WCU FINAL PATHO PARK CH16,18,19,20

What is systolic BP

Peak pressure during systole

Heart is contacting which is left ventricle

Reflects amount of blood (SV) ejected with each best and compliance of the aorta and large arteries

When it contracts it creates a huge amount of force because it pushes blood out of aorta to entire body

What is stroke volume

Amount of blood pumped out

What increases with age as the aorta and large arteries lose elasticity

Systolic BP

What is on top and bottom number for Bp

Systolic = top

Diastolic = bottom

What is diastolic BP

Lowest pressure during diastole

Left ventricle is relaxing therefore filling up with blood from left atrium

Reflects closure of the aortic valve the energy stored in elastic fibers of the large arteries and the resistance to flow through arterioles into the capillaries

What is the correct blood flow through the heart

Pulmonary veins from lungs to left atrium through the mitral valve to left ventricle through the aortic valve through the aorta

Left side = oxygenated blood

From the superior and inferior vena cava to the right atrium through the tricuspid valve to right ventricle through pulmonary valve to pulmonary artery to the lungs

Right side = deoxygenated blood

What some factors that influence mean arterial pressure

Blood volume

Cardiac output

Resistance

Relative distribution of blood between arterial and venous blood vessels

What is blood volume determined by

Fluid intake

And

Fluid loss which may be passive or regulated at kidneys

What is cardiac output determined by

Heart rate and stroke volume

What is resistance determined by

Diameter of the arterioles

What is relative distribution of blood between arterial and venous blood vessels determined by

Diameter of the veins

What is endiastolic volume (EDV)

Preload

Amount of blood coming into the heart

What is systemic vascular resistance

Afterload

Resistance in blood vessels

Load you have to overcome to send blood into vessels

How is BP controlled by RAA

A decrease in extracellular fluid and decrease arterial BP tells the kidneys to secrete renin which goes to Angiotensinogen that turns to ANG I and with the help of ACE (lungs) turns into ANG II

Goes to adrenal cortex and arterioles

Adrenal cortex turns into aldosterone which sodium gets reabsorbed by kidneys to increase vascular volume and increase arterioles blood pressure

Arterioles start to vasoconstrict which will increase arterial BP

What is normal BP

systolic: less than 120

And

diastolic: less than 80

What is elevated BP

Systolic: 120-129

And

Diastolic: less than 80

What is high blood pressure (hypertension) stage 1

Systolic: 130-139

Or

Diastolic: 80-89

What is high BP (hypertension) stage 2

Systolic: 140 or higher

Or

Diastolic: 90 or higher

What is hypertensive crisis BP

Systolic: higher than 180

And/or

Diastolic: Higher than 120

What does BP control involve

Both the cardiovascular and the renal system

What are baroreceptor reflex

Sense changes in BP

Stretch receptors

When baroreceptors sense BP increases how does it try to lower it

Cardiovascular and renal system

Which system is faster

Cardiovascular

What happens when cardiovascular system turns on to Lower Bp

Compensated by cardiovascular system which will Vasodilation and decreases cardiac output which will decrease BP

What happens when the renal system turns on to lower BP

Compensated by kidneys which will excrete fluid in urine which is decrease blood volume therefore decrease BP

When BP increases what system turns off and what turns on

SNS turns off and PNS turns on

What does the PNS effect

Only effect SA node which controls HR

What happens when SNS turns off

Controls the ventricles, arterioles, and veins

So all will turn off to decrease BP

What are the two types of hypertension

Primary and secondary

What is primary or essential hypertension

Just have it

Idiopathic- elevation of BP occurs without evidence of other disease

Accounts for 90-95% of hypertension

What are the subtypes of primary hypertension

Isolated systolic

Isolated diastolic

Combined systolic and diastolic

What are the risk factors for primary hypertension

Uncontrolled: family history, race, age

Lifestyle factors: high sodium intake, excessive calories intake, obesity, sedentary, metabolic syndrome, excessive alcohol consumption, obstructive sleep apnea, oral contraceptives, smoking

What are the manifestations of primary hypertension

Usually related to long term effects of hypertension or organ systems of the body

Damaged organs include: heart, brain, kidney, perpetual vascular disease, eyes

What are the major risk factors in primary hypertension

Atherosclerosis and all major atherosclerotic cardiovascular disorders (heart failure, stroke, coronary and peripheral artery disease)

What are some treatments for primary hypertension

Lifestyle modification

What is secondary hypertension

Attributed to a specific identifiable pathology or condition

Accounts for 5-10% of hypertensive cases

Many of the conditions causing it can be corrected or cured by surgery or medical treatment

What are some secondary hypertension

Renal hypertension (kidneys are the issue)

Adrenocortical disorder (adrenal gland issue)

Coarctation of the aorta

Obesity/obstructive sleep apnea

Pregnancy

What are some physiologic mechanisms of anti-hypertension drugs reducing BP

Diuretics

Beta-adrenergic receptor blockers

ACE inhibitors

Angiotensin II receptor blocker

Calcium channel blockers

Central alpha2-adrenergic agonists

Central alpha1-adrenergic anatagonist

Vasodilators

What do anti-hypertension drugs do

Aim to reduce stroke volume, reduce systemic vascular resistance, or decrease heart rate

