HLTH 201: Ch. 26 - Disorders of Blood Flow & Blood Pressure

What is arteriosclerosis?

natural degenerative process that occurs with age causing stiffening of the arteries and arterioles

What is atherosclerosis?

formation of atheroma (fatty plaques) under the tunica intima (innermost layer)

what are the stages of atherosclerosis?

fatty streak, atheroma plaque forms, complicated lesion (outer covering of plaque ruptures and thrombus over plaque forms)

when do s/s of atherosclerosis appear?

when blood vessel is severely narrowed or totally blocked causing ischemia

what are unstable plaques?

plaques with thin fibrous caps that can rupture and form a thrombus

what are non modifiable causes of atherosclerosis?

age, gender, genetics/family history

what are modifiable causes of atherosclerosis?

obesity, diet, smoking (increases LDL (bad cholesterol) and decreases HDL (good cholesterol)), sedentary lifestyle, diabetes mellitus, hypertension

what are treatments of atherosclerosis?

change diet (high fiber, low fat), drugs (statins lowers cholesterol), controlling the primary disorder, stop smoking, angioplasty, bypass surgery

What is an angioplasty?

putting a balloon catheter and stent inside blood vessel to increase diameter

what does partial and full occlusion of arteries caused by atherosclerosis do to the heart?

partial: angina pectoris, full: myocardial infraction

what does partial and full occlusion of arteries caused by atherosclerosis do to the brain?

partial: transient ischemic attack, full: cerebrovascular accident (CVA)

what does occlusion of arteries caused by atherosclerosis do to the peripheral arteries?

peripheral artery disease, gangrene

what is peripheral artery disease?

obstruction of large arteries that supply limbs (ex. legs)

what are risk factors that can cause peripheral artery disease?

smoking, diabetes, obesity, high blood pressure, high cholesterol

what are the signs and symptoms of peripheral artery disease?

gradual onset, claudication (calf pain), foot cool to touch, weak or absent pedal or femoral pulse, severe reduction of blood flow causing ischemic pain, ulcerations, gangrene

what are treatments of peripheral artery disease?

walking, avoiding injury (takes longer to heal), avoiding risk factors, drugs (NSAIDS), balloon angioplasty, stents

What is vasculitis?

inflammation of blood vessels

what is pathogen mediated vasculitis?

pathogen attaches to blood vessel wall and immune system attacks pathogen causing blood vessel to become inflamed

what is non-infectious vasculitis?

blood vessel inflammation caused by certain medications

what are typical signs and symptoms of vasculitis?

fever, aches/pains in area

What is an aneurysm?

wall of blood vessel weakens and stretches to form an out pocketing of the vessel wall

what are the three layers of a blood vessel?

tunica intima (contacts blood), tunica media (muscle layer), tunica externa (outermost layer)

what are the types of aneurysms?

true aneurysm, false aneurysm, saccular aneurysm, fusiform aneurysm, berry aneurysm

What is a true aneurysm?

weakening in all 3 layers of the blood vessel wall

What is a false aneurysm?

local damage to blood vessel causing blood to accumulate between the layers of the blood vessel wall

What is a saccular aneurysm?

Bulge on one side of the vessel

What is a fusiform aneurysm?

equal bulging all around the vessel

What is a berry aneurysm?

aneurysm that occurs where one blood vessel divides into two blood vessels (commonly seen in the circle of Willis)

what is a major sign that a patient has a berry aneurysm?

very severe and painful headache

what are the causes of aneurysms?

congenital defects, trauma, infection, atherosclerosis

what are ways to treat aneurysms?

clipping off, coiling to prevent blood from entering

What is systolic pressure?

ventricular contraction

what is diastolic pressure?

ventricular relaxation

what is the short term regulator for blood pressure?

baroreceptors

what is the long term regulator for blood pressure?

kidneys

What is the baroreflex?

automatic response to change in blood pressure that increases sympathetic activity to increase heart rate, CO, BP

What is hypertension?

high blood pressure \>120/80

what are the two categories of hypertension?

primary/essential hypertension, secondary hypertension, hypertensive crisis

what is primary/essential hypertension?

elevated BP without an identified cause; 90-95% of all cases

what is secondary hypertension?

Elevated BP with a specific cause

What does the renin-angiotensin-aldosterone system do?

vasoconstrictor, increases ADH, increases aldosterone

what is a hypertensive crisis?

\>180/120

what are risk factors for primary/essential hypertension?

family history, race, age

what are lifestyle risk factors for primary/essential hypertension?

high salt diet, obesity, excessive alcohol consumption, insulin resistance

what are risk factors for secondary hypertension?

kidney disease (activates renin-angiotensin aldosterone system which vasoconstricts), hyperaldosteronism, pheochromocytoma (benign tumor of adrenal medulla causing the release of epi/norepi), illicit drug use

what are the targeted organs of hypertension

heart (hypertrophy, MI), brain (stroke), kidneys (chronic kidney disease), retinopathy (ruptured BV in eyes), blood vessels (peripheral vascular disease)

how do you diagnose hypertension?

Elevated BP documented in \> 2 separate occasions

what are treatments for hypertension?

lifestyle changes, loose weight, exercise, low salt diet

what are some side effects of hypertension medications?

orthostatic hypotension, nausea, impotence (erectile disfunction), heart rate not increasing with exercise, dry cough

what are types of hypertension one can get during pregnancy?

gestational hypertension, preeclampsia to eclampsia, chronic hypertension, preeclampsia superimposed with chronic hypertension

What is gestational hypertension?

hypertension without proteinuria that occurs after 20 weeks of pregnancy and resolves 12 weeks postpartum

What is preeclampsia/eclampsia?

hypertension with proteinuria that occurs after 20 weeks of pregnancy

what pathological findings can be seen in a patient with preeclampsia?

elevated serum creatine and liver enzymes, decreased platelets

how is preeclampsia caused?

decreased blood flow to placenta causes the release of toxic chemicals that damage the endothelium

What does eclampsia cause that preeclampsia does not?

seizures

what is chronic hypertension in pregnancy?

hypertension that was present before pregnancy

what is preeclampsia superimposed on chronic hypertension?

hypertension that occurs before 20 weeks with proteinuria that can cause premature delivery

which type of hypertension during pregnancy has the worst prognosis?

preeclampsia superimposed on chronic hypertension

What is orthostatic hypotension?

A drop in blood pressure due to a sudden change of posture.

why are the elderly more prone to developing orthostatic hypotension?

poor baroreflex (poor short term BP regulation), chronically dehydrated state

what are the causes of orthostatic hypotension?

low blood volume (dehydration), drug induced, aging, bed rest, autonomic nervous system disfunction (causes poor baroreflex)

How is orthostatic hypotension diagnosed?

using 24 hour blood pressure monitor

how is orthostatic hypotension treated?

treating underlying cause, slowly changing positions, electrolytes (gatorade), medications that prevent BP changes, moving legs before standing up

What are varicose veins?

pooling of blood in veins due to incompetent valves

who is prone to getting varicose veins?

anyone on their feet for long periods of time, increased intrabdominal pressure (obesity, pregnancy)

What is deep vein thrombosis?

blood clot in a deep vein

what are the causes of deep vein thrombosis?

blood stasis, dehydration

what are the signs and symptoms for deep vein thrombosis?

inflammation, pain, swelling, deep muscle tenderness, elevated WBC count

what are the treatments for a deep vein thrombosis?

using tPA to dissolve the clot first, anticoagulant, pneumatic compression devices