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Phys: Cardio > Arterial Blood Pressure > Flashcards

Arterial Blood Pressure Flashcards

1
Q

How is blood pressure maintained?

A
  1. The contraction of left ventricle
  2. The resistance of the systemic vasculature
  3. The compliance of arterial walls
  4. The viscosity & volume of blood
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2
Q

Wat is the equation for pulse pressure?

A

(PP)= SBP-DBP

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3
Q

What are the equations for mean arterial pressure?

A

MAP=1/3(PP) + DBP

MAP= CO x TPR (aka SVR)

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4
Q

Define mean arterial pressure

A

ave. pressure over a complete cardiac cycle of systole and diastole

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5
Q

When is MAP important?

A

ICU and shock

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6
Q

How does bp change as blood flows through the body?

A
  1. Blood pressure continues to drop in arterioles & declines to between 20 & 40 mm Hg in capillaries
  2. Blood pressure continues to decrease further in venules & approaches zero in veins
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7
Q

What is bp in the RA called? What is the value?

A

central venous pressure (CVP) and is 0 mmHg (equal to atm. pressure)

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8
Q

How is blood pumped through veins?

A
  1. Muscular pump:
    B. Contractions of skeletal muscles squeeze the veins, forcing blood back to heart
  2. Respiratory/Thoracic pump:
    A. Expansion & contraction of lungs
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9
Q

How can bp be adjusted?

A
  1. Cardiac Output
  2. Resistance to blood flow in blood vessels
  3. MAP= CO x TPR
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10
Q

What is the relationship between bp and hr and RR?

A
  1. Inverse relationship between changes in bp and heart rate; when bp dec, hr inc
  2. When BP inc, dec HR & RR dec
    When BP dec, inc HR & RR inc
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11
Q

How is HR regulated?

A

Fluctuations in heart rate are result of changes in sym & parasym outflow from medullary cardiovascular centers, in response to degree of baroreceptor stretch

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12
Q

Where is the cardiovascular center located?

A

medulla

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13
Q

Where cardiac baroreceptors located? Why are they important?

A

Carotid sinus
Aortic arch
Send isngals to the cv center in the medulla about bp

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14
Q

How does the cv center in the medulla respond to dec bp?

A
  1. If sudden decrease in BP:
  2. Decreased baroreceptor firing, cardiovascular center in medulla responds by increasing symp. outflow and reduces parasymp. outflow to the heart
  3. Inc HR, contractility, TPR, SV, CO, venoconstriction and arteriole vasoconstriction
  4. Inc venoconstriction= incr venous return to heart which incr preload and CO is increased.
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15
Q

What is the effect of carotid sinus massage? What is it used for? What needs to be assessed first?

A
  1. Slows HR via baroreceptor reflex
  2. Noninvasive technique to terminate SVT
  3. Check for carotid bruit first
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16
Q

Define orthostatic hypotension. What can cause it?

A
  1. Syncope upon standing
  2. Transient reduction in venous return that is not adequately compensated by the baroreceptor reflex
  3. can be a side effect of some meds: alpha blockers
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17
Q

What higher brain centers help regulate bp? How?

A
  1. cerebral cortex, hypothalamus, limbic system
  2. Signal cardiovascular center when conditions require adjustments to blood pressure in response to Stress, fight or flight, hot/cold temperatures
18
Q

How do the kidneys help regulate bp?

A
  1. Arterioles in JGA contain high-pressure baroreceptors
  2. Provide hormonal mechanism for regulating blood pressure by controlling blood volume
  3. Renin-angiotensin-aldosterone system
    A. Important mechanism in hemorrhage
19
Q

How does RAAS affect bp?

A
  1. In response to decreased blood pressure, juxtaglomerular cells in kidneys secrete renin into blood
  2. Renin stimulates the conversion angiotensionogen to angiotensin I
  3. Angiotensin I is converted to angiotensin II in lungs
20
Q

How does Ang II affect bp?

