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Heep Cardio 2

Cardiovascular System 2, Heep, Survey of Western Clinical Sciences, Bastyr

What are Disorders of arterial circulation? Cholesterol and hyperlipidemia Atherosclerosis Vasculitis Arterial occlusions Thrombus, embolus, vasospasm Aneurysms
Describe Vasculitis: Inflammation of the tunica intima of arteries. Can affect the arteries of any organ. Can be occlusive blocking the vessel like Raynaud’s and Buerger’s disease – or non-occlusive like temporal arteritis
Is Vasculitis only in the arteries? Can be in veins and capillaries too.
Etiology of Vasculitis: Infection (Hep B), autoimmune diseases, trauma to the artery, radiation (sun burn or for cancer), smoking, toxins in body like lead poisoning, cancer.
What are other names for Vasculitis? Angitis, arteritis
Describe Complications of angiitis: In the acute phase presents with pain and swelling due to inflammation. Based on the area involved, can cause ischemia and necrosis of the tissue and organ.
How do you diagnose Vasculitis: Diagnosis based on lab: high ESR, leukocytosis, hematuria, proteinuria…. Biopsy
Tx of arteritis: with Steroids/corticosteroids and cytotoxic immunosuppresant agents like cyclophosphamide.
Describe (Giant Cell) Temporal arteritis: Non-occlusive Inflammation of temporal, vertebral and ophthalmic arteries.
Who is most likely to contract Giant Cell temporal arteritis? Female to male is 2:1 ratio
Etiology of Giant Cell temporal arteritis: unknown or autoimmune
Symptoms of Giant Cell temporal arteritis: severe unilateral HA, blurry vision and diplopia and facial pain. In 80% of cases causes blindness.
What is a common complication of Giant Cell temporal arteritis: Blindness in 80% of cases
Describe Raynaud’s disease and phenomenon: Occlusive vasculitis Severe vasospasm of the arteries and arterioles of the fingers and toes (and sometimes nose).
What is the difference between R. Disease and R. Phenomenon? R. Disease in healthy women with no known etiology – cold and emotions aggravates it. R. Phenomenon can be due to overuse of hands, frostbite, occupational trauma, autoimmune diseases, extreme temperature exposure. Causes of Raynauds P.
Manifestations of Raynauds d. and P.: Bilateral Skin color changes due to ischemia (pale to cyanotic). Reduction in sensory perception, tingling and numbness in the area affected Pain and sometimes swelling Nail and finger tip skin thickness End stage ulceration and gangrene
Treatment strategy for Raynaud’s: No smoking, No expose to cold. Avoid emotional stress Avoid anti-allergy and decongestant meds In severe cases meds: Ca channel blocker like diltiazem and nifedipine Α-adrenergic receptor blocking like Prazosin (alpha 1 blocker)
Describe Buerger’s disease: Also known as Thromboangiitits obliterans Inflammation of the medium size arteries – occlusive – mostly in lower legs
Who is most likely to get Buerger’s disease? Men who are heavy smokers or tobacco users, 25 – 40 years old.
Sx Buerger’s disease? ischemia and pain, intermittent claudication, cold feeling in toes, nail and skin changes. Advanced loss of pulse and gangrene.
What is the only cause of Buerger’s disease? Smoking
Describe Aneurysms: Abnormal localized dilation of a blood vessel, mostly happens in arteries. Common in Aorta (men after age 50), thoracic aorta, abdominal aorta and circle of Willis.
Etiology of Aneurysms: congenital, trauma, infection, atherosclerosis, collagen/vascular Dz.
Manifestations of Aneurysms: from no Sx to pulsating mass and rupture and bleeding. Pain referred to back and neck and low back.
How to Dx Aneurysms: with MRI and CTscan
What are 3 Disorders of venous circulation: Varicose veins Chronic venous insufficiency Venous thrombosis
What circulates blood in the venous system: Venous circulation dependent of veins valves and muscle contraction (muscle pump).
Describe Varicose veins: dilated and convoluted veins of the lower extremities. Happen due to venous insufficiency, venous valves incompetency.
Etiology of Varicose Veins: DVT, congenital venous malformation, pressure on abdominal veins as in pregnancy or tumor. Sedentary life style.
Other risk factors for Varicose Veins: Obesity, FHx, increased intra-abdominal pressure as pregnancy (more common in women after 50 years old) or lifting, prolonged standing or sitting.
Sx of Varicose Veins: pain, swelling of lower extremities, dilated veins, dermatitis and ulcers.
Define Thrombus: blood clot that forms on the wall of a vessel. Can be occlusive. Happens in atherosclerosis.
Define Embolus: free moving particle in the blood. Can cause occlusion. Mostly come from heart due to heart problems or lower extremity veins. Types of emboli: fat, blood, air and amniotic fluid.
Describe Venous Thrombosis Thrombus in the vein, causing inflammation AKA thrombophlebitis
Where is Venous Thrombosis: Can be either is superficial veins or deep (DVT).
