Chapter 33  McCance- Cardiovascular and Venous Diseases

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Questions and Answers

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?

  • 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?

  • 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?

<p>Venous stasis, venous intimal damage, and hypercoagulable states (B)</p> Signup and view all the answers

A patient who has undergone orthopedic surgery is at risk for deep vein thrombosis (DVT). Which intervention is most appropriate for this patient?

<p>Early mobilization (A)</p> Signup and view all the answers

D-dimer testing is utilized in the diagnosis of DVT. What would a negative D-dimer indicate?

<p>The absence of thrombosis (D)</p> Signup and view all the answers

Which statement best describes the pathophysiology of superior vena cava syndrome (SVCS)?

<p>Progressive compression of the SVC leading to venous distention (D)</p> Signup and view all the answers

When a patient presents with edema and venous distention in the face, neck, and upper extremities, what condition should be suspected?

<p>Superior vena cava syndrome (C)</p> Signup and view all the answers

Hypertension is caused by increases in what two factors?

<p>Cardiac output, total peripheral resistance (A)</p> Signup and view all the answers

A patient with primary hypertension is prescribed a beta-blocking medication. What system is directly opposing the effects of with this medication?

<p>Sympathetic nervous system (SNS) (C)</p> Signup and view all the answers

The RAAS contributes to hypertension by what means?

<p>All of the above (D)</p> Signup and view all the answers

What is a major factor that shifts the pressure-natriuresis relationship in individuals with hypertension?

<p>Decreased renal excretion of salt (B)</p> Signup and view all the answers

Endothelial dysfunction contributes to primary hypertension by decreasing the production of what?

<p>Nitric oxide (C)</p> Signup and view all the answers

Which statement correctly describes complicated hypertension?

<p>It is characterized by damage to the walls of systemic blood vessels. (B)</p> Signup and view all the answers

Which event is associated with accelerated atherosclerosis?

<p>Hypertension (B)</p> Signup and view all the answers

What is a key characteristic of hypertensive crisis (malignant hypertension)?

<p>Diastolic pressure is usually greater than 140 mmHg (A)</p> Signup and view all the answers

Individuals with malignant hypertension are at risk for what complication if blood pressure is sustained?

<p>Cerebral edema (A)</p> Signup and view all the answers

What is the definition of orthostatic hypotension?

<p>Decrease in systolic blood pressure of at least 20 mmHg within 3 minutes of standing (D)</p> Signup and view all the answers

An older adult is diagnosed with orthostatic hypotension. Why is this condition more prevalent in older adults?

<p>Slowing of postural reflexes (B)</p> Signup and view all the answers

Which of the following is the most appropriate initial treatment for secondary orthostatic hypotension?

<p>Correcting the underlying disorder (A)</p> Signup and view all the answers

What is a true aneurysm?

<p>Localized dilation of a vessel wall involving all vessel layers (C)</p> Signup and view all the answers

Which components are found in a patient with atherosclerosis and contribute to remodeling and weakening of a vessel wall?

<p>Eroded vessel walls, high blood pressure (B)</p> Signup and view all the answers

What effect does the use of beta-adrenergic medications treat for growing aortic aneurysms?

<p>Decrease blood pressure to decrease vessel wall dilation (D)</p> Signup and view all the answers

What causes arterial thrombi?

<p>Roughening of tunica intima by atherosclerosis (A)</p> Signup and view all the answers

What are two threats of arterial thrombi?

<p>Occlusion of an artery causing ischemia, thromboembolus travels to distal vascular bed (D)</p> Signup and view all the answers

What are treatment options for a patient diagnosed with arterial thrombi?

<p>Heparin, warfarin derivatives, athrombolytics (D)</p> Signup and view all the answers

What is an embolus?

<p>Bolus of matter circulating in the bloodstream (B)</p> Signup and view all the answers

A patient experiences occlusion of a vessel due to arterial thromboembolism. What characterizes a limb that is ischemic?

