MEDRADSC 1B03 Lecture Notes - Lecture 31: Peripheral Artery Disease, Atheroma, Arteriosclerosis
Cardiovascular, system
Define&and&briefly&describe&the&following&selected&pathologies:
Arteriosclerosis
Pathophysiology
•
A&term&for&all&types&of&arterial&changes
•
Best&applied&to°enerative&changes&in&arteries&and&arterioles&in&people&over&
50&and&with&diabetes
•
Elasticity&is&lost&and&walls&become&thick&and&hard,&lumen&narrows&and&may&
become&obstructed
•
Leads&to&diffuse&ischemia&and&necrosis
Atherosclerosis
Pathophysiology
•
Presence&of&atheromas&-plaques&consisting&of&lipids,&cells,&fibrin&and&cell&debris,&
often&with&attached&thrombi&which&form&inside&the&walls&of&arteries
•
Affected&artery&is&rough,&elevated&and&has&loose&pieces&of&plaque&and&thrombus
•
Caused&by&lipids&circulating&in&blood&which&build&up&sites&of&of&arterial& injury&
along&with&fibrous&tissue,&prostaglandins&are&released&and&more&inflammation&
and&cells&come&to&the&site&causing&arterial& flow&to&become&turbulent
•
Plaque&may&ulcerate&and&break&open
•
Blood&flow&decreases&due&to&blockage
•
Atheroma&damages&arterial&wall,&weakening&the&structure&and&decreasing&its&
elasticity,&it&eventually&calcifies
•
Can&cause&angina,&myocardial&infarction,&stroke&,&renal&damage&and&peripheral&
vascular&disease
Etiology
•Nonmodifiable&factors
○Age
○Gender&(women&have&more&HDL&until&menopause&when&estrogen&levels&
decrease)
○Genetics
•Modifiable
○Obesity&(high&LDL&cholesterol&diets)
○Smoking
○Exercise
○Diabetes
○Poorly&controlled&hypertension
○Oral&contraceptives
○High&blood&cholesterol&and&high&BP
Diagnostic&Tests
•Checking&HDL&and&LDL&levels
•CRP&indicates&inflammation&-low&CRP&means&lower&risk&of&cardiovascular&
disease
Treatment
•Losing&weight
•Healthier&diet
•Lowering&serum&cholesterol&and&LDL&levels
•Control&diabetes
Angina,Pectoris
Pathophysiology
•Chest&pain&when&there&is&a&deficit&of&oxygen&to&the&heart&muscle
•Can&occur&when&heart&is&working&harder&than&it&needs&to&be&and&is&in&demand&for&
oxygen&(exercising)
•Classic/exertional&angina&
○Variant&angina&in&which&vasospasm&occurs&at&rest
•Unstable&angina
○More&serious&form
○Prolonged&pain&at&rest&and&of&recent&onset
○Could&be&caused&by&breakage&of&atheroma
○Could&cause&myocardial&infarction
Etiology
•May&be&caused&by&a&blockage&due&to&atherosclerosis
•Insufficient&myocardial&blood&and&oxygen&supply
•Severe&anemias&and&respiratory&disease&can&also&cause&oxygen&deficiency&
•Tachycardia&associated&with&hyperthyroidism&can&cause&it
•Exposure&to&weather&extremes&or&pollution&or&eating&a&large&meal
Signs&and&Symptoms
•Occurs&as&brief,&recurrent&episodes&of&chest&pain&usually&triggered&by&a&physical&
or&emotional&stress&which&increases&demand&on&the&heart&for&oxygen
•Tightness,&pressure&in&chest&may&radiate&to&neck&or&left&arm
•Excessive&sweating
•Nausea
•Can&last&a&few&seconds&or&minutes
Treatment
•Nitroglycerin&(vasodilators)
•Stress&reduction&techniques
Myocardial,Infarction
Pathophysiology
•When&coronary&artery&is&totally&obstructed,&leading&to&prolonged&ischemia&and&
cell& death&of&the&heart&wall
•Thrombus&may&build&to&obstruct&artery
•Vasospasm&may&occur&due&to&atheroma,&leading&to&total&obstruction
