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110 Cards in this Set
- Front
- Back
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Arteries
- Two major divisions: 1. Muscular |
*found in peripherals
*constrict or dilate to move blood |
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Arteries
- Two major divisions: 2. Elastic |
large arteries
example, Aorta pressure from heart keeps blood moving |
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- 3 layers:
1. Tunica Intima (Interna) |
made up of endothelial cells
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- 3 layers:
2. Tunica Media |
made up of muscle cells
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- 3 layers:
3. Tunica Adventicia (Externa) |
made up of connective tissue
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Lumina
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opening on inside of vessels
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Arterioles
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lack outer connective tissue layer
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Capillaries
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1 cell thick,
endothelial layer, diffusion occurs very easily (where oxygen is exchanged) |
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Venules
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2 layers,
lack outer connective layer |
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Veins
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- 3 layers
- More cells - More cells that are holding functioning cells together - Do not have elasticity - Pressure is much lower than in arteries - Veins have valves, arteries do not |
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Diseases of the Vascular System
1. Arteriosclerosis |
walls of vessel become thicker, become harder and lose elasticity
- Change occurs in tunica intima or media |
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Risk factors: Arteriosclerosis
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* Age – part of normal aging process, expect to see some degree
* Diet – high fat, high in cholesterol, triglycerides * Stress – leads to hypertension, contributes to arteriosclerosis * Smoking * Obesity * Metabolic diseases: diabetes * Alcohol * Lack of exercise |
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Arteriosclerosis obliterans
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walls have thickened to extent lumen is closing, completely shut off blood supply
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Atherosclerosis
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form of arteriosclerosis, thickening of artery plus deposits in artery (either lipids and/or calcium)
- Not normal, do not expect to see - Lesion where deposit develops – atheroma - Tend to lead to clot formation - Found in larger vessels, for example, femoral, aorta, iliac |
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Risk factors: Atherosclerosis
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- Same risk factors, however, diet plays a much larger role
- A diet high in LDL – worse offender |
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Degrees of Atherosclerosis:
Fatty streaks |
-Least serious
-streaks of fat on vessel wall - No symptoms - Can occur at any age - Reversible |
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Degrees of Atherosclerosis:
Fibrous plague |
lipids and collagen start to build up in artery
- Not reversible - Increased blood pressure |
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Degrees of Atherosclerosis:
Complicated lesion |
-Most serious
-deposits calcify - Decreased blood flow - Increased blood clotting - High blood pressure - Can lead to complete occlusion - As both progress, in order to prevent problems with blood flow, like necrosis, body develops collateral circulation – goes around to continue the flow of blood - Contribute to heart attack, angina, TIA’s (mini strokes), strokes, gangrene, etc. |
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Peripheral Artery Disease –
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inflammatory process that occurs in arteries,
*often lower extremities |
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Symptoms,ext of Peripheral Artery disease
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- Symptom: Intermittent claudication – anything that would decrease blood flow, pain that occurs when person exercises (walking from one side of room to another)
- Hypoxia occurs – low oxygen levels, causes cramping and pain - Can be relieved by rest |
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Thromboangitis obliterans (Buerger’s disease)
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- Inflammatory disease
- affecting lower extremity, leads to inflammation of veins - Begins in small vessels - Progresses to larger vessels - Usually seen in male population - Tend to be younger men, 20’s to 30’s who are heavy smokers - Hypersensitivity to nicotine |
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Symptoms of Buergers
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- Symptom: Intermittent claudication
- Decrease in size of lumen, results in ulceration of lower extremities and gangrene |
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Arteritis
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inflammation of artery,
can be caused by localized infection, trauma |
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Aneurysms
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ballooning of vessel,
due to a weak point in arterial wall, will bulge outward from pressure of blood |
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Types of Aneurysms
1. Mycotic |
small weak points on vessel wall due to infections in that area
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Types of Aneurysms
2. Saccular |
affects one portion of artery (does not go all way around)
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Types of Aneurysms
3. Fusiform |
entire circumference of artery (bulges entire way around)
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Types of Aneurysms
4. Dissecting |
any type of aneurysm can develop into a dissecting artery – blood dissects artery wall
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Characteristics of Aneurysms
