Febuary 4 - Hypertension, Coronary Artery Disease & Heart Failure

Question 1

Blood Pressure is determined by

Answer 1

• The amount of blood that your heart pumps (cardiac output)
• The amount of resistance to blood flow in the arteries ( SVR)
• Baroreceptors- act to sense changes in BP and transmit information to vasomotor center
• Sympathetic nervous system effects-(norepinephrine)
• Endocrine effects ( e.g.: Aldosterone)

Question 2

What does increased Aldosterone do

Answer 2

Increased Aldosterone = increased Sodium reabsorption = Increased H2O reabsorption = Increased blood volume = increased cardiac output

Question 3

Hypertensive hearts have

Answer 3

Thick ventricles

Question 4

Causes of Primary Hypertension

SS

Answer 4

Genes
Sodium and water retention
Altered renin–angiotensin mechanism
Stress and increased sympathetic nervous system activity
Insulin resistance and hyperinsulinemia
Endothethelial cell dysfunction (vasoconstrictor and keep cell healthy)
Obesity

Often none: but include:
Fatigue
Blurred vision
Palpitations
Angina
Related to organ dmg

Question 5

Causes of Secondary Hypertension

Answer 5

Coarctation or congenital narrowing of the aorta
Renal disease such as renal artery stenosis and parenchymal disease
Endocrine disorders such as pheochromocytoma, Cushing’s syndrome, and hyperaldosteronism
Neurological disorders such as brain tumours, quadriplegia, and head injury
Sleep apnea
Medications (long term steroid use)
Pregnancy-induced HTN
INDIRECT THINGS

Question 6

Causes of Coronary Heart Disease / Atherosclerosis

Atheroma =

ASA meds open

Ischemia

What is angina and the
2 forms

What is ACS

Answer 6

• Endothelial lining of vessels reacts to hyperlipidemia and hypertension
• inflamed vessels
• platelets stick to blood vessels
• Blockage
• fibrous caps explodes and bloods vlots form causing obstructed and turbulent vessels

Atheroma = plaque

Asa meds open up flow to the heart

Ischemia – a temporary decreased or lack of blood flow to the heart

Angina – chest pain that is the clinical manifestation of reversible myocardial ischemia – 2 kinds – stable and unstable (ruptured plaque).

Acute coronary syndrome = not enough oxygen (ruptures plaque) [Prolonged ischemia]

Question 7

Angina types and SS

Administer

Answer 7

Chronic Stable Angina
-same pattern of onset, duration and symptoms, brief pain, stops after factors gone, predictable,

Unstable Angina
-Unpredictable, provoked by nothing, no elevated serum markers

Administer - asprin, nitro, oxygen
Position – sitting up in high fowlers
Decrease anxiety

Question 8

Heart Failure

• What is it
• unable to meet what
• characterized by
• Is classified as
• Things indicating

Types and what they cause

Solving HF

Answer 8

An abnormal condition involving impaired cardiac pumping/filling

Heart is unable to produce an adequate cardiac output (CO) to meet metabolic needs

Characterized by:
Ventricular dysfunction
Reduced exercise tolerance
Diminished quality of life
Shortened life expectancy 

Heart failure (HF) is not a disease but a “syndrome”

Systolic/ diastolic failure
Impaired contractile function (e.g., MI)
Increased afterload (e.g., hypertension)

Left sided heart failure = pulmonary congestion and edema (back up of blood)
Right sided heart failure from left side HF = Jugular venous distension, Hepatomegaly, splenomegaly, Vascular congestion of GI tract, Peripheral edema (blood back up into right atrium and systemic venous)

High fowler, nitroglycerin, oxygen, reduce volume, vasodilators, diuretics (thiazide, loop)

Question 9

Symptoms of heart failure

Answer 9

big pupils, gray/blue/pale skin, dyspnea, orthopnea (cant breath sitting), crackles/wheeze, low BP, N/V, Edema, Anxiety , low O2, confusion, jugular vein distension, fatigue MI, S3, tachycardia, low Output, Weak pulse