Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BS - Cardiovascular System > Blood Pressure Control > Flashcards

Blood Pressure Control Flashcards

1
Q

What is the equation for blood pressure?

A

Mean systemic arterial pressure =

cardiac output x total peripheral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why must blood pressure be closely auto-regulated?

A

To ensure there is a balance between organ perfusion and vascular damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the equation for total peripheral resistance?

A

R = (8nL)/pi x r^4

R = resistance to blood flow
L = length of the vessel
n = viscosity of the blood
r = radius of the vessel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What component has the largest effect on the value for total peripheral resistance?

A

radius of the blood vessel

This, therefore, also has a large effect on blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What else can the value for TPR be affected by?

A

Autonomic nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the aims of the short- and long-term control mechanisms to regulate blood pressure?

A

To balance any changes in blood pressure to maintain a consistent organ perfusion pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the role of baroreceptors and where are they located?

A

In the carotid sinuses and aortic arch

They detect arterial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How will decreased arterial pressure affect the baroreceptors?

A

Decreased firing of the baroreceptors

This increases sympathetic tone and decreases parasympathetic tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How will increased arterial pressure affect the baroreceptors?

A

Increased firing of the baroreceptors

This increases parasympathetic tone and decreases sympathetic tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

On which organs does the sympathetic nervous system act on to achieve:

i. positive chronotropy
ii. positive dromotropy
iii. positive ionotropy
iv. positive lusitropy

A

i. sino-atrial node
ii. atrioventricular node
iii. ventricles and atria
iv. atria and ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is meant by ‘positive chronotropy’?

A

The action of the sympathetic nervous system will increase the heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is meant by ‘positive dromotropy’?

A

The sympathetic nervous system increases conduction velocity through the AV node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is meant by ‘positive inotropy’?

A

The sympathetic nervous system increases the strength of muscular contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is meant by positive ‘lusitropy’?

A

The sympathetic nervous system increases the rate of myocardial relaxation after contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the other 2 actions of the sympathetic nervous system after activation by baroreceptors?

A
  1. activation of the renin-angiotensin-aldosterone system

2. suprarenal stimulation leads to the release of catecholamines from the adrenal glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 2 types of natiuretic peptide?

What type of blood pressure control are they involved in?

A

Long-term blood pressure regulation

ANP - atrial natriuretic peptide

BNP - brain natriuretic peptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the role of natriuretic peptides in blood pressure regulation?

A

They induce the excretion of Na+ in urine

They try to reduce the pressure in the system by increasing fluid loss through urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When are natriuretic peptides released?

What condition is diagnosed by measuring levels of natriuretic peptides?

A

When myocytes are mechanically stretched by increasing plasma volume

Measuring levels of natriuretic peptides is used in diagnosing heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is hypertension defined by?

A

Having a systolic blood pressure greater than or equal to 140 mmHg

and/or a diastolic blood pressure greater than or equal to 90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is hypertension a result of?

A

Blood pressure control mechanisms are dysfunctional or unable to compensate for stressors on the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 2 types of hypertension?

A
  1. Primary (essential) (90% of cases)

2. Secondary (10% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is significant about the cause of primary hypertension?

A

There is no cause of hypertension

It happens due to pathological maladaptation of the blood system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is significant about the cause of secondary hypertension

A

There is something wrong with the body that is causing the blood pressure to be high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the most common contributing factors to primary (essential) hypertension?

