Podcast
Questions and Answers
Which factor contributes directly to the development of varicose veins?
Which factor contributes directly to the development of varicose veins?
- Decreased transforming growth factor beta in vessel walls
- Increased prostacyclin to thromboxane A2 ratio
- Decreased intravascular hydrostatic pressure
- Increased venous hydrostatic pressure (correct)
A patient with chronic venous insufficiency experiences hyperpigmentation and lipodermatosclerosis. Which pathophysiologic process is most directly responsible for these skin changes?
A patient with chronic venous insufficiency experiences hyperpigmentation and lipodermatosclerosis. Which pathophysiologic process is most directly responsible for these skin changes?
- Decreased inflammatory response
- Circulatory stasis and tissue hypoxia (correct)
- Increased immune response
- Increased arterial blood flow
What is the major difference between a thrombus and a thromboembolus?
What is the major difference between a thrombus and a thromboembolus?
- A thrombus is mobile, while a thromboembolus is stationary.
- A thrombus is attached to a vessel wall, while a thromboembolus has detached. (correct)
- A thrombus is composed of platelets, while a thromboembolus is composed of red blood cells.
- A thrombus has detached from a vessel wall, while a thromboembolus is attached to the vessel wall.
According to Virchow's triad, what three factors promote venous thrombosis?
According to Virchow's triad, what three factors promote venous thrombosis?
A patient who has undergone orthopedic surgery is at risk for deep vein thrombosis (DVT). Which intervention is most appropriate for this patient?
A patient who has undergone orthopedic surgery is at risk for deep vein thrombosis (DVT). Which intervention is most appropriate for this patient?
D-dimer testing is utilized in the diagnosis of DVT. What would a negative D-dimer indicate?
D-dimer testing is utilized in the diagnosis of DVT. What would a negative D-dimer indicate?
Which statement best describes the pathophysiology of superior vena cava syndrome (SVCS)?
Which statement best describes the pathophysiology of superior vena cava syndrome (SVCS)?
When a patient presents with edema and venous distention in the face, neck, and upper extremities, what condition should be suspected?
When a patient presents with edema and venous distention in the face, neck, and upper extremities, what condition should be suspected?
Hypertension is caused by increases in what two factors?
Hypertension is caused by increases in what two factors?
A patient with primary hypertension is prescribed a beta-blocking medication. What system is directly opposing the effects of with this medication?
A patient with primary hypertension is prescribed a beta-blocking medication. What system is directly opposing the effects of with this medication?
The RAAS contributes to hypertension by what means?
The RAAS contributes to hypertension by what means?
What is a major factor that shifts the pressure-natriuresis relationship in individuals with hypertension?
What is a major factor that shifts the pressure-natriuresis relationship in individuals with hypertension?
Endothelial dysfunction contributes to primary hypertension by decreasing the production of what?
Endothelial dysfunction contributes to primary hypertension by decreasing the production of what?
Which statement correctly describes complicated hypertension?
Which statement correctly describes complicated hypertension?
Which event is associated with accelerated atherosclerosis?
Which event is associated with accelerated atherosclerosis?
What is a key characteristic of hypertensive crisis (malignant hypertension)?
What is a key characteristic of hypertensive crisis (malignant hypertension)?
Individuals with malignant hypertension are at risk for what complication if blood pressure is sustained?
Individuals with malignant hypertension are at risk for what complication if blood pressure is sustained?
What is the definition of orthostatic hypotension?
What is the definition of orthostatic hypotension?
An older adult is diagnosed with orthostatic hypotension. Why is this condition more prevalent in older adults?
An older adult is diagnosed with orthostatic hypotension. Why is this condition more prevalent in older adults?
Which of the following is the most appropriate initial treatment for secondary orthostatic hypotension?
Which of the following is the most appropriate initial treatment for secondary orthostatic hypotension?
What is a true aneurysm?
What is a true aneurysm?
Which components are found in a patient with atherosclerosis and contribute to remodeling and weakening of a vessel wall?
Which components are found in a patient with atherosclerosis and contribute to remodeling and weakening of a vessel wall?
What effect does the use of beta-adrenergic medications treat for growing aortic aneurysms?
What effect does the use of beta-adrenergic medications treat for growing aortic aneurysms?
What causes arterial thrombi?
What causes arterial thrombi?
What are two threats of arterial thrombi?
What are two threats of arterial thrombi?
What are treatment options for a patient diagnosed with arterial thrombi?
What are treatment options for a patient diagnosed with arterial thrombi?
What is an embolus?
What is an embolus?
A patient experiences occlusion of a vessel due to arterial thromboembolism. What characterizes a limb that is ischemic?
