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Pathophysiology > Exam 2: Ch 18 Blood Pressure Disorders > Flashcards

Exam 2: Ch 18 Blood Pressure Disorders Flashcards

1
Q

aneurysm

A

abnormal dilation and outpouching of an artery

most common in aorta (any part)

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2
Q

berry aneurysm

A

spherical dilation at bifurcation

Circle of Willis

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3
Q

dissecting aneurysm

A

tear in intima allows blood to enter vessel wall

False aneurysm

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4
Q

1/2 of people with an aortic aneurysm

A

have HTN

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5
Q

if an aortic aneurysm is above the kidneys…

A

must cut off kidney blood supply to fix

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6
Q

symptoms of an aortic aneurysm

A

depends on size and location

AAA most common and 90% below renal arteries

can be asymptomatic

pain

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7
Q

diagnosis of aortic aneurysms

A

ultrasound

felt as pulsitile mass

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8
Q

treatment of aortic aneurysm

A

surgical resection

endovascular vs. open is the same chance of success

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9
Q

aortic dissecting aneurysm

A

acute and life threatening

seen in conn tissue disease (marfan’s)

Excruciating pain

H&P most critical

lower BP and correct surgically

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10
Q

blood pressure

A

rapid rise in pressure during ejection of blood from left ventricle up aorta

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11
Q

dicrotic notch

A

closure of aortic valve

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12
Q

pulse pressure

A

SBP - DBP

Difference between systolic and diastolic pressures

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13
Q

mean arterial pressure

A

DBP + PP/3

Average pressure in arterial system during ventricular contraction and relaxation

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14
Q

calculate BP

A

CO x PVR

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15
Q

calculate CO

A

SV x HR

SV = (blood ejected per beat)

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16
Q

PVR

A

peripheral vascular resistance

reflects changes in the radius of arterioles

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17
Q

systolic BP

A

size and velocity of SV

compliance of large elastic arteries

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18
Q

systolic HTN

A

less compliance of large elastic arteries

stiff aorta

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19
Q

diastolic BP

A

properties of large arteries and size of SV

resistance of arterioles

competency of aortic valve

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20
Q

diastolic HTN

A

higher PVR slows runoff

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21
Q

pulse pressure

A

high when SV is high

low in hypovolemic shock (low SC and high PVR)

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22
Q

hypovolemic shock

A

high PVR (normal or high diastolic BP)

low SV (low systolic BP)

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23
Q

old person w/ stiff arteries will have…

A

high systolic BP (HTN forever)

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24
Q

short term BP regulation

A

keep BP constant for minutes-hours

neural

humoral

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25
Q

neural short term BP regulation has sensors in…

A

baroreceptors (pressure)

work via SNS and PNS

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26
Q

neural short term BP regulation mechanisms

A

sensors in carotid and aortic bodies

baro/chemo receptors

respond to low BP, pH, O2, high CO2

communicate to cardiovascular centers (SNS)

chemoreceptors up ventilation

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27
Q

neural responses brain stem

A

output to heart increases HR and contractility

output to vessels increases PVR

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28
Q

humoral short term BP regulation has sensors in…

A

JGA and elsewhere

uses RAA system

increases blood volume

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29
Q

humoral short term BP regulation mechanisms

A

low BP, blood volume, blood NA sensed by JGA

JGA releases renin, which converts angiotensin –> A1

A1 –> A2 by ACE (lung capillaries)

A2 is a vasoconstrictor –> aldosterone release from adrenal cortex

A2 –> ADH release from posterior pituitary

blood volume increased, BP restored

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30
Q

aldosterone

A

increases Na retention by kidneys

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31
Q

ADH

A

increases H2O retention by kidney

32
Q

kidneys in long term BP regulation

A

vascular volume controls BP, and BP controls kidney filtration

some ppl with HTN respond to sodium restriction

many diuretics useful in BP regulation

kidney damage or chronic increases in Na/H2O intake (high BP)

33
Q

ECF volume in long term regulation of BP

A

one time ECF increase = high CO and PVR –> high BP
urine output increases
diuresis returns blood volume and BP to normal

chronic high ECF causes persistent HTN with high PVR

34
Q

indirect ascultation

A

Sphygmomanometer (bladder)

width of bladder > 40% of upper arm circumference

undersize bladder –> overestimation of BP

slower deflation = higher accuracy

35
Q

automated methods of BP measurement

A

doller

microphone

pressure sensor

36
Q

direct methods of BP measurement

A

arterial catheter

37
Q

essential HTN

A

90% of cases

High BP without evidence of other disease

BP > 140/90

requires more than 1 elevated reading

38
Q

stages of HTN

A

normal 120/80, recheck in 2 yrs

pre HTN 120-139/80-89, recheck in 1 yr

stage 1 HTN 140-159/90-99, confirm within 2mo

stage 2 HTN >160sys OR >100 dia, treat within 1mo

39
Q

HTN risk factors

A

family history

age: SBP higher throughout life, DBP increases until 50
race: african americans have more and more severe HTN

metabolic problems: type 2 DM, obesity

40
Q

lifestyle factors in HTN

A

Na intake

obesity

EtOH

K+ intake

41
Q

Na intake

A

high salt and H2O intake increases blood volume and BP

salt restriction helps treat

75% of dietary salt in food processing

42
Q

DASH

A

dietary approach to stop HTN

advocates fruits and veggies, and whole grains

43
Q

obesity and HTN

A

distribution more important than weight

high waist/hips ratio associated with HTN

44
Q

EtOH

A

3+ drinks/day increases SBP

45
Q

K intake

A

low K increases SBP

mechanism unknown

46
Q

HTN can be ____, ____ or ____

A

systolic, diastolic, or both

47
Q

isolated systolic HTN

A

high complication risk

high shear stress (vessel damage)

