Disorders of Blood Flow & Cardiac Function

Vein Obstruction

• downstream

• reduced flow → edema

Arterial Obstruction

• upstream

• increased pressure → distal ischemia

Thrombosis

• aka blood clot

• w/i blood vessel or chamber of heart

What causes thrombosis?

• slow dramatic blood flow

• rupture of fibrous cap

• clot problems

• drugs

Result of Arterial Thrombosis

• ischemia → necrosis

Result of Venous Thrombosis

• edema

• w/ inflammation = thrombophlebitis

Clinical Manifestations of AThrom

• 6 P’s

• any sort of emergency health condition like MI or stroke

Clinical Manifestations of VThrom

• calf/groin tenderness, swelling, none

• DVT

• Pulmonary Embolism

Thrombosis Treatment & Prevention

• anticoagulant or thrombolytic therapy (arterial)

• Exercise & Diet

• anticoagulant therapy, anti-platelet drugs, anti-embolic socks or compression devices, ambulation

Embolus

• free moving particles break loose → through body → lodge into small vessel → block blood flow

Arterial Embolus

Embolus leaving L ventricle → ischemic stroke

• Based on brain area affected, loss of cognitive function, motor changes, and different levels of sensory loss

Venous Embolus

Embolus leaving R ventricle → pulmonary embolus

• Sudden onset of SOB, increased respiratory rate, chest pain, sudden death

Embolus Treatment

Embolectomy

• Surgical removal of clot

Filter in the inferior vena cava (Greenfield filter)

• Net that catches clot, prevents pulmonary embolism

Fibrinolytic (thrombolytic) therapy

• Breaks down clot

Vasospasm

• excessive vasoconstriction

Vasospasm Causes

• vessel injury

• extreme hot/cold

• neuro disorders

  • Subarachnoid hemorrhage and delayed cerebrovascular ischemia

Vasospasm Manifestations

• Prinz metal angina (CAV)

• hands/fingers/toes (Raynaud Syndrome)

Vasospasm Inflammation

• Vasculitis

  • in intima of artery

• Phlebitis

  • lining of vein

Aneurysms

• localized arterial dilations, outward

• emergency

• bc age, genes, HTN

• True

  • weakening in all 3 arterial wall layers

• False

  • extravascular hematoma

True Aneurysms

• Saccular: one-sided

• Fusiform: both sides

• Berry: stem/neck

Aneurysm manifestations

• Cerebral: increasing intracranial pressure, hemorrhapic stroke

• Aortic: sudden severe tearing pain that radiates into back/abdomen, shock

Aneurysm Diagnosis

• Cerebral: CT, MRI, angiography

• Aortic: CT, TEE

Atherosclerosis

• progressive disease

• accumulations of lipids + fibrous elements in large arteries

What causes Atherosclerosis?

Cell injury → inflammation of endothelium → endothelial dysfunction → lipid-dense macrophages embedding in arterial wall → smooth muscle/lipid lesion formation and plaque rupture

Atherosclerotic Plaque

• made of smooth muscle cells, lipoprotein, and inflammatory debris

• decrease arterial vessel radius and perfusion