypertension in the CNS?
Headache Blurred vision Nausea/vomiting Weakness Fatigue Confusion Mental status changes Rupture of cerebral vessels-stroke
What are the two things that happen with a clot in a vein?
Heart congestion Pulmonary embolism
What are the most common causes of hypovolemic shock?
Hemorrhage Burns Dehydration Peritonitis Pancreatitis
What does excess loss of blood flow result from?
Hemorrhage (hypovolemia)
What can cause an aneurysm to rupture?
Hypertension
What are the two main diseases arteriosclerosis is related to?
Hypertension and diabetes
How is Virchow's Triad scored?
If the person has two of the risk factors, they need to be put on blood thinners immediately
What are the causes of orthostatic hypotension?
Immobility Medications Dehydration Hemorrhage Anemia Poor cardiac function Poor circulation (arterial and venous)
Where are the two most common locations for aneurysms to form?
In the abdomen or thoracic aorta
Where can thrombi form?
In the arteries and veins
What does impaired circulation lead to?
Inadequate blood flow Excess loss of blood flow
What is hypertension?
Increased cardiac output or peripheral resistance, characterized by structural and functional changes in the heart and vascular system
What are the signs and symptoms of PAD?
Increased fatigue and weakness in the legs Intermitten claudication Sensory impairment Weak peripheral pulses Change in skin appearance
What do high levels of LDL indicate?
Inflammation and thrombus formation in the vessels
What is thrombophlebitis?
Inflammation of the vein at the site of a thrombus formation
What can thrombus formation be in response to?
Injury and wound healing
What does inadequate blood flow result from?
Injury to vessels Obstructive processes Inadequate movement of blood
What are the most common causes of anaphylactic shock?
Insect stings Drugs Nuts Shellfish
What does renin do?
It activates renin angiotensin aldosterone, which causes retention of fluid
What happens to circulation with a DVT?
It becomes congested
What happens to circulation with varicose veins?
It becomes congested
Why is a deep vein thrombus life-threatening?
It can dislodge and move to the lungs, where it can cause a pulmonary embolism
How can glucose cause arteriolosclerosis?
It causes atherosclerosis in arteries, which leads to chronic inflammation and atrophy downstream in the arterioles
How does the SNS regulate hypertension?
It causes vasodilation or vasoconstriction as needed
What happens to oxygenation to peripheral tissues with occluded arteries?
It decreases
What happens to perfusion with vessel obstruction?
It decreases
What happens to blood flow to the tissues with decreased artery lumen?
It decreases (it is compromised)
What happens to the skin with varicose veins?
It gets edemetous
Why is primary hypertension called the silent killer?
It has no symptoms until it is too late
Why would you elevate a patient's legs with varicose veins?
It helps the blood drain back to the heart
What happens to ADH secretion with shock?
It increases
What happens to heart attack risk in smokers?
It increases
What happens to renin secretion with shock?
It increases
What happens to cardiac output in a hypervolemic state?
It increases, along with blood pressure and heart rate
What does glucose do to the intima of a vessel?
It irritates it and causes inflammation all throughout the circulatory system on the arterial side
What is the pain like for varicose veins?
It is an aching pain
What happens to vessel lumen with thrombus formation?
It is narrowed, increasing the pressure inside the vessel
What happens to blood flow with a thrombi?
It is obstructed
Why do the fatty streaks become fibrous in thrombus formation?
It is the body's way of trying to smoothen out the vessel lumen
What is peripheral vascular disease (PVD)?
It is the exact same thing as PAD
What is a fusiform aneurysm?
It is where all layers of a vessel balloon on both sides of the vessel
Why is it hard to recover from atherosclerosis when intermittent claudication occurs?
It makes it painful to exercise, which is the only way to get rid of atherosclerosis
What does a DVT do to venous return?
It obstructs blood flow from going back to the heart
How does an embolism cause a clot?
It occludes blood flow in a smaller vessel distant from the site of initiation
What happens to blood flow with varicose veins?
It pools in the legs instead of returning to the heart
What does HCL do?
It prevents the buildup of plaque from LDL
What is the difference between LDL and HCL?
LDL deposits on damaged vessels; HCL cleans out damaged vessels
What are the signs and symptoms of hypertension in the cardiovascular system?
Left ventricle hypertrophy Cardiomegaly Pulmonary edema from circulatory congestion
What is intermittent claudication?
Leg pain that is caused by muscle ischemia during exercise
What is the cause of hypovolemic shock?
Loss of blood or plasma
What are the changes to skin with PAD?
Marked pallor or cyanosis Skin dry and hairless Toenails thick and hard
What are the most common causes of cardiogenic shock?
Myocardial infarction of the left ventricle Cardiac arrhythmias Pulmonary embolism Cardiac tamponade
If a thrombus is in a superficial vein, is it life threatening?
No
Is a DVT a risk for stroke?
No
How do fibrous plaques become embolisms?
Occasionally chunks of the plaques will break off and move downstream to smaller vessels
What is arteriolosclerosis?
Overall degenerative damage of the small vessels in the kidneys, brain, heart, retina, feet, and legs
Why does intermittent claudication occur?
Oxygen demand in the muscles is not reached because of narrowing of the vessels, which causes a sharp pain in the muscles
Why is there sensory impairment with PAD?
Oxygen does not reach the nerve endings due to decreased blood flow
What is the difference between coronary heart disease and PAD?
