5 Cardiac part 3

Question 1

Hypertension definition

Answer 1

Two or more BPs at two consecutive visits Diastolic over 90 or systolic 140-160

Question 2

Primary HTN

Answer 2

Idiopathic or essential
95% of all cases
Etiology based on modifiable and non modifiable risk factors
Clinical manifestations base on specific organs damaged

Question 3

Non-modifiable risk factors

Answer 3

Inheritance
Age
Race - African Americans. Due to sodium retention, SNS hyperactivity, RAAS hyperactivity, vasodilator deficits or socioeconomic factors

Question 4

Modifiable Risk Factors

Answer 4

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

Question 5

More modifiable HTN risk factors

Answer 5

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

Question 6

Clinical manifestations

Answer 6

Strong correlation with atherosclerosis and what goes with it (MI, Stroke)
Hypertensive retinopathy
Chronic renal disease, nephropathy, albuminuria
ED

Question 7

Secondary HTN

Answer 7

From underlying disease process like
Renal disorders
Adrenocortical disorders
Pheochromo
Coartcation of Aorta
Oral contraceptives

Question 8

Renal disorders HTN

Answer 8

Decrease renal perfusion (usually from atherosclerosis) results in more renin, increases PVR and fluid retention

Question 9

Adrenocortical disorders HTN

Answer 9

More aldosterone or glucocorticoid release from adrenals

Ultimate result Na+ retention

Question 10

Pheochromocytoma HTN

Answer 10

Tumor of adrenal medulle leads to proliferation and release of catechols which increase PVE and cardiac function

Question 11

Coarctation of the Aorta HTN

Answer 11

Narrowing of aorta (usually distal to subclav arteries)

Increase upper body pressure but decreased lower where kidneys are so increased RAAS

Question 12

Oral contraceptives HTN

Answer 12

Increased E and progesterone leads to water retention from sodium

Question 13

Hypertensive Crisis (malignant hypertension)

Answer 13

Acute elevation of pre-existing HTN
Diastolic over 120
Acute effects are seen cerebral, renal and within eye

Question 14

Cerebral effects from hypertensive crisis

Answer 14

Vasospasm of cerebral arteries and cerebral edema leads to ichemia related neuro manifestations

Question 15

Renal effects from hypertensive crisis

Answer 15

Decreased renal activity leads to retention of waste, lyte issues, pH disorders

Question 16

Eye effects from hypertensive crisis

Answer 16

Increase optic nerve pressure leads to visual deficits

Question 17

PIH Pregnancy induced hypertension

Answer 17

5-10% of pregnancy

Major cause of maternal and neonatal mortality worldwide

Question 18

PIH 3 stages

Answer 18

Preeclampsia
Eclampsia
HELLP
Hemolysis
Elevated liver enzymes
Low platelet

Question 19

Etiology PIH

Answer 19

Unknown but possible from maternal response to placenta (when placenta delivers PIH disappears)

Question 20

Pathology PIH

Answer 20

Vasoconstriction of blood vessels which increases BP and decreases perfusion to kidneys (proteinuria and edema, CNS (sensory disturbances and seizures), liver (HELLP)

Question 21

Definition of postural hypotension

Answer 21

Decrease in systolic 20 or diastolic 10 within 3 minutes of standing due to a pooling of blood in lower ext

Question 22

Age related etiologies of orthostatic hypotension

Answer 22

Decreases:
ANS response
ADH and RAAS
Skeletal muscle
Blood volume

Question 23

Blood volume related etiologies of orthostatic hypotension

Answer 23

Dehydration

Diuretic use

Question 24

Impaired mobility etiology orthostatic hypotension

Answer 24

Decreased mobility reduces blood volume, muscle activity, venous tone and PVR

Question 25

ANS disorders causing orthostatic hypotension

Answer 25

CVA involving cardiovasc center
Diabetes related PVD
Spinal cord injury

Question 26

Clinical manifestations orthostatic hypotension

Answer 26

Usually related to neuro hypoperfusion
Lightheaded/dizzy
Nausea
Weakness
Syncope