Blood pressure and HTN

Question 1

Methods for measuring blood pressure

Answer 1

• non-invasive: indirect; using blood pressure cuff
• invasive: direct; use large needle to go through the muscular arterial wall

Question 2

Mean arterial pressure

Answer 2

• takes into account that diastole is longer than systole
• average of SBP and DBP = somewhat accurate but MAP is a little lower
• normal is 70-110 mmHg
• when MAP falls below 60 organs may be deprived of oxygen

Question 3

Pulse pressure

Answer 3

• SBP-DBP
• normal is 40-60 mmHg
• both abnormally wide and very narrow pulse pressures can indicate CV disease

Question 4

Simple bed side monitoring

Answer 4

• HR: actually done at heart
• pulse: distally measured
• SPO2
• Temperature
• Respiratory
• Blood pressure

Question 5

More invasive monitoring

Answer 5

• HR
• SPO2
• ABP = arterial blood pressure
• POP: pulmonary artery pressure
• CO2

Question 6

Hypotension causes

Answer 6

• low cardiac output
• vascular problems

Question 7

hypotension causes that cause low cardiac output

Answer 7

• arrythmias
• structureal disease
• hypovolemia

Question 8

How can arrythmias cause low cardiac output

Answer 8

• bradycardia
• tachycardia
• fibrillation

Question 9

Examples of structural disease cause low cardiac output

Answer 9

• valve disease
• ischemia heart disease
• pericardial disease
• cardiac tamponade
• congenital disease
• obstructive cardiomyopathy
• dilated cardiomyopathy
• primary pulmonary hypertension

Question 10

hypovolemia causing cardiac output to be low

Answer 10

• hemorrhage
• diarrhea
• dehydration
• orthostatic volume shifts
• drugs (diuretics)

Question 11

What are vascular problems that can cause hypotension

Answer 11

• systemic vasodilation
• obstructive

Question 12

What conditions/types of conditioins can cause systemic vasodilation that can cause hypotension

Answer 12

• sepsis
• anaphylaxis
• neurogenic
• autonomic dysfunction
• drugs

Question 13

Obstruction causing hypotension

Answer 13

• pulmonary emolism

Question 14

orthostatic postural hypotension

Answer 14

• defined as a decrease in systolic by 20 mmHg or diastolic by 10 mmHg within 3 minutes of standing
• caused by sluggish parasympathetic NS

Question 15

High blood pressure

Answer 15

• resting BP >120/80
• increased prevalence in adults over 50 but can occur at any age
• BP is related to blood volume and vessel conditions
• SBP = CO x TPR

Question 16

Types of HTN

Answer 16

• labile
• essential (primary) HTN
• secondary HTN

Question 17

labile HTN

Answer 17

• fluctuates comes and goes

Question 18

essential (primary) HTN

Answer 18

• not due to a specific identifiable cause
• interplay between NS, CV, kidneys = hard to tell

Question 19

secondary HTN

Answer 19

• due to a specific pathology or cause
• secondary HTN is rarer

Question 20

Secondary HTN causes

Answer 20

• renal disorders
• endocrine disorders
• hormonal contraceptive
• white coat disorder
• pregnancy
• cancers
• drugs/heavy alcohol
• renal stenosis
• malformed aorta

Question 21

risk factors for primary HTN

Answer 21

• genetics
• smoking
• sedentary lifestyle
• type A personality
• obesity
• alcohol use
• diabetes
• diet high in fat, cholesterol and sodium
• atherosclerosis

Question 22

HTN and atherosclerosis relationship

Answer 22

• HTN contributes to atherosclerosis and vice versa
• dont respond to vasoconstriction or vasodilation with atherosclerosis
• HTN causes microtears that lipids get into

Question 23

Unmanaged HTN

Answer 23

• over time can lead to diastolic dysfunction initially then systolic dysfunction
• if left unmanaged can contribute to diagnosis of heart failure

Question 24

diastolic heart failure

Answer 24

• filling dysfunction
• high afterload causes hypertrophy
• less filling due to less space
• thick and stiff heart muscles

Question 25

Systolic heart failure

Answer 25

• contraction dysfunction
• muscle is weak not a great contraction

Question 26

Pathophysiology of diastolic dysfunction

Answer 26

• initially prolonged HTN causes diastolic dysfunction
• HTN cause vessels to hypertrophy and increases afterload
• with increased afterload LV becomes stiffer, thicker and develops left ventricular hypertrophy
• this reduces the passive filling volume
• even at rest there is increased pressure in LV = higher LV EDP
  related to the smaller space within the ventricle

Question 27

how is the atria affected with diastolic dysfunction

Answer 27

• left ventricular hypertrophy = passive filling volume decreases
• heart relies more on active contraction from atria
• creates greater load on left atria/result in changes to atrial muscle
• increase risk of insufficient CO esp in pts with arrhythmia or tachycardia

Question 28

Pathophysiology - systolic dysfunction

Answer 28

• prolonged severe (unmanaged) HTN results in systolic dysfunction
• as LV filling volume decreases HR increases to maintain CO
• heart is working harder
• heart musucle weaknes over time
• less filling time and decreased contractility contributes to decreased stroke volume and increase ESV
• results in decrease ejection fraction

Question 29

Target organ damage related to HTN impacts other organs

Answer 29

Brain:

• cerebral aneurysm
• hemorrhagic CVA stroke

Heart:

• congestive heart failure
• atherosclerosis
• angina
• MI

Kidney:

• nephrosclerosis
• chronic renal failure

Eyes:

• retinopathy: arteriolar damage with microaneurysms and rupture (small vessels)

Question 30

best proven nonpharmacological interventions for prevention and treatment of hypertension

Answer 30

• weight loss
• healthy diet: DASH:
• reduce intake of dietary sodium
• enhanced intake of dietary potassium
• physical activity
• moderation in alcohol intake

Question 31

DASH diet basics

Answer 31

• Dietary approach to Stop HTN
• rich in fruits and veggies
• fat-free/low fat milk and milk products
• whole grains
• fish
• poultry
• beans
• seeds
• nuts
• less sodium, sweets, added sugears, beverages containing sugar fats, red meats

Question 32

Antihypertensive drug classes

Answer 32

• ACE inhibitors
• ARBS
• Alpha blockers
• beta blockers
• calcium channel blockers
• diuretics

Question 33

ACE inhibitors

Answer 33

• drug name: “pril”
• inhibit Angiotension converting enzyme
• decrease SVR(PVR), SV

Question 34

ARBs

Answer 34

• ” sartan”
• block angiotensin 2 receptors
• decrease SVR and SV

Question 35

Alpha blockers

Answer 35

• “osin”
• block alpha receptors
• decrease SVR

Question 36

betablockers

Answer 36

• “LOL”
• block beta receptors
• decrease HR, SV

Question 37

calcium channel blockers

Answer 37

• “dipine”
• block calcium channels
• decrease SVR

Question 38

diuretics

Answer 38

• “ide”
• facilitate diuresis
• decrease SV

Question 39

Role of PT with HTN

Answer 39

• examination must include vitals
• monitoring of vitals during exercise
• prevention and education
• lifesytle modificaiton
• exercise prescription: low intensity and longer duration

Question 40

general guidelines for PTs for pts with high BP

Answer 40

• know your patients medical history
• medical clearance for adult patients with resting BP near high end values
• be aware of patients medications and expected side effects
• in patients with know target organ damage, BP must be controlled at rest and exercise
• stop exercise if SPB >200 or DBP >110