•Thrombus&may&break&off&and&flow&to&smaller&portion&of&vessel&and&block&blood&
flow
•Heart&tissue&becomes&necrotic&with&ischemia&developing&around&area
•If&blood&supply&is&restored&within&20-30&minutes,&irreversible&damage&may&be&
prevented
Etiology
•Atherosclerosis
Signs&and&Symptoms
•Feeling&pressure,&heaviness&or&burning&in&chest&or&radiating&pain&to&left&arm,&jaw&
or&neck
•Sudden&shortness&of&breath,&sweating,&weakness&or&fatigue
•Nausea,&indigestion
•Anxiety&or&fear
Diagnostic&Tests
•ECG
•Serum&enzymes&can&be&found&in&blood&from&necrotic&tissue
Treatment
•Analgesics
•Oxygen&therapy
•Anticoagulants&(heparin,&warfarin)
•Pace&maker
•Cardiac&rehabilitation&programs
Congestive,Heart,Failure
Pathophysiology
•When&heart&is&unable&to&pump&sufficient&blood&to&meet&metabolic&needs&of&the&
body
•Usually&chronic&condition
•Can&occur&due&to&another&condition&(infarction,&valve&defect)
•Usually,&one&side&of&the&heart&fails&first
•Mechanisms&in&the&body&which&are&meant&to&help&actually&aggravate&the&
condition
○Reduced&blood&flow&causes&vasoconstrictor&hormones&to&be&released&
causing&increased&blood&volume&to&the&heart,&adding&to&the&heart's&
workload
○SNS&increases&heart&rate,&decreasing&effectiveness&of&filling&chambers&and&
increasing&work&for&the&heart
○Chambers&of&the&heart&dilate&and&cardiac&muscle&hypertrophies&which&
demands&increased&blood&supply,&myocardial&cells&replaced&with&fibrous&
tissue
•Two&effects&when&heart&cannot&maintain&pumping&ability
○Cardiac&output&or&stroke&volume&decreases
○Backup&congestion&develops&in&circulation&behind&affected&ventricle
Etiology
•Infarction&that&impairs&pumping&ability&or&efficiency&of&the&conducting&system,&
valvular&changes,&or&congenital&heart&defects&may&cause&failure&of&the&affected&
side
•Coronary&artery&disease&is&the&leading&cause
•Right&CHF&can&be&caused&by&pulmonary&disease
Signs&and&Symptoms
•Failure&of&either&side
○Decreased&blood&supply&to&tissues&and&general&hypoxia
○Fatigue&and&weakness
○Dyspnea&(breathlessness)
○Dizziness
○Hot&or&cold&intolerance
•Compensation&mechanisms
○Indicated&by&tachycardia
○Pallor
○Daytime&oliguria
•Backup&effects&of&left&sided&CHF&due&to&pulmonary&congestion
○Dyspnea
○Difficulty&breathing&when&lying&down
○Cough
○Paroxysmal&nocturnal&dyspnea&indicates&the&presence&of´&pulmonary&
edema
•Signs&of&right&sided&CHF&and&systemic&backup
○Edema&in&feet&or&legs
○Hepatomegaly&and&splenomegaly
○Ascites
○Acute&right-sided&failure
Hypertension
Pathophysiology
•Chronic&elevation&of&systemic&blood&pressure&that&in&the&long&term&causes&end-
organ&damage&which&results&in&increased&morbidity&and&mortality
Etiology
•Primary&hypertension
○No&identifiable&cause
•Secondary&hypertension&(caused&by&underlying&condition)
○Obstructive&sleep&apnea
○Kidney&problems
○Adrenal&gland&tumours
○Thyroid&problems
○Defects&in&blood&vessels&you're&born&with&
○Medications
○Alcohol/drugs
Signs&and&Symptoms
•No&signs&and&symptoms
•May&have&headache,&shortness&of&breath&or&nose&bleeds&if&BP&reaches&life&
threatening&stage
Aortic,Aneurysms
Pathophysiology
•Localized&dilation&and&weakening&of&arterial& wall&in&abdominal&or&thoracic&aorta
