Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NETTER SECTION 4 CARDIOVASCULAR > CHAPTER 25–27 HYPERTENSION > Flashcards

CHAPTER 25–27 HYPERTENSION Flashcards

1
Q

5 ADVERSE EFFECTS OF HYPERTENSION

A

–acceleration of atherogenesis
–Elevated systolic and diastolic pressures are independent risk
–often occurs in combination with other risk factors such as dyslipidemia, glucose intolerance, hyperinsulinemia, obesity
–Association of hypertension and other risk factors is multiplicative rather than additive

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

what is the increase in cardiovascular disease associated with elevated blood pressures

A

115/75, cardiovascular disease risk doubles with each increase of 20/10

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

percent reduction in risk with blood pressure treatment

A

with drug therapy for hypertension:
–stroke decreases by 35%
–Myocardial infarction decreases by 20%
–Heart failure decreases by 50%

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

classification of high blood pressure

A

<120 and <80 = normal
120–139 or 80–89 = pre-hypertension

140–159 or 90–99 = stage I hypertension
>160 or >100 = stage II hypertension

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

prevalence of hypertension worldwide

A

–about 1 billion persons worldwide with hypertension
–About 70 million deaths per year worldwide
–Increased prevalence in developing countries
–#1 cause of preventable death in developing countries

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

prevalence of hypertension in US adults

A

–30% of adults in US have hypertension

–30 million men
–35 million women

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

percent of patients with hypertension who are aware of disease

A

76% are aware of disease

65% receiving medication

37% have controlled hypertension

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

etiology of hypertension

A

–most often results from increased total peripheral vascular resistance
–Increased cardiac output places lesser part

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

physiologic causes of hypertension

A

–inappropriate activation of renin–angiotensin system.
–Decreased renal sodium excretion.
–Increase in sympathetic nervous system activity

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

environmental factors and hypertension

A

–excess sodium intake
–Obesity
–Stress

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

discuss isolated systolic hypertension

A

–correlates with stiffening of large arteries
–Increase in systolic pulse-wave velocity
–Causes increase in systolic blood pressure and increased myocardial work with decrease coronary perfusion

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

clinical presentation of hypertension

A

usually asymptomatic

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

cardiac manifestations of hypertension

A

result from hypertrophic effects of increased afterload and acceleration of coronary atherosclerosis caused by hypertension

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

left ventricular hypertrophy discussion

A

Left ventricular hypertrophy is powerful and independent risk factor for cardiovascular morbidity.
–Is usually concentric hypertrophy = increase in wall thickness relative to chamber dimensions

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

myocardial fibrosis discussion

A

stimulated in part by angiotensin II and aldosterone levels
–Causes decreased ventricular compliance and diastolic dysfunction
–May result in congestive heart failure despite normal ventricular systolic function

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

coronary artery disease and hypertension

A

hypertension is independent risk factor for coronary artery disease.
–LVH and accelerated atherosclerosis combine to greatly enhanced risk for congestive heart failure and cardiovascular death

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

characteristics of patients with diastolic heart failure

A

–tend to be older, female and hypertensive
–Less mortality
–Normal left ventricular ejection fraction
–Typically long-standing hypertension and LVH

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

malignant/accelerated hypertension

A

–very high systolic and diastolic pressures
–Severe neuroretinitis
–Proteinuria
–Microscopic hematuria
–Impairment of renal function
Other symptoms caused by proliferative endocarditis and fibroid necrosis and small arteries

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

differential diagnoses of hypertension

A

–95% have essential hypertension.
–5% is secondary hypertension
–Obesity is contributing factor to essential hypertension.

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

drugs causing secondary combined systolic and diastolic hypertension

A 
–oral contraceptives
–Estrogens
–licorice
–Cyclosporine
–Cocaine
–Amphetamines
–Sympathomimetics
–Monoamine oxidase inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

secondary causes of isolated systolic hypertension

A 
increased left ventricular STROKE VOLUME
–COMPLETE HEART BLOCK
–AORTIC REGURGITATION
–PATENT DUCTUS ARTERIOSUS
–HYPERTHYROIDISM
–ARTERIOVENOUS FISTULA
–SEVERE ANEMIA
–BERIBERI
–PAGET'S DISEASE OF BONE

Decreased aortic distensibility
–Aortic arteriosclerosis
–Coarctation of aorta

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

indications for searching for secondary hypertension

A 
–age of onset <20 years
–Age of onset >50 years
–target organ damage
–Serum creatinine >1.5 mL/deciliter
–Hypokalemia
–Abdominal bruit
–Labile pressures with tachycardia, sweating, and tremor
–Family history of renal disease
–Poor response to generally effective therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DASH diet

A

= dietary approach to stop hypertension

–fruits, vegetables, low-fat dairy products,
–Rich in potassium, magnesium, and calcium

–Low in sugar, red meat, added fats,sodium

24
Q

first-line hypertension drugs

A 
Dyazide diuretics
Beta-adrenergic receptor blockers
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Calcium antagonists
25
Q

defining hypertensive crisis

A

acute organ dysfunction of the cardiovascular nervous system accompanying either by a marked absolute elevation of blood pressure 1 her blood increase in blood pressure in a previously normotensive individual