A
  1. over-activation of physiological mechanisms
  2. age-related decrease in baroreceptor sensitivity
  3. age-related vascular calcification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the 5 most common causes of secondary hypertension?
1. renal - renovascular disease, parenchymal disease 2. endocrine - Conn's or Cushing's syndrome 3. cardiovascular - coarctation of the aorta 4. tumour - pheochromocytoma 5. pregnancy - pre-eclampsia/eclampsia
26
What is pheochromocytoma?
A tumour of the adrenal glands caused by overactivation and catecholamine excess
27
What is significant about calcification of the blood vessels with increasing age?
Blood vessels are not as compliant The total peripheral resistance cannot change as much
28
Why are at least three readings needed to diagnose hypertension?
"White coat syndrome" makes people anxious in a clinical setting This causes their blood pressure to rise
29
What is often used to overcome the complications of "white-coat syndrome"?
Ambulatory/home blood pressure monitoring
30
How does hypertension lead to left ventricular hypertrophy? What is this?
It involves thickening of the left ventricular wall It occurs in response to the increase in pressure in the left ventricle
31
What happens to the cells in left ventricular hypertrophy and what is the result of this?
The cells do not become more numerous, they get bigger The result of this is to try and force more blood out of the heart
32
What is diastolic dysfunction? How is it a result of left ventricular hypertrophy?
Impaired filling of the left ventricle during diastole Thickening of the LV wall means that the ventricle cannot relax properly to allow it to fill with blood
33
How diastolic dysfunction and LVH affect LV end diastolic pressure?
LVH leads to increased stiffness Diastolic dysfunction leads to impaired relaxation Both of these factors will increase LV end diastolic pressure
34
How can increased LV end diastolic pressure lead to systolic heart failure?
The increase in pressure is transmitted back into the LA and into the lungs This leads to pulmonary congestion that leads to heart failure
35
How does prolonged hypertension affect the blood vessels?
It leads to vascular remodelling
36
Where does eutrophic remodelling occur? What is the result of this?
Small arteries Media-to-lumen ratio is increased but medial cross-sectional area decreased This increases systemic vascular resistance and leads to an increase in diastolic blood pressure
37
Where does hypertrophic modelling occur and what is involved?
Large arteries Media-to-lumen ratio and the medial cross-sectional area are increased
38
How does hypertrophic remodelling lead to an increase in systolic blood pressure?
Thickening of the smooth muscle layer leads to an increase in the stiffness of the wall
39
What is significant about remodelling of the arteries increasing blood pressure further?
remodelling reduces the compliance of the arteries This further increases the blood pressure
40
What conditions are the blood vessels more prone to in hypertension?
1. large vessel structural damage | 2. atherosclerosis
41
Which parts of the body are affected by atherosclerotic disease?
All parts of the body are affected as all parts of the body contain blood
42
What can atherosclerosis in the coronary arteries, kidneys and neck lead to?
Coronary arteries - heart failure, arrhythmias, angina, myocardial infarction Kidneys - renal failure Neck - stroke
43
What are the 3 steps involved in hypertensive neuropathy?
1. renal arteriole thickening leads to luminal narrowing 2. the resulting ischaemia leads to tubular atrophy and interstitial fibrosis 3. this leads to damage to the glomeruli, leading to haematoproteinuria
44
What is the outcome of hypertensive neuropathy?
Damage to the glomeruli leads to increased leakage Things that are not meant to pass through the filter., such as proteins, pass through and are detected in urine
45
What is hypertensive retinopathy?
Popping of the small blood vessels in the eye due to high blood pressure If untreated, a patient will eventually go blind
46
What are the 4 visible signs of hypertensive retinopathy?
1. papilledema 2. exudates 3. flame haemorrhages 4. cotton wool spots
47
What is papilledema?
Swelling of the optic disc This is the point where the optic nerve enters the eye
48
What is an exudate?
Any fluid that filters from the circulatory system into lesions/areas of inflammation
49
What causes flame haemorrhages?
Accumulation of blood at the level of the nerve fibre
50
What are cotton wool spots and what causes them?
Fluffy white patches on the retina Caused by damage to the nerve fibres due to swelling of the retinal nerve fibres
51
Why are hypertension investigations carried out?
1. to look for a cause of secondary hypertension 2. to assess end-organ damage (signs of dysfunction in major organs which are affected by hypertension)
52
What is a full blood count used to look at in hypertension?
Haemoglobin levels This gives an indication of blood viscosity
53
What is a urea and electrolyte test used to look at in hypertension?
It assesses kidney function It looks for signs of renal impairment and hypernatremia
54
What is hypernatremia?
A rise in serum sodium concentration
55
Why are lipid and glucose levels measured when performing tests on hypertension?
To look for any other cardiovascular disease risk factors e.g. glucose in urine indicates diabetes
56
What are urine samples checked for in hypertension?
Haematuria and proteinuria | presence of blood and/or protein in the urine
57
What is indicated by haematuria and/or proteinuria in hypertension?
If hypertension has affected the kidneys, blood and/or protein is present in urine
58
What would be seen on an ECG of someone with left ventricular hypertrophy and why?
QRS complex has a high amplitude Hypertrophied muscle has a higher electrical amplitude
59
How could LVH be identified from an echocardiogram?
The thickness of the left ventricle wall can be measured to see if it is hypertrophied
60
Why might the diameter of the left atrium be measured on an echocardiogram?
To see whether left atrial dilatation is present
61
Why might left atrial dilatation be present? What type of patients is this expected to be seen in?
