Exam 1 Patho Review

everything

Varicose Veins

Enlarged, twisted veins often found in the legs. They occur when the valves inside the veins malfunction, cuasing blood to flow backward and pool

Thrombus formation

Can happen with varicose veins due to stagnant blood flow, leading to potential complications such as deep vein thrombosis and increases the risk of a pulmonary embolism

Thrombus

Blood clot that forms within a blood vessel and remains attached to the site of formation or can dislodge and travel to other parts of the body turning into an embolus

Deep vein thrombosis

A condition where a blood clot forms in a deep vein, usually in the legs, potentially leading to serious complications if the clot dislodges

Hypertension

Occurs when the force of blood against the artery walls is consistently too high —> over time can damage arteries and lead to complications

Orthostatic hypotension

Form of low blood pressure that can happen when you stand up to quickly from sitting or lying down - can cause dizziness. lightheadedness, or fainting ass the body struggles to adjust to the sudden change in position

Aneursym

a bulge or ballooning in a blood vessel caused by a weakness in the vessel wall

Types of aneurysms

include healthy. vesel, saccular, fussiform, dissection, and false, each differing in shape and location

True aneurysm

Involve all 3 layers of the arterial wall and are best described as a weakening of the vessel wall that have a wide base, walls composed of myocardium, and are low risk for rupture; they are the saccular and fusiform aneurysms

What is another name for a berry aneurysm

Cerebral aneurysm

Cardiac aneurysm

Most common form after MI when intraventricular tension stretches the non-contracting infarcted muscle

Why is the aorta particularly susceptible to aneurysm formation

Due to its high pressure and stress, combined with age-related degeneration of the vessel wall and the absence of penetrating vsa vasorum in the media layer

Most common cause of arterial aneurysm

Atherosclerosis, which leads to vessel wall weakening and dilation and plague formation erodes the vessel well and contributes to inflammation

Proteinases (proteases)

Enzymes that break down proteins into smaller peptides or amino acids, process called proteolysis

Atherosclerosis

Buildup of fatty deposits (plaque) on the inner walls of arteries, which can restrict blood flow - condition is a major cause of heart disease

Peripheral artery disease (PAD)

Narrowing or blockage of the arteries outside of the heart and brain, typically in the legs causing reduced blood flow and potential complications like pain, ulcers, or gangrene.

Coronary artery disease

narrowing or blockage of the coronary arteries, which supply blood to the heart muscle - usually caused by atherosclerosis and can lead to chest pain, MI, and heart failure

Most common cause of heart disease

Coronary artery disease

Superficial main coronary arteries

include the left main coronary artery and right coronary artery, which supply blood to the heart muscle

Left coronary artery

Anterior descending artery, circumflex

Right coronary artery

Posterior descending artery, marginal artery

Anastomoses

Communication between blood vessels

Preload

Primary factor affecting stroke volume, pressure in the ventricles at the end of diastole and is influenced by the volume of blood returning to the heart

Frank - Starlings Law of the Heart

The principle that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart, due to the myocardial stretch

Afterload

Resistance against which the ventricle must overcome, highly influenced by peripheral vascular resistance

Tunica Intima

Single cell layer, innermost and narrowest layer of the artery

Tunica Media

Elastic fibers and muscle layer responsible for regulating blood vessel diameter and maintaining blood pressure

Tunica adventitia

Fibrous tissue covering the outermost layer of blood vessels, providing structural support and protection

Peripheral circulation

Arteries → arterioles → capillaries → venules, veins

SNS

fight or flight, epinephrine/norepinephrine, alpha-adrenergic receptors, beta-1 adrenergic receptors

Alpha-adrenergic receptors

Receptors that respond to epinephrine and norepinephrine, primarily causing vasoconstriction and increased blood pressure.

Beta 1 adrenergic receptors

Heart: increase HR and contractility

Beta 2 adrenergic receptors

Lungs: bronchodilation

Chemical neurotrnasmitter

Acetylcholine

Cholinergic receptors

Receptors that respond to acetylcholine, involved in parasympathetic nervous system functions

SLUDGE Pneumonic for cholinergic response

Symptoms include Salivation, Lacrimation, Urination, Defecation, Gastrointestinal issues, and Emesis

Anticholinergic response

Mad as a hatter, blind as a bat, red as a beet, dry as a bone

Examples of tachydysrythmias

uncontrolled afib, atrial flutter, paroxysmal supra-ventricular tachycardia, vtach

Bradydysrythmias

sinus bradycardia, av blocks, junctional rhythms, idioventricular rhythms

Risk factors of varicose veins

age, female, family hx, obesity, pregnancy, DVT, prior leg injury

Varicose vein cause

blood pooling in the vein due to valve damage and the effects of gravity, leading to gradual venous distention over time

when does valve damage occur for varicose veins

when prolonged increased pressure renders the valve of the vein, unable to maintain normal pressure, the vein swells from the extra pressure and the surrounding tissue becomes oedematous due to increased hydrostatic pressure

Chronic venous insufficiency (CVI)

inadequate venous return over a long period of time, inflammatory rx in the vessels are caused by venous hypertension, circulatory stasis, and tissue hypoxia

Symptoms of chronic venous insufficiency

edema of the lower extremities, hyperpigmentation of the feet and ankles

Venous stasis ulceration

circulation to the extremities can become sluggish, which reduces the supply of oxygen and nutrients to the cells and impedes waste removal from the cells

Venous stasis ulcers

are skin sores that occur due to poor circulation and prolonged venous hypertension, often resulting from chronic venous insufficiency and can lead to significant pain and complications if left untreated

Tx of varicose veins/CVI

noninvasive treatments such as elevating the legs, wearing compression stockings, and performing physical exercise; invasive management includes ablation and sclerotherapy, surgical ligation, conservative vein resection, and vein stripping

Thrombus

Blood clot that remains attached to a vessel wall

detached thrombus name

Thromboembolism

are venous or arterial thrombi more common

venous thrombi as flow and pressure are lower in the veins than the arteries

Where is DVT occur primarily

lower extremities, and is more likely to cause a pulmonary embolism

Where are DVTs involves 90% of the time

femoral and popliteal veins as it is the more dependent part of the body and prone to stasis

3 factors that promote DVT

venous stasis, venous endothelial damage, hypercoagulative states (inherited disorders, malignancy, pregnancy, use of oral contraceptives or hormone replacement therapy)

High likelihood of DVT resulting from

orthopedic sx, spinal cord injury, obstetric/gynaecological procedure

Antiplatelet

medications that prevent blood clot formation by inhibiting platelet aggregation (ex. ASA)

What does hypertension result from

Sustained increase in peripheral resistance (arteriolar vasoconstriction)or increased cardiac output, leading to elevated blood pressure

Pre Hypertension

Systolic 120-139 mmHg and Diastolic 80-89 mmHg

Hypertension Stage 1

Systolic 140-159 mmHg and Diastolic 90-99 mmHg

Hypertension Stage 2

Systolic 160 mmHg or higher and Diastolic 140 mmHg or higher

Malignant hypertension

A severe form of hypertension characterized by extremely high blood pressure, often exceeding 180/140 mmHg, and can lead to organ damage.

Endothelial dysfunction

A condition where the endothelium (inner lining of blood vessels) loses its normal function, contributing to various cardiovascular diseases

shift in pressure - natriuresis relationship

A physiological response where changes in blood pressure affect the kidneys' ability to excrete sodium, impacting fluid balance and blood volume

What organs do the hormones specifically come from the RAAS system come from?

The hormones from the Renin-Angiotensin-Aldosterone System (RAAS) primarily come from the kidneys, liver, and adrenal glands. Renin is produced by the kidneys, angiotensinogen is produced by the liver, and aldosterone is secreted by the adrenal glands

What does high hydrostatic pressure in the capillaries cause?

High hydrostatic pressures in the capillaries cause vascular fluid to push into the interstitial space

Encephalopathy

a broad term for brain dysfunction, which can result from various causes, including metabolic disturbances, infections, or toxins

Papilledema

swelling of the optic nerve head due to increased intracranial pressureIt can lead to vision problems and is often a sign of serious underlying conditions

Orthostatic Hypotension

refers to a decrease in systolic blood pressure of at least 20 mmHg or a decrease in diastolic blood pressure of at least 10 mmHg within 3 min of moving to a standing position

what is the mediated reflex arteriolar

response to changes in blood pressure that helps maintain cerebral perfusion during postural changes

What happens when we go from a sitting to standing position

The baroreceptor - mediated reflex arteriolar and venous constriction and increased HR compensate for the gravitational changes

What is the equation for the carbonic acid-bicarbonate buffer system

CO2+H2O = H2CO3 = HCO3- + H+

Marfan’s syndrome

A genetic disorder affecting connective tissue causing structural abnormalities and problems with tissue homeostasis

Syphillis

A sexually transmitted infection caused by the bacterium Treponema pallidum, which can lead to serious health complications if left untreated