A patient experiences occlusion of a vessel due to arterial thromboembolism. What characterizes a limb that is ischemic?
How does air totally blocking a vessel cause ischemia and necrosis to occur?
How does air totally blocking a vessel cause ischemia and necrosis to occur?
In which situation might amniotic fluid embolism be suspected?
In which situation might amniotic fluid embolism be suspected?
In a patient who recently experienced trauma to trauma to the long bones, what are likely the two most common causes to develop fat emboli after skeletal trauma?
In a patient who recently experienced trauma to trauma to the long bones, what are likely the two most common causes to develop fat emboli after skeletal trauma?
What is known about Buerger disease (thromboangiitis obliterans)?
What is known about Buerger disease (thromboangiitis obliterans)?
Which symptoms are associated with Buerger Disease? Select all that apply.
Which symptoms are associated with Buerger Disease? Select all that apply.
Raynaud disease is associated with what?
Raynaud disease is associated with what?
What is the primary focus when there is a diagnosis of atherosclerosis?
What is the primary focus when there is a diagnosis of atherosclerosis?
Atherosclerosis begins with injury to which cells?
Atherosclerosis begins with injury to which cells?
Elevated levels of serum LDL result in a patient experiencing which condition from complications caused?
Elevated levels of serum LDL result in a patient experiencing which condition from complications caused?
How does an increase in transforming growth factor beta (TGF-β) contribute to the development of varicose veins?
How does an increase in transforming growth factor beta (TGF-β) contribute to the development of varicose veins?
Which mechanism leads to the skin ulcerations that characterize chronic venous insufficiency?
Which mechanism leads to the skin ulcerations that characterize chronic venous insufficiency?
What is the significance of persistent venous outflow obstruction in the pathophysiology of deep vein thrombosis (DVT)?
What is the significance of persistent venous outflow obstruction in the pathophysiology of deep vein thrombosis (DVT)?
Why is a D-dimer assay often used in the diagnostic workup for deep vein thrombosis (DVT)?
Why is a D-dimer assay often used in the diagnostic workup for deep vein thrombosis (DVT)?
What treatments are used to dissolve clot extension or embolization for someone at high risk and diagnosed with a deep vein thrombosis?
What treatments are used to dissolve clot extension or embolization for someone at high risk and diagnosed with a deep vein thrombosis?
What aspect of the superior vena cava's (SVC) anatomy makes it particularly vulnerable to compression?
What aspect of the superior vena cava's (SVC) anatomy makes it particularly vulnerable to compression?
How do collateral vessels help reduce the severity of superior vena cava syndrome (SVCS)?
How do collateral vessels help reduce the severity of superior vena cava syndrome (SVCS)?
Which physiological process is LEAST directly affected by the diagnostic criteria change for hypertension in 2017, compared to the 2014 criteria?
Which physiological process is LEAST directly affected by the diagnostic criteria change for hypertension in 2017, compared to the 2014 criteria?
What is the primary mechanism by which isolated systolic hypertension (ISH) increases the risk of cardiovascular events?
What is the primary mechanism by which isolated systolic hypertension (ISH) increases the risk of cardiovascular events?
How is the pressure-natriuresis relationship altered in primary hypertension?
How is the pressure-natriuresis relationship altered in primary hypertension?
What is the role of the sympathetic nervous system (SNS) in the pathogenesis of primary hypertension?
What is the role of the sympathetic nervous system (SNS) in the pathogenesis of primary hypertension?
What vascular effect does angiotensin II (ang II) mediate that contributes to sustained hypertension?
What vascular effect does angiotensin II (ang II) mediate that contributes to sustained hypertension?
How do natriuretic hormones influence blood pressure regulation?
How do natriuretic hormones influence blood pressure regulation?
How does obesity contribute to primary hypertension?
How does obesity contribute to primary hypertension?
What is a characteristic vascular change seen in complicated hypertension?
What is a characteristic vascular change seen in complicated hypertension?
Which renal change is an early sign of target organ damage in complicated hypertension?
Which renal change is an early sign of target organ damage in complicated hypertension?
Describe what is known about what happens in hypertension during the arterial damage stage.
Describe what is known about what happens in hypertension during the arterial damage stage.
How does physical training work for lowering elevated blood pressure?
How does physical training work for lowering elevated blood pressure?
What direct vascular benefit is achieved by stopping smoking during hypertension treatment?
What direct vascular benefit is achieved by stopping smoking during hypertension treatment?
What vascular action occurs with the use of beta-adrenergic blockage medications treat for growing aortic aneurysms?
What vascular action occurs with the use of beta-adrenergic blockage medications treat for growing aortic aneurysms?
