Understanding Perfusion

Introduction to Perfusion

• Perfusion refers to blood flow vessels that delivers nutrients and oxygen to tissues
• It's essential for maintaining cellular function

Key Components and Physiology

• Effective perfusion requires a working heart to pump, hoses (blood vessels), and vehicles (blood)
• The heart pumps blood, vessels carry it, and blood components such as plasma, platelets, red and white blood cells are transported throughout the body

Cardiovascular System

• The heart pumps blood, supplying oxygen and nutrients to organs and tissues.
• Arteries, veins, and capillaries are pathways for blood, like a highway system.
• Blood consists of plasma, red and white blood cells, and platelets, each has a role in perfusion

Problems with Perfusion: Ischemia and Infarction

• Ischemia occurs when blood flow is reduced, leading to a shortage of oxygen and nutrients
• This can occur acutely or chronically.
• Infarction results when blood supply is completely obstructed, leading to tissue death and scarring
• Chronic hypertension or sickle cell anemia can cause repeated ischemic events, leading to fibrosis and long-term tissue damage.

Categories of Perfusion Issues

• Cardiac perfusion refers to blood flow to the heart muscle
• Tissue perfusion refers to blood flow to body tissues
• Tissue perfusion depends on cardiac output and vascular resistance.
• Diseases related to obstruction include Hypertension, Atherosclerosis, Peripheral Vascular Disease, Deep Vein Thrombosis.
• Structural or functional heart issues
• Heart failure is the inability of the heart to pump adequately
• Cardiomyopathy leads to structural changes in the heart affecting function

Pathophysiology of Hypertension

• Persistent high blood pressure damages arterial walls
• It is met with temporarily compensating mechanisms that try to regulate it
• Chronic high pressure causes endothelial injury which leads to inflammation, scarring, and increased risk of arterial disease.
• There are two types: Essential and Secondary
• Essential hypertension has no identifiable cause and gradual onset
• Secondary hypertension has an underlying medical condition such as kidney disorders

Risk Factors of Hypertension

• Modifiable risk factors: Obesity, poor diet high in salt and fat, physical inactivity, smoking, and alcohol use.
• Non-modifiable risk factors are increased risk due to age and genetic family history of hypertension
• Stress, socioeconomic status and environmental pollutants can contribute to risk

Manifestations & Diagnostic Tests of Hypertension

• Hypertension is often asymptomatic
• Symptoms can include headaches, dizziness, blurred vision, and chest pain.
• Blood pressure readings of 140/90 mmHg or higher indicate hypertension
• Evaluations include heart rate assessment and evaluation of cardiovascular health.
• Further diagnostic tests include blood tests such as serum creatinine, electrolytes, and lipid panel
• Echocardiogram, chest X-ray, and EKG are imaging tests

Complications of Hypertension

• Hypertension increases the risk of heart attack and stroke
• It can lead to heart failure because of prolonged pressure load
• High blood pressure can damage the kidneys, leading to chronic kidney disease and reduced kidney function
• Hypertension leads to increased risk of ischemic and hemorrhagic stroke.
• Chronic hypertension can contribute to cognitive decline and dementia.

Pathophysiology of Heart Failure

• Heart's inability to pump effectively results from systolic dysfunction (impaired contraction) or diastolic dysfunction (impaired relaxation)
• This dysfunction leads to reduced cardiac output and systemic congestion.
• Forward and backward effects occur:
• Forward effects include reduced oxygen supply to tissues and backward effects include fluid buildup in the lungs and peripheral tissues.
• Heart failure is chronic and progressive
• Compensatory mechanisms initially maintain function but eventually worsen heart damage.

Risk Factors of Heart Failure

• Modifiable risk factors: Hypertension, coronary artery disease, and diabetes
• Can also be obesity, sedentary lifestyle, and excessive alcohol consumption.
• Non-Modifiable risk factors are Age and family history of heart failure
• Other contributing factors include kidney disease or arrhythmias and high cholesterol levels

Manifestations of Right vs Left Heart Failure

• Right-Sided Heart Failure causes fluid buildup in peripheral tissues (edema)
• Symptoms include weight gain, enlarged liver, and swollen legs.
• Left-Sided Heart Failure causes fluid buildup in the lungs (pulmonary edema)
• Symptoms include shortness of breath, coughing, and fatigue
• Right-sided failure primarily affects systemic circulation and left-sided failure affects the pulmonary system, leading to respiratory symptoms

Activity Intolerance

• Easy fatiguability accompanies activity intolerance and increasing HR, BP, RR with minimal activity
• Symptoms present as decreasing 02 sat with activity that improves with rest and muscle weakness
• Decompensating presents Dizziness, diaphoresis, cyanosis and changes in mental status and consciousness while Bradycardia, hypotension, dysrhythmias are present