•May&be&a&saccular&shape&(bulging&wall&on&one&side)&or&fusiform&shape&
(circumferential&dilation&along&artery)
•Dissecting&aneurysms&develop&when&there&is&a&tear&in&the&intima,&allowing&blood&
to&flow&along&length&of&vessel&in&between&layers&of&arterial&wall
•Develops&from&defect&in&medial&layer,&dilation&enlarges,&hypertension&develops&
and&a&thrombus&forms&in&the&area,&obstructing&arteries&
•Many&eventually&rupture&causing&a&hemorrhage
Etiology
•Atherosclerosis
•Trauma&(car&accidents)
•Syphilis
•Congenital&defects
•Hypertension
Signs&and&Symptoms
•Asymptomatic&for&a&long&period&of&time&until&they&become&very&large&or&rupture
•Abdominal&aneurysms&&are&detected&as&pulsating&masses&with&abnormal&sounds
•Rupture&leads&severe&hemorrhage&and&death
•Severe&pain&and&shock
Shock
Pathophysiology
•Also&known&as&hypotension&results&from&decreased&circulating&blood&volume,&
leading&to&decreased&tissue&perfusion&and&general&hypoxia
Type Mechanism Specific,Causes
Hypovolemic Loss&of&blood&or&plasma Hemorrhage,&burns,&
dehydration,&peritonitis,&
pancreatitis
Cardiogenic Decreased&pumping&
capability&of&the&heart
Myocardial&infarction&of&left&
ventricle,&cardiac&arrhythmia,&
pulmonary&embolus,&cardiac&
tamponade
Vasogenic&
(neurogenic&or&
disruptive)
Vasodilation&owing&to&loss&
of&sympathetic&and&
vasomotor&tone
Pain,&fear,&spinal&cord&injury,&
hypoglycemia&(insulin&shock)
Anaphylactic Systemic&vasodilation&and&
increased&permeability&
owing&to&severe&allergic&
reaction
Insect&stings,&nuts,&shellfish,&
drugs
Septic&
(endotoxic)
Vasodilation&caused&by&
infection&due&to&gram-
negative&bacteria
Virulentµorganisms&(gram-
negative&bacteria)&or&multiple&
infections
Signs&and&Symptoms
•Thirst&
•Agitation/restlessness
•Cool,&moist,&pale&skin
•Tachycardia
•Dizziness
Self%Study%Unit
Tuesday,& February&20,&2018
5:45&PM
Cardiovascular, system
Define&and&briefly&describe&the&following&selected&pathologies:
Arteriosclerosis
Pathophysiology
•A&term&for&all&types&of&arterial&changes
•Best&applied&to°enerative&changes&in&arteries&and&arterioles&in&people&over&
50&and&with&diabetes
•Elasticity&is&lost&and&walls&become&thick&and&hard,&lumen&narrows&and&may&
become&obstructed
•Leads&to&diffuse&ischemia&and&necrosis
Atherosclerosis
Pathophysiology
•Presence&of&atheromas&-plaques&consisting&of&lipids,&cells,&fibrin&and&cell&debris,&
often&with&attached&thrombi&which&form&inside&the&walls&of&arteries
•Affected&artery&is&rough,&elevated&and&has&loose&pieces&of&plaque&and&thrombus
•Caused&by&lipids&circulating&in&blood&which&build&up&sites&of&of&arterial& injury&
along&with&fibrous&tissue,&prostaglandins&are&released&and&more&inflammation&
and&cells&come&to&the&site&causing&arterial& flow&to&become&turbulent
•Plaque&may&ulcerate&and&break&open
•Blood&flow&decreases&due&to&blockage
•Atheroma&damages&arterial&wall,&weakening&the&structure&and&decreasing&its&
elasticity,&it&eventually&calcifies
•Can&cause&angina,&myocardial&infarction,&stroke&,&renal&damage&and&peripheral&
vascular&disease
Etiology
•
Nonmodifiable&factors
○
Age
○
Gender&(women&have&more&HDL&until&menopause&when&estrogen&levels&
decrease)
○
Genetics
•
Modifiable
○
Obesity&(high&LDL&cholesterol&diets)
