[HEAL 3106] Midterm 1

Systems

are high order structures that perform a specialized function

Heart; Right side; Left side

• CENTRAL part of the cardiovascular system; performs same action repetitively

• acts as a double-sided pump

  • _____ - pumps blood to/from the lungs

  • _____ - pumps blood to the rest of the body

Blood; Whole blood; Plasma; Formed elements

• FLUID of the circulatory system

• _____ - blood w/ all components

• _____ - liquid matrix

• _____ - cell and cell fragments

Vessels

• conduct blood between the heart & rest of the body

  • it is a closed system

  • interacts extensively w/ other fluid compartments

Arteries; Veins; Capillaries

• _____ - carry blood AWAY from the heart; aka EFFERENT VESSELS; does NOT have VALVES

• _____ - carry blood TO the heart; aka AFFERENT VESSELS; has VALVES (valves maintain UNIDIRECTIONAL blood flow)

• _____ - exchange substances bet. BLOOD & TISSUES; LARGEST CROSS-SECTIONAL AREA

1. Transport gases, nutrients, hormones, and wastes

2. Regulate pH, fluids and ion of the interstitial fluid/cells

3. Restrict fluid loss at injury sites within blood vessels

4. Defend against toxins and pathogens

5. Stabilize body temperature

FUNCTIONS OF THE CARDIOVASCULAR SYSTEM (TRRDS)

Etiology; Pathogenesis; Molecular changes

• _____ - the CAUSE of the disease

• _____ - how the disease process EVOLVES

• _____ - MORPHOLOGY - fundamental structure/form of cells & tissues

Clinical manifestations; Diagnosis; Clinical course

• _____ - how the disease PRESENTS itself (SYMPTOMATIC/ASYMPTOMATIC)

• _____ - NATURE/CAUSE of a health problem

• _____ - the EVOLUTION of a disease (ACUTE/SUB-ACUTE/CHRONIC)

Transthyretin; Tafamidis

• is a protein that circulates in our blood

  • due to age/mutations, it misfolds and accumulates in the heart

  • leads to a disease known as ATTR-CM (heart weakness, failure, death)

• there is a therapy for this disease known as _____

blood flow; blood pressure; arterial; venous; capillary

• _____ as _____

• _____ pressure - force exerted by blood against ARTERIES

  • HIGHEST and PREDOMINANTLY determines SYSTEMIC PRESSURE

• _____ pressure - force exerted by blood against VEINS

• _____ pressure - force exerted by CAPILLARIES

aorta; 120mmHg; systemic circulation; systolic; 120mmHg; diastolic; 80mmHg

• highest pressure is at the _____ which generates pressure about _____

• _____ - pressures are HIGHER than Pulmonary circulation pressures

• _____ - PEAK PRESSURE measured @ _____

• _____ - MINIMUM PRESSURE measured @ _____

systolic - diastolic; diastolic + (systolic - diastolic) / 3

(1) PULSE PRESSURE FORMULA

(2) MEAN ARTERIAL PRESSURE (MAP)

• is more DIASTOLIC because it spends 2/3 of its time relaxing = resting state

stretchability; compliance; systole; diastole

• ARTERIES and PULSE PRESSURE is determined by _____

• how easily a vessel stretches is known as _____

• [!] pressure must be HIGHER than resistance; blood needs to flow NORMALLY not backwards! 

• during _____ influx of blood stretches the arterial walls → INCREASES PRESSURE

• during _____ walls recoils, MAINTAINING PRESSURE

sphygmomanometer; cuff inflated to pressure; pressure released; korotkoff’s sound; lower pressure

• blood pressure can be measured using a _____

• _____ > SBP (No flow, no sound)

• _____ < SBP (Some flow, some sound; turbulent flow aka _____)

• _____ < DBP (Normal flow, no sound)

tissue perfusion; autoregulation; central regulation

• _____ - blood flow through TISSUES; must match in demand of tissue

• _____ - SHORT TERM; local changes in blood flow within CAPILLARIES; regulated by PRECAPILLARY SPHINCTERS (causes vasoconstriction & vasodilation of vessels)

• _____ - SHORT & LONG TERM; regulated by cardiovascular centers in the brain; involves NEURAL and ENDOCRINE systems; can & alter blood flow to nonessential/inactive tissues; HOMEOSTASIS (normal range of BP) can decrease BP = restored!!! :)

  • 3 parts:

    • cardioACCELERATORY center (increases heart rate)

    • cardioINHIBITORY center (inhibits heart rate)