Diagnostic Tests for Heart Failure

• Blood tests focus on B-type natriuretic peptide (BNP) levels in order to assess severity
• Tests also examine serum electrolytes, creatinine, and liver function.
• Imaging studies focus on echocardiograms for Evaluating heart structure and function
• Chest X-rays check for heart enlargement and pulmonary congestion while electrocardiograms (EKG) identify arrhythmias or heart damage
• Cardiac MRIs give detailed information on heart anatomy

Complications of Heart Failure

• There is an increased risk of arrhythmias and sudden cardiac arrest which can lead to cardiogenic shock
• Renal implications include decreased cardiac output which reduces kidney perfusion leading to chronic kidney disease and fluid retention.
• Pulmonary congestion leads to shortness of breath and increased risk of pulmonary edema and respiratory distress due to respiratory issues

Pathophysiology of Peripheral Arterial Disease (PAD)

• Atherosclerosis is the underlying cause of PAD and results where plaque builds up in the arteries
• This leads to reduced blood flow and oxygen delivery to the limbs.
• Stages of PAD involve being asymptomatic, claudication, rest pain and potential for tissue necrosis
• Decreased perfusion leads to hypoxia and tissue damage which can progresses to critical limb ischemia if untreated, impacting limb function

Risk Factors of Peripheral Arterial Disease (PAD)

• Smoking and diabetes are modifiable factors and lead to increased risk of PAD accelerating atherosclerosis
• Age, family history of vascular diseases are non-modifiable
• Hypertension and hyperlipidemia contribute to plaque formation and chronic kidney disease increases risks with PAD

Manifestations of Peripheral Arterial Disease (PAD)

• Intermittent claudication presents as pain or cramping in the lower limbs during exercise
• This is relieved by rest and occurs because of insufficient blood flow
• Persistent pain at rest, especially at night means there is worsening ischemia and advanced disease
• Reduced hair growth, pale or bluish skin, and weak pulses occur with ulcerations or sores on the feet that do not heal as visible changes

Diagnostic Tests for Peripheral Arterial Disease (PAD)

• Ankle-Brachial Index (ABI): Compares blood pressure in the ankle with blood pressure in the arm
• Lower values mean reduced blood flow to the limbs.
• Doppler Ultrasound measures blood flow in the arteries of the legs
• This helps detect blockages or reduced circulation
• Magnetic Resonance Angiography (MRA) visualizes blood vessels to identify areas of narrowing or blockage providing detailed images to guide treatment decisions.

Complications of Peripheral Arterial Disease (PAD)

• Reduced blood flow impairs healing leading to painful ulcers, leading to ulcers and non-healing wounds
• Severe blockage results chronic pain and tissue damage indicating Critical Limb Ischemia which leads to a limb amputation if left untreated
• Complete obstruction causes tissue death leading to gangrene with requires immediate medical attention to prevent a systemic infection

Pathophysiology of Chronic Venous Insufficiency (CVI)

• Damaged or weakened valves cause dysfunction and fail to prevent backflow which results in blood pooling in the legs
• Venous Hypertension comes from increased pressure in veins and causes vascular congestion
• This then causes swelling, discomfort, and potential skin changes
• Chronic Inflammation from persistent congestion then follows, leading to skin damage that results in varicose veins and venous ulcers over time

Risk Factors of Chronic Venous Insufficiency (CVI)

• Obesity and a Sedentary Lifestyle where Prolonged sitting or standing impedes blood flow are modifiable risks
• Increased Age decreases vein elasticity. Also increases risk in female gender, especially due to hormonal influences as Non-Modifiable risk factors
• History of Deep Vein Thrombosis (DVT) increases the risk and Pregnancy increases blood volume and pressure on veins are associated conditions

Manifestations of Chronic Venous Insufficiency (CVI)

• There is the appearance of Varicose Veins which are enlarged, which are twisted veins often visible just beneath the skin caused by prolonged increased pressure in the leg veins
• And Edema, swelling of the lower extremities due to fluid buildup is also present as well that is worsened by prolonged standing/sitting
• the Skin becomes thickened, discolored, or develops sores because chronic inflammation can lead to venous ulcers in Skin Changes

Diagnostic Tests for Chronic Venous Insufficiency (CVI)

• Duplex ultrasound combines traditional ultrasound and Doppler to assess blood flow and identify valve dysfunction.
• Venography is invasive imaging that uses contrast dye to visualize vein structure and detect blockages, blood clots, and valve issues
• Photoplethysmography (PPG) measures changes in blood volume to evaluate venous function with it being non-invasive and is often used to assess venous insufficiency severity

Complications of Chronic Venous Insufficiency (CVI)

