Patho: Cardio Module-Vascular
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- Is a split S2 a normal sound?- what causes a split S2?
- Very often split S2 is normal. When you inhale, you get more blood on right side (due to compression of vena cava) and pulmonic valve stays open longer (because it has more blood to get through the valve). Aortic valve closes 1st. No pathology associated with this. Splitting of S2 is going to be in 2nd interspace.
- What is an intrinsic mechanism of bp control?
- Intrinsic Mechanisms- the control of blood flow incorporates some organs that can autoregulate their blood pressure. That organ constricts to increase pressure or dialates to decrease bp. Brain, heart, and kidney are organs that can autoreg. Kidney’s afferent or efferent arteries are used to autoregulate kidney.
- How does the ANS affect the pulmonary/coronary blood vessels?
- SNS: constrict, PNS: dilate (that's what the notes say!)
- What is the difference between atherosclerosis and arteriolar sclerosis?
- Arteriolar sclerosis is where hypertension has its impact on small vessels in the kidney, heart, and brain. Atherosclerosis is the hardening of large vessel walls, ie arteries
- When a patient is put on insulin, what is most likely to happen to there blood lipid panel?
- The patient's blood lipids will increase because the individual has been use to breaking down lipids instead of directly using glucose for cellular energy.
- Name 4 non-modifiable risk factors.
- Age, gender, heredity, ethnicity
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Right HF, obesity, and pregnancy can all be related to:
A. arterial insufficiency
B. venous insufficiency - B. venous insufficiency
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Match the following choices with either arterial insufficency or venous insufficiency:
A.Smoking
B.Atherosclerosis
C.Prolonged standing
D.Inflammatory: Buerger disease
E.Trauma
F.High hematocrit
G.High platelets
H. -
Arterial Insufficiency:
A.Smoking, B.Atherosclerosis,
D.Inflammatory:Buerger disease
E.Trauma (both)
H.Emboli from LV
I.Vasospasm
M.Diabetes
Venous Insufficiency:
C.Prolonged Standing
E.Trauma (both)
F.High hematocrit
G.High platelets
J.Stasis of blood
K.Immobility - A form of Arteritis, Thromboangiitis Obliterans, is also called...
- Burgurs Disease
- Describe Burgur's Disease; who gets it; what is disease process; what are the symptoms; what is the therapy?
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Burgurs Disease: affects small to medium size arteries in upper extremities. Get fibrotic scarring. Part of scarring process involves neighboring nerves. Tends to be associated w/smoking in men less than 40. Inflammatory response that causes scarring.
Symptoms: related to decreased arterial blood flow. Pain, numbness/tingling, cold, hair loss, skin breakdown resulting in ulcers
6 or 5 P’s of obstruction: Pulselessness, palor, pain, poichiotosis (polar), paralysis.
If you stress a muscle, you normally would get increased blood flow. However, if you have this disease you get claudication (cramping) because there is NOT increased blood flow like normal.
Tell them to stop smoking (if they are). AND/OR amputation.
Peripheral vascular disease: people have obstructions to blood flow. - What is the typical target population of Raynaud's Disease; what are the symptoms; the pathology; the therapy?
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Population- usually women. Symptoms- arterial spams that occurs in hands and fingers. Fingers get blue (blood supply leaving), white (blood gone), and red (blood returning).
Patho- vasoconstrictive response to vibration (factory work) and cold.
Therapy: wear gloves, stay away from vibrations adn try to alleviate stress. - How would you simply describe an individual's aneurysm if the diagnosis was a false fusiform aneurysm?
- The individual would have weakness all the way around the vessel but one of the 3 tunicas/layers is uneffected.
- What is an aneurysm? What ar the 4 different types of classification?
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An aneurysm is an outs-pouching/ballooning in a vessel wall. Fusiform vs Saccule- has to do with whether or not the aneurysm goes all the way around the vessel.
A fusiform aneurysm involves all weakness on all sides of the vessel. A saccule only has an outpouching on one side.
True vs False- has to do with which layers of the vessel are involved in the aneurysm
true- all three layers invovled (advnetitia, media, intima)
False- only 2 layers are involved. -
Is an acute arterial occlusion an emergency?
Why or why not? - It is an emergency! Anytime you start to lose a pulse it is an emergency. This patient is a surgical candidate.
- Why is it that diabetics have neuropathy?
- WHen sugars are out of whack sorbital forms. This breaks down the myelin sheath that surrounds the nerve.
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Which set of symptoms are more likely associated with acute ischemia to a certain area of the body?
A.pain
pallor
pulselessness
paresis
paralysis
poikilothermy
B.intermittent claudication
atrophy (skin, hair) -
A. is the answer.
The characterists of B are more associated with chronic ischemia. - DVT is the precursor to what serious condition? If patient is going to be bed bound of a long time, what are two simple things to do to help prevent DVT and thus PE?
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PE.
Put Tet hose on and put patient on anticoagulant - What is an example of chronic venous insufficiency- DVT or varicose veins?
- DVT. Chronic venous insufficiency has to do with deep veins such as the femoral. As pressure starts to back up and venous pressure ='s arterial pressure patient get stasis ulcers on skin.
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Arrange the following letters in the progression of the disease state:
A. DVT
B. Valvular incompetance
C. chronic venous insufficiency. - B. valvular incompetance causes C. chronic venous insufficiency which progresses to A. DVT
- When considering how to treat thrombophlebitis, what is some symptomatology what would indicate if the patient has a DVT or superficial phlebitis?
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Fever is the biggest and lower extremity edema vs no fever and localized swelling.
DVT: fever, extremity edema, general leg pain
Superficial: general leg pain, inflammation, swelling, warm. Collateral veins MINIMIZE edema. - Secondary lymphedema is due to what? What causes primary lymphedema?
- Surgical removal of lymphnodes such as in radical mastectomy- secondary. Congenital, such as thorasic duct obstruction is primary.
- Concerning hypertension, why is it that simply getting older can lead to hypertension?
- Arteries lose their pliability as you get older- thus it is harder to pump blood through them.
- What are 4 simple risk factors for hypertension?
- Age, race, sodium intake, obsity.
- What is the normal function of the kidneys as it relates to Na and K?
- Keep Na and dump K.
- What is the age group that we start to think of secondary causes of hypertension?
- >60 and < 20. Typically if you are going to develop hypertension as you age, you will have it by 40.
- What are the secondary causes of hypertension? (Think that you NEVER what patients to have these!)
- Neurologic, Endocrine, Vascular, Exogenous compounds, Renal (2-3% and most common secondary form).
- How does inactivating the RAA cascade (via an ACE-I) produce hyperkalemia?
- An ACE would decrease the production of aldosterone. Aldosterone acts on the kidney to normally excrete K and retain Na.
- What is typically the cause of primary hypertension and what % of hypertension accounts for primary hypertension?
- Primary hypertension has unknown etiolgy and accounts for 95% of the cases of hypertension.
- When you remember to investigate secondary HTN cause what conditions do you think about?
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CPR DASH
CCC, PPP, RR, DASH
Coarctation of aorta, Cushings Syndrome, Contraceptive use; Polycytemia, Pheochromoctyoma, pregnancy-induced hypertension; renal disease, renal artery stenosis; drug induced (cocaine, ephedra, NSAID's); aldosteronism; sleep apnea; hyperthyroidism - What are 4 hormonal influences of hypertension?
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1.Renin-angiotensin-aldosterone
2.Anti-diuretic hormone
3.Adrenal catecholamines
4.Atrial natriuretic peptide