PAD occurs in arteries away from the heart; coronary heart disease occurs in the arteries around the heart
What are the most common causes of vasogenic shock?
Pain Fear Spinal cord injury Hypoglycemia (insulin shock)
Why is BMI a test for atherosclerosis?
People who are obese have a higher incident of vascular disease
How does atherosclerosis cause aneurysms?
Plaque formation erodes the vessel wall and causes overstretching
What are the signs and symptoms of hypertension in the kidneys?
Poor urinary output Hematuria Proteinuria Problems with eliminating urinary waste
Why is there warmth in the area of a DVT?
Pulsations of blood hitting the clot inflame the area causing redness, edema, and warmth
How does renin-angiotensin-aldosterone regulate hypertension?
Regulates sodium and thus water excretion
What are the three main regulatory systems for hypertension?
SNS Renin-angiotensin-aldosterone Kidneys
Which type of aneurysm is seen in the brain?
Saccular
What are the diagnostic tests used with atherosclerosis?
Serum lipid levels (LDL and HDL) C-Reactive protein (CRP) BMI Exercise stress testing
In which stage of hypertension, does damage to the kidneys begin?
Stage 1
In which stage of hypertension does fluid on the brain become evident?
Stage 2
What often causes aneurysms in the brain?
Syphilis
What is the cause of anaphylactic shock?
Systemic vasodilation and increased permeability due to severe allergic reaction
What two systems compensate for shock?
The SNS and adrenal medulla
Which artery does hypertension increase the risk of atherosclerosis in?
The aorta
Where is the only place atherosclerosis occurs?
The arteries
How does age affect atherosclerosis?
The arteries become more narrow and there is a higher risk of thrombus formation
What is an aneurysm?
The ballooning of a blood vessel due to weakness in the arterial wall
Why is there a higher chance of clots with blood pooling?
The blood coagulates as it pools
What is phlebitis?
The buildup of a clot in a superficial vein
What is chronic venous insufficiency?
The chronic inability to move blood forward back to the heart
What can happen in the brain with malignant or resistant hypertension?
The increased hydrostatic pressure puts pressure on the brain causing encephalopathy and death
What happens if the intima is irritated?
The irritated areas cause inflammation
Where is renin secreted from?
The kidneys
What is a dissecting aneurysm?
The layers of the vessel dissect with fluid in between the layers
What is the relationship between HCL and atherosclerosis?
The more HCL you have, the less atherosclerosis you will have
Why does perfusion decrease with vessel obstruction?
The movement of blood through the vessel is blocked
How do the valves in the veins work normally?
The muscles around the veins constrict, opening up the valves and shooting the blood forward
What happens if the lumen of an artery is decreased?
The pressure the heart has to pump against increases
Why can't blood return to the heart with CVI?
The valves in the legs are damaged and don't function effectively
What happens the longer a person has hypertension?
The work of the heart is increased and it begins to lose function
How does Raynaud's Disease occur?
There is abnormal constriction of peripheral vessels, especially in the hands and feet
What happens in arteriolosclerosis?
There is abnormal thickening of the intima of arterioles, causing them to lose elasticity and become hardened
What happens to the lungs if amniotic fluid gets into them?
There is an anaphylactic response that causes large amounts of fluid buildup
What happens if an aneurysm ruptures?
There is major hemorrhaging and tissue damage
Why can CVI occur in bedridden patients?
There is no leg movement or constriction of muscle to move the blood forward if a person is laying down all the time
Why are peripheral pulses with PAD weak?
There is obstruction of blood flow, so decreased blood pressure through vessels
Why should you not raise the legs of a person with PAD?
They already have enough trouble getting blood down to the legs; raising the legs decreases blood flow even more
What happens to glucocorticoids with shock?
They are secreted
What happens to the vessels with varicose veins?
They become overstretched
What do Beurger's Disease and Raynaud's Disease do to vessels?
They cause abnormal constriction
Why does hypercholesterolemia not automatically put someone at a higher risk for clot formation?
They could have high HCL levels, which help prevent atherosclerosis
Why do aneurysms occur?
They develop from a defect in the medial layer
What happens to heart cells if they are deprived of oxgyen?
They die permanently
What happens to the valves in the veins with high amounts of pressure?
They get weak and floppy, which can cause regurgitation of blood
Why are diabetic patients at a high risk for heart disease?
They have high levels of LDL, which results in high levels of atherosclerosis
What types of sensory impairment occur with PAD?
Tingling Burning Numbness
What happens with smokers with Beurger's Disease?
Tissue in the periphery dies causing loss of fingers and toes
What is Virchow's Triad used for?
To make a determination if a person is at a high risk for forming clots
What causes statis dermatitis?
Varicose veins
What is the most common form of chronic venous insufficiency (CVI)?
Varicose veins
What type of vessel disorder can happen in pregnant women?
Varicose veins
What does a high level of CRP + LDL indicate?
Vascular disease
What is the cause of vasogenic (neurogenic or distributive) shock?
Vasodilation due to a loss of sympathetic and vasomotor tone
What is the cause of septic (endotoxic) shock?
Vasodilation due to severe infection
What happens when a vein is occluded?
Venous return is blocked, leading to circulatory congestion
What are the most common causes of septic shock?
Viruses or multiple infections
When does cardiomegaly occur?
With chronic hypertension
Are varicose veins genetic?
Yes
If a thrombus is in the deep veins, is it life threatening?
Yes
Who is Beurger's Disease usually seen in?
Young men, especially young men who smoke
