Cardio-clinical-HTN-Bennet Flashcards
HTN is considered what bp level :
>130/80
HTN trends have increased/decreased just about everywhere.
increased
The number one modifiable risk to early death is :
High BP or HTN
What is the average pressure within the patient’s arteries through one cardiac cycle?
MAP
What is a better predictor of stress on arterial walls?
MAP
What is a normal MAP?
70-100
>60 needed to maintain cerebral/renal/cardiac; MAP >100 is high)
For every mmHg increase in SBP or a mmHg increase in DBP: the risk of death from heart attack & stroke, and the risk of heart failure and aortic aneurysm
20; 10; DOUBLES; DOUBLES
What 3 things can lead to HTN:
Too much volume, renin, catecholamines
Pheochromocytoma increases which catecholamine? which can increase BP?
Norepinephrine
Primary HTN causes include:
Genetics
Age
High salt,
low potassium diet
Insulin resistance/diabetes
Inactivity
ETOH
Obesity
Secondary HTN (known cause) which may be reversible causes include:
Meds/drugs
Chronic kidney disease (RAS, FMD, PKD)*
Endocrine causes
Coarctation of Aorta
Sleep Apnea
Major causes of HTN for 0-18:
Renal parenchymal disease
Aortic coarctation
Major causes for HTN for ages 19-39
Thyroid dysfunction
Fibromuscular dysplasia
Renal parenchymal disease
Endogenous Cushing’s Syndrome
major causes for HTN in ages 40-64
Hyperaldosteronism
Thyroid dysfunction
OSA
Exogenous (Iatrogenic) Cushing’s Syndrome
Pheochromocytoma
Major causes of HTN in ages >65
Renal Artery Stenosis
Chronic Kidney Disease (CKD)
Hypothyroid
Cushing’s (iatrogenic) is caused by which drug?
steroids
Testosterone supplements can increase EPO which can lead to slurrying of blood and lead to:
HTN
What is a cause for resistant HTN caused by low K+ levels?
Aldosteronism (Conn’s Syndrome)
- adrenal tumor
- bilateral adrenal hyperplasia
What is the most common cause of resistant HTN?
sleep apnea
Obstructive sleep apnea (OSA) is also a common cause of :
hypertension
Fibromuscular dysplasia (string of pearls narrowed renal arteries) and tortuosity is a cause of HTN in which population?
younger women
Diffucult to control HTN involving renal arteries in older age?
renal artery stenosis
If treating FMD or Renal artery stenosis with ACE inhibitors, what happens to Cr lab values?
Serum creatinine rises 30%, significantly
FMD (renal string of pearls) and renal artery disease both can compromise sufficient to the glomerular complex and lead to kidney injury.
blood pressure
Kidney’ s issues lead to HTN problems in what manner?
messing with Na+
altered RAS system
increased endothelin (vasoconsticor)
inhib NO
Endocrine disorders -Pheochromocytoma, Carcinoid and other neuroendocrine tumors producing excess:
and have what effect on BP
EPI/NE/DOPAMINE/ SEROTONIN; SSRI/SNRI/TCA (ie antidepressants)-can also raise BP
Coarctation is another cause of HTN , there is a 75% mortality by age
46
Where do you listen for a possible coarctation of the aorta?
posterior, L inferior scapula
What is endogenous cushing’s syndrome?
excess cortisol production (due to tumor on adrenal gland->10-15%); overproduction of ACTH by pituitary tumor ( ie Cushing’s Disease -70% or extra-pituitary, ACTH-producing tumor->10-15%)
Exogenous (iatrogenic Cushing’s): leading to resistant HTN, truncal obesity, striae, elevated glucose, easy bruising, osteoporosis at young age. is more or less common than endogenous Cushing’s and is caused by?
more common, steroids