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
what 2 things might it result in?
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
symptoms of restrictive/infiltrative cardiomyopathy
- extertional dyspnea
- abdominal swelling
- ankle edema
causes of restrictive cardiomyopathy
- scleroderma
- amyloidosis
- sarcoidosis
- DM
- hemochromatosis
- chemo agents
- radiation
list other types of cardiac pathologies
- valvular heart disease
- arrhythmias/dysrhymias
- myocarditis
- diabetic heart disease
- diseases of pericardium
- aneurysm
list types of valvular disease
- regurgitation
- stenosis
list diseases impacting the pericardium
- pericarditis
- constrive pericarditis
- pericardial effusion
what is an aneursym?
an abnormal stretching (dilation) in the wall of an artery, a vein, or the heart with a diameter that is at least 50% greater than normal
cardiac structures unique to fetal circulation
- foramen ovale → allows a R to L atrial shunt
- ductus arteriosus → pulmonary artery to aorta shunt
- ductus venosus → umbilical cord to IVC in order to bypass the liver
embyrologic defects
- ventricular septal defect (SD)
- hole in the wall separating the two lower chambers of the heart
- eventually the L ventricle can work so hard that it starts to fail
- pulmonary HTN
- tetralogy of fallot
what is HLHS?
hypoplastic left heart syndrome
an underdeveloped left side of the heart. The aorta and left ventricle are too small and the holes in the artery and septum did not properly mature and close
what is tetralogy of fallot?
congenital heart defect involving 4 anatomical abnormalities
- RV hypertrophy
- ventricular septal defect (VSD)
- overriding aorta
- pulmonary infunibular stenosis
list S/S of congenital defects
- increased pulse
- increased respirations
- retarded growth
- dyspnea, orthopnea
- fatigue
- URI
