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

CM’s of AThrom

• 6 P’s

• any sort of emergency health condition like MI or stroke

What are the 6 P’s

• Pallor

• Polar

• Pulselessness

• Pain

• Paresthesia

• Paralysis

CMs of VThrom

• calf/groin tenderness, swelling, none

• DVT

• Pulmonary Embolism

Thrombosis Prevention

• Exercise & Diet

  • staying active

  • normal cholesterol levels

• Interventions and Drug Therapy

  • anticoagulant therapy

  • anti-platelet drugs

  • anti-embolic socks

  • compression devices

  • ambulation

A/V Thrombosis Treatment

• anticoagulants

• thrombolytic therapy (arterial)

DVT

• in a deep vein of lower extremity

Leg: unilateral, calf pain, swelling, tenderness

Respiratory: lungs, pulmonary embolism

Risks: Virchow’s Triad

Embolus

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

  • dislodged thrombus

  • air bubble

  • amniotic fluid

  • cancer cells

  • foreign shit

Arterial Embolus

• Most from heart

  • MI

  • Valve Disease

  • Endocarditis

  • Dysrhythmias

  • HF

Arterial Embolus Examples

• 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

• From deep vein

  • MOST lethal embolism to the lungs

Venous Embolus Examples

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

• Break down clot

Vasospasm

• excessive vasoconstriction of arterial smooth muscles → fucks with flow

Vasospasm Causes

• vessel injury

• extreme hot/cold

• neuro disorders

  • Subarachnoid hemorrhage

  • delayed cerebrovascular ischemia

CMs of Vasospasm

• Prinz metal angina (CAV)

  • chest pain

  • cardiac arrest

  • fainting

• hands/fingers/toes (Raynaud Syndrome)

  • barely any flow

  • coldness/numbness

  • skin (white, blue, red)

  • throbbing or tingling

Types of 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/ how it works

Cell injury → LDL enter intima and oxidizes → inflammation of endothelium → endothelial dysfunction → monocytes differentiate → lipid-dense macrophages consume LDLs → foam cell → embed arterial wall → release cytokines → 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

Test and Treatment for Atherosclerosis

Diagnotstics

• BP

• BMI

• Blood Tests

• Doppler

Treatment

• weight reduction

• no smoking

• cholesterol-lowering drugs

• balloon / laser angioplasty

Coronary Heart Disease

• not enough oxygenated blood to myocardium (cardiac ischemia) bc of coronary arterial atherosclerosis

Collateral Circulation

• arterial anastomoses

• either predisposition for angiogenesis or presence of chronic ischemia