Pathophysiology exam 3-Questions and Answers

CHF - ANSWER Failure of the heart's pumping ability to keep up with the demands of the body Is CHF a condition or a disease - ANSWER Condition CHF involves a reduction in what - ANSWER cardiac output Systolic failure - ANSWER failure to contract well Diastolic failure - ANSWER failure to fill enough To calculate ejection fraction - ANSWER EDV-ESV= SV SV/EDV= EF (expressed as percentage) symmetric hypertrophy - ANSWER normal response to cardiovascular conditioning as occurs in athletes concentric hypertrophy - ANSWER the wall thickness greatly increases and loses compliance= lower EDV and diastolic failure eccentric hypertrophy - ANSWER chamber radius is increased and the wall thickness is increased moderately and causes higher EDV, reduced EF and systolic failure CAD - ANSWER coronary artery disease Stenosis - ANSWER narrowed valves MI - ANSWER Myocardial infarction= heart attacks Regurgitation - ANSWER incompetent (leaky) valves Congestive heart failure - ANSWER can be left or right depending on what side of the heart is affected by the underlying condition. It can even be biventricular (both sides) Right side CHF - ANSWER - failure of rt side to pump -most often a result of left side failure - blood becomes congested in the systemic circuit - S&S are peripheral edema, weight gain, visceral congestion, portal hypertension jugular vein dissension ascites Left side CHF - ANSWER -failure of the left side to pump -Etiology: CAD, MI, Hypertension, and aortic or mitral valve problems -congestion will be seen in the lungs and low perfusion will be seen in the body (systemic arteries) -S&S are congestion in pulmonary circuit= pulmonary edema, cyanosis, SOB, dyspnea (difficulty breathing) -Poor perfusion=. confusion, kidney failure, cold extremities COPD - ANSWER -group of respiratory disorders characterized by chronic and recurrent obstruction of airflow in the pulmonary airways - 2 types: emphysema and chronic bronchitis Alpha-1 Antitrypsin Hereditary Deficiency - ANSWER will cause early onset COPD in nearly all afflicted individuals Emphysema Pathophysiology - ANSWER -Etiology: smoking #1 cause -smoking and irritants cause the release of elastase and other proteases from PMNs and macrophages upon injury -smoking triggers the inflammatory response -smoking inactivates alpha 1 antitrypsin allowing neutrophil enzymes to destroy the lungs - the obstruction in emphysema is trapped air -this interferes with gas exchange Chronic Bronchitis - ANSWER - etiology= smoking #1 cause - airway obstruction caused by inflammation of the major and small airways -hyperplasia of submucosal glands causes excess mucous secretion and metaplasia of endothelium=blocked airways -mucous is the obstruction Pink puffers - ANSWER classic emphysema patients exhibits cachexia and hyperpnoea Blue bloater - ANSWER chronic bronchitis patient; cyanotic and edematous (for pulmonate) -patient: productive cough RBC/ erythrocytes - ANSWER Carry oxygen WBC/leukocytes - ANSWER fight foreign invaders Platelets/thrombocytes - ANSWER help form clots Plasma - ANSWER liquid part of the blood-increases or decreases with hydration level of the patient Hematocrit (Hct) - ANSWER the % of RBCs in whole blood. Normal hct is around 45% Hemoglobin (Hb) - ANSWER the protein on RBCs that bind oxygen. Hb itself is red. it is what makes RBCs and blood red Erythropoietin - ANSWER chemical released from the kidneys (mainly) telling the bone marrow to produce more RBCs Complete Blood Count - ANSWER RBC 4.2-6.1 million/microliter (mm3) Hb 12-16 g/dl (women) 14-18 g/dl (men) HCt 40-55% (women a little on the lower end, men a little on the higher end) WBC 5,000-10,000/ mm3 Platelet 150,000-300,000/ mm3 signs and symptoms of blood diseases - ANSWER - fatigue - petechiae (little bruises) -pallor (pale) - cyanosis -tachycardia (resting HR over 100 BPM) -angina pectoris (chest pain) -hyperpnea(fast breathing) -dyspnea, SOB -jaundice -infection/ immune deficiencies/ opportunistic infections RBC disorders - ANSWER disorders occur when numbers are either excessive or inadequate- a balance must exist between production and destruction Polycythemia - ANSWER -elevated # of RBC's -increase in RBCs due to hyperactivity of the myeloid tissue -S&S hyper-viscosity, sluggish/stasis of flow and thrombus formation are problems Anemia - ANSWER -lower Tham normal oxygen capacity of the blood -etiology: RBC or Hb Fe deficiency anemia - ANSWER - hemmorhagic anemia due to chronic blood loss -insufficient dietary intake - pregnancy