What is coronary heart disease

is characterized by impaired coronary blood flow, usually result of atherosclerotic coronary arteries (CAD) leading to cardiac ischemia

Also through: thrombus formation, coronary vasospasm, endothelial cell dysfunction

blood vessels that are feeding the heart itself aren't able to allow blood flow like it should

What are the two types of coronary heart disease

chronic - ischemic heart disease

acute coronary syndrome - represents spectrum of ischemic coronary disease ranging from unstable angina through myocardial infarction

What are the disorders that usually appear to affect the whole heart and cause symptoms of both right and left sided heart failure

pericardial disorders (surrounds the heart)

coronary heart disease

myocardial diseases

What are pericardial disorders

pericarditis (inflammation of the pericardium)

may causes ECG changes and pain

how can pericardial disorders restrict the hearts movement

pericardial effusion = serous exudate (from the circulatory system) filling the pericardial cavity which may lead to cardiac tamponade

constrictive pericarditis = fibrous scar tissue makes pericardium stick to the heart

What is chronic ischemic heart disease

imbalance in blood supply and demand for oxygen

What are some things that can cause less blood

atherosclerosis, vasospasm (blood vessels spasm leading to vasoconstriction), thrombosis (blood clot that obstructs flow)

What are some things that can cause higher oxygen demand

stress, exercise, cold

Name the kinds of anginas

Stable

Variant

Silent myocardial ischemia

what is stable angina

pain when heart's oxygen demand increases

blood flow is normal but heart needs more oxygen than it normally does

What is variant angina

pain when coronary arteries spasm

comes and goes

what is silent myocardial ischemia

myocardial ischemia without pain

oxygen is deprived to the heart

ex. dr tell you had a heart attack but patient didn't know

What happens during acute coronary syndrome

ECG changes: T-wave inversion (reflects downward), ST-segment depression or elevation, abnormal Q wave

Serum cardiac markers: proteins released from necrotic heart cells (myoglobin, creatine kinase, troponin)

What happens during acute myocardial infarction

chest pain: severe, crushing, constrictive, like heartburn

SNS response: GI distress, nausea, vomiting, tachycardia and vasoconstriction, anxiety, restlessness, feeling of impending doom

hypotension and shock: weakness in arms and legs

What are some myocardial diseases

hypertrophic cardiomyopathy

restrictive cardiomyopathy

MI, myocarditis

dilated cardiomyopathy

permpartum cardiomyopathy

What is Hypertrophic cardiomyopathy

unusually thick ventricles, not enough room for blood to fill

defects in their contractile proteins, make cells too weak

they hypertrophy to do the same amount of work as normal cells

need more oxygen and perform less efficiently, so prone to heart failure and sudden death during exertion

What happens when the ventricles of the heart relax

diastole

semilunar valves close which is the second heart sound 'dup'

AV valves open

What happens when the ventricles of the heart contract

systole

AV valves close which is the first heart sound 'lub'

semilunar valves open

What are the AV valves of the heart

mitral - left

tricuspid - right

what are the semilunar valves of the heart

aortic - left

pulmonary - right

what are valve defects and how do you identify them

blood going through defective valves make noise, called heart murmurs

identify them by where they are (near which valve) how they sound (high, low pitch) when they happen (systole, diastole)

What is a stenosis valve defect

valves do not open all the way; harder to force blood through

stiff hard to open, closes fine

will hear murmur when the valve is open

What is a regurgitant valve defect

valves do not close all the way; it leaks when it should be closed

opens fine doesn't close correctly or properly

will hear murmur when valve should be closed

when does aortic valve stenosis happen

during systole

when does mitral valve regurgitation happen

during systole

when does mitral valve stenosis happen

diastole

when does aortic valve regurgitation happen

diastole

what are some left-sided valvular disorders

mitral valve disorders; stenosis, regurgitation, prolapse may lead to regurgitation

aortic valve disorders; stenosis, regurgitation

What are some congenital heart defects (present at birth) and explain

Atrial septal defects = allows blood flow between atrias

ventricular septal defects = allows blood flow between ventricles

endocardial cushion defects = no separation between the chambers of the heart (mixing of deox. and ox. blood)

coarctation of the aorta = narrowing of aorta

patent ductus arteriosus = the ductus arterioles (which connects the aorta and pulmonary artery) remains open, allowing blood to flow between the 2 vessels

pulmonary stenosis = pulmonary valve harder to open

transposition of the great vessels = 2 major vessels that carry blood away from the heart (aorta and pulmonary artery) are switched (transposed)