Aortic dissection

Tearing of intimal layer of the aorta likely to occur in areas which are under the greatest stress

• ascending aorta distal to the aortic valve

• descending aorta just beyond to L subclavian artery

What may aortic dissection cause

aortic valve insufficiency if dissection progresses toward aortic valve

Aortic root aneurysm

a bulge in the wall of the aorta where it leaves the heart

Thoracic Aortic Aneurysm

true aneurysm of the portion of the aorta, which is the thoracic space, beyond the main aortic branches

What most commonly causes thoracic aortic aneurysms

Atherosclerosisis the most common cause, often leading to weakening of the aortic wall, and turbulent blood flow

Symptoms of a thoracic aortic aneurysm

Chest, neck and/or back pain, in cases of rupture, “tearing” pain is severe, cough and/or dyspnea (if pressure on trachea), difficulty swallowing (if pressure on the esophagus)

Arterial Thrombus: 2 potential threats to circulation

The thrombus may grow large enough to occlude the artery, causing ischemia in tissues supplied by the artery, the thrombus may dislodge, become a thromboembolism that travels through the vascular system until it occludes flow into a distal vascular bed

Pharacological treatment for an arterial thrombus

Heparin, warfarin derivates, thrombin inhibitors, or thrombolytics are commonly used to prevent clot formation or dissolve existing clots

Emboli (mobile)

Matter circulating in the blood stream that can lead to an obstruction of a vessel, can consist of: dislodged thrombus, air bubble, aggregate of amniotic fluid, fat, bacteria, cancer cells, foreign cells, foreign substance and object

Where does an embolus travel to

Travels in the bloodstream until it reaches a vessel it cannot pass through

Pulmonary emboli

originates on the venous side (mostly from deep veins of the legs) and the system circular or in the right heart

Arterial emboli

Most commonly originate in left side of the heart and are associated with thrombus after MI, valvular disease, left ventricular failure, endocarditis, and dysrhythmias

Embolism

Causes ischemia or infarction is tissues distal to the obstruction, producing organ dysfunction and pain

Infarction

Tissue death due to insufficient blood supply, often resulting from occlusion of blood vessels

Occlusion of a coronary artery causes what?

MI

Occlusion of a cerebral artery causes what?

Stroke or TIA

Leading cause of CAD and cerebrovascular disease

Arteriosclerosis

Prostaglandins in arterial blood

Arterial blood flow becomes more turbulent, and platelets release prostaglandins which draw more platelets to the area and worsen inflammation —> further obstruction and potential thrombus formation

What starts to happen with a total obstruction from a fully occluded artery

Begins with injury to the endothelial cells that line artery walls, leading to increased permeability and platelet aggregation, which can promote thrombus formation

How do plaque form and rupture?

macrophages release growth factors that stimulate smooth muscle cell proliferation

smooth muscle cells in the region of endothelial injury proliferate, produce collage, and migrate over the fatty streak, forming a fibrous plaque

the fibrous plaque may calcify, protrude into the vessel lumen, and obstruct blood flow to distal tissues (especially during exercise), which may cause symptoms

Ex. Angina and myocardial infarction.

Clinical manifestations of atherosclerosis

Presents with S&S of inadequate perfusion of tissues because of obstruction of the vessels supplying the tissues such as chest pain, fatigue, and shortness of breath, which can lead to critical conditions like heart attack or stroke.

Interventions for acute ischemia, MI, or stroke

Cardiac catheterization, tissue plasminogen activator (tPA) or through mechanical removal of thrombi

Major cause of myocardial ischemia

Atherosclerosis leading to CAD

Peripheral artery disease

a circulatory atherosclerosis disease characterized by narrowed arteries reducing blood flow to the limbs and often leads to leg pain, cramping, can cause gradual or acute lower extremity ischemia

How should symptomatic PAD be managed?

Vasodilators in combination with antiplatelet and antithrombotic medication and cholesterol-lowering medications

How do CAD and hyperlipidemia affect heart health

Can have suboptimal cardiovascular health stratus secondary to multiple cardiovascular risk factors; increased rates of obesity and diabetes, uncontrolled hypertension, dyslipidemia

Dyslipidemia

unhealthy level for one or more fats in the patients blood

Difference between stable and unstable angina

Stable angina is characterized by predictable chest pain that occurs with exertion and is relieved by rest, while unstable angina presents as unpredictable chest pain that may occur at rest or with minimal exertion and indicates a higher risk of heart attack