    • VASOMOTOR center (causes vasoconstriction/vasodilation)

baroreceptors

• NEURAL REGULATION is initiated by pressure receptors aka _____

• receptors found in the AORTA and CAROTID SINUS

• stimulate centers in the medulla to control heart rate & vasoconstriction of vessels

• SHORT TERM!

kidney; RAAS system

• _____ = plays a vital role for long-term regulation of blood pressure

• _____ = activates a cascade of hormones to control BP LONG TERM; involves MANY organs & hormones; main system involved in control of blood volume and BP; results in VASOCONSTRICTION; REABSORPTION OF WATER & SODIUM; INCREASED THIRST

  • (1) KIDNEY senses a drop in BP

  • (2) releases RENIN

  • (3) ANGIOTENSINOGEN → ANGIOTENSIN 1 → ANGIO 2

    • ANGIO 2 causes VASOCONSTRICTION → BP rises

    • ANGIO 2 activates ALDOSTERONE → REABSORPTION OF WATER and SODIUM → BP rises

hypertension; primary; secondary; office bp measurement; out of office

• ELEVATED blood pressure

• SEX-DEPENDENT

• normal is 120/80 (normotensive)

• 2 types:

  • _____ = essential or idiopathic (no idea what’s happening)

  • _____ = other disorder (kidney disease)

• _____ = measurement taken in a clinical setting, prone to the white-coat hypertension and masked hypertension

  • WHITE COAT HYPERTENSION - BP can be falsely elevated due to the stress of a medical visit.

  • MASKED HYPERTENSION - BP can be normal in the office but high at other times, leading to misdiagnosis.

• _____

  • HOME BP MONITORING - Patients take their own BP readings at home over days, weeks, or months.

    • PROS: provides long-term BP information in a familiar, stress-free environment and has been shown to better predict health outcomes than office readings alone

    • CONS: requires proper patient education on how to take accurate readings and can be subject to user error. 

  • AMBULATORY BP MONITORING - portable device worn by the patient for 24 hours, taking BP readings at regular intervals throughout the day and night

    • PROS: Captures the 24-hour BP profile

    • CONS: Can be expensive, requires repeated monitoring, and can be affected by poor measurement techniques

low normal - <120, <80
normal - 120-129, 80-84
high normal - 130-139, 85-89
stage 1 - 140-159, 90-99
stage 2 - 160-179, 100-109
stage 3 - >=180, >=110

STAGES OF HYPERTENSION

non-modifiable risk factors; modifiable risk factors

• _____ = are inherent and cannot be altered (ex: family history, gender, race, age)

  • stiffening of large arteries (more stiff = less compliance/stretch)

  • decreased baroreceptor sensitivity

  • increased vascular resistance

  • decreased renal blood flow
    

• _____ = are those that can be changed through lifestyle or environmental adjustments (ex: sedentary lifestyle, poor dietary habits, diabetes, smoking, drug use, stress, salt intake)

  • raises blood volume

  • increases sensitivity to sympathetic nervous system
    
    *red underlined PRIMARY!

primary hypertension; heart; brain; systemic vascular

• typically ASYMPTOMATIC

• _____ = thickening of the left ventricle (hypertrophy); atherosclerosis of the coronary vasculature

  • it’s detrimental because it’s getting smaller and smaller, blood is less

• _____ = strokes, dementia, and cognitive impairment

• _____ = atherosclerosis

ACE; ARBs; B-blockers

• _____ = prevents the CONVERSION of Angio I to Angio II

• _____ = blocks Angio II from BINDING to Angio II receptors

• _____ = reduce heart rate and cardiac output (decreases BP)

artery; capillary

• _____ = LARGEST vessel

• _____ = SMALLEST vessel

  • consists of a continuous tube of endothelial cells w/ basement membrane (lacks tunica media & externa)

  • very thin important for movement

slow movement; many capillaries = low total resistance; atherosclerosis

• _____ is needed to promote substance exchange between capillaries and tissues

• resistance is affected how? _____

• _____ is an example of resistance

CHP; filtration; BCOP; reabsorption

• _____ = blood pressure within capillary beds; highest near the arteriole side of the capillary

• _____ = PUSHES water and small solutes OUT of capillaries

• _____ = pressure exerted by plasma proteins within blood; remains the same throughout the capillary

• _____ = PULLS water and small solutes INTO capillaries

Edema

• _____ = swelling produced by the EXPANSION of interstitial volume; SWOLLEN = DECREASE IN BLOOD FLOW

• 4 causes:

  • increased capillary pressure

  • increased capillary permeability

  • decreased colloidal osmotic pressure

  • obstruction of lymph flow

• LOCATION SPECIFIC

  • BRAIN, LARYNX, LUNGS can be life-threatening

  • JOINTS interfere with movement

capillary filtration pressure; capillary permeability; capillary colloidal osmotic pressure; obstruction of lymph flow; lymphedema

• _____ = causes fluids to ENTER interstitial fluid; PRESSURE RISE = MORE FLUID; generalized EDEMA, heart failure, kidney disease, pregnancy

• _____ = ENLARGED = CAPILLARIES DAMAGED = MORE PLASMA ENTER; inflammation, allergic reactions

• _____ = PULLS fluid BACK into capillaries; DECREASES = LESS FLUID RE-ENTERS; decreased production/loss of plasma proteins

• _____ = when this one is blocked, an EDEMA is formed aka _____; most often seen in the LIMBS

pitting test; compression stockings; diuretic therapy; administer albumin

• _____ = pressure on a swollen area for 5-15s; GRADE will be dependent on deep it is & quickly it rebounds

  • GRADE 1 - IMMEDIATE rebound, 2mm pit

  • GRADE 2 - <15s, 3-4mm pit

  • GRADE 3 - 15-60s, 5-6mm pit

  • GRADE 4 - 2-3min, 8mm pit

• _____ = increase interstitial fluid pressure; RESISTANCE to outward movement of fluids

• _____ = common to other chronic diseases (heart failure, kidney disease)

• _____ = used in individuals with liver failure and kidney disease

pulmonary circuit; systemic circuit

• _____ = moves blood through the LUNGS; aka central circulation

  • right ventricle, left atrium, lungs, pulmonary vasculature

• _____ = moves blood through the REST OF THE BODY; aka peripheral circulation

  • left ventricle, right atrium systemic vasculature, peripheral tissues

tunica externa; tunica media, tunica intima

• _____ = OUTERMOST LAYER; anchors vessel to surrounding tissues; THICKEST IN VEINS

• _____ = MIDDLE LAYER; contains sheets of smooth muscle; THICKEST IN ARTERIES; VASOCONSTRICTION & VASODILATION

• _____ = layer that faces the LUMEN/INSIDE of the vessel; single layer of endothelial cells; creates continuous barrier

F = triangle P / R

FORMULA FOR BLOOD FLOW

plaque; occlusion

• hardening of the arteries

• formation of a _____ within the subendothelial layer of INTIMA of arteries

• it contains fats, cholesterol, calcium and cell debris

occlusion

leads to ______ (blockage) of the arteries

• leads to more TURBULENT blood flow

  • MORE TURBULENT = MORE RESISTANCE = SLOWER BLOOD FLOW

  • HIGHER BP

• type of fluid flow w/ eddies and swirls (NON-LAMINAR)

• opposes resistance, promotes blood flow (F=△P/R)

• leads to INADEQUATE NUTRIENT & O2 DELIVERY

• leads to TISSUE WASTING (ATROPHY)

artherosclerosis; resistance

the largest effect that ______ has on blood flow is due to _____

lipoproteins

• lipids are primarily transported in circulation as _____

• composed of triglycerides, cholesterol, and proteins aka apoproteins)

• more associated with ATHEROSCLEROSIS (ApoB-100 → most common)

LDL; HDL

• _____ = considered “BAD”; carries cholesterol to cells; if too much cholesterol → buildup of plaque within arteries = atherosclerosis!!

• _____ = considered “GOOD”; acts as a “scavenger”; picks up extra cholesterol from blood vessels & carries to liver for processing/removal

familial hypercholesterolemia; ApoB

• _____ = inherited condition when individuals have severe levels of circulating cholesterol/LDL

• _____ = people with this have a mutation in which protein?

endothelial cell injury, migration of inflammatory cells, lipid accumulation and smooth muscle cell proliferation, development of a plaque

DEVELOPMENT OF ATHEROSCLEROSIS (4) (EMLD)

endothelial cell injury

• repeated and multiple injuries to the ENDOTHELIUM

• endothelium is disrupted and the subendothelial layer becomes exposed → lipid accumulation increases

migration of inflammatory cells

• due to injury, endothelial cells express adhesion molecules to recruit inflammatory cells such as MONOCYTES

  • monocytes migrates to the intima, matures into macrophages

    • repairs damaged area

    • engulf accumulated LDL

lipid accumulation and smooth muscle cell proliferation

• macrophages laden with lipid transform into FOAM CELLS

  • foam cells releases growth factors → causes PROLIFERATION of smooth muscle cell

