HTN + Cardiac Pathologies Flashcards
what is the double product?
DP = HR X SBP
describe the BP categories
types of HTN
- Essential or primary HTN
- no known cause
- 90% of cases
- Secondary HTN
- caused by conditions that affect your kidneys, arteries, heart or endocrine system
- 10% of all HTN cases
- treatment focuses on managment of the underlying cause
how can HTN impact renal function?
- uncontrolled high BP can cause arteries in the glomeruli to narrow, weaken or harden
- these damaged arteries deliver less and less filtrate to the nephron
- the kidneys perceive this reduce filtration as a reason to increase water and sodium reabsorption resulting in increased blood volume and therefore BP
how can diabetes impact renal function and thus BP?
- chronically elevated glucose levels damages glomerular filtration, reducing glomerular filtration
- kidney responds by reabsorping more water and sodium, increasing fluid volume and blood pressure
how does HTN result in a pathologic heart?
- results in pathologic cardiac hypertrophy
- causes fibrosis rendering the heart stiffer
- HFpEF
- Myocyte hypertrophy
- accelerated myocyte death
- reduced capillarization/reduced blood flow
what is cor pulmonale?
aks pulmonary heart disease
enlargement/dysfunction of the right ventricle caused by a primary pulmonary disorder like pulmonary HTN
symptoms of cor pulmonale
- chest pain
- fatigue
- bilateral LE edema
- syncope or passing out
diseases of the lung and pulmonary vessels associated with cor pulmonale
- lung diseases
- COPD
- diffuse pulmonary interstitial fibrosis
- extensive, persistent atelectasis (collapsed lung)
- cystic fibrosis
- pulmonary embolism
- pulmonary vessel diseases
- pulmonary vascular sclerosis
- drug, toxin, XTR induced vascular stenosis
diseases affecting chest wall movement
- kyphoscolosis
- marked obesity
- neuromuscular disease
diseases inducing pulmonary arteriolar constriction
- hypoxemia
- airway constriction
- hypoventilation
- chronic altitude sickness
List the 11 steps for taking BP
- pt rests for 5 minutes
- legs uncrossed
- feet flat on floor
- arm supported
- correct cuff size
- cuff placed over bare arm
- no talking
- no mobile phone use or reading
- BP measurements taken in both arms
- correctly ID BP from arm with higher reading as being clincially more important
- correctly ID which arm to use for future readings (arm with higher BP)
what is a cardiomyopathy
disorder within the cardiac myocytes themselves which results in abnormal cellular and hence cardiac performance
reduced EF predicts mortality and morbidity
list types of cardiomyopathies
- dilated cardiomyopathy → enlarged ventricles
- hypertrophic cardiomyopathy → thickened, stiffened walls
- restrictive cardiomyopathy → stiffened walls
describe dilated cardiomyopathy
characterized by abnormal cardiac morphology (ie chamber dilation) and contractile impairment resulting in decreased EF and/or SV
describe what the results of remodeling look like in dilated cardiac myopathy
- a heavier than normal heart weight
- hypertrophied cardiac myocytes
- loss of myofibrils
- fibrosis
- chamber walls are thinned
- produces systolic dysfunction and reduced EF
most common form of cardiomyopathies
list some causes of dilated cardiac myopathy
- genetic mutations
- various viral infections including HIV
- various toxins
- metabolic disorders
- myocarditis
S/S of dilated cardiac myopathy
- symptoms
- fatigue
- dyspnea on exertion, SOB, cough
- orthopnea, parozysmal noctural dyspnea
- increased edema, weight, or abdominal girth
- signs
- tachypnea
- tachycardia
- HTN or hypotension
T/F: hypertrophic cardiomyopathy is the single most common cause of death in apparently healthy young people
TRUE
describe hypertrophic cardiomyopathy
- normal BPs are percieved as excessive by functionally defective myocytes
- LV free wall hypertrophy occurs as a compensatory mechanism
- septal wall can hypertrophy disrupting normal LV outflow tract
- ultimately heart decompensates (decreases functional capacity) and fails
T/F: the majority of hypertrophic cardiomyopathy cases are asymptomatic
TRUE
first clinical manifestation is often sudden death
what is the difference between obstructive and nonobstructive HCM?
- Obstructive
- the septal wall thickens and the LV free wall of the ventricles stiffen, obstructing blood flow into the aorta
- Nonobstructive
- the walls of the LV stiffens, reducing LVEDV and SV
- blood flow is not blocked
S/S of HCM
- chest pain
- SOB
- fatigue
- arrhytmias
- dizziness
- lightheadedness
- fainting (syncope)
- swelling in the ankles, feet, legs, abdomen and veins in the neck
what is restrictive/infiltrative cardiomyopathy?
- characterized by restricted diastolic filling/loss of compliance
- characterized by idiopathic fibrosis-rigid heart walls/reduced compliance
- systolic function is normal
- EDVs are diminished/chambers cannot expand
- ESVs and EFs are normal; SV is compromised
- ventricular filling pressures are very high
