HTN Flashcards
S2Q1
HTN:
most what since what
ASCVD - pathology, 1=1=1
high BP = what = what = (3)
elevated SBP vs. DBP (1.2)
- mostly undiagnosed since asymptomatic
- high BP = atherogenesis = CV events = CVA, MI, heart failure
- elevated SBP > DBP = stroke
- elevated DBP > SBP = MI, heart attack
atherosclerotic CV disease
- heart or vessel that would take its root
- form & deposit cholesterol into arterial walls = calcified = bulging of arteries
HTN: Occurs with
1 - what, (3)
2 - associated
3 - associated
4
dyslipidemia
- abnormal lipid level, high bad low good cholesterol
- high triglyceride
- resistance to insulin-stimulated glucose uptake
glucose uptake: DM
hyperinsulinemia: associated c glucose uptake
obesity
HTN: Factors
(3)
arteries - what, branches (2.1)
fibrosis - 1=1=1=2
SaO2
coronary arterial hypertrophy
dec myocardial vascularity
narrowing of epicardial arteries
- main supply of heart
- left circulation: left coronary artery = left ant descending & left circumflex
- right circulation: right coronary artery
perivascular fibrosis
- Htn = inflammation = fibrosis (scarring & non-contractile)
HTN:
SBP, DBP - sound, ventricular what
clues - 2 age, usual organ (3)
SBP
- 1st sound heard after releasing cuff
- ventricular emptying & contract
DBP
- last sound appreciated not heard, korotkoff disappears
- ventricular filling & relax
CLUES
- HPN at <20y
- diastolic HPN at >50y
- brain heart kidney
HTN: Arterial Pressure
factor 1 - formula, SV what, HR & BP relationship, if dehydrated then what, homeostasis what
factor 2 - what
arterial pressure depends on:
cardiac output
- (SV)(HR)
- SV: amount of blood in each pump
- HR DP BP
- if dec SV = inc HR
- less blood taken (dehydrated) = less venous return = dec SV = dec CO = hypotension
- homeostasis: if parameter changes others will adjust
peripheral resistance
- all forces in arterial walls
HTN: MAP
what, where, formula
if ischemic stroke, otherwise
borderline BP
MAP
- average pressure throughout cardiac cycle in aorta
- 1/3 (SBP+2DBP)
- if ischemic stroke = just maintain BP don’t lower otherwise infarct & to protect ischemic penumbra
borderline BP: 120-138/80-89
HTN: BP Guidelines
(7)
optimal, normal, high normal, grade 1 (mild), grade 2 (mod), grade 3 (severe), isolated systolic Htn
<120
120-129
130-139
140-159
160-179
>180
140
<80
80-84
85-90
90-99
100-109
110
90
HTN: Principal Mechanism
volume - what, purpose, extracellular x BP, Na purpose (2), kidney as what + why
intravascular volume
- amount of fluid inside vessels
- primary determinant of long-term arterial BP
- extracellular volume DP BP
- Na: determinant of extracellular vol; attracts water = Htn
- kidney as target of Htn since if NaCl intake exceed capacity to expel Na = inc vol & CO
HTN: Principal Mechanism
ANS - main purpose (3)
catecholamine - purpose, (3), rhythm, tonic phasic reflex
ANS
- maintain homeostasis of volume, BP, chemoreceptor signals
ENDOGENOUS CATECHOLAMINES
- fight or flight response
- dopamine norepinephrine epinephrine
- circadian rhythm: dec HR BP in sleep but catecholamine surge = inc again when wake up
- tonic CV regulation: contract
- phasic: sometimes excrete sometimes don’t
- adrenergic reflex: manage short-term BP
HTN: Principal Mechanism
norepinephrine - synthesized by, released to (2), either (2) via (1)
epinephrine - synthesized by, released into what by what
NOREPINEPHRINE
- synthesized by adrenergic neurons
- released to synaptic cleft or receptor sites on tissues
- either metabolized or taken up into neuron via active reuptake process
EPINEPHRINE
- synthesized by adrenal medulla
- released into circulation via adrenal stimulation
HTN: Principal Mechanism
baroreceptor - what, where (2), age, purpose (1=1)
rate of firing x BP
- baro: pressure
- stretch-sensitive receptor at aortic arch & carotid sinus
- deteriorate in elderly
- rapid buffering = dec sympathetic outflow
- rate of firing DP BP
HTN: RAA System
renin - what, synthesized as, main purpose, stimulated by (3), synthesized where (2)
macula densa mechanism - if what + where then what
baroreceptors - if what + where then what
RENIN
- aspartyl protease synthesized as enzymatically inactive precursor
- inc fluids
- stimulated via beta adrenoreceptors, nervous, stress
- synthesized in kidney portion of renal afferent arteriole (juxtaglomerular cells) & group of sensory cells at distal end of loop of henle (macula densa)
- macula densa mechanism: if dec NaCl transport into thick ascending limb of henle = stimulate JG cells = renin = fluid
- baroreceptors: if dec pressure/stretch at renal afferent arteriole (less fluid enters kidney) = stimulate JG cells
HTN: RAA System
renal arteriole - purpose (2), circulates where
tubular system - purpose
inhibition (3)
RENAL AFFERENT ARTERIOLE
- where blood enters kidney
- cleans; excess water or Na = urine
- circulates in capillary tuft
TUBULAR SYSTEM
- forms urine
RAA SYSTEM INHIBITION
- inc NaCl, stretch/pressure in arteriole, beta receptor blockade
HTN: RAA System
angiotensin - how made (3G), what, stimulus (2), inc BP via (4)
- angiotensinogen peptide –> angiotensin I –> go from kidney to lungs (ACE) = angiotensin II
- potent vasoconstrictor
- stimulus: low Na & arteriole pressure
inc BP:
- inc SNS activity, Ca
- inc vasopressin & aldosterone
HTN: RAA System
aldosterone - what, main purpose (2), stimulate (2=1=1), can lead to (4),
enhanced extracellular & what = what
- potent mineralcorticoid
- Na & water retention
- stimulate cardiac fibrosis & (L) ventricle hypertrophy = fibrosis = no contract/pump
- can lead to: cardiac hypertrophy, CHF, glomerular hyperfiltration, albuminuria
- enhances extracellular matrix & collagen in myocardium = muscle cell replaced by non-contractile