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- Most common cause: arteriosclerosis and atherosclerosis
- Trauma - Most common site: aorta |
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Symptoms of Aneurysms
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1. May never know you have had an aneurysm
2. Depending on the area, may develop pain - Therefore, symptoms depend on area of aneurysm - Biggest danger: will rupture (does not have to be fatal) - Surgical procedures if aneurysm is discovered |
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Raynaud’s disease
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Vascular disease;
results from intermittent spasms of arterioles - Occurs more upper extremities - More common in women - Age 15 to 35 - Blood cannot get into hand or foot - Hand very cold to touch, pale, hands and nail beds turn blue (possibly cyanosis) - experience pins and needles, and some dull pain - Spasms releases, blood rushes back into hand/foot, becomes bright red, throbbing pain, warm - Exposure to cold ( usually 50 degrees and colder) |
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Phlebitis
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Conditions of Veins
*inflammation of vein |
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Sign/symptoms: Phlebitis
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1. Heat
2. Redness 3. Swelling - Can be caused by infection, more commonly caused by injury to vein wall or by immobility (after surgery, prolonged bed rest) - Pregnancy – pressure on lower extremities |
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Thrombophlebitis
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Conditions of Veins
*inflammation of vein with a clot - Heat, redness, and swelling, can feel the clot in vein - Same causes as phlebitis |
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Varicose veins
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Conditions of Veins
*Abnormally distended and twisted - Occurs in superficial veins - Legs most common site - Cause: stasis of blood due to incompetent valves - More common on women - Less muscle mass - Pregnancy - High heels - Standing for long periods of time - Spend most of time walking on carpeting - Crossing leg at knee |
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Hypertension
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high blood pressure
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Measure blood pressure
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systolic – contraction
over diastolic – chambers are filling (ventricles are relaxed) |
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blood pressure (adult)
pre-hypertension |
120/80 mm Hg
pre-hypertension |
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Normal blood pressure is now
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110/70
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old vs new stats for hypertension
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140/90,
now considering – 130/80 |
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2 types of hypertension
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1. Primary or Essential hypertension –
idiopathic – no known cause – MOST COMMON 2. Secondary hypertension – results from some underlying condition in body Ex:Renal disease - If underlying cause can be fixed, hypertension will go away |
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2 Classifications: hypertension
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1. Benign – slow increase over time of blood pressure
2. Malignant – usually seen in younger people, sudden increase in blood pressure |
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-Predisposing factors: hypertension
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1. Age
2. Race – seen in higher rate in Afro-American and Hispanic population 3. Sodium – fat 4. Smoking 5. Familial history 6. Obesity – lack of exercise |
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Aftermath of predisposing factors: hypertension
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- Major contributor to other occurrences in body
- untreated will damage vessels - Especially vessels in eyes, heart, kidneys, and brain - Major cause of heart failure, kidney failure, stroke, heart attack - If a person has aneurysm and uncontrolled hypertension = great risk for rupture - With a blood pressure of 120/80, twice as likely to develop complications over someone with a normal blood pressure; 140/90, 4 times as likely - 3 elevated blood pressures, at least 24 hours apart to be diagnosed with hypertension - referred to as silent killer – no signs or symptoms |
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Post-mortem considerations
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- Extra dye – do not know how far fluid is getting
- Stronger fluid, lower pressure - Clots – message, pulsate machine, multi-point - Aneurysm – ruptured – swelling in that area, turn off machine |
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Layers of the heart:
Epicardium |
outside layer of the heart, serous tissue
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Layers of the heart:
Myocardium |
middle layer, muscle tissue
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Layers of the heart:
Endocardium |
inner most layer, serous tissue
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Layers of the heart:
Pericardium |
extension of the epicardium, fluid filled sac
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Visceral
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closer to heart
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Parietal
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closer to chest wall
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Vessels to myocardium
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coronary arteries
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Predisposing factors for heart disease:
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- Age
- Smoking - Weight - Diet – high in fat, cholesterol, triglycerides - Family history – very key - Hypertension - Lack of exercise - Stress - Alcohol - Diabetes |
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Congenital Heart Disease (CHD)
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usually results from a defect in heart (structural damage)