What is a shunt

is an opening or connection that lets blood move from one side of the circulation to the other

most shunts occur in the heart and move blood either from L to R or R to L

because L side is stronger, blood usually goes from L to R

what is a foramen ovale shunt

normal before birth

blood goes from R to L atrium, bypassing the lungs

What is a ductus arteriosus shunt

normal before birth

blood goes from the pulmonary trunk to aorta, by passing the lungs

what is a ductus venosus shunt

normal before birth

blood goes from the visceral veins to vena cava, bypassing the liver

describe a left to right shunt

normal blood flow still but extra blood is going to heart

less blood goes to body, more blood goes to lungs

from left heart goes to body but also goes to right heart which will cause less blood going to body and more blood going to lungs

what is normal blood flow

left heart to aorta to body to vena cava to right heart to pulmonary artery to lungs to pulmonary vein and back to left heart

describe right to left shunt

blood from the right heart goes to the lungs but also goes to the left heart (blood moves from R to L) which causes less blood going to lungs and deoxygenated blood goes to body

what does the adequate perfusion of body tissues depends on

pumping of the heart

vascular system to transport blood, and sufficient blood to fill the system

ability of tissues to extract and use blood oxygen and nutrients

what is heart failure

the impaired ability of the heart to pump blood to maintain sufficient cardiac output to meet metabolic demands of tissues and organs

what does heart failure result in

congestion of blood flow in the systemic or pulmonary venous circulation

from impaired ability of myocardial fibers to contract, relax, or both

What are some heart failure causes and pathogenesis

a potential consequence of most cardiac disorders

myocardial ischemia (most common)

acute myocardial infarction

hypertension

degenerative conditions of the heart collectively known as cardiomyopathies

excessive work demands

volume overload

what are some types of heart failure

high-output

low-output

systolic

diastolic

right-sided heart

left sided heart

what is high-output heart failure

supernormal output but inadequate due to excessive metabolic needs, anemia, arteriovenous shunting

what is low-output failure

impaired heart pumping due to ischemic heart disease and cardiomyopathy

what is systolic heart failure

impaired ejection of blood from the heart due to decreased contractility, volume overload, or pressure overload

what is diastolic heart failure

impaired filling of heart due to smaller ventricular chamber size, hypertrophy, poor compliance

what is right sided heart failure

impairs ability to move deoxygenated blood from systemic to pulmonary circulation

Diastolic: RV does not accept enough blood from body

Systolic: RV does not pump enough blood to lungs

body fills with blood

lungs do not oxygenate enough blood

what is left sided heart failure

impairs pumping of blood from the low pressure pulmonary to the high pressure arterial circulation

Systolic: LV does not pump enough blood to body

Diastolic: LV does not accept enough blood from lungs

body lacks blood

lungs fill with fluid

what are some adaptive mechanisms to cardiac output

in heart failure, cardiac reserve is largely maintained through compensation

SNS

RAA

frank-straling mechanism

myocardial hypertrophy and remodeling

what is the frank-starling curve

the heart increases SV by increasing ventricular EDV, which increases myocardial fiber stretch to optimize actin and myosin overlap

what is pulmonary edema

Hb not completely oxygenated

capillary fluid moves into alveoli: lung becomes stiffer, harder to inhale, less gas exchange in alveoli, crackles, frothy sputum

what are some treatments for heart failure

relieve symptoms and improve quality of life, and as a long-term goal halt or reverse cardia dysfunction

aimed at improving CO while minimizing congestive symptoms and cardiac workload

surgical repair

pharmacologic treatments

restriction of salt intake

diuretic therapy to facilitate excretion of edema fluid

restriction of activity

pacemakers may be used to help synchronize ventricular contraction

what can result from circulatory shock

an acute failure of the circulatory system to supply peripheral tissues and oragans of the body with an adequate blood supply resulting in cellular hypoxia

not a specific disease

what is the pathogenesis of shock

inadequate cellular oxygenation

impaired tissue oxygenation results in cellular hypoxia

failure of microcirculaito not auto-regulate blood flow leads to activation of coagulation

Inadequate cellular oxygenation may result from

Decreased cardiac output

Maldistribution of blood flow

Reduced blood oxygen content

impaired tissue oxygenation results in cellular hypoxia causing

anaerobic metabolism

free radical production

macrophage induction

compensatory mechanism of shock

homeostatic mechanism are sufficient to maintain adequate tissue perfusion despite a reduction in CO

SNS activation attempts to maintain BP even though CO has fallen

progressive stage of shock is marked by hypotension and marked tissue hypoxia (lactate production increases with anaerobic metabolism; lack of ATP leads to cellular swelling, dysfunction, death; cellular and organ dysfunction result form oxygen free radicals, release of inflammatory cytokines, and activation of the clotting cascade)

what is hypovolemic shock

loss of whole blood

loss of plasma

loss of extracellular fluid

what is cariogenic shock

alteration in cardiac function

what is obstructive shock

anything blocking blood flow

inability of heart to fill properly

obstruction to outflow from the heart

what is distributive shock

have problems distributing blood because something wrong with blood vessels

loss of sympathetic vasomotor tone

presence of vasodilating substance in the blood

presence of inflammatory mediators (anaphylactic, neurogenic, septic)

what is sepsis or systemic inflammatory response syndrome

results from severe systemic inflammatory response to infection

inflammatory mediators released into the circulation (tumor necrosis factor, interleukins, prostaglandins)

cause systemic signs of inflammation (fever and increases respiration, respiratory alkalosis, vasodilation, hypotension, increased capillary permeability with edema, warm flushed skin)

activate inflammatory pathways (coagulation, complement system)