Sickle cell anemia - ANSWER -a single amino acid substitution results in deformed hemoglobin causing the RBC to sickle when deoxygenated. The deformed RBC obstructs blood flow in microcirculation causing occlusion and tissue hypoxia -treatment: hydroxyurea and EPO, bone marrow transplant -prognosis- life expectancy is around 50 Ascites - ANSWER pathological accumulation of fluid in the peritoneal cavity thrombocytopenia - ANSWER decreased number of circulating platelets -bone marrow is not producing platelets -the spleen is hoarding the platelets (pooling) -decreased survival/lifespan of platelets Aspirin use - ANSWER can cause impaired platelet aggregation only use for CV disease; prescribed Hemostasis - ANSWER normal hemostatic mechanism to maintain the fluidity of the blood in the vascular system and yet allow the rapid formation of a solid plug to close a vessel defect thrombus - ANSWER solid mass of platelets, cells and fibrin formed within an intact vessel -"White thrombus" granular and friable mass - lines of Zahn- striations; formed during flow and found mainly in arteries embolus - ANSWER abnormal mass moving in the blood stream embolism - ANSWER sudden occlusion of a vessel by an embolus most common emboli/ embolus will be a thromboemboli Factors that predispose thrombosis: virchows triad - ANSWER 1. endothelial damage 2. stasis or turbulence of flow/disturbance in flow 3. hypercoagulation Endothelial damage - ANSWER disruption in the endothelium leads to exposure of sub endothelial collagen -more common in arteries then veins hemodynamic stress - ANSWER stress wear and tear atherosclerosis - ANSWER deposition of fatty plaque within vessel wall disruption in normal flow - ANSWER the two most common are turbulence flow and stasis of flow Turbulent flow - ANSWER a loss of normal, laminar flow Bifurcations - ANSWER splitting/ branching of vessels leads to turbulence in that area Plaque - ANSWER (atherosclerosis) causes blood to flow in odd patterns around the narrowing aneurysms - ANSWER dilation of vessel wall (can cause both turbulence and stasis) Stasis - ANSWER sluggish flow allows for clotting factors to accumulate and increases blood contact with endothelium Atrial fibrillation - ANSWER arrhythmia leading to incomplete atrial emptying and stasis in the atria Mural thrombus - ANSWER thrombi can form over an infarcted region off the ventricular wall DVT - ANSWER deep vein thrombosis - caused by post op recovery, bed rest, long distance travel, pregnancy, IV drug use -large can cause edema, pain, cyanosis, ischemia -small can be asymptomatic DVT complications - ANSWER -Pulmonary embolism - a significant cause of mortality - massive pe can cause cv and pulmonary collapse saddle thrombi - ANSWER this is a really large embolism that straddles the bifurcation of pulmonary trunk into the pulmonary arteries leading to the lungs. Therefore all blood flew out of the right ventricle will be stopped. This is almost immediately fatal in most cases Treatment/ prevention of DVT - ANSWER - early ambulation: get patients moving - pneumatic compression: cuffs that go around legs of patients - anticoagulants/ thromboembolytics: like aspirin, heparin and TPA -vena cava filters Infarction - ANSWER region of necrosis caused by ischemia a thrombus can either partially or fully occlude the lumen of a vessel leading to ischemia/ infarction occlusion of coronary arteries - ANSWER myocardial infarction occlusion of cerebral arteries - ANSWER cerebral vascular accident (stroke) Infarction outcome depends on - ANSWER 1. tolerance to hypoxia 2. tissue vasculature 3. rate of occlusion 4. occlusion duration (how long the ischemia lasts) embolism - ANSWER the sudden occlusion of a traveling mass (embolus) aneurysm - ANSWER localized dilation of a blood vessel most common in the aorta Types of aneurysms - ANSWER 1. berry- small spherical dilation usually found in circle of willis 2. Fusiform-entire circumference of vessel- AAA- abdominal aortic aneurysm 3. Dissecting- layers of the vessel wall separate and fill with blood Pathogenesis/ etiology of aneurysms - ANSWER congenital defect- you can just be born with it trauma- smoking, accidents infection- syphillis, used to be an issue before antibiotics atherosclerosis-most common cause of aneurysm - S&S are most often asymptomatic; symptomatic if compressing surrounding tissue treatment for aneurysms - ANSWER -grafts- do for AAA - endovascular coiling- cooling treatment for berry aneurysms - clipping- do this when we can't coil the berry aneurysms - meds to