- Failure of heart to form properly in embryonic development - Approximately 10% of newborns have a heart defect – much higher among premature - will hear heart murmurs |
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Ventricular Septal Defect (VSD)
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- Most common heart defect
- More serious - A hole between ventricles - Beginning – blood moving from left to right – due to pressure, left side is much thicker than right - No cyanosis, oxygenated blood - Will then switch right to left - Creates cyanosis – bluish discoloration due to lack of oxygen |
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Atrial Septal Defect (ASD)
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- A hole between atria
- Less serious - Can live normal lives not knowing have this disease |
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Coarctation of the aorta
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- Fibrous band forms around aorta, causes narrowing of lumen of aorta (right around area of heart)
- Heart will have to work harder to pump blood through narrowed aorta |
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Patent ductus arteriosis
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- Between aorta and pulmonary artery
- Should close at time of birth or shortly after – if it doesn’t close becomes patent (stays open) - Mixing oxygenated and deoxygenated blood |
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Tetralogy of Fallot:
Pulmonary artery stenosis |
narrowing of lumen
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Tetralogy of Fallot:
VSD |
ventricular septal defect
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Tetralogy of Fallot:
Overriding aorta |
aorta comes all the way up around over heart and ventricles – blood cannot leave;
problems with heart expanding (Cardiac Tapenade) |
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Tetralogy of Fallot:
Hypertrophy Right Ventricle |
increase in size, right ventricle very muscular, severe cyanosis ---
due to 1 and 2. Cannot undergo surgery. |
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Valvular Defects:
Stenosis |
narrowing of valve
Insufficiency of Incompetence – valve does not close completely Leads to regurgitation – backflow of blood through valve |
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Valvular Defects:
Prolapse |
valve goes wrong way (opposite direction)
- Mitral valve is most common |
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Valvular Defects:
Heart murmurs occur |
sound of blood moving in a way it’s not suppose to move
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Murmurs are Pathologic
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above
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Murmurs are Physiologic –
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no structural defect.
Comes and goes ( not constant). Stress, illness and fear and make it happen |
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2 types of murmurs:
Clicking murmur |
valve is stuck closed, blood must force it open creating clicking
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2 types of murmurs:
Whooshing murmur |
backflow of blood
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Compensation
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body will try to adapt for disease
- Cardiac output – rate and strength - Hypertrophy will occur – increased strength of heartbeat - Increase heart rate - Thin the blood to make easier to move – Fibinolisten produced |
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Decompensation
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when body cannot make up for defect (compensation fails)
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Cardiomyopathy
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disease of muscle of heart
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Characteristics of cardiomyopathy
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Dilated – chamber (dilates) increases size, muscle thins
- Usually occurs in atria, can occur in ventricle |
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Causes of cardiomyopathy
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- Can be idiopathic
- Infection (STREP) - Nutritional deficiency - Electrolyte imbalance – sodium and potassium - Toxins - Radiation |
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Results of cardiomyopathy
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enlarged atria --- Cardiac output decreases – more blood stays in atria
- Can lead to heart failure |
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Hypertrophic
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muscle of heart gets larger (thickening), chamber gets smaller
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Characteristics of Hypertrophic
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Usually occurs in ventricles, can occur in atria
- Idiopathic - Increased cardiac output initially, then decreases over time (muscle will tire) - Hypertension, increased heart rate, angina (force of contraction), arrhythmias - Leads to CHF |
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Restrictive
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when vessels cannot expend properly (anything that would restrict ability of heart to expand) --- usually a result of something else (lupus)
-ventricles cannot expand properly, restriction of volume |
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Inflammatory Processes:
Endocarditis |
inflammation of inner lining of heart (endocardium)
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Predisposing factors: Endocarditis
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- Usually bacterial or fungal origin
- Most common: Strep, then Staph -congenital or valvular defects - Sepsis, valvular defects, cardiomyopathy |
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Inflammatory Processes:
Myocarditis – |
inflammation of muscle layer (myocardium)
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Characteristics of Myocarditis
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- Usually bacterial or fungal origin, also can be caused by toxins or radiation to chest area
- Usually asymptomatic - Will resolve itself, no needed treatment |
