Blood Vessels and CS

What os the leading cause of mortality and morbidity: 1/3 of deaths

Diseases of the blood vessels and heart

What is impaired perfusion due to

Obstruction, rupture of blood vessels or failure of heart to pump blood

What is the most common cause of cardiovascular disease

Atherosclerosis

What are risk factors for cardiovascular disease

Hypertension, diabetes mellitus, hyperlipidemia, smoking

What do arteries do

Carry blood AWAY from heart

What do arteries carry

Oxygen-rich blood

What do the pulmonary arteries carry

Oxygen-poor blood

What do veins do

Pump blood TOWARD the heart

What doe veins carry

Oxygen-poor blood

What do the pulmonary veins carry

Oxygen-rich blood

What are the blood vessel layers

Intima, media, adventicia (tunica externa)

What are the ABCS of the aortic vessels

Aorta, Brachiocephalic trunk, Carotid artery, Subclavian artery

What does brachiocephalic trunk split into

Right carotid and right subclavian

What is A B C and S

Aorta, brachiocephalic trunk, carotid artery (left), subclavian artery (left)

What is edema

Abnormal accumulation of fluid in interstitial tissues

What is effusion

Abnormal accumulation of fluid in body cavities

What is thrombosis

Occlusion of blood vessels by LOCAL blood clot

What is embolism

Blockage of blood vessel by CIRCULATING blood clot

What can embolism be caused by besides blood clot

Fat, air, amniotic fluid

Where is a venous thrombus and where will it end up

Right side of heart, will end up in lungs causing pulmonary embolism

Where is arterial thrombus and what will it cause and where

Left side of heart, results in arterial thrombosis anywhere in the body

What is infarction

Tissue necrosis due to occlusion of arterial blood supply leading to tissue ischemia

What is shock

Dramatic drop in blood pressure leading to hypo perfusion

Where is peripheral edema

Arms, legs

What is pulmonary edema

Fluid in lungs

Where is pleural effusion

Pleural cavity, fluid around the lungs

What is pericardial effusion

Fluid in the sac around the heart

What is Ascites

Fluid in peritoneal cavity

What less to edema: What is increased hydrostatic pressure

More fluid being pushed out of the blood vessels

What less to edema: What is reduced plasma oncotic pressure

Less protein in blood to retain fluid

What less to edema: What is lymphatic obstruction

Impaired drainage of tissue fluid

What less to edema: What does sodium + water retention cause

Increased fluid volume in the body

What less to edema: What does inflammation do

Leads to increased vascular permeability, fluid leaks into the tissues

What is pitting edema

Depression remains upon pressure

What is lymphedema

Often nonpitting

75% of blood flowing through liver comes from:

Portal vein

What is acute hemorrhage

Rapid blood loss

What is chronic hemorrhage

Slow, ongoing blood loss

What is internal hemorrhage

Bleeding into body cavities or organs

What is caused by within tissue hemorrhage

Hematoma

What kind of hematoma is usually tolerated

Large hematomas in soft tissue

Why is epidural hematoma (bleeding within skull) an emergency

It rapidly increases intracranial pressure

What is petechiae, including size

1-2mm. In skin, mucous surface. Associated with low platelet counts and hypertension

What is purpura, including size

3mm-1cm. Vascular inflammation, vessel fragility, slighty raised

What type of hemorrhage is Henoch-Scholein associated with

Purpura

What is ecchymosis, including size

>1cm. Bleeding in tissues (subcutaneous) post injury or bleeding disorder. Leakage of RBC from small ruptured vessel

What is a hematoma

Pocket of blood in tissues, hurts, can be felt

What is hemostasis

Normal mechanism of how bleeding is terminated

What is the primary step of hemostasis

Platelets bind to damaged or inflamed vessel and form platelet plug (in seconds)

What is the secondary step of hemostasis

Coagulation cascade forms a fibrin clot that cements platelet plug (in minutes)