26
Q

antihypertensives contraindicated in pregnancy

A

ACE inhibitor,

angiotensin receptor blocker

27
Q

antihypertensive contraindicated in renal insufficiency

A

potassium sparing agents is a relative contraindication

28
Q

antihypertensives contraindicated in peripheral vascular disease

A

beta blocker

29
Q

antihypertensive contraindicated in gout

A

diuretic

30
Q

antihypertensives contraindicated in depression

A

–beta blocker

–Central alpha agonist

31
Q

common central alpha agonist medications

A

–clonidine
–Guanfacine
–Methyldopa

32
Q

percentage of middle-aged persons and United States with high blood pressure

A

20%

33
Q

common causes of secondary hypertensionin elderly

A

–renal parenchymal disease

–Atherosclerotic renal artery stenosis

34
Q

causes of renal artery stenosis

A

–atherosclerosis= 90%

–Fibromuscular dysplasia = 10%

35
Q

pathogenesis of renal artery stenosis

A 
–same as generalized  atherosclerosis obliterans
–Smoking
–Dyslipidemia
–Hypertension
–Glucose intolerance
–Genetic predisposition
36
Q

definition of renal vascular hypertension

A

= secondary to atherosclerotic renal artery sclerosis or fibromuscular dysplasia, causing a decrease in renal perfusion pressure

37
Q

define high-grade renal artery stenosis

A

> 60% of lumen of major renal artery
–Accounts for 3% of cases of hypertension
–Does not always cause hypertension

38
Q

smoking and renal artery stenosis

A

90% of older patients with renal artery stenosis are or have been heavy smokers
–Usually Other atherosclerosis

39
Q

discussed renal artery stenosis caused by fibromuscular dysplasia

A

–presents at younger age
–Common in women under 50 years old

–Can occur in children
+/- Abdominal bruit

40
Q

differential diagnosis of renal vascular hypertension and essential hypertension

A

–in older people with peripheral vascular disease, prevalence of atherosclerotic renal artery stenosis is high EKG up to 50%.
–Prevalence of essential hypertension in this group is 60%.
–Therefore difficult to separate

41
Q

diagnosis of renal artery stenosis

A

–Gold standard his renal arteriogram showing stenosis of proximal third of the renal artery
–fibromuscular dysplasia shows characteristic areas of stenosis alternating with aneurysmal dilation dictation = “string of pearls”
– Renal arteriogram is expensive, invasive, and does not provide information on function.
–Doppler ultrasound of renal arteries is often used, but less predictable and more operator dependent

42
Q

treatment renal artery stenosis

A

–surgical revascularization with balloon angioplasty and/or vascular stent
–Medical treatment= treatment of underlying causes and lifestyle

43
Q

mechanism of secondary hypertension caused by adrenal cortex

A

–overproduction of aldosterone
–Overproduction deoxy corticalsterone
–Overproduction of cortisol

44
Q

examples of mineralocorticoids versus glucocorticoids

A

mineralocorticoids
–Aldosterone
–desoxy corticosterone (DOC)

glucocorticoids
–Cortisol

45
Q

function of mineralocorticoids in secondary hypertension

A

increase salt and water retention by kidney

46
Q

function of glucocorticoids and secondary hypertension

A

marked hypersecretion of cortisol can stimulate mineralocorticoid receptors and cause a release of DOC and vasoconstrictors

47
Q

normal control of aldosterone secretion

A

by renin-angiotensin system

–ACTH and serum potassium concentrations less important

48
Q

mechanism of hypertension caused by aldosterone

A

increased stimulation of mineralocorticoid receptors and a cortical collecting ducts of the kidney
–Causes (of sodium channels leading to increased tubular reabsorption of sodium and secondary reabsorption of water
–Also increased secretion of potassium and hydrogen ions

49
Q

idiopathic hyperaldosteronism

A

= 30% of patients with hyper aldosteronism
–Surgically curable aldosterone producing adenoma
Two thirds have bilateral adrenal gland hyperplasia

50
Q

clinical presentationof primary aldosteronism

A 
–hypertension
–Hypokalemia
–Excessive urinary excretion of potassium
–Suppressed plasma renin activity
–Mild hyponatremia
–Metabolic alkalosis
51
Q

symptoms of hypokalemia

A 
–polyuria
–Polydipsia
–Muscle cramps
–Muscle weakness
–Glucose intolerance
52
Q

suspect primary aldosteronism when

A

–hypertension with spontaneous hypokalemia
–Hypertension with severe and refractory diuretic induced hypokalemia
–Family history of hyperaldosteronism
–Unexplained hypertension, refractory to treatment
–Unexplained hypertension in children and young adults
–Incidentally discovered adrenal tumor

53
Q

testing for primary aldosteronism

A

measure plasma aldosterone concentration and plasma renin activity

54
Q

treatment of primary aldosteronism

A

–surgical adrenalectomy

–Spironolactone

55
Q

discuss pheochromocytoma

A

= a tumor arising from adrenal medullary chromaffin cells that produces excess secretion of catecholamines causing intermittent or sustained hypertension

56
Q

symptoms of pheochromocytoma

A

hypertension with triad of headache, sweating, palpitations

Other common symptoms
–Pallor
–Nausea
–Tremor
–Weakness
–Anxiety
–Epigastric pain
–Chest pain
–Flushing
–Dizziness
57
Q

hypertension and Cushing’s disease

A

–hypertension may be severe

–Target organ damages is common

NETTER SECTION 4 CARDIOVASCULAR (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions