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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
Q

Systolic heart failure

A
  • contraction dysfunction
  • muscle is weak not a great contraction
26
Q

Pathophysiology of diastolic dysfunction

A
  • 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
Q

how is the atria affected with diastolic dysfunction

A
  • 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
Q

Pathophysiology - systolic dysfunction

A
  • 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
Q

Target organ damage related to HTN impacts other organs

A

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
Q

best proven nonpharmacological interventions for prevention and treatment of hypertension

A
  • weight loss
  • healthy diet: DASH:
  • reduce intake of dietary sodium
  • enhanced intake of dietary potassium
  • physical activity
  • moderation in alcohol intake
31
Q

DASH diet basics

A
  • 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
Q

Antihypertensive drug classes

A
  • ACE inhibitors
  • ARBS
  • Alpha blockers
  • beta blockers
  • calcium channel blockers
  • diuretics
33
Q

ACE inhibitors

A
  • drug name: “pril”
  • inhibit Angiotension converting enzyme
  • decrease SVR(PVR), SV
34
Q

ARBs

A
  • ” sartan”
  • block angiotensin 2 receptors
  • decrease SVR and SV
35
Q

Alpha blockers

A
  • “osin”
  • block alpha receptors
  • decrease SVR
36
Q

betablockers

A
  • “LOL”
  • block beta receptors
  • decrease HR, SV
37
Q

calcium channel blockers

A
  • “dipine”
  • block calcium channels
  • decrease SVR
38
Q

diuretics

A
  • “ide”
  • facilitate diuresis
  • decrease SV
39
Q

Role of PT with HTN

A
  • examination must include vitals
  • monitoring of vitals during exercise
  • prevention and education
  • lifesytle modificaiton
  • exercise prescription: low intensity and longer duration
40
Q

general guidelines for PTs for pts with high BP

A
  • 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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