• Chronic inflammation leads to non-healing sores on the lower legs making venous ulcer painful and prone to infection
• Persistent venous pressure causes skin discoloration and thickening, increasing risk of cellulitis and other skin infections and skin changes
• Prolonged venous stasis causes blood clots called Deep Vein Thrombosis (DVT) Which Can lead to pulmonary embolism

Pathophysiology of Deep Vein Thrombosis (DVT)

• Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the leg (Virchow's triad) because of stasis, hypercoagulability, or endothelial injury
• Prolonged immobility (e.g., long flights, bed rest) that can lead to stasis
• Sluggish blood flow increases the risk of clot formation
• Certain cancer diagnosis, genetic disorders, or hormone therapy is an increase of clotting tendency

Risk Factors of Deep Vein Thrombosis (DVT)

• Prolonged Immobility can happen during bed rest, long flights, or extended sitting and impedes blood flow
• This leads to increased risk of clot formation in the deep veins.
• Medical Conditions such as underlying Cancer, Heart failure, or Inflammatory diseases and genetic predisposition to hypercoagulability can increase the risk.
• Smoking and obesity increases risk
• Hormonal therapy, such as birth control pills, elevates the risk

Manifestations of Deep Vein Thrombosis (DVT)

• Affected leg experiences sudden swelling accompanied by pain that worsens by walking/standing and Swelling and pain
• affected Skin becomes red or discolored along with warmth and tenderness and Skin Changes
• Some individuals may experience no symptoms (asymptomatic) and DVT remains hidden until and if incidentally discovered during imaging

Diagnostic Tests for Deep Vein Thrombosis (DVT)

• Ultrasound Imaging is most commonly used as duplex to create imaging that shows real-time images of flowing blood and identify clots
• D-Dimer Blood Test Measure fibrin degradation products to elevated levels, but not definitively
• Venography utilizes contrasts to allow visualization when ultrasound reveals an inconclusive or with need for more information

Complications of Deep Vein Thrombosis (DVT)

• Clots will move through the veins causing a Pulmonary Embolism (PE) that affects lung processes with a potential of becoming life-threatening
• A post-Thrombotic Syndrome (PTS) causes chronic pain, discomfort and altered skin in the affected area
• Chronic Venous Insufficiency Causes damaged veins that also increases recurrent DVT and leg symptom problems

Pathophysiology of Arteriosclerosis and Atherosclerosis

• Hypertension, Smoking, high cholesterol levels, causes damage, starts the decline on the arterial interior which effects Arteriosclerosis (Endothelial Injury )
• Lipoproteins increases in area as well as LDL, starts fatty streaks that cause Atheroma on the tissue and Formation
• the Injury causes inflammation response and the body begins to try to self repair
• The Muscle fibers in the heart are altered and cause vessel narrowing and Plaque Maturation can occur

Process Map of Atheroma Development

• High blood pressure and smoking combine after cell damage, as well as high levels of toxic lipids that have accumulated on injury, all factors of Endothelial (Injury and Lipid Accumulation)
• Injury starts response of Monocytes migrating and changing and forming 'foam cells', for what is called the Fatty-streak (Inflammatory Response)
• Muscle begins migration while collagen is produces which causes a fatty streak to form in the area (Fibrous Cap Formation) and then (Plaque Complication) over time the plaque can rupture and formation occur

Risk Factors for Atherosclerosis

• Genes, race, family history and the effects of high levels of genetic predispositions all influence risk factors- genetic predispositions
• Smoking, sedentary life style, poor diet are contributing factor that reduce risk factor is high lifestyle
• Hypertension, hyperlipidemia exacerbate effects to the organ with risk reduction of proper prevention heart- chronic Condition

Manifestations of Atherosclerosis

• Angina can become the major cause of an Myocardial heart problem for the cardiovascular system
• TIA transient or accident events affect neurology with the brain - Cerebral
• The limb area and Intermittent issues will occur - Peripheral (PAD)

Diagnostic Tests for Atherosclerosis

• Blood vessel blockage and extent of plaque are what Angiography looks for
• Arter flow quality is what they want to visualize for and Peripheral use-Ultrasound
• A Test that looks at cholesteryl, triglycerides, and other testing Blood
• A heart monitor looking for Aterio and Electrical signal usage- Electrocardiogram

Complications of Atherosclerosis

• Complete damage from artery blockage results to heart attack- Myocardial infaction
• Lack of oxygen results to brain problem or potential artery- Stroke
• Weak spots for walls and rupture formation - Aneurysm
• Narrow artery in limb is caused by necrosis,pain,and sores known for PAD-Peripheral Arterial