What is the feared complication of Venous Thrombosis: If the thrombus releases, can move to lungs and cause pulmonary embolism (cough, SOB, dyspnea, chest pain).
Describe Risk factors for thrombophlebitis and DVT: Bed rest and immobility, sedentary life style, lower body paralysis. Myocardial infarction (heart attack), congestive heart failure Trauma to abdominal area, tumor, pregnancy OCP, Dehydration, Smoking, ETOH Hip fracture Cancers
Sx of DVT: 50% of cases asymptomatic. When Sx present: pain, swelling and muscle ache and tenderness, ankle and calf edema, redness, heat Positive “Homan’s sign”
Describe Prevention and treatment of Venous Thrombosis: Eliminate the risk factors Meds: heparin and warfarin (anti-coagulants).
Describe Hypertension: High Bp
What is the most common cardiovascular disorder? Hypertension, As many as 50 million American adults have it
Risk factors for Hypertension: Prevalence increases with age More common among African-Americans Obesity and high salt intake
Tx for Hypertension: It can be controlled with meds and prevent its complications.
What are the two Types of hypertension: Primary or essential Secondary, which is due to other health problems: kidney diseases, adrenal, cancers…
Describe Causes of Essential Hypertension: Multi-factorial Incidence increases with age More common in African Americans, obesity, high Na low K intake, smoking, lack of exercise and EtOH consumption. Stress and OCP can contribute to HTN
Complications of Essential Hypertension: End organ damage: eyes, kidneys, heart and brain.
Sx of Hypertension: Mostly asymptomatic Headache Pressure in eyes, nocturia, SOB, edema, chest pain, transient weakness or blindness
IS HTN Acute or Chronic: HTN is a chronic disease
Describe secondary HTN: HTN due to another disease condition Only 5-10% of hypertensive cases. Age range would be ≤ 30 and ≥ 50.
Risk factors for HTN in Younger age: renal artery stenosis, coarctation of aorta (kids), Cocaine abuse
Risk Factors for HTN in Older age: often associated with atherosclerosis (esp in renal arteries)
Causes of Secondary HTN: Renal diseases (in general) – Renal artery stenosis Adrenal disorders High aldosterone High glucocorticoids (Cushing’s Dz) Pheochromocytoma Coarctation of aorta
What are the effects of Licorice on HTN: – works like aldosterone, increases blood volume
How do you diagnose Malignant Hypertension: Sudden elevation in BP – diastole ≥ 120
Risk factors for Malignant HTN: More common in African American
Associated problems with Malignant HTN: renal disorders, vascular changes, retinopathy.
Meds for HTN: Diuretics Adrenergic receptor inhibitors: beta-blockers ACE inhibitors Ca channel blockers
What are the Two main types of Stroke: Hemorrhagic Ischemic: Thrombosis, embolus, or systemic hypoperfusion
What are 7 disorders of Cardiac Function? Disorders of pericardium Coronary heart disease Myocardial diseases Infectious and immunologic heart disorders Valvular heart disease Heart failure Shock
Describe the general complications of pericardial disorders: All cause pressure on the heart. Interfere with filling and venous return to the heart. Reduce preload, and therefore cardiac output.
Describe General manifestations of Pericardial disorders: Chest pain (+ friction rub in auscultation and ECG changes). Dyspnea (SOB) Elevated ESR in lab, leukocytosis
What is ESR? inflammatory marker
Describe Pericarditis: Inflammation of the pericardium. Happens acutely.
Manifestation of Pericarditis: Sharp pain in chest. Can radiate to abdomen, neck, arm. Pain aggravated with deep breathing. Pain reduced when leaning forward.
Etiology of Pericarditis: Infectious: viral, bacterial (TB, Staph, Strep) Autoimmune: Rheumatic fever, Rheumatoid Arthritis, Lupus Metabolic: kidney problems Trauma Tumors and radiation therapy MI
Describe Pericardial Effusion: Presence of fluid in the pericardial cavity Presses on the heart chambers and increases intra-cardiac pressure
Differnece between acute Pericardial effusion and Chronic Pericardial effusion: If happens acutely, large amount of exudate can be life threatening. In Chronic cases less severe as pericardium has time to stretch (can host up to 200 ml without symptoms).
What are the 2 types of pericardial effusion: Cardiac tamponade: accumulation of fluid or blood in the pericardium. Due to trauma to chest, rupture of aneurysm. MI and rupture of heart. Cancer. Chronic pericarditis with effusion: especially in malignancies.
Tx principles for Pericardial Effusion: all pericardial cases need to be referred.
Triad of Sx for cardiac (pericardial) tamponade: Hypotension JVP increased so distended JV Muffled heart sounds Others: SOB, anxiety, dyspnea…
What do you do if Pt presents with Hypotension, Muffled heart sounds and distended JV? Tamponade is an emergency, needs referral to ER.
Created by: bastyr41