• accumulation DEFORMS the vessel wall (creates ATHEROSCLEROSIS lesion → PLAQUE formation)

development of a plaque; fibrous cap, core, shoulder

• consists of smooth muscle cells, immune cells (macrophages, leukocytes) and dense extracellular matrix (connective tissues)

• 3 COMPONENTS? (FCS)

fatty lesions; fibrous atheromatous plaque; complicated atheromatous plaque

• _____ = thin, yellow discolorations; initial, very common

• _____ = grey/pearly white; MORE DYSFUNCTIONAL, dangerous → occlusion of vessels can occur

• _____ = dark red discoloration; MOST DYSFUNCTIONAL, high risk of ulcerations, hemorrhages, thrombus

thrombus; embolism; stable thrombus; unstable thrombus

• _____ = blood clot

• _____ = when a thrombus is dislodged & get lodged in a distant vessel that is too small to pass

• _____ = meshwork of THIN, dense fibrin fibers with FEW OR NO pores; OCCLUSIVE THROMBUS

• _____ = meshwork of THICK, looser fibrin fibers with LARGE pores; higher chances can be dislodged; SERIES OF EMBOLISM

statins; HMG-CoA reductase

• _____ = main drug class used to treat high LDL/atherosclerosis

• it inhibits/blocks _____ → rate-limiting step in the synthesis of de novo (made in the body) cholesterol = LOWERING LEVELS OF LDL

aneurysm; tunica media; aorta

• abnormal localized dilation of a blood vessel; abnormal bulge/ballooning

• it develops primarily in the _____

  • MMPs (matrix metalloproteinases) → breaks down extracellular matrix @ the t.m

  • ! STRUCTURAL INTEGRITY OF VESSEL WALL IS AFFECTED !

• most common in the _____

saccular aneurysm; fusiform aneurysm; berry aneurysm; all layers

• _____ = weakness on ONE SIDE of the vessel

• _____ = weakness on BOTH SIDES of the vessel

• _____ = small SPHERICAL dilation of the vessel at a bifurcation

• _____ = what layer is FALSE ANEURYSM?

vessel dissection; vessel rupture; aortic dissection; aortic rupture; size dependent

• _____ = tearing of the INTIMAL LAYER

• _____ = tearing of ALL 3 VESSEL LAYERS

• _____ = separation of the layers of the aorta; creates “FALSE LUMEN”

• _____ = tearing of ALL LAYERS OF THE AORTA; no lumen

• risk of rupture is _____

  • may also be SEX-DEPENDENT (depends on the diameter & sex)

atherosclerosis/aneurysm, hypertension, connective tissue diseases, blunt chest trauma

WHAT CAUSES AORTIC DISSECTIONS?

- _____ = ulcers and/or thrombus weaken/penetrate aortic walls

- _____ = elevated BP creates wall tension

- _____ = “Marfan syndrome”

- _____ = x

Debakey system; type I; type II; type III

- _____ = most used for aortic dissection

- _____ = involve the ASCENDING/DESCENDING aorta; 60% of cases

- _____ = involve the ASCENDING aorta only; 10-15% of cases

- _____ = involve the DESCENDING aorta only; 25-30% of cases

symptoms of aortic aneurysm/dissection/rupture

• severe chest/upper back pain

• severe stomach pain (abnormal aortic aneurysm)

• loss of consciousness

• shortness of breath

• similar symptoms of stroke

• leg pain

• difficulty walking

medical management; surgical treatment; open; tevar

• _____ = anti-hypertensive medication, lipid lowering therapies “STATINS” (drug)

• _____ = open heart surgery, TEVAR (thoracic endovascular aortic repair), Hybrid (open & minimally invasive)

• _____ = placement of a graft as false vessel by opening the chest & blocking blood flow while repaired

• _____ = placement of a graft using a catheter (minimally invasive because no opening of chest)

<5.0cm; >5.5cm; grey zone

• _____ = surgery NOT RECOMMENDED → medical management

• _____ = surgery RECOMMENDED to replace the aorta

• _____ = aorta BETWEEN 5.0-5.5

Anatomy; Pathology; Physiology; Pathophysiology

• _____ = identification & description of the body structures of living things

• _____ = study of structural & functional changes in cells, tissues, and organs

• _____ = functions of the human body under normal conditions

• _____ = how disease states affect body function

abdominal aorta and iliac arteries, coronary arteries

2 SITES OF ATHEROSCLEROSIS?