Pathophysiology of Acute Coronary Syndrome

• Atherosclerotic plaque will trigger other issues resulting into clot known that will block the artery , Plaque Rupture
• Blockage will cause formation in artery - Thrombus area blockage
• restricted flow or heart attack can occur -Ischemia and Infarction
• Drug abuse or stress are triggered factors such a factor, can't expand blood vessel- Vasospasm Contribution

Risk Factors for Acute Coronary Syndrome

• Age, genes, race can effect levels with a higher risk for males unless reaching menopauseNonmodifiable Factor
• unhealthy diet, laziness, smoking lead to other conditions that lead to other heart problem or the modifiable - Lifestyle
• High blood pressure, cholesterol, and uncontrolled diseases. are conditions related as well that are Modifiable-Factors

Manifestations of Acute Coronary Syndrome

• Tightness and chest pain radiate from the area known , heart attack - Chest/Angina
• Shortness of oxygen because heart cannot carry enough energy- Shortness of Breath
• High sweating, nausea and fatigue -Diaphoresis (and Nausea)
• Dizziness and extreme fatigue - Fatigue and Dizziness

Different Types of Angina

• Stress for the body, such as exercise lead predictable heart pains usually controlled with meds - (Stable Angina)
• Without trigger heart pain can occur more severe on heart - unstable Angina)
• Muscle tissue can occur because of arteries and chest pains are typical (Prinzmetal)

Diagnostic Tests for Acute Coronary Syndrome

• ECG is what helps the Electrical activity and abnormal for the heart (electrocardiogram
• Troponin confirms heart has high level of risk after the blood test-
• blockage with use or Coronary X-ry - Coronary Angiography
• Exercising to test the condition Stress test

Complications of Acute Coronary Syndrome

• Myocardial infarction is a problem can reduced fluid and output and inefficiency in heat

• Ischemitis and abnormality's are what caused Arrhymias cause rapid or high stroke - Atrial Fibrillation

• Cardiogenic stroke or artery -Shock

Pathophysiology of Inflammatory and Infectious Cardiovascular Diseases

• Heart problem can caused by agents- bacterial Leads to vegetate which problems and dysfunction- Endocarditis
• The immune system can start a response , heart
• Damage- Immune Response (Group A)
• From myocardial infarction- (Pericarditis) Restricts flow Viral infection -Myocardial

Risk Factors for Inflammatory and Infectious Cardiovascular Diseases

• Illness such as immuno/suppression or IV drugs can cause cardio infections to predispose
• Group history can cause Cardio effect( rheumatic)
• Prosthetic Heart can Cause the Cardio factor IV - introduction of Pathogens- Heart valves can cause risks of heart risks-

Manifestations of Inflammatory and Infectious Cardiovascular Diseases

• High Body temp -is a common result, typically from infections
• Murmues Valve vegetate disrupt normal flow inside of heart- Pericardial Effusion and swelling in legs and body from swelling and fluid-

Diagnostic Tests for Inflammatory and Infectious Cardiovascular Diseases

Cultures that show what's causing in effect with high diagnosis or infection- blood tests Visualize from vegetation to Cardio for pericardical. - Echo Check rythem rhythm and heart changes. By ECG to - Segment high- high signal Infections or what can elevated C- reactive. -Protein for infections

Complications of Inflammatory and Infectious Cardiovascular Diseases

• Weak body caused result infections which reduced pressure (for heart)

• Infections can cause Valve Destruction-

• Embolism (vegetation can cause strokes and organ malfunction) Pericardiacal can lead to fluid in heart and what requires treatment (for infection.)

Overview of Valvular Disease

• Defect ( Stenosis and Regurgitation) will affect flow
• Function of how the workload affects. Arrymthmia and leads to heart failure- (Thromboembolison
• Common is Aortic and tricuspid-leads to aorticstenosis

Pathophysiology and Pathogenesis of Valvular Disease

• Stenosis (restrict flow) and also Regurgitation (allows backward Flow) causes Low Cardiac Output-
• Malfunctions or increased pressure causes Hypertrophy.-dilation heart disease with not treatment-
• Prolonged Pressure ,fibrosis, thickening causes (Cellular,Damage and Fibrosis)

Risk Factors for Valvular Disease

• Predominantly affects older people due to high degenerative rate with age-
• Heart Condition (hyper, diabetes, myocardial. Effects risks for health condition
• Smoking Inactivity and poor diet or lifestyle factor.

Clinical Manifestations of Valvular Disease

• (Low energy for breath and fatigue Effect of heart-Dysphea Can lead arrhythmias -Chest pain or Palpitations heart In Edema an Synoscope Fluid accumulation and heart fainting , with legs ,ankle or feet.

Diagnostic Tests for Valvular Disease

• Visualize structure- function with heart sounds - Echo (doppels
• EGCS help assess - rythm
• Catherization with - measures pressure and treatment issues,