○
Smoking
○
Exercise
○
Diabetes
○
Poorly&controlled&hypertension
○
Oral&contraceptives
○
High&blood&cholesterol&and&high&BP
Diagnostic&Tests
•
Checking&HDL&and&LDL&levels
•
CRP&indicates&inflammation&-low&CRP&means&lower&risk&of&cardiovascular&
disease
Treatment
•
Losing&weight
•
Healthier&diet
•
Lowering&serum&cholesterol&and&LDL&levels
•
Control&diabetes
Angina,Pectoris
Pathophysiology
•
Chest&pain&when&there&is&a&deficit&of&oxygen&to&the&heart&muscle
•
Can&occur&when&heart&is&working&harder&than&it&needs&to&be&and&is&in&demand&for&
oxygen&(exercising)
•
Classic/exertional&angina&
○
Variant&angina&in&which&vasospasm&occurs&at&rest
•
Unstable&angina
○
More&serious&form
○
Prolonged&pain&at&rest&and&of&recent&onset
○
Could&be&caused&by&breakage&of&atheroma
○
Could&cause&myocardial&infarction
Etiology
•May&be&caused&by&a&blockage&due&to&atherosclerosis
•Insufficient&myocardial&blood&and&oxygen&supply
•Severe&anemias&and&respiratory&disease&can&also&cause&oxygen&deficiency&
•Tachycardia&associated&with&hyperthyroidism&can&cause&it
•Exposure&to&weather&extremes&or&pollution&or&eating&a&large&meal
Signs&and&Symptoms
•Occurs&as&brief,&recurrent&episodes&of&chest&pain&usually&triggered&by&a&physical&
or&emotional&stress&which&increases&demand&on&the&heart&for&oxygen
•Tightness,&pressure&in&chest&may&radiate&to&neck&or&left&arm
•Excessive&sweating
•Nausea
•Can&last&a&few&seconds&or&minutes
Treatment
•Nitroglycerin&(vasodilators)
•Stress&reduction&techniques
Myocardial,Infarction
Pathophysiology
•When&coronary&artery&is&totally&obstructed,&leading&to&prolonged&ischemia&and&
cell& death&of&the&heart&wall
•Thrombus&may&build&to&obstruct&artery
•Vasospasm&may&occur&due&to&atheroma,&leading&to&total&obstruction
•Thrombus&may&break&off&and&flow&to&smaller&portion&of&vessel&and&block&blood&
flow
•Heart&tissue&becomes&necrotic&with&ischemia&developing&around&area
•If&blood&supply&is&restored&within&20-30&minutes,&irreversible&damage&may&be&
prevented
Etiology
•Atherosclerosis
Signs&and&Symptoms
•Feeling&pressure,&heaviness&or&burning&in&chest&or&radiating&pain&to&left&arm,&jaw&
or&neck
•Sudden&shortness&of&breath,&sweating,&weakness&or&fatigue
•Nausea,&indigestion
•Anxiety&or&fear
Diagnostic&Tests
•ECG
•Serum&enzymes&can&be&found&in&blood&from&necrotic&tissue
Treatment
•Analgesics
•Oxygen&therapy
•Anticoagulants&(heparin,&warfarin)
•Pace&maker
•Cardiac&rehabilitation&programs
Congestive,Heart,Failure
Pathophysiology
•When&heart&is&unable&to&pump&sufficient&blood&to&meet&metabolic&needs&of&the&
body
•Usually&chronic&condition
•Can&occur&due&to&another&condition&(infarction,&valve&defect)
•Usually,&one&side&of&the&heart&fails&first
•Mechanisms&in&the&body&which&are&meant&to&help&actually&aggravate&the&
condition
○Reduced&blood&flow&causes&vasoconstrictor&hormones&to&be&released&
causing&increased&blood&volume&to&the&heart,&adding&to&the&heart's&
workload
○SNS&increases&heart&rate,&decreasing&effectiveness&of&filling&chambers&and&
increasing&work&for&the&heart
○Chambers&of&the&heart&dilate&and&cardiac&muscle&hypertrophies&which&
demands&increased&blood&supply,&myocardial&cells&replaced&with&fibrous&
