perfusion (emily)
what is the equation for cardiac output
CO=SVxHR
what is the difference between pressure in system and pulmonary circulation
systemic: increased pressure delivering oxygen to body
pulmonary: decreased pressure delivering blood from right side of heart to lungs
what is ischemia
decreased blood flow to tissue
what is an embolis
a mass flowing through blood stream
what is a thrombus
Attached to vessel wall and can turn into an embolis
what is infarction
blood flow is cut off, leading to cell death/necrosis
what is anoxia
absence of oxygen
what is central perfusion
force of blood movement generated by CO and requires adequate cardiac function, BV, and BP
what is tissue/local perfusion
volume of blood flowing to target tissue
what is required in tissue/local perfusion
patent vessels, adequate hydrostatic pressure, and capillary permeability
what is an oclusion
narrowing of vessels that limit the amount of blood coming through, often seen in ATHROSCLEROSIS
impaired central perfusion occurs when cardiac output is inadequate, what are results of reduced CO
reduction of oxygenated blood reaching tissues, untreated can lead to ischemia and cell injury/death
loss of vessel patency and permeability, and inadequate central perfusion are associated with:
impaired tissue perfusion
what results from acute obstruction of a coronary artery
acute coronary syndrome
what is a type of heart attack where blood flow is reduced but not completely blocked
NSTEMI
what is a more severe heart attack where the coronary artery is completely blocked
STEMI
what is the condition where the heart doesn't get enough blood flow and oxygen and can ppotentially lead to a heart attack
unstable angina
what are the symptoms of unstable angina
unexpected chest pain and occurs at rest
in what condition is there no significant changes in the ST segment on an ECG and no elevation in cardiac biomarkers (troponin)
unstable angina
what is stable angina
chest pain from a reasonable cause like exercise
what is sudden cardiac death
an unexpected death occuring without prior warning symptoms and is confirmed post-mortem
examples of modifiable risk factors
smoking, obesity, diabetes mellitus
unmodifiable risk factors
age, sex, and genetics
who are more likely to get acute coronary syndrome, men or women
men
what is a sign a child may have impaired perfusion
squatting and fatigue
what are signs an infant may have impaired perfusion
poor weight gain and dusky colour
what are signs and symptoms of impaired perfusion
pain, dizziness, dyspnea, edema, bleeding/bruising
what are examples laboratory tests for diagnosis
cardiac markers, serum lipids, CBC, bone marrow biopsy
arteriograms and venograms are radiographic studies that detect:
oclusions in veins or arteries
what are the 3 most common collaborative intervention strategies
diet modification & smoking cessation
increased activity
pharmacotherapy
what do anticoagulants do
prevent blood clots
what pharmacotherapy is considered a clot buster
thrombolytics
what pharmacotherapy agent increases cholesterol
antilipidemics
defibrilation, pacemakers, electrical cardioversion,and ablation therapy are procedures and interventions for:
central perfusion
bypass/graft surgery, stent/angioplasty, and endarterectomy are interventions for:
tissue/local perfusion
what are the only unilateral relationships to perfusion
pain, cognition, elimination, and gas exchange
increased BP increases the risk for:
MI, heart failure, stroke, renal disease
what does the regulation of BP primarily depend on
CO and systemic vascular resistance
what is the equation for arterial BP
COxSVR
what is CO and how is it calculated
HRxSV
CO is volume of blood pumped out per min
what roles does the renal system play in regulating BP
short term: sympathetic NS
long term: kidneys through hormonal mechanisms
what is arterial BP
force exerted by blood against walls of vessels, must be sufficient to maintain tissue perfusion during rest and activity
what factors influence systemic vascular resistance (SVR)
diameter, resistance, and tone of blood vessels
what are examples of a vasoconstrictor
endothelin, angiotensin, norepinepherine
prostaglandins and nitric oxide are examples of:
vasodilators
how does the nervous system respond to a decrease in arterial pressure
activates SNS and increases BP by
-increasing HR and cardiac contractility
-causing vasoconstriction in peripheral arterioles
-releasing renin from kidneys
what is the net effect of SNS activation on arterial pressure
increases arterial pressure by increasing CO and SVR
what role do baroreceptors play in regulating BP
sense a change in BP and transmit the information to vasomotor centers in the brainstem
how does the parasympathetic NS reduce BP
stimulates vagus nerve, decreases HR, which reduces CO
what is tonic vasoconstriction and how is it maintained
continuous low-level activity of the sympathetic NS that maintains vascular tone under normal conditions
what are the effects of alpha-1 receptor activation
heart has increased contractility
and norepinepherine causes vasoconstriction
what are the effects of alpha-2 adrenergic receptor activation
presynaptic membrane inhibits norepinepherine release
vasoconstriction
what are the effects of beta-1
heart:
-increased contractility, HR, and conduction speed
juxtagloerular cells:
-increased secretion of renin
what are the effects of beta-2
activated by epinepherine and causes vasodialation
smooth and skeletal muscle and organs relax
where are baroreceptors located
carotid sinus
what happens to baroreceptors are stimulated by an increase in BP
send inhibitory impulses to sympathetic vasomotor centre in brainstem
what are the results of an inhibition of sympathetic acitivity
decrease in HR, force of contraction, and vasodilation
how do kidneys contribute to BP regulation
control sodium excertion and extracellular fluid volume
what does sodium retention cause in the body
water retention which increases ECF volume
what happens when ECF volume increases
increases venous return to the heart
how does increased venous return affect the heart
increases SV
how does increased SV affect BP
elevates BP by increases CO
what does the stimulation of the sympathetic NS cause in the adrenal medulla
releases epinephrine with a small portion of norepinephrine
how does epinephrine affect CO
increases HR and myocardial contractility
what is the effect of epinephrine on beta-2-adrenergic receptors in skeletal muscle
vasodilation in peripheral arterioles of skeletal muscles
what is the effect of epinephrine on alpha-1 adrenergic receptors in peripheral arterioles
vasoconstruction
true or false hypertension is the leading cause of death
true
what % of people over the age of 25 are diagnosed with hypertension
40%
what is the mean threshold for diagnosis in diabetes
SBP >130, DBP>80
what is the mean OBPM threshold for diagnosis in absence of compelling indicators
SBP>140, DBP>90
where should the cuff be when taking BP
middle of the cuff at heart level, lower edge of cuff 3cm above elbow crease
if someone has a mean office BP of >180/110, they have:
hypertension
what is the MOBP stage one of hypertension
140-159/90-99
what is isolated systolic hypertension
sustained elevation in SBP =/>140 with a DBP =/<90
what is primary HTN
no cause, 95% of diagnosis
risk factors: age, obesity, smoking, too much Na
what is secondary HTN
known cause, 5% of diagnosis, occurs in those with renal or vascular disorders, or drug use
what are the diagnosis of a hypertensive emergency (severe HTN)
BP measurement, ECG, urinalysis, serum electrolyte and creatinine measurements
what is treatment for severe/emergency HTN
BP reduction with IV antihypertensives
whatis hypertension manifestations
asymptomatic until severe and target organ disease has occured
what are signs of end organ disease in the heart
left ventricular hypertrophy, myocardial ischemia, and left sided heart failure
what are signs of end organ disease in coronary arteries
atherosclerosis, myocardial ischemia/infarction
what kind of BP measurement should be used in follow ups
standard office BP measurement