<p>Almost waxy whiteness (C)</p> Signup and view all the answers

How does air totally blocking a vessel cause ischemia and necrosis to occur?

<p>It displaces blood in the arterioles and capillary beds (B)</p> Signup and view all the answers

In which situation might amniotic fluid embolism be suspected?

<p>Labor and delivery (A)</p> Signup and view all the answers

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?

<p>Defective fat metabolism and release of globules from bone marrow. (B)</p> Signup and view all the answers

What is known about Buerger disease (thromboangiitis obliterans)?

<p>It is an autoimmune condition linked to smoking. (C)</p> Signup and view all the answers

Which symptoms are associated with Buerger Disease? Select all that apply.

<p>Sluggish blood flow (A), Cyanosis or blue coloring of the skin (C), Rubor or redness of the skin (D)</p> Signup and view all the answers

Raynaud disease is associated with what?

<p>Vasospasms (C)</p> Signup and view all the answers

What is the primary focus when there is a diagnosis of atherosclerosis?

<p>Reduce tissue perfusion (D)</p> Signup and view all the answers

Atherosclerosis begins with injury to which cells?

<p>Endothelial cells (C)</p> Signup and view all the answers

Elevated levels of serum LDL result in a patient experiencing which condition from complications caused?

<p>CAD (C)</p> Signup and view all the answers

How does an increase in transforming growth factor beta (TGF-β) contribute to the development of varicose veins?

<p>It stimulates permanent remodeling of vessel walls. (D)</p> Signup and view all the answers

Which mechanism leads to the skin ulcerations that characterize chronic venous insufficiency?

<p>Venous hypertension and circulatory stasis (A)</p> Signup and view all the answers

What is the significance of persistent venous outflow obstruction in the pathophysiology of deep vein thrombosis (DVT)?

<p>It may result in post-thrombotic syndrome. (D)</p> Signup and view all the answers

Why is a D-dimer assay often used in the diagnostic workup for deep vein thrombosis (DVT)?

<p>Because it is very sensitive in detecting the presence of thrombosis. (C)</p> Signup and view all the answers

What treatments are used to dissolve clot extension or embolization for someone at high risk and diagnosed with a deep vein thrombosis?

<p>Anticoagulation with low-molecular-weight heparin (D)</p> Signup and view all the answers

What aspect of the superior vena cava's (SVC) anatomy makes it particularly vulnerable to compression?

<p>Its location in the rigid thoracic compartment (A)</p> Signup and view all the answers

How do collateral vessels help reduce the severity of superior vena cava syndrome (SVCS)?

<p>By providing an alternate route for venous return (A)</p> Signup and view all the answers

Which physiological process is LEAST directly affected by the diagnostic criteria change for hypertension in 2017, compared to the 2014 criteria?

<p>Heart Rate (C)</p> Signup and view all the answers

What is the primary mechanism by which isolated systolic hypertension (ISH) increases the risk of cardiovascular events?

<p>By contributing to damage (C)</p> Signup and view all the answers

How is the pressure-natriuresis relationship altered in primary hypertension?

<p>The kidneys excrete less salt at a given blood pressure. (D)</p> Signup and view all the answers

What is the role of the sympathetic nervous system (SNS) in the pathogenesis of primary hypertension?

<p>It promotes adequate blood pressure and tissue perfusion (A)</p> Signup and view all the answers

What vascular effect does angiotensin II (ang II) mediate that contributes to sustained hypertension?

<p>Arteriolar remodeling (D)</p> Signup and view all the answers

How do natriuretic hormones influence blood pressure regulation?

<p>They modulate renal sodium excretion. (D)</p> Signup and view all the answers

How does obesity contribute to primary hypertension?

<p>It causes changes in adipokines and increases SNS and RAAS activity (C)</p> Signup and view all the answers

What is a characteristic vascular change seen in complicated hypertension?

<p>Hypertrophy and hyperplasia of smooth muscle cells in vessel walls (D)</p> Signup and view all the answers

Which renal change is an early sign of target organ damage in complicated hypertension?

<p>Small amounts of protein (A)</p> Signup and view all the answers

Describe what is known about what happens in hypertension during the arterial damage stage.

<p>arterioles are incapable of regulating blood flow to the capillary beds (A)</p> Signup and view all the answers

How does physical training work for lowering elevated blood pressure?

<p>Increases stroke volume (A)</p> Signup and view all the answers

What direct vascular benefit is achieved by stopping smoking during hypertension treatment?

<p>Eliminates vasoconstrictor effects. (D)</p> Signup and view all the answers

What vascular action occurs with the use of beta-adrenergic blockage medications treat for growing aortic aneurysms?

<p>decreasing blood pressure (C)</p> Signup and view all the answers

Flashcards

Telangiectasias

Small, widened blood vessels visible in the skin. They are not considered varicose veins.

Varicose vein

Condition in which venous blood has pooled, producing distortion of the veins, leakage, increased pressure, and inflammation.

Chronic Venous Insufficiency (CVI)

Persistent ambulatory lower extremity venous hypertension, venous hypertension, circulatory stasis, and tissue hypoxia.

Deep Venous Thrombosis (DVT)

A blood clot that remains attached to a vessel wall.

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Thromboembolus

A detached thrombus.

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Triad of Virchow

Venous stasis, venous intimal damage and hypercoagulable states.

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Superior Vena Cava Syndrome (SVCS)

Clinical manifestation of progressive compression of the superior vena cava (SVC), leading to venous distention in the upper extremities and head.

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Hypertension (HTN)

Consistent elevation of systemic arterial blood pressure.

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Isolated Systolic Hypertension (ISH)

Elevated systolic blood pressure accompanied by normal diastolic blood pressure.

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Causes of Hypertension

Increases peripheral resistance, blood volume, or both.

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Increased SNS activity

Vasoconstriction

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RAAS

Maintains blood pressure and tissue perfusion.

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Overactivity of RAAS in Hypertension

Volume retention results, increased blood volume, also contributes to an increased blood pressure.

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Complicated Hypertension

Damage is determined primarily by systolic blood pressure.

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Target organs

Kidney, brain, heart, extremities and eyes.

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Orthostatic Hypotension (OH)

Decrease in systolic blood pressure of at least 20 mmHg or a decrease in diastolic blood pressure of at least 10 mmHg within 3 minutes of moving to a standing position.

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Aneurysm

A localized dilation or outpouching of a vessel wall or cardiac chamber.

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Atherosclerosis

Accumulation of lipid-laden macrophages within the arterial wall, leading to plaque formation.

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Complicated Plaques

When plaque ruptures, exposure of underlying tissue results in platelet adhesion.

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Peripheral Artery Disease (PAD)

Athlerosclerotic disease of arteries that perfuses the limbs. Especially the lower extremities.

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Myocardial Ischemia

The cells are living but cannot perform their normal function.

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Plaque and Rupture

Occurs because of inflammatory activation of proteinases (matrix metalloproteinases and cathepsins), apoptosis of cells within the plaque, and bleeding within the lesion (plaque hemorrhage).

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Acute coronary syndromes

Abolishment of supply.

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Ischemia attack

Local state which the cells are temporary deprived of blood supply.

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Myocardial Infarction

Impaired Myocardial metabolism enough to have cell deprivation and eventually cell death.

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Stable Angina

Characterized by reversible subendocarial Ischemia is frequently seen in angina.

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Prinzmetal angina

Reversible ischemia is seen in the syndrome.

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Silent Ischemia

Individuals with neurological disorders.

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Coronary Heart Disease

Can diminish myocardial blood supply enough to cause Ischemia and is potentially life threatening when related to STEMI

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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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