tissue
•Two&effects&when&heart&cannot&maintain&pumping&ability
○Cardiac&output&or&stroke&volume&decreases
○Backup&congestion&develops&in&circulation&behind&affected&ventricle
Etiology
•Infarction&that&impairs&pumping&ability&or&efficiency&of&the&conducting&system,&
valvular&changes,&or&congenital&heart&defects&may&cause&failure&of&the&affected&
side
•Coronary&artery&disease&is&the&leading&cause
•Right&CHF&can&be&caused&by&pulmonary&disease
Signs&and&Symptoms
•Failure&of&either&side
○Decreased&blood&supply&to&tissues&and&general&hypoxia
○Fatigue&and&weakness
○Dyspnea&(breathlessness)
○Dizziness
○Hot&or&cold&intolerance
•Compensation&mechanisms
○Indicated&by&tachycardia
○Pallor
○Daytime&oliguria
•Backup&effects&of&left&sided&CHF&due&to&pulmonary&congestion
○Dyspnea
○Difficulty&breathing&when&lying&down
○Cough
○Paroxysmal&nocturnal&dyspnea&indicates&the&presence&of´&pulmonary&
edema
•Signs&of&right&sided&CHF&and&systemic&backup
○Edema&in&feet&or&legs
○Hepatomegaly&and&splenomegaly
○Ascites
○Acute&right-sided&failure
Hypertension
Pathophysiology
•Chronic&elevation&of&systemic&blood&pressure&that&in&the&long&term&causes&end-
organ&damage&which&results&in&increased&morbidity&and&mortality
Etiology
•Primary&hypertension
○No&identifiable&cause
•Secondary&hypertension&(caused&by&underlying&condition)
○Obstructive&sleep&apnea
○Kidney&problems
○Adrenal&gland&tumours
○Thyroid&problems
○Defects&in&blood&vessels&you're&born&with&
○Medications
○Alcohol/drugs
Signs&and&Symptoms
•No&signs&and&symptoms
•May&have&headache,&shortness&of&breath&or&nose&bleeds&if&BP&reaches&life&
threatening&stage
Aortic,Aneurysms
Pathophysiology
•Localized&dilation&and&weakening&of&arterial& wall&in&abdominal&or&thoracic&aorta
•May&be&a&saccular&shape&(bulging&wall&on&one&side)&or&fusiform&shape&
(circumferential&dilation&along&artery)
•Dissecting&aneurysms&develop&when&there&is&a&tear&in&the&intima,&allowing&blood&
to&flow&along&length&of&vessel&in&between&layers&of&arterial&wall
•Develops&from&defect&in&medial&layer,&dilation&enlarges,&hypertension&develops&
and&a&thrombus&forms&in&the&area,&obstructing&arteries&
•Many&eventually&rupture&causing&a&hemorrhage
Etiology
•Atherosclerosis
•Trauma&(car&accidents)
•Syphilis
•Congenital&defects
•Hypertension
Signs&and&Symptoms
•Asymptomatic&for&a&long&period&of&time&until&they&become&very&large&or&rupture
•Abdominal&aneurysms&&are&detected&as&pulsating&masses&with&abnormal&sounds
•Rupture&leads&severe&hemorrhage&and&death
•Severe&pain&and&shock
Shock
Pathophysiology
•Also&known&as&hypotension&results&from&decreased&circulating&blood&volume,&
leading&to&decreased&tissue&perfusion&and&general&hypoxia
Type Mechanism Specific,Causes
Hypovolemic Loss&of&blood&or&plasma Hemorrhage,&burns,&
dehydration,&peritonitis,&
pancreatitis
Cardiogenic Decreased&pumping&
capability&of&the&heart
Myocardial&infarction&of&left&
ventricle,&cardiac&arrhythmia,&
pulmonary&embolus,&cardiac&
tamponade
Vasogenic&
(neurogenic&or&
disruptive)
Vasodilation&owing&to&loss&
of&sympathetic&and&
vasomotor&tone
Pain,&fear,&spinal&cord&injury,&
hypoglycemia&(insulin&shock)
Anaphylactic Systemic&vasodilation&and&
increased&permeability&
owing&to&severe&allergic&
reaction
Insect&stings,&nuts,&shellfish,&
drugs
Septic&
(endotoxic)
Vasodilation&caused&by&
infection&due&to&gram-
negative&bacteria
Virulentµorganisms&(gram-
negative&bacteria)&or&multiple&
infections
Signs&and&Symptoms
•Thirst&
•Agitation/restlessness
•Cool,&moist,&pale&skin
•Tachycardia
•Dizziness
Self%Study%Unit
Tuesday,& February&20,&2018 5:45&PM
Cardiovascular, system
Define&and&briefly&describe&the&following&selected&pathologies:
Arteriosclerosis
Pathophysiology
•A&term&for&all&types&of&arterial&changes
•Best&applied&to°enerative&changes&in&arteries&and&arterioles&in&people&over&
50&and&with&diabetes
•Elasticity&is&lost&and&walls&become&thick&and&hard,&lumen&narrows&and&may&
become&obstructed
•Leads&to&diffuse&ischemia&and&necrosis
Atherosclerosis
Pathophysiology
•Presence&of&atheromas&-plaques&consisting&of&lipids,&cells,&fibrin&and&cell&debris,&
often&with&attached&thrombi&which&form&inside&the&walls&of&arteries
•Affected&artery&is&rough,&elevated&and&has&loose&pieces&of&plaque&and&thrombus
•Caused&by&lipids&circulating&in&blood&which&build&up&sites&of&of&arterial& injury&
along&with&fibrous&tissue,&prostaglandins&are&released&and&more&inflammation&
and&cells&come&to&the&site&causing&arterial& flow&to&become&turbulent
•Plaque&may&ulcerate&and&break&open
•Blood&flow&decreases&due&to&blockage
•Atheroma&damages&arterial&wall,&weakening&the&structure&and&decreasing&its&
elasticity,&it&eventually&calcifies
•Can&cause&angina,&myocardial&infarction,&stroke&,&renal&damage&and&peripheral&
vascular&disease
Etiology
•Nonmodifiable&factors
○Age
○Gender&(women&have&more&HDL&until&menopause&when&estrogen&levels&
decrease)
○Genetics
•Modifiable
○Obesity&(high&LDL&cholesterol&diets)
○Smoking
○Exercise
○Diabetes
○Poorly&controlled&hypertension
○Oral&contraceptives
○High&blood&cholesterol&and&high&BP
Diagnostic&Tests
•Checking&HDL&and&LDL&levels
•CRP&indicates&inflammation&-low&CRP&means&lower&risk&of&cardiovascular&
disease
Treatment
•Losing&weight
•Healthier&diet
•Lowering&serum&cholesterol&and&LDL&levels
•Control&diabetes
Angina,Pectoris
Pathophysiology
•Chest&pain&when&there&is&a&deficit&of&oxygen&to&the&heart&muscle
•Can&occur&when&heart&is&working&harder&than&it&needs&to&be&and&is&in&demand&for&
oxygen&(exercising)
•Classic/exertional&angina&
○Variant&angina&in&which&vasospasm&occurs&at&rest
•Unstable&angina
○More&serious&form
○Prolonged&pain&at&rest&and&of&recent&onset
○Could&be&caused&by&breakage&of&atheroma
○
Could&cause&myocardial&infarction
Etiology
•
May&be&caused&by&a&blockage&due&to&atherosclerosis
•
Insufficient&myocardial&blood&and&oxygen&supply
•
Severe&anemias&and&respiratory&disease&can&also&cause&oxygen&deficiency&
•
Tachycardia&associated&with&hyperthyroidism&can&cause&it
•
Exposure&to&weather&extremes&or&pollution&or&eating&a&large&meal
Signs&and&Symptoms
•
Occurs&as&brief,&recurrent&episodes&of&chest&pain&usually&triggered&by&a&physical&
or&emotional&stress&which&increases&demand&on&the&heart&for&oxygen
•
Tightness,&pressure&in&chest&may&radiate&to&neck&or&left&arm
•
Excessive&sweating
•
Nausea
•
Can&last&a&few&seconds&or&minutes
Treatment
•