elevated PP strong risk indicator for elderly

48
Q

target organ damage in systolic HTN

A

heart increased workload –> LVH (left ventricular hypertrophy)

risk factor for atherosclerosis, HF, CHD, stroke, PAD, renal failute

49
Q

diagnosis of isolated systolic HTN

A

requires multiple elevated readings

person should be relaxed and seated

50
Q

treatment of systolic HTN

A

drugs

TLC (theraputic lifestyle changes)

goals relaxed for 60+ years of age & DM

51
Q

drug classes for HTN

A

diuretics lower blood volume and PVR

beta-blockers lower HR and SV to lower BP

ACE inhibitors block A1 –> A2

A2r blockers block A2 action (receptors)

calcium channel blockers dilate arteries

antagonists of A1 receptors

52
Q

how to treat HTN

A

under 60 treat @ 140/90

60+ no DM treat at 150/90

if DM or chronic kidney disease treat at 140/90 regardless of age

53
Q

theraputic lifestyle changes

A

DASH

exercise

less salt

moderate EtOH

lose weight

less stress

no smoking

54
Q

secondary HTN (10%) due to another disease

A

renal HTN

steroid hormone abnormalities

pheochromocytoma

coarctation of aorta

oral contraceptives

55
Q

renal HTN

A

type of 2ndary HTN

any disease that lowers salt and water excretion –> high BP

renovascular HTN activated RAA system

renal artery stenosis is usual cause

may require angioplasty or open surgery

56
Q

steroid hormone abnormalities

A

type of 2ndary HTN

primary hyperaldosteronism (Na absorbed, K excreted) or glucocorticoids

often show hypokalemia

use Aldo blockers

57
Q

pheochromocytoma

A

2ndary HTN

tumor of adrenal medulla or sympathetic chain

makes NE and Epi

produces headache, nervousness, sweating

measure carechole metabolisms in urine (VMAs)

use alpha and beta blockers –> surgery

58
Q

coarctation of the aorta

A

2ndary HTN

often at takeoff of subclavian arteries

activates RAA system

59
Q

oral contraceptives

A

2ndary HTN

major cause of HTN in young women

mechanism unk, but hormone induced volume expansion

generally resolves when drugs stopped

60
Q

malignant HTN

A

sudden BP elecation to DBP > 120 – seen in 2ndary HTN

cerebral vasospasm occurs to protect brain

cerebral edema, renal damage likely without aggressive treatment

61
Q

HTN in pregnancy (6-8%)

A

good prenatal care mandatory

chronic HTN: high BP prior to 20 wks

preeclampsia/eclampsia

gestational HTN: high BP 1st seen in pregnancy w/o protinuria

62
Q

preeclampsia/eclampsia

A

high BP after 20 wks

protinuria, high creatinine/liver enz, low platelet count

more common in women with chronic high BP, DM, multiple pregnancies

low placental blood flow –> toxins –> endothelial damage –> end organ damage

platelets aggregate at damages epithelium

definitive diagnosis at delivery

63
Q

HELLP

A

hemolysis, elevated liver enzymes, and low platelets

variant of preeclampsia

classification system addresses lab abnormalities of blood vessels, liver and other organ systems (higher platelets is worse)

64
Q

pediatric HTN

A

norms based on height and sex

most is 2ndary

primary seen in adolescents

should be treated

65
Q

orthostatic hypotension

A

abnormal drop in HTN

occurs when blood pools in legs

cause dizziness and blackouts

cardiovascular reflexes are supposed to prevent this

66
Q

causes of orthostatic hypotension

A

hypovolemia – diuretics

other drugs like antihypertensives

aging – poor cerebral circulation

prolonged bedrest – low plasma volume

ANS disorders

67
Q

treatment of orthostatic hypotension

A

physical exam and history

correct cause (fluid and electrolyte imbalance) if possible

support hose

mineralocorticoids or alpha agonists

68
Q

diseases of venous circulation – lower extremities

A

leg has superficial veins… saphenous and deep

incompetent veins can allow backflow (valves fail)

muscle pump & 1 way valves direct blood flow

69
Q

varicose veins

A

dilated tortuous veins in legs

primary: originate in saphenous
2ndary: result from blockage of deep venous channels

70
Q

etiology of varicose veins

A

prolonged standing and abdominal pressure (pregnancy)

71
Q

diagnosis and treatment of varicose veins

A

physical exam

pressure stockings, surgical removal of superficial

72
Q

chronic venous insufficiency

A

consequences of DVT and valve failure

produces tissue congestion and edema –> necrosis/ulceration

compression and surgery, skin grafting

73
Q

venous thrombosis

A

thrombus (clot) in vein –> inflammation

can be deep or superficial

can produce a pulmonary embolism

statins may prevent

74
Q

risk factors for venous thrombosis

A

venous stasis (bed rest, shock)

increased coagulation (dehydration, BCP/HRT)

vascular trauma (surgery/injury)

75
Q

symptoms, diagnosis, treatment of venous thrombosis

A

pain, swelling, fever

venography, ultrasound

anticoagulants, maintain bedrest until no swelling

increase activity slowly with elastic hose

surgery

Pathophysiology (24 decks)

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