Guided Lecture Notes

Chapter 17: Disorders of Blood Flow and Blood Pressure

Learning Objective 1. Discuss at least three major properties of endothelial cells and

their associated functions/factors.

 Identify the three layers of the blood vessels, and list their components (refer to

PowerPoint Slide 2 and Fig. 17-1).

 List the major properties of endothelial cells, and describe their function (refer to

PowerPoint Slide 5 and Table 17-1).

 State the functions of vascular smooth muscle.

Learning Objective 2. List the five types of lipoproteins and state their function in

terms of lipid transport and development of atherosclerosis.

 Discuss the incidence of hyperlipidemia in the U.S.

 Define lipoprotein and apoprotein, and describe their general structure (refer to

PowerPoint Slide 7 and Fig. 17-3).

 Identify the sites of lipoprotein synthesis, and explain how lipoproteins are

transported through the body (refer to PowerPoint Slides 10, 11, 15, and Fig. 17-

4).

 Explain how lipoproteins are named, and describe the function of each one (refer

to Fig. 17-2).

 Describe how atherosclerosis develops (refer to PowerPoint Slides 6 and 13).

Learning Objective 3. Describe the role of low-density lipoprotein receptors in removal

of cholesterol from the blood.

 Explain the LDL receptor-dependent and non-LDL receptor pathways.

Learning Objective 4. Cite the criteria for diagnosis of hypercholesterolemia.

  Differentiate between primary and secondary hypercholesterolemia.

 State the normal and high values for LDL, HDL, and total cholesterol (refer to

Table 17-2).

 Discuss other risk factors (besides LDL) for coronary artery disease (refer to

Chart 17-1).

 Discuss the treatment of hypercholesterolemia.

Learning Objective 5. List the vessels most commonly affected by atherosclerosis and

describe the vessel changes that occur with atherosclerosis.

 Define atherosclerosis, arteriosclerosis, fatty streaks, and fibrous atheromatous

plaques, and identify the most common sites of atherosclerosis (refer to Figs. 17-6

and 17-7).

Learning Objective 6. Describe possible mechanisms involved in the development of

atherosclerosis.

 Discuss the pathogenesis of atherosclerosis (refer to PowerPoint Slides 13–14

and Fig. 17-8).

Learning Objective 7. List risk factors for atherosclerosis.

 Identify the risk factors for atherosclerosis, and discuss preventative measures that

may minimize these factors.

Learning Objective 8. Describe the role of inflammation in the development of

atherosclerosis and how it can be assessed clinically.

 Discuss the use of CRP as a predictor of cardiovascular risk, and explain its

advantages over LDL measurement in the diagnosis of atherosclerosis.

Learning Objective 9. State the signs and symptoms of acute arterial occlusion.
  Describe the pathology and clinical manifestations of acute arterial occlusion.

Learning Objective 10. Describe the pathology associated with the vasculitides and

relate it to four disease conditions associated with vasculitis.

 Describe the vasculitides, and state which cells are affected.

 List the causes of vasculitides.

 Classify the vasculitides according to affected vessel (refer to Table 17-3).

Learning Objective 11. Compare the manifestations of ischemia associated with

atherosclerotic peripheral vascular disease, Raynaud disease, and thromboangiitis

obliterans (i.e., Buerger disease).

 Describe the causes, clinical manifestations, diagnosis, and treatment of

peripheral arterial disease, Raynaud disease, and thromboangiitis obliterans (refer

to Fig. 17-9).

Learning Objective 12. Distinguish between the pathology and manifestations of aortic

aneurysms and dissection of the aorta.

 Describe the three types of aneurysms (refer to PowerPoint Slide 22 and Fig. 17-

10).

 Describe the causes, clinical manifestations, diagnosis, and treatment of

abdominal aortic aneurysms and aortic dissection (refer to Fig. 17-11).

Learning Objective 13. Define the terms arterial blood pressure, systolic blood

pressure, diastolic blood pressure, pulse pressure, and mean arterial blood pressure.

 Define the terms arterial blood pressure, systolic blood pressure, diastolic blood

pressure, pulse pressure, and mean arterial blood pressure, and explain their

clinical significance (refer to Fig. 17-12).

Learning Objective 14. Explain how cardiac output and peripheral vascular resistance

interact in determining systolic and diastolic blood pressure.

 Describe how CO and PVR affect blood pressure values.

Learning Objective 15. Describe the neural, humoral, and renal mechanisms for short-

term and long-term regulation of blood pressure.