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Inflammatory Processes:
Pericarditis |
inflammation of the pericardium
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Characteristics of Pericarditis
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- Same as mycarditis
- Will result in severe pain **Pleuritic pain – pressure on heart ** Friction Rub – sandpaper, layers of pericardium rub together - Can lead to restrictive cardiomyopathy --- heart failure |
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Inflammatory Processes:
Pleuritic pain |
inflammation of all 3 layers
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Carditis
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inflammation of at least 2 layers
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Rheumatic Heart Disease
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can affect any layer of heart, frequently the valves of heart
– diagnostic sign, if it is there the disease is present |
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Characteristics of Rheumatic Heart Disease
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- Almost always caused by Strep
Diagnostic Sign: Aschoff’s Bodies |
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Aschoff’s Bodies
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Nodules that form on myocardium
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Results of Rheumatic Heart Disease
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- Will eventually affect valves –murmurs
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Coronary Artery Disease
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- Decreased blood flow to heart, myocardium will lack oxygen and nutrients
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Characteristics of Coronary Artery Disease
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- Epidemic in Western World
- White males, 50 to 60 (middle aged) --- Now equal in every segment of population - Most common cause: Atherosclerosis - Thrombosis can also cause disease |
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Risk factors of Coronary Artery Disease
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- Diet – very important
- Smoking – very large factor - Obesity - Lack of exercise - Stress - Family history – very important - Diabetes - Most common symptom: angina |
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Angina
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severe pain around heart
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Characteristics of Angina
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- radiant into left shoulder, no further
- occur whenever there is need for increased oxygen - Exercise, sexual activity, stress, after eating large meals, exposure to cold -relived by whatever is causing it and nitroglygen (dilates the vessels – easier blood flow) - Coronary Artery Disease can lead to myocardial infarction (MI) --- Heart Attack - Crushing pain in chest, radiating into left arm, up into left jaw and possibly right shoulder: Typical for male, females do not experience pain in this area |
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Female characteristics of Angina
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- Females feel pain in back and kidney area (silent heart attacks)
- 25% of people will die of first heart attack |
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MI
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actual death of tissue, does not occur in angina (only decreased oxygen levels)
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Characteristics of MI
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- Pain begins spontaneously
- No trigger, not relived by rest like angina - Tends to happen in sleep |
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Cardiac Failure:
Acute |
Cardiac Arrest
- Sudden stoppage of heart beat and less circulation |
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Cardiac Failure:
Chronic – |
Congestive Heart Failure
- Occurs over time - Contractible ability of heart decreases over time |
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Causes of chronic cardiac failure
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- Heart defects
- Atherosclerosis - Hypertension - Inflammatory processes (especially pericarditis) - Metabolic diseases like diabetes - Left Ventricular Failure - Will not be pumping effectively - Blood will be in pulmonary system - Pulmonary symptoms will result - Dyspnea – difficulty breathing, shortness of breath - Productive cough - Tachycardia - Weakness and fatigue - Right Ventricular Failure - System circulation - Edema – usually very severe, pitting edema - Distended neck veins - Ascites - Weakness, fatigue |
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Ascites
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accumulation of fluid in abdomen --- nausea and vomiting common
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Tachycardia
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increased heart rate, due to body wanting to circulate blood
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Hypertensive Heart Disease:
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-Hypertension
- Hypertrophy of ventricles, dilation of atria - Can lead to congestive heart failure |
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Hypertension
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increased blood pressure, heart must work harder
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Post-mortem Considerations:
- Implantations of pacemakers and defibrillators |
- Placement should not cause a problem with injection or drainage
- Increased demand for fluid |
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Post-mortem Considerations:
Post op |
recent surgery
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Post-mortem Considerations:
Bypass |
scaring on chest and leg (long incision on leg)
- Remove staples on leg, tightly suture incision, glue over (plastics) |
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Post-mortem Considerations:
Cyanosis |
message
- Pulmonary edema/Ascites - Pressure of fluid, problem with lower extremities |
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Post-mortem Considerations:
CHF |
thorough aspiration
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