5 Cardiac part 3 Flashcards
Hypertension definition
Two or more BPs at two consecutive visits Diastolic over 90 or systolic 140-160
Primary HTN
Idiopathic or essential
95% of all cases
Etiology based on modifiable and non modifiable risk factors
Clinical manifestations base on specific organs damaged
Non-modifiable risk factors
Inheritance
Age
Race - African Americans. Due to sodium retention, SNS hyperactivity, RAAS hyperactivity, vasodilator deficits or socioeconomic factors
Modifiable Risk Factors
Sedentary lifestyle (decreased vasc compliance and fat) Diet (LDLs, K+, Fiber) Salt intake (Affects RAAS + volume retention) Abdominal Obesity - insulin resistance, SNS and RAAS stimulation
More modifiable HTN risk factors
Insulin resistance - more SNS to compensate
Smoking - endothelial damage
-ETOH SNS activation and increased cardiac function and PVR (moderation reduces VD)
Cocaine - sodium channel blockade and increase in SNS
Clinical manifestations
Strong correlation with atherosclerosis and what goes with it (MI, Stroke)
Hypertensive retinopathy
Chronic renal disease, nephropathy, albuminuria
ED
Secondary HTN
From underlying disease process like Renal disorders Adrenocortical disorders Pheochromo Coartcation of Aorta Oral contraceptives
Renal disorders HTN
Decrease renal perfusion (usually from atherosclerosis) results in more renin, increases PVR and fluid retention
Adrenocortical disorders HTN
More aldosterone or glucocorticoid release from adrenals
Ultimate result Na+ retention
Pheochromocytoma HTN
Tumor of adrenal medulle leads to proliferation and release of catechols which increase PVE and cardiac function
Coarctation of the Aorta HTN
Narrowing of aorta (usually distal to subclav arteries)
Increase upper body pressure but decreased lower where kidneys are so increased RAAS
Oral contraceptives HTN
Increased E and progesterone leads to water retention from sodium
Hypertensive Crisis (malignant hypertension)
Acute elevation of pre-existing HTN
Diastolic over 120
Acute effects are seen cerebral, renal and within eye
Cerebral effects from hypertensive crisis
Vasospasm of cerebral arteries and cerebral edema leads to ichemia related neuro manifestations
Renal effects from hypertensive crisis
Decreased renal activity leads to retention of waste, lyte issues, pH disorders
Eye effects from hypertensive crisis
Increase optic nerve pressure leads to visual deficits
PIH Pregnancy induced hypertension
5-10% of pregnancy
Major cause of maternal and neonatal mortality worldwide
PIH 3 stages
Preeclampsia Eclampsia HELLP Hemolysis Elevated liver enzymes Low platelet
Etiology PIH
Unknown but possible from maternal response to placenta (when placenta delivers PIH disappears)
Pathology PIH
Vasoconstriction of blood vessels which increases BP and decreases perfusion to kidneys (proteinuria and edema, CNS (sensory disturbances and seizures), liver (HELLP)
Definition of postural hypotension
Decrease in systolic 20 or diastolic 10 within 3 minutes of standing due to a pooling of blood in lower ext
Age related etiologies of orthostatic hypotension
Decreases: ANS response ADH and RAAS Skeletal muscle Blood volume
Blood volume related etiologies of orthostatic hypotension
Dehydration
Diuretic use
Impaired mobility etiology orthostatic hypotension
Decreased mobility reduces blood volume, muscle activity, venous tone and PVR
