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BDS1 BAMS: Cardiovascular System > Blood Pressure > Flashcards

Blood Pressure Flashcards

1
Q

What is the Mean Arterial Blood Pressure (MABP)?

A

The driving force for blood flow through the organs/systemic circulation (everything except the lungs)

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2
Q

Why is Mean Arterial Blood Pressure important?

A

Ensures adequate blood flow to organ systems

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3
Q

What value is arterial blood pressure maintain at?

A

120/80 mmHg

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4
Q

What is systolic blood pressure (SBP)?

A

Pressure in arteries (aorta) during myocardial contraction (systole)

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5
Q

What is diastolic blood pressure (DBP)?

A

Pressure in arteries (aorta) during myocardial relaxation (diastole) i.e. when ventricles are refilling

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6
Q

How do you calculate pulse pressure?

A

SBP - DBP

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7
Q

How do you calculate Mean Arterial Blood Pressure?

A

DBP + 1/3 pulse pressure
OR
CO x TPR

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8
Q

What does TPR stand for?

A

Total peripheral resistance

Refers to systemic vascular resistance

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9
Q

When is blood pressure the highest?

A

Waking up

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10
Q

When is blood pressure the lowest?

A

Sleeping

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11
Q

What can you use to measure blood pressure?

A

A sphygmomanometer
Occlude the artery of an extremity (e.g. arm) with an inflatable cuff and by auscultation of for detection of Korotkoff sounds

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12
Q

What are the 2 main mechanisms of blood pressure regulation?

A
  1. Rapid regulation e.g. nerves, hormones

2. Long-term regulation e.g. blood volume

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13
Q

What are baroreceptors?

A

Mechanoreceptors that detect changes in blood pressure by detecting the degree of stretch in the blood vessel walls

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14
Q

Which 2 locations are baroreceptors most abundant?

A
  1. Aortic arch

2. Carotid sinus

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15
Q

Describe the carotid sinus

A
  • Two carotid arteries supply the head and neck (right and left)
  • Each carotid artery divides into 2 smaller arteries
  • Where the artery wall is thinner and contains a large number of branching nerve endings - this are is the carotid sinus
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16
Q

Which nerve innervates the carotid sinus baroreceptors?

A

Nerve of Hering (a branch of the glossopharyngeal nerve; CN IX)

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17
Q

Which nerve innervates he aortic arch baroreceptors?

A

Aortic nerve (combines with vagus nerve)

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18
Q

Which baroreceptors (carotid sinus or aortic arch) are most sensitive to pressure change/changes in stretch?

A

Aortic arch baroreceptors

Have a higher threshold pressure

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19
Q

What is ‘normal’ BP?

A

120/80 mmHg

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20
Q

Describe the frequency of baroreceptor firing when blood pressure is increased or decreased

A
  • Frequency of baroreceptor firing is constant within normal blood pressure ranges
  • Elevation in BP: frequency of AP firing by baroreceptors is quickened
  • Decrease in BP: decrease in AP firing by baroreceptors
21
Q

What effect does an increase in baroreceptor AP firing have on sympathetic discharge?

A

Increased baroreceptor AP firing leads to decreased sympathetic discharge. Trying to reduce cardiac output and reduce blood pressure

22
Q

What effect does a decrease in baroreceptor AP firing have on sympathetic discharge?

A

Decreased baroreceptor AP firing leads to increased sympathetic discharge. Trying to increase heart rate and blood pressure

23
Q

Where is the medullary cardiovascular centre located?

A

In the medulla oblongata

24
Q

What is the Vasalva Manoeuvre?

A

Attempting to expire against a closed glottis

Associated with exhaling when mouth and nose are closed e.g. lifting heavy weights

25
Q

What does the vasalva manoeuvre lead to ?

A

1) Increased intra-thoracic pressure
2) Raising BP. Increased baroreceptor firing
3) Heart rate falls transiently - impeding venous return of blood to the heart
4) Fall in CO and MAP
5) As MAP decreases, HR increases and stabilises blood pressure

26
Q

What happens after the vasalva manoeuvre i.e. when the glottis is re-opened to allow expiration?

A

1) Intra-thoracic pressure falls.
2) BP falls initially
3) Venous return is rapidly restored
4) EDV and CO increase, increasing BP
5) Increased BP is sensed by baroreceptors and this results in bradycardia - slowing of the heart

27
Q

Why are baroreceptors ineffective monitors of absolute pressure of blood in carotid arteries to the brain?