A
  1. Angiotensin II causes vasoconstriction of arteries/arterioles which in turn leads to decreased excretion of water
  2. Angiotensin II also stimulates the secretion of aldosterone by adrenal cortex
  3. Aldosterone reduces urine output by increasing water & sodium retention
  4. As a result of all of these, BP 
21
Q

How do epi and NE affect bp?

A

Secreted by adrenal medulla
Secreted as part of the “fight or flight” response
Inc bp

22
Q

How does ADH affect bp?

A

Secreted by posterior pituitary

Increases BP by stimulating kidneys to retain water

23
Q

Where is ANP secreted, when is it secreted and what does it do?

A
  1. Hormone produced by endocrine cells in walls of right atrium
  2. Produced as a result of stretching atrial wall due to increased blood volume
  3. Causes natriuresis and diuresis
  4. Inhibits renin release & secretion of aldosterone & ADH
24
Q

Where is BNP secreted, when is it secreted and what does it do?

A
  1. Hormone produced by left ventricular cells in response to excessive stretching during diastole
  2. Increase Na+ ion excretion
  3. Increase urine production
  4. Blocks release of ADH, aldosterone, epinephrine, norepinephrine
  5. Stimulates peripheral vasodilation
25
Q

Where is EPO secreted, when is it secreted and what does it do?

A
  1. Hormone produced by kidneys if blood pressure drops or if decreased blood volume
  2. Stimulates production & maturation of RBC’s
  3. Leads to increased volume & viscosity of blood
26
Q

Where is nitric oxide secreted, when is it secreted and what does it do?

A
  1. Secreted by endothelial cells
  2. < 5 s half-life
  3. Relaxes vascular smooth muscle cells causing vasodilatation
  4. Inhibits plt adhesion and aggregation
  5. Clinically, nitroglycerin exerts its vasodilator action by being converted to NO, treatment of angina
27
Q

How does nicotine raise bp?

A
  1. Stimulating SNS to cause vasoconstriction

2. Stimulating adrenal medulla to increase secretion of epinephrine & norepinephrine

28
Q

How does alcohol affect bp?

A

Raises bp, but mechanism unclear

29
Q

What type of HTN is the most common?

A

Essential, increased peripheral resistance

30
Q

What is the pathophys of htn?

A
  1. When the resistance against which the LV must pump (afterload) is elevated for a long period, the cardiac muscle hypertrophies
  2. Over time, the ability to compensate for high peripheral resistance is exceeded, the heart fails (untreated or long term poorly controlled)
31
Q

Who is at a higher risk for atherosclerosis?

A

Incidence of atherosclerosis increases in hypertensive pts

32
Q

What happens to bp as a pt ages? Why?

A
  1. SBP rises almost linearly between 30 and 84 yo, DBP rises until 50 yo and levels off or decreases
  2. With aging, the elastin fibers in the arterial walls are gradually replaced by collagen fibers that cause vessel to be less compliant and stiffer
33
Q

What is the cause of htn in 95% of pts?

A

Idiopathic

34
Q

What are the tx options for essential htn?

A 
1. Lifestyle modifications
A. Diet & exercise, lower BMI
B. Smoking cessation
C. limit alcohol
2. meds
35
Q

Define secondary htn

A

Hypertension secondary to known causes

36
Q

What known causes can lead to htn?

A
  1. Renal artery stenosis
  2. Hyperaldosteronism
  3. Cushing disease
  4. Coarctation of aorta
  5. Pheochromocytoma
37
Q

How is secondary htn treated?

A

Treat underlying cause

38
Q

What are complications of long term htn?

A
  1. Left ventricular hypertrophy
  2. Coronary artery disease
  3. Stroke or TIA
  4. Heart failure
  5. Renal disease
  6. PVD
  7. Retinopathy
39
Q

Define LVH

A
  1. an incr TPR and incr in vascular stiffness increases load on LV
  2. incr in muscle mass and wall thickness
40
Q

Define CAD

A

asst w/ HTN as well as accelerated by chronic HTN, may lead to MI

Phys: Cardio (6 decks)

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