prevent enlargement- like HTN drug treatment -watchful waiting dark red homogenous gelatinous caused by stasis of flow - ANSWER red thrombi granular friable crumbling fragmenting deposited in layers over long periods of time - ANSWER white thrombi Which of the following would contribute to thrombosis 1. endothelial damage 2. turbulent flow 3. hypercoagulative blood 4. sluggish flow 5. thrombophilia 6. axial flow 7. vessel wall injury 8. prothrombin states - ANSWER 1,2,3,4,5,7,8 besides interfering with optimal cardiac output, why is atrial fibrillation something that should be treated? - ANSWER atria are quivering and the blood is staying in the atria which is stasis of flow what is the difference between varicose veins and dvt - ANSWER varicose veins are superficial so they don't travel to the lungs, dvt drain into the inferior vena cava pumped to the lungs as a pulmonary embolism what is it called when a thrombus forms over an akinetic portion of the ventricular wall - ANSWER mural thrombus endothelial damage is more common in________ than________ - ANSWER arteries, veins over many years, a thrombus forms in the common carotid artery of a 72 year old female. though the main thrombus is firmly attached to the endothelium, a piece of the thrombus breaks off and becomes an emboli. Choose the true statement/s about the scenario: A. if the embolus becomes wedged in an upstream vessel, it would cause ischemia, hypoxia, and potentially necrosis to the tissue supplied by this vessel B. this would be an example of a thromboembolism C. this would be a red thrombus D. the embolism has the chance of reaching the lungs and causing a pulmonary embolism E. All of the above are correct F. A and B are correct - ANSWER F. A and B are correct After a myocardial infarction, a thrombus can form over the myocardial area that is no longer pumping. This thrombus is called a ______ and is due to _________ - ANSWER mural thrombus, stasis of flow Stasis of blood flow increases the risk of thrombus formation because of: A. prolonged platelet contact with the endothelium B. hemodynamic wall stress C. increased liver production D. all of the above - ANSWER A. prolonged platelet contact with the endothelium A 72 year old man with a history of rheumatic heart disease and recurrent atrial fibrillation non responsive to medication, suffered a CVA and died. At autopsy, the enlarged left atrium filled with a large thrombus. Mitral valve disease was advanced. What caused his stroke - ANSWER pieces breaking off the thrombus that formed in the left atrium An embolus in the right atrium could travel to: A. brain B. Kidneys C. Liver D. Lungs E. all of the above - ANSWER D. lungs What anastomoses protects (somewhat) brain perfusion in cases of unilateral carotid (or verterbral) occlusion? - ANSWER circle of willis What is the difference between a cerebral vascular accident (ischemic stroke) and a myocardial infarction (heart attack) - ANSWER Region/ location which of the following would predispose thrombus formation in the leg veins: A. surgery B. hyper coagulability states C. prolonged bed rest D. air travel involving prolonged sitting E. all of the above - ANSWER E. all of the above What class of drugs is TPA - ANSWER anticoagulants/ thromboembolytics An 83-year-old woman fell and broke her left wrist. She underwent open reduction with internal fixation of the radial head fracture. The patient spent 4 days of recovery in the hospital. the course of the recovery went as expected though her ability to participate in PT was limited to bedside as she had a limited ability to ambulate without assistance. She was about to be discharged to a rehab center when she suddenly developed difficulty breathing. A. what do you suspect B. what part/s of Virchows triad has contributed to this condition C. How could it have been prevented - ANSWER A. DVT that lead to pulmonary embolism B. Stasis of flow, hypercoagulability C. pneumatic compression cuff that inflates and deflates describe door to balloon time. why is it important - ANSWER time they come through the door until the balloon is inserted. This time is important because if blood flow is restored, we can reduce the size/severity go the infarct without looking which of the following are abnormal: A. RBC 5.4/ mm3 B. WBC 10,000/ mm3 C. Platelets 800,000/ mm3 - ANSWER C. platelets 800,000/ mm3 Atrial Fibrillation: A. is the uncoordinated contraction of the atria B. leads to stasis of flow in the atria C. increases a person's risk for cerebral vascular accidents D. all of the above - ANSW