What is thrombosis

The undesired activation of the coagulation system leading to occlusion

What are the most important coagulation factors

Blood vessels, platelets, coagulation system

What is the sequence of events of the coagulation system

1. Injury, 2. arteries constrict, 3. injury exposes extracellular matrix and tissue factors activating coagulation, 4. platelets adhere to site of injury and become activated and release granules activating more platelets, 5. fibrin is produced by cascade and stabilizes platelet thrombus

What factors are important in primary hemostasis

vWF, TF, collagen

What does the tissue factor pathway do

Jump starts coagulation, makes thrombin burst, used for PT test (TRIGGERS COAGULATION)

What does the contact activation pathway do

Activated by thrombin, SUSTAINS COAGULATION

What is hemophilia A

Deficiency of factor VIII

What is hemophilia B

Deficiency of factor IX

What is Xarelto, pradaxa, and rivaroxaban Eliquis

Direct-acting oral anticoagulants

What do DOACs target

Factor Xa or Thrombin (Factor II)

What are the three main factors of thrombus formation and what are they known as

Known as Virchow’s Triad:

1. Stasis of blood flow, platelets are forced against vessel walls and get activated by endothelium

2. Endothelial injury, exposure of extracellular matrix activates platelets (important in atherosclerosis, inflammation, smoking)

3. Blood hyper-coagulability, elevated prothrombin

What are symptoms of DVT

Swelling, pain, redness

How is DVT diagnosed

Ultrasound, elevated D dimers (>300 mg/mL)

With what conditions is DVT risk increased

Superficial vein thrombosis, Chronic venous insufficiency (Varicose)

What is varicose veins

Insufficiency of venous valves, CVI

What are signs of pulmonary embolism

Sudden onset shortness of breath, chest pain, blue skin, tachycardia, dizziness

How do you diagnosis Pulmonary embolism

Pulse oximetry, chest x-ray, CT with radio contrast

What is tPA

Tissue plasminogen activator

What are lines of zahn

Alternating bands of pale pink and red in thrombus

What is the pink in lines of zahn

Platlets and fibrin

What is the red in lines of zahn

RBC

Where do lines of zahn usually form

Arteries, only in live patients

What is the most important cause of arterial thrombosis

Atherosclerosis

What is it when there is an embolism of the brain

Ischemic stroke

What is it when there is an embolism of the kidney

Renal infarction

What is it when there is an embolism of the lower extremities or skin

Acute limb ischemia or gangrene

What is it when there is an embolism of the intestine

Bowel infarction

What is infarction

ischemic necrosis caused by loss of blood supply, usually due to arterial blockage

What is Anemic (WHITE) infarct

Arterial occlusion, occurs in solid organs w/ end-arterial circulation (Heart, kidney, spleen)

What is hemorrhagic (RED) infarct

Blood enters tissues from collateral vessels after reperfusion (lungs, intestine, venous)

What does fat embolism usually follow

Fractures of long bones (femur or pelvis)

Where do fat droplets lodge in fat embolism

Pulmonary and systemic microvasculature

What are symptoms of fat embolism

Dyspnea, confusion, petechiae

What are air embolisms caused by

surgery, trauma, catheterization, chest wall injury

Decompression sickness (the bends) is an example of

Air embolism

What is amniotic fluid embolism

Entering of amniotic fluid or fetal tissue into mom’s blood circulation due to rupture of uterine veins or placental tear

What are symptoms of amniotic fluid embolism

Sudden onset Severe dyspnea, cyanosis, seizure, coma

What is epidural hematoma and what vessel is it associated with

Bleeding between skull and dura mater, arteries

What is subdural hematoma and what vessel is it associated with

Bleeding between dura mater and arachnoid mater, veins

What is the presentation of epidural hematoma

Loss of consciousness, then a lucid interval, then rapid neurologic decline

What are symptoms of epidural hematoma

Severe headache, vomiting, ipsilateral fixed dilated pupil (CN III compression)