B3W3 Flashcards
What are the clinical markers for hypertension diagnosis
three measurements of 140/90 over several weeks
Pathophysiology of HTN
hypertension leads to the thinning of arteriole walls and narrowing of arteriole lumen
Primary v secondary hypertension
primary - has no known cause
secondary - due to underlying chronic illness (such as DM, cushings, pheochromocytoma, sleep apnea, increased alcohol, increased Na
Largest risk factor for HF
hypertension
HF decreases or increases cardiac output
decreases
Systolic v diastolic heart failure
systolic: impaired ability to pump blood into circulation leading to decreased CO, decreased SV, decreased EF, decreased contractility
diastolic: impaired filling of the blood (decreased ventricular wall relaxation , decreased EDV, decreased SV, NO CHANGE IN EF
Clinical symptoms of (R) sided heart failure
fatigue and weight gain
hepatomegaly (large liver), peripheral edema, JVD
Clinical symptoms of (L) sided HF
fatigue, orthopnea/PND (paroxysmal nocturnal dyspnea, shortness of breath
S3/S4 heart signs, cyanosis, tachycardia, pulmonary congestion (crackling, wheezes, tachypnea and rales)
How do you distinguish (L) and (R) sided HF clinically?
where edema is present.
(L) = pulmonary circulation is backed up
(R) = systemic circulation is backed up
How does the PV loop move when you have systolic dysfunction
down and to the right
(decreases in SV, CO, EF, MAP, contractility)
What are the clinical causes of systolic dysfunction
MI, ischemia, chronic volume overload (from aortic or mitral valve regurgitation) and increased afterload (from aortic stenosis or uncontrolled HTN)
What happens to the ESPVR during systolic dysfunction
slope moves down
What happens to the ESPVR during diastolic dysfunction
nothing. no change in EF leads to no change in this relationship
What are the clinical causes of diastolic dysfunction
Impaired (L) ventricle relaxation, (L) ventricle hypertrophy, restrictive cardiomyopathy, myocardial ischemia
How can the left ventricle have clinical obstructions of filling?
Mitral stenosis, pericardial constriction (tampanade)
How does the PV loop change in diastolic dysfunction
left and up because there is decreased ventricular filling
How does a decrease in left ventricular function lead to salt and water retention
Decreased LV function leads to decreased CO which gives the false sense of hypovolemia. This creates abnormal reflexes to cause neurohormonal activation which will lead to the RAAS system to activate hormones to salt and water retention of the body to increase blood volume
What are the substances that are released by the neurohormonal activation pathway to cause water and salt retention
NE, renin, ADH, ANP (renal dilation),ET-1
Give a list of the medications that are used in HF patients
-adrenergic agonists
-adrenergic antagonists
-RAAS inhibitors
-Ca Channel blockers
-Dieuretics
-Mineralcorticoids
-Combined therapy
-Cardiac glycosides
How do adrenergic agonists act on cardiac muscle
alpha 1 - vasoconstriction
beta 1-2 - increases HR, contractility, dilation of vasculature
beta 2- vasodilation/bronchodilation
Phenylephrine
Isoproternol
Albuterol
adrenergic agonists
How do adrenergic antagonists act on cardiac muscle
negative ionotropic and chronotropic effects - aids in prevention of the heart working too hard, can reduce cardiac remodeling caused by neurohormonal activation
What are the types of medications that reduce mortality in HF patients
beta blockers, ACE inhibitors
What are the non pharmacological treatments for HF
Dietary decrease in Na, decrease in smoking, alcohol, maintain body weight, exercise, or treating underlying illnesses for secondary hypertension