 Define baroreceptor and chemoreceptor, and identify their locations in the body

(refer to Fig. 17-14).

 Describe the neural and humoral mechanisms of controlling blood pressure, both

immediately and long-term (refer to Figs. 17-13 and 17-15).

Learning Objective 16. Cite the definition of hypertension put forth by the seventh

report of the Joint National Committee on Detection, Evaluation, and Treatment of High

Blood Pressure.

 Classify blood pressure values consistent with prehypertension, stage 1, and stage

2 hypertension (refer to Table 17-4).

Learning Objective 17. Differentiate essential, systolic, secondary, and malignant forms

of hypertension.

 Identify the causes of essential, systolic, secondary, and malignant hypertension.

 Identify the organs most likely to be damaged by hypertension (refer to Chart 17-

2).

Learning Objective 18. Describe the possible influence of genetics, race, age, obesity,

diet and sodium intake, and alcohol consumption on the development of essential

hypertension.
  Discuss the modifiable/lifestyle and nonmodifiable/constitutional risk factors

associated with essential hypertension (refer to Table 17-5).

Learning Objective 19. Describe the behavior modification strategies used in the

prevention and treatment of hypertension.

 Identify lifestyle changes that are used to prevent and treat hypertension.

Learning Objective 20. List the different categories of drugs used to treat hypertension

and state their mechanisms of action in the treatment of high blood pressure.

 Describe the mechanism of action for diuretics, alpha- and beta-adrenergic

blocking agents, ACE (angiotensin-converting enzyme) inhibitors, and calcium

channel blockers.

Learning Objective 21. Explain the changes in blood pressure that accompany normal

pregnancy, and describe the four types of hypertension that can occur during pregnancy.

 Discuss the incidence of, and morbidity and mortality associated with,

hypertensive disorders during pregnancy.

 Describe normal/typical changes in blood pressure that occur during pregnancy.

 Classify hypertensive disorders that occur during pregnancy, describe the changes

in blood pressure that occur, and explain how each classification is treated (refer

to Table 17-6).

Learning Objective 22. Cite the criteria for the diagnosis of high blood pressure in

children.

 Cite the incidence of secondary and essential hypertension in infants, children,

and adolescents.
  Differentiate between normal, high-normal, stage 1, and stage 2 hypertension in

children.

 Identify causes and discuss treatment for hypertension in children.

Learning Objective 23. Define systolic hypertension, and describe the circulatory

changes that occur with aging that predispose an individual to the development of

systolic hypertension.

 Discuss the prevalence of hypertension among the elderly.

 Describe normal blood pressure changes that occur with age.

 Define systolic hypertension, and discuss possible causes, diagnosis, and

treatment options.

Learning Objective 24. Define the term orthostatic hypotension.

 Define orthostatic hypotension, and identify the mechanisms of blood control that

occur when one stands immediately (refer to Fig. 17-16).

 Describe the diagnosis and treatment of orthostatic hypotension.

Learning Objective 25. Explain how fluid deficit, medications, aging, disorders of the

ANS, and bed rest contribute to the development of orthostatic hypotension.

 List possible acute and chronic conditions that are associated with orthostatic

hypotension.

Learning Objective 26. Describe venous return of the blood from the lower extremities,

including the function of the muscle pumps and the effects of gravity, and explain how

they relate to the development of varicose veins.

 Identify the two components of the venous system of the legs.

  Describe the venous circulation in the legs, and list the factors that may lead to the

development of varicose veins (refer to Figs. 17-17 and 17-18).

Learning Objective 27. Differentiate primary from secondary varicose veins.

 Differentiate between the etiology and incidence of varicose veins.

 Describe the clinical manifestations of, and treatments for, primary and secondary

varicose veins.

Learning Objective 28. Characterize the pathology of venous insufficiency as it relates

to the development of stasis dermatitis and venous ulcers.

 Describe the etiology and pathology of chronic venous insufficiency.

 Explain how venous insufficiency may lead to stasis dermatitis and venous ulcers.

Learning Objective 29. Cite risk factors associated with venous thrombosis and

describe the manifestations and treatment of the disorder.

 Define thrombophlebitis, deep venous thrombosis (DVT), and venous thrombosis.

 Identify risk factors for the development of venous thrombosis, and describe the

associated clinical manifestations (refer to Chart 17-3).

 Explain how venous thrombosis is diagnosed and treated.