High pressure in the ventricles due to LVH is transmitted back to the atria This is present in patients who have had hypertension for a long time
62
How can coarctation of the aorta be identified on an echocardiogram? What is this?
By using the Doppler effect There is an abnormal narrowing in the aorta which leads to high blood pressure
63
What is fundoscopy? Why is it used in patients with hypertension?
It involves looking at the retina in the back of the eyes This is used to detect grade I - IV hypertensive retinopathy
64
In the case of pheochromocytoma, what test may be performed?
24-hour urinary catecholamines are collected
65
In the case of Conn's syndrome, what test may be performed?
Plasma renin-aldosterone levels are measured
66
What are the 5 lifestyle modifications involved in the management of hypertension?
1. increased exercise helps with blood pressure control 2. weight loss 3. changing diet 4. smoking cessation 5. education
67
Why does increasing exercise and weight loss help with management of hypertension?
Increased exercise helps with blood pressure control Being overweight increases blood pressure and is associated with diabetes
68
What dietary changes help in management of hypertension?
Cutting down on salt and reducing the amount of alcohol consumed
69
What type of education may help people manage their hypertension?
Resources that allow people to make decisions for themselves They do not like being told what to do directly
70
What is high blood pressure a risk factor for? How does this affect smoking cessation?
Cardiovascular disease If you have another risk factor for CVD, this should try to be cut out as well as lowering the blood pressure
71
If lifestyle changes do not work, what treatment is used for hypertension? Why is this not the preferred method of treatment?
Pharmacological treatments Medications have side effects so it is preferable that BP is lowered through lifestyle changes
72
What is the A(B)CD of pharmacological management of high blood pressure?
A - ACE inhibitors and ARBs (B) - Beta blockers C - Calcium channel blockers D - diuretics
73
What is a commonly used ACE inhibitor and how does it work?
Ramipril It inhibits angiotensin-converting enzyme (ACE) angiotensin I cannot be converted to angiotensin II
74
What is a common angiotensin II receptor blocker (ARB)? How does it work?
Candesartan It blocks the effects of angiotensin II, even though it is still present in the blood stream
75
How do calcium channel blockers work?
They disrupt the movement of Ca2+ through calcium ion channels
76
What are the 2 types of calcium channel blockers and an example?
Dihydropyridine (e.g. amlodipine) Non-dihydropyridine (e.g. diltiazem)
77
How do dihydropyridines lower blood pressure?
They cause vasodilation
78
How do non-dihydropyridines lower blood pressure?
They cause vasodilation They are also negatively inotropic (decrease strength of muscular contraction) And negatively chronotropic (decrease heart rate)
79
What is the result of blocking calcium channels on the heart and blood vessels?
It reduces total peripheral resistance It also reduces cardiac output by decreasing the force and speed of contraction of the heart
80
What are diuretics and how do they reduce the blood pressure?
They induce diuresis which reduces the circulating volume of the blood This reduces the preload, and the blood pressure
81
What are the 2 types of diuretics and examples?
Thiazide diuretics (e.g. Bendroflumethiazide) Loop diuretics (e.g. furosemide)
82
What is the difference between loop and thiazide diuretics?
Loop diuretics act on the loop of Henle in the nephron Thiazide diuretics act on the distal convoluted tubule
83
Why are beta blockers no longer used to treat hypertension?
They are not as effective as other treatments and have more side effects
84
How does Bisoprolol affect the heart and blood vessels?
It is a beta blocker that also reduces renin secretion It blocks the effects of the sympathetic nervous system on the heart There is no suprarenal stimulation or activation of the RAAS
85
What type of drug is doxazosin and how does it work?
It is an alpha-blocker which blocks the effects of adrenaline Adrenaline causes blood vessels to narrow
86
How do moxonidine and spironolactone work?
moxonidine lowers sympathetic nervous system activity spironolactone is an aldosterone antagonist
87
According to NICE guidelines, what are the 4 steps involved in a treatment plan for treating hypertension?
1 - Patients <55 start on A Patients >55 or black start on C 2 - A + C 3 - A + C + D 4 - add another diuretic or a-blocker or b-blocker
88
According to NICE guidelines, how should treatment for hypertension begin? Why?
Patients are started on a low dose to allow their body to get used to the medication This allows for a gradual change rather than a steep decrease in BP
89
According to NICE guidelines, what happens if the initial dose of the first drug is not effective?
The dose can be increased over time until the blood pressure is significantly improved
90
According to NICE guidelines, what happens if the patient reaches the maximum dose of the first drug and it is not effective?
If they reach the maximum dose and their blood pressure is still high, a second medication is added The same process is repeated
91
What should be done if a patient is on 3 different medications and their blood pressure has still not improved?
Ask the patient if they are taking their medication Many patients stop taking medication as they do not like the side effects
92
Which hypertension drugs are preferred in left ventricular systolic dysfunction?
ACE inhibitors and A2RBs Beta blockers
93
Which hypertension drugs are preferred in angina?
Beta blockers and calcium channel blockers
94
Which hypertension drugs are preferred in diabetes/proteinuria?
ACE inhibitors and A2RBs
95
When should ACE inhibitors and A2RBs not be used?
1. pregnancy 2. renal artery stenosis 3. hyperkalaemia (high potassium levels)
96
Why should ACEi/A2RBs not be used in renal artery stenosis?
This can lead to pulmonary oedema and a massive fall in blood pressure
97
When should beta blockers not be used and why?
Asthma Blue inhalers contain beta agonists
98
When should diuretics not be used?
1. hypokalaemia (low potassium levels) | 2. gout

BS - Cardiovascular System (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions