Cardiovascular - Systemic Hypertension

Question 1

What is systemic hypertension

Answer 1

pathologic elevation in systemic blood pressure, usually secondary to another condition

Question 2

Basic pathophysiology of systemic hypertension

Answer 2

arterial/arteriolar walls are diseased, vessel lumen is narrowed
reduced blood flow to tissues (ischemia) and/or hemorrhage due to vessel/capillary fragility

Question 3

4 organs prone to damage? (aka target organ damage)

Answer 3

renal, ophthalmic, neurologic, cardiovascular

Question 4

T/F: all animals with systemic hypertension show severe clinical signs

Answer 4

false, some are asymptomatic (which is important because it can be overlooked)

Question 5

Potential clinical findings of renal damage caused by systemic hypertension

Answer 5

isosthenuria, azotemia, proteinuria, structural abnormalities (atrophy)

Question 6

Effects of systemic hypertension on kidneys

Answer 6

glomerular and/or tubulointerstitial ischemia, necrosis, atrophy

Question 7

Most common cause of hypertension

Answer 7

renal disease

Question 8

Which is FALSE regarding renal damage and hypertension?
A) renal disease is the most common cause of hypertension
B) treatment of hypertension with amlodipine reduces proteinuria
C) increased proteinuria increases likelihood of survival
D) azotemia can be seen in hypertensive animals

Answer 8

C- decreased proteinuria increases likelihood of survival

Question 9

Which of the following is FALSE regarding ophthalmic damage caused by hypertension?
A) occurs in a majority of cats and dogs
B) vision loss may occur
C) retinal detachment is possible
D) none of the above

Answer 9

D - none of the above are false, all are possible

Question 10

clinical signs of ophthalmic damage due to hypertension

Answer 10

vision loss
retinal hemorrhage/edema
retinal detachment
intraocular hemorrhage (hyphema)

Question 11

Potential neuro signs caused by hypertension

Answer 11

seizure, vestibular signs, disorientation, mentation or behaviour change

Question 12

You are looking at a thoracic radiograph. There is heart enlargement at 12 o clock (think to DI)! This means there is a dilated aorta. What is a strong possibility of cause?

Answer 12

hypertension

Question 13

T/F: myocardial diastolic dysfunction w or w/o hypertrophy can be seen in hypertensive dogs

Answer 13

true

Question 14

Conditions that cause systemic hypertension in DOGS

Answer 14

renal disease, hyperadrenocorticism, DM, obesity, hyperaldosteronism, pheochromocytoma, hypothyroidism, hypertensive medication

Question 15

Conditions that cause systemic hypertension in CATS

Answer 15

renal disease, hyperthyroidism, DM, obesity, hyperaldosteronism, pheochromocytoma

Question 16

A cat comes into your clinic for a PE. It is a busy day in the clinic and there are a lot of people and animals making a lot of noise. You take a BP reading and it shows that the cat is hypertensive. Are you concerned about the results?

Answer 16

Yes, this could be stress induced hypertension. Rule out by changing room and personnel, find less stressful environment, ensure good technique, or try another day

Question 17

A small cuff size gives a falsely ___ pressure while a large cuff size gives a falsely ___ pressure.

Answer 17

high, low

Question 18

Key to diagnosing hypertension

Answer 18

look for an underlying cause (TOD)

Question 19

Treatment of hypertension

Answer 19

reduce current TOD and reduce risk for future TOD

ACE inhibitors - indirect vasodilator, first choice in dogs (don’t use in dehydrated and hypovolemic patients)

Question 20

Drug of choice to treat canine systemic hypertension

Answer 20

Ace inhibitors

Question 21

Drug of choice to treat feline systemic hypertension

Answer 21

Amlodipine

Question 22

Where should you measure BP

Answer 22

artery at the level of the heart

Question 23

MoA of amlodipine

Answer 23

inhibits calcium influx across vascular smooth muscle cells

Question 24

MoA of ace inhibitors

Answer 24

indirect vasodilators, blocks formation of angiotensin II (arterioconstrictor, stimulates aldosterone)