Alteration in Arterial/Vascular Function - CARDIAC PP 1

impared circulation

• this is the responsibility of the cardiovascular muscle (heart)

  • impared parts can lead to inadequate blood flow

    • decreased or excess blood flow (excess blood flow in the wrong place)

• leads to:

  • inadequate blood flow

  • excess blood flow

• results from

  • injury to vessels (vessel has ruptured open)

    • atherosclerosis: damage of the inside part of a vessel

  • obstructive processes

    • blood clot

    • plaque build up

  • inadequate movement of blood

• inadequate blood volume

obstruction

this is a way that causes impared circulation

• contributes to altered perfusion

  • blocks movement of blood

  • tissues arent getting nutrients - necrosis

• occluded arteries:

  • no oxygenated blood to peripheral tissues

  • arteries arent getting it there - aorta

• occluded veins:

  • restricts venous return and leads to circulatory congestion

  • veins return co2 back to right side of the heart (inferior and superior ven cava)

  • if blocks it is gonna create a back flow and this excess fluid stays in the tissues - edema

thrombus formation

• this can be helpful for when we are bleeding but it is bad when were not bleeding and instead creates an obstruction

• can happen in response to injury and wound healing

• undesired thrombi, however, can form in either arteries or veins

  • DVT: typical one we see

  • occludes blood flow

virchow’s Triad

• 3 major factors that are responsible for undesired thrombus formation

  • 1. vessel wall damage

    • surgery post op

  • 2. excessive clotting

    • pt with clotting disorder or has thick blood

  • 3. alterations in blood flow, such as turbulence or sluggish blood movement

    • post op pt again (slow)

      • pace of blood flow is less bc they are bed rest

    • bed rest pt

preventative care - were trying to prevent these major factors from causing a clot

vessel layers

larger arteries have these layers

• strong

• stiff and ridged bc they are withstanding the pressure from the left ventricle

  • left ventricle pushes the hardest

    • have to have pressure to get to the tip of your toes

• an ex of this is ur femoral artery

things that can cause issues to the vessel layers

• hypertension: more pressure than what our body is designed to withstand

  • can cause nicks to intima layer

    • with the dranage - we have blood rushing past it to keep that part damage

• diabetes

  • excess glucose (sugar crystals) causing nicks in the intima

• nicking of the intima causes irritation and inflammation and that can lead to scaring make the space within the lumen smaller and then increases the hypertension causing more nicks

arterial thrombus formation

1. arteries

   1. injury to the intima (inner lining of the vessel)

      1. ex: hyperglycemia and hypertension

   2. LDL deposits into the damage area of the vessel

      1. LDL: bad cholesterol

         1. sticky and clumpy anc creates a tighter layer in the vessicle

   3. becomes engulfed by macrophages producing foam cells

      1. this is our bodies response and says that inflammation can fix it

      2. foam cells combine with additional lippids

      3. forms fatty streaks

• fatty streaks gradually become fibrous plaques

• fibrous plaques accumulate at the sites of injury (called an atheroma)

• coved by platelet caps that continue to expand

  • body tries to fix this by covering the platelet cap but adding another layer is decreasing the limit in the lumen causing high hypertension

• this process is called atherosclerosis

• this is where the thrombus then forms

atherosclerosis: major determinants of disease

• age (nonmodifiable)

• is accelerated by lifestyle (modifyable)

  • diet

  • obesity

  • smoking

  • lack of exersise

• high bp and diabetes (chronic illnesses)

  • high bp - starts with the damage to the intima layer

• familial genetic influence

atherosclerosis: diagnostic test

• serum lipid levels (LDL and HDL)

  • LDL: bad cholesterol

    • fat that clumps up and causes blockage

  • HDL: good cholesterol

    • keeps vessels slick so things dont stick

    • only way to increase this is to do exersize and doing this also reduces some of the LDL

  • C-reactive protein (CRP)

    • marker of inflammation

  • BMI

    • usually important in someone who is obese or morbidly obese

  • exerscise stress testin

arteriolosclerosis overall

• overall degenerative damage of the SMALL vessels in the kidneys, brain, heart, retina, feet, and legs

• abnormal thickining of the intima → loose elasticity → becomes hardened

• related to disease, such as, hypertension and diabetes

• leads to diffuse ischemia and necrosis

  • esp. kidneys, brain or heart damage and retinal damage

  • feet become necrotic (especially in those with diabetes)