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Cardiopulmonary PT > Blood pressure and HTN > Flashcards

Blood pressure and HTN Flashcards

1
Q

Methods for measuring blood pressure

A
  • non-invasive: indirect; using blood pressure cuff
  • invasive: direct; use large needle to go through the muscular arterial wall
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2
Q

Mean arterial pressure

A
  • 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
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3
Q

Pulse pressure

A
  • SBP-DBP
  • normal is 40-60 mmHg
  • both abnormally wide and very narrow pulse pressures can indicate CV disease
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4
Q

Simple bed side monitoring

A
  • HR: actually done at heart
  • pulse: distally measured
  • SPO2
  • Temperature
  • Respiratory
  • Blood pressure
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5
Q

More invasive monitoring

A
  • HR
  • SPO2
  • ABP = arterial blood pressure
  • POP: pulmonary artery pressure
  • CO2
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6
Q

Hypotension causes

A
  • low cardiac output
  • vascular problems
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7
Q

hypotension causes that cause low cardiac output

A
  • arrythmias
  • structureal disease
  • hypovolemia
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8
Q

How can arrythmias cause low cardiac output

A
  • bradycardia
  • tachycardia
  • fibrillation
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9
Q

Examples of structural disease cause low cardiac output

A
  • valve disease
  • ischemia heart disease
  • pericardial disease
  • cardiac tamponade
  • congenital disease
  • obstructive cardiomyopathy
  • dilated cardiomyopathy
  • primary pulmonary hypertension
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10
Q

hypovolemia causing cardiac output to be low

A
  • hemorrhage
  • diarrhea
  • dehydration
  • orthostatic volume shifts
  • drugs (diuretics)
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11
Q

What are vascular problems that can cause hypotension

A
  • systemic vasodilation
  • obstructive
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12
Q

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

A
  • sepsis
  • anaphylaxis
  • neurogenic
  • autonomic dysfunction
  • drugs
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13
Q

Obstruction causing hypotension

A
  • pulmonary emolism
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14
Q

orthostatic postural hypotension

A
  • defined as a decrease in systolic by 20 mmHg or diastolic by 10 mmHg within 3 minutes of standing
  • caused by sluggish parasympathetic NS
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15
Q

High blood pressure

A
  • 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
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16
Q

Types of HTN

A
  • labile
  • essential (primary) HTN
  • secondary HTN
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17
Q

labile HTN

A
  • fluctuates comes and goes
18
Q

essential (primary) HTN

A
  • not due to a specific identifiable cause
  • interplay between NS, CV, kidneys = hard to tell
19
Q

secondary HTN

A
  • due to a specific pathology or cause
  • secondary HTN is rarer
20
Q

Secondary HTN causes

A
  • renal disorders
  • endocrine disorders
  • hormonal contraceptive
  • white coat disorder
  • pregnancy
  • cancers
  • drugs/heavy alcohol
  • renal stenosis
  • malformed aorta
21
Q

risk factors for primary HTN

A
  • genetics
  • smoking
  • sedentary lifestyle
  • type A personality
  • obesity
  • alcohol use
  • diabetes
  • diet high in fat, cholesterol and sodium
  • atherosclerosis
22
Q

HTN and atherosclerosis relationship

A
  • HTN contributes to atherosclerosis and vice versa
  • dont respond to vasoconstriction or vasodilation with atherosclerosis
  • HTN causes microtears that lipids get into
23
Q

Unmanaged HTN

A
  • over time can lead to diastolic dysfunction initially then systolic dysfunction
  • if left unmanaged can contribute to diagnosis of heart failure
24
Q

diastolic heart failure

A
  • filling dysfunction
  • high afterload causes hypertrophy
  • less filling due to less space
  • thick and stiff heart muscles
25
Systolic heart failure
- contraction dysfunction - muscle is weak not a great contraction
26
Pathophysiology of diastolic dysfunction
- 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**
27
how is the atria affected with diastolic dysfunction
- 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
28
Pathophysiology - systolic dysfunction
- 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
29
Target organ damage related to HTN impacts other organs
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)
30
best proven nonpharmacological interventions for prevention and treatment of hypertension
- weight loss - healthy diet: DASH: - reduce intake of dietary sodium - enhanced intake of dietary potassium - physical activity - moderation in alcohol intake
31
DASH diet basics
- 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
32
Antihypertensive drug classes
- ACE inhibitors - ARBS - Alpha blockers - beta blockers - calcium channel blockers - diuretics
33
ACE inhibitors
- drug name: "pril" - inhibit Angiotension converting enzyme - decrease SVR(PVR), SV
34
ARBs
- " sartan" - block angiotensin 2 receptors - decrease SVR and SV
35
Alpha blockers
- "osin" - block alpha receptors - decrease SVR
36
betablockers
- "LOL" - block beta receptors - decrease HR, SV
37
calcium channel blockers
- "dipine" - block calcium channels - decrease SVR
38
diuretics
- "ide" - facilitate diuresis - decrease SV
39
Role of PT with HTN
- examination must include vitals - monitoring of vitals during exercise - prevention and education - lifesytle modificaiton - exercise prescription: low intensity and longer duration
40
general guidelines for PTs for pts with high BP
- 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

Cardiopulmonary PT (25 decks)

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