Nitroglycerin&(vasodilators)
•
Stress&reduction&techniques
Myocardial,Infarction
Pathophysiology
•
When&coronary&artery&is&totally&obstructed,&leading&to&prolonged&ischemia&and&
cell& death&of&the&heart&wall
•
Thrombus&may&build&to&obstruct&artery
•
Vasospasm&may&occur&due&to&atheroma,&leading&to&total&obstruction
•
Thrombus&may&break&off&and&flow&to&smaller&portion&of&vessel&and&block&blood&
flow
•
Heart&tissue&becomes&necrotic&with&ischemia&developing&around&area
•
If&blood&supply&is&restored&within&20-30&minutes,&irreversible&damage&may&be&
prevented
Etiology
•
Atherosclerosis
Signs&and&Symptoms
•
Feeling&pressure,&heaviness&or&burning&in&chest&or&radiating&pain&to&left&arm,&jaw&
or&neck
•Sudden&shortness&of&breath,&sweating,&weakness&or&fatigue
•Nausea,&indigestion
•Anxiety&or&fear
Diagnostic&Tests
•ECG
•Serum&enzymes&can&be&found&in&blood&from&necrotic&tissue
Treatment
•Analgesics
•Oxygen&therapy
•Anticoagulants&(heparin,&warfarin)
•Pace&maker
•Cardiac&rehabilitation&programs
Congestive,Heart,Failure
Pathophysiology
•When&heart&is&unable&to&pump&sufficient&blood&to&meet&metabolic&needs&of&the&
body
•Usually&chronic&condition
•Can&occur&due&to&another&condition&(infarction,&valve&defect)
•Usually,&one&side&of&the&heart&fails&first
•Mechanisms&in&the&body&which&are&meant&to&help&actually&aggravate&the&
condition
○Reduced&blood&flow&causes&vasoconstrictor&hormones&to&be&released&
causing&increased&blood&volume&to&the&heart,&adding&to&the&heart's&
workload
○SNS&increases&heart&rate,&decreasing&effectiveness&of&filling&chambers&and&
increasing&work&for&the&heart
○Chambers&of&the&heart&dilate&and&cardiac&muscle&hypertrophies&which&
demands&increased&blood&supply,&myocardial&cells&replaced&with&fibrous&
tissue
•Two&effects&when&heart&cannot&maintain&pumping&ability
○Cardiac&output&or&stroke&volume&decreases
○Backup&congestion&develops&in&circulation&behind&affected&ventricle
Etiology
•Infarction&that&impairs&pumping&ability&or&efficiency&of&the&conducting&system,&
valvular&changes,&or&congenital&heart&defects&may&cause&failure&of&the&affected&
side
•Coronary&artery&disease&is&the&leading&cause
•Right&CHF&can&be&caused&by&pulmonary&disease
Signs&and&Symptoms
•Failure&of&either&side
○Decreased&blood&supply&to&tissues&and&general&hypoxia
○Fatigue&and&weakness
○Dyspnea&(breathlessness)
○Dizziness
○Hot&or&cold&intolerance
•Compensation&mechanisms
○Indicated&by&tachycardia
○Pallor
○Daytime&oliguria
•Backup&effects&of&left&sided&CHF&due&to&pulmonary&congestion
○Dyspnea
○Difficulty&breathing&when&lying&down
○Cough
○Paroxysmal&nocturnal&dyspnea&indicates&the&presence&of´&pulmonary&
edema
•Signs&of&right&sided&CHF&and&systemic&backup
○Edema&in&feet&or&legs
○Hepatomegaly&and&splenomegaly
○Ascites
○Acute&right-sided&failure
Hypertension
Pathophysiology
•Chronic&elevation&of&systemic&blood&pressure&that&in&the&long&term&causes&end-
organ&damage&which&results&in&increased&morbidity&and&mortality
Etiology
•Primary&hypertension
○No&identifiable&cause
•Secondary&hypertension&(caused&by&underlying&condition)
○Obstructive&sleep&apnea
○Kidney&problems
○Adrenal&gland&tumours
○Thyroid&problems
○Defects&in&blood&vessels&you're&born&with&