A

Because baroreceptor activity adapts over time and heart rate will increase at the same level
Baroreceptors are short term regulators of blood pressure only

28
Q

What effect does baroreceptor resetting have during exercise?

A

Maintains cardiac output as heart rate does not fall in response to increased blood pressure accompanying exercise

29
Q

What is the major influence for long-term regulation of blood pressure?

A

Blood volume

30
Q

Describe the negative feedback loop of increasing blood volume on blood pressure

A
  • Increased blood volume increases arterial pressure

- However, an increased arterial pressure reduces blood plasma volume via increasing renal excretion of salt and water

31
Q

What are arterioles?

A

Small diameter blood vessels

32
Q

What causes the radius of arterioles to decrease?

A

Sympathetic nerves
Noradrenaline
alpha-1 adrenoceptors
Causes vasoconstriction

33
Q

What causes the radius of arterioles to increase?

A

Sympathetic cholinergic nerves:
Acetyl chlorine acting on muscarinic receptors

Plasma:
Adrenaline acting on beta-2 adrenoceptors

Local controls:
Increased K+, adenosine, decrease in PO2

Causes vasodilation

34
Q

Describe mechanisms of local control of blood pressure

A
  • Local changes in systemic vascular resistance (total peripheral resistance TPR)
  • Occurs in response to factors such as metabolites, blood gases, endothelium derived factors
  • Ability to override central blood pressure control systems
35
Q

What is capillary fluid shift?

A
  • The movement of fluid across the capillary membrane between blood and interstitial fluid compartment
  • Occurs in venous dilators
  • Caused by reduced proximal capillary hydrostatic pressure
  • Most vasodilators have effects on both arteries and veins
36
Q

What is hypertension?

A
  • Clinic blood pressure of 140/90 mmHg or higher
37
Q

What is hypertension?

A

Clinic blood pressure of 140/90 mmHg or higher

38
Q

How can blood pressure be lowered in a patient with hypertension?

A

Lifestyle changes

Pharmacological intervention

39
Q

Which factors can increase risk of hypertension?

A
  • Age
  • Cigarette smoking
  • High salt intake
  • Lack of exercise
  • Being overweight
  • Regularly drinking large amounts of alcohol
  • Stress
  • Genetic predisposition
  • Family history
40
Q

Which health conditions can increase risk of developing hypertension (HT)?

A
  • Chronic Kidney Disease (CKD)
  • Glomerulonephritis
  • Diabetes
  • Obstructive sleep apnea
  • Hormone problems - over/under active thyroid
41
Q

Which therapeutics can increase hypertension risk?

A
  • Contraceptive pill
  • NSAIDs
  • Recreational drugs (cocaine, amphetamines)
42
Q

What clinical consequences can hypertension lead to?

A
  • Left ventricular hypertrophy (LVH)
  • Thickening of arteries
  • Atherosclerosis deterioration

Which may lead to

  • Renal disease
  • Heart failure
  • Angina or myocardial infarction (cardiac ischaemia)
  • Stroke
43
Q

Why is hypertension called “the silent killer”?

A
  • People often unaware they have hypertension

- Hypertension often lacks noticeable symptoms until very severe

44
Q

What is secondary hypertension?

A

Hypertension caused by another medical condition

45
Q

What is clonidine?

A
  • A drug for treating hypertension
  • Reduces sympathetic outflow to CNS
  • An alpha-2 adrenoceptor agonist
  • Decreases: peripheral resistance, renal vascular resistance, heart rate, blood pressure
46
Q

What are important considerations regarding patients with hypertension in dentistry?

A

Many anti-hypertensive drugs have interactions with local anaesthetics and analgesics - may lead to local anaesthetic toxicity

Dental treatment stressful for many patients - increase in BP may lead to acute complications e.g. myocardial myocardial infarction or stroke

Crucial to obtain up to date medical history

47
Q

What are important considerations regarding patients with hypertension in dentistry?

A

Many anti-hypertensive drugs have interactions with local anaesthetics and analgesics - may lead to local anaesthetic toxicity

48
Q

What is postural hypotension?

A
  • Abnormal drop in blood pressure when individual stands up after sitting/lying down
  • Symptoms = dizziness, light-headedness, fainting
  • May be asymptomatic
  • More common in older people/those with underlying conditions that affect sympathetic or parasympathic nervous system (Parkinson’s disease, diabetes)
  • May also be caused by dehydration or medicines
49
Q

What is postural hypotension?

A

Abnormal drop in blood pressure when individual stands up after sitting/lying down
Symptoms = dizziness, light-headedness, fainting

BDS1 BAMS: Cardiovascular System (4 decks)

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