Flashcards
Telangiectasias
Telangiectasias
Small, widened blood vessels visible in the skin. They are not considered varicose veins.
Varicose vein
Varicose vein
Condition in which venous blood has pooled, producing distortion of the veins, leakage, increased pressure, and inflammation.
Chronic Venous Insufficiency (CVI)
Chronic Venous Insufficiency (CVI)
Persistent ambulatory lower extremity venous hypertension, venous hypertension, circulatory stasis, and tissue hypoxia.
Deep Venous Thrombosis (DVT)
Deep Venous Thrombosis (DVT)
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Thromboembolus
Thromboembolus
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Triad of Virchow
Triad of Virchow
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Superior Vena Cava Syndrome (SVCS)
Superior Vena Cava Syndrome (SVCS)
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Hypertension (HTN)
Hypertension (HTN)
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Isolated Systolic Hypertension (ISH)
Isolated Systolic Hypertension (ISH)
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Causes of Hypertension
Causes of Hypertension
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Increased SNS activity
Increased SNS activity
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RAAS
RAAS
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Overactivity of RAAS in Hypertension
Overactivity of RAAS in Hypertension
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Complicated Hypertension
Complicated Hypertension
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Target organs
Target organs
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Orthostatic Hypotension (OH)
Orthostatic Hypotension (OH)
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Aneurysm
Aneurysm
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Atherosclerosis
Atherosclerosis
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Complicated Plaques
Complicated Plaques
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Peripheral Artery Disease (PAD)
Peripheral Artery Disease (PAD)
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Myocardial Ischemia
Myocardial Ischemia
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Plaque and Rupture
Plaque and Rupture
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Acute coronary syndromes
Acute coronary syndromes
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Ischemia attack
Ischemia attack
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Myocardial Infarction
Myocardial Infarction
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Stable Angina
Stable Angina
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Prinzmetal angina
Prinzmetal angina
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Silent Ischemia
Silent Ischemia
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Coronary Heart Disease
Coronary Heart Disease
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Study Notes
Cardiovascular Disease Overview
- Cardiovascular disease remains the primary cause of mortality in both the United States and globally
- Disorders affecting veins, arteries, and the heart itself fall under the umbrella of cardiovascular diseases
- Pathophysiology focuses on genetic, neurohumoral, inflammatory, and metabolic processes causing tissue and cellular changes
Diseases of the Veins
- Chronic venous diseases go from small widened vessels (telangiectasias), to varicose veins, and chronic vascular insufficiency
Varicose Veins
- Condition develops when blood pools in veins causing distortion, leakage, increased hydrostatic pressure and inflammation
- Causes include incompetent valves, venous obstruction, or muscle pump dysfunction
- Increased hydrostatic pressure increases transforming growth factor beta (TGF-β) and basic fibroblast growth factor (bfgf) in vessel walls, resulting in permanent vessel remodeling, creates clotting potential
- Risk factors include being female, pregnancy, increased weight or age, leg trauma, prolonged sitting or standing, and family history
- Key symptoms are visible distended veins, itching, burning, throbbing around the lower leg, and muscle cramping or pain
- Chronic venous insufficiency symptoms are edema, pain, skin changes (hyperpigmentation and lipodermatosclerosis), and necrosis (venous stasis ulcers)
Deep Vein Thrombosis (DVT)
- Deep Vein Thrombosis (DVT) is classified as a venous thromboembolism which includes pulmonary embolism (PE)
- DVT is a blood clot attached to a vessel wall, usually in a lower extremity. a detached thrombus is a thromboembolus
- Venous thrombi are more common due to lower pressure in the veins
- Annually, 2 million individuals in the United States will have DVT with 44,000 deaths
- Virchow's triad that promotes thrombosis:
- Venous stasis is connected with immobility, obesity or CHF
- Venous intimal damage is related to trauma, venipuncture, IV medications
- Hypercoagulable states are due to malignancy, pregnancy of genetic disorders
- Almost all who are hospitalized will be at risk of DVT particularly those with orthopedic issues or are older
- Most thrombi dissolve without treatment due to Thromboembolization
- PTS or post-thrombotic syndrome can result from persistent venous outflow obstruction
- Clinical manifestations can be absent but can include pain, unilateral leg swelling, dilation of superficial veins, calf tenderness, cyanotic skin
- D-dimer serum concentrations and Doppler ultrasonography test for diagnosis; ultrasound confirms D-dimer results
- DVT is based on extension or embolization. Anticoagulation may be indicated for high risk instances.
- Catheter-direct thrombolytics dissolve clots quicker, but bleeding is a risk
- Pharmacomechanical treatments with clot removal is an option
- Recurrence is high, direct thrombin inhibitors are recommended, 3 months of therapy is indicated
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