○Medications
○Alcohol/drugs
Signs&and&Symptoms
•No&signs&and&symptoms
•May&have&headache,&shortness&of&breath&or&nose&bleeds&if&BP&reaches&life&
threatening&stage
Aortic,Aneurysms
Pathophysiology
•Localized&dilation&and&weakening&of&arterial& wall&in&abdominal&or&thoracic&aorta
•May&be&a&saccular&shape&(bulging&wall&on&one&side)&or&fusiform&shape&
(circumferential&dilation&along&artery)
•Dissecting&aneurysms&develop&when&there&is&a&tear&in&the&intima,&allowing&blood&
to&flow&along&length&of&vessel&in&between&layers&of&arterial&wall
•Develops&from&defect&in&medial&layer,&dilation&enlarges,&hypertension&develops&
and&a&thrombus&forms&in&the&area,&obstructing&arteries&
•Many&eventually&rupture&causing&a&hemorrhage
Etiology
•Atherosclerosis
•Trauma&(car&accidents)
•Syphilis
•Congenital&defects
•Hypertension
Signs&and&Symptoms
•Asymptomatic&for&a&long&period&of&time&until&they&become&very&large&or&rupture
•Abdominal&aneurysms&&are&detected&as&pulsating&masses&with&abnormal&sounds
•Rupture&leads&severe&hemorrhage&and&death
•Severe&pain&and&shock
Shock
Pathophysiology
•Also&known&as&hypotension&results&from&decreased&circulating&blood&volume,&
leading&to&decreased&tissue&perfusion&and&general&hypoxia
Type Mechanism Specific,Causes
Hypovolemic Loss&of&blood&or&plasma Hemorrhage,&burns,&
dehydration,&peritonitis,&
pancreatitis
Cardiogenic Decreased&pumping&
capability&of&the&heart
Myocardial&infarction&of&left&
ventricle,&cardiac&arrhythmia,&
pulmonary&embolus,&cardiac&
tamponade
Vasogenic&
(neurogenic&or&
disruptive)
Vasodilation&owing&to&loss&
of&sympathetic&and&
vasomotor&tone
Pain,&fear,&spinal&cord&injury,&
hypoglycemia&(insulin&shock)
Anaphylactic Systemic&vasodilation&and&
increased&permeability&
owing&to&severe&allergic&
reaction
Insect&stings,&nuts,&shellfish,&
drugs
Septic&
(endotoxic)
Vasodilation&caused&by&
infection&due&to&gram-
negative&bacteria
Virulentµorganisms&(gram-
negative&bacteria)&or&multiple&
infections
Signs&and&Symptoms
•Thirst&
•Agitation/restlessness
•Cool,&moist,&pale&skin
•Tachycardia
•Dizziness
Self%Study%Unit
Tuesday,& February&20,&2018 5:45&PM
Document Summary
Define and briefly describe the following selected pathologies: Pathophysiology: a term for all types of arterial changes, best applied to degenerative changes in arteries and arterioles in people over. 50 and with diabetes: elasticity is lost and walls become thick and hard, lumen narrows and may become obstructed, leads to diffuse ischemia and necrosis. Gender (women have more hdl until menopause when estrogen levels decrease) Diagnostic tests: checking hdl and ldl levels, crp indicates inflammation - low crp means lower risk of cardiovascular disease. Treatment: losing weight, healthier diet, lowering serum cholesterol and ldl levels, control diabetes. Pathophysiology: chest pain when there is a deficit of oxygen to the heart muscle, can occur when heart is working harder than it needs to be and is in demand for oxygen (exercising, classic/exertional angina. Variant angina in which vasospasm occurs at rest: unstable angina. Prolonged pain at rest and of recent onset. Could be caused by breakage of atheroma.