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Pathophys > HTN Heart Disease/Cor Pulmonale > Flashcards

HTN Heart Disease/Cor Pulmonale Flashcards

1
Q

Poiseuille’s Law: Q=ΔP X r4

If r decreases, how can we preserve blood flow and what does that mean for the heart?

A

r decreases -> resistance increases -> blood flow decreases = only option to preserve blood flow is to increase ΔP which mean the heart has to work harder

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2
Q

The systolic pressure (120 ave) means what?

A
  • Maximum pressure exerted against the wall of a blood vessel
  • Also represents work done by the heart and O2 utilization of the heart
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3
Q

The diastolic pressure (80 ave) means what?

A
  • The minimum pressure exerted against the wall of a blood vessel
  • Diastolic pressure occurs just before the next cardiac contraction
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4
Q

What is the equation for double product?

A

DP = HR X SBP

Double Product = Heart Rate X Systolic Blood Pressure\

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5
Q

As SBP goes up, what does that mean for DP if HR stays constant?

A

Heart will do more work as SBP increases and HR stays constant

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6
Q

Blood pressure category: systolic/diastolic:

normal -

A

less than 120 and less the 80

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7
Q

Blood pressure category: systolic/diastolic:

Elevated -

A

120-129 and less than 80

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8
Q

Blood pressure category: systolic/diastolic:

High blood pressure (HTN) stage 1 -

A

130-139 or 80-89

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9
Q

Blood pressure category: systolic/diastolic:

High blood pressure (HTN) stage 2 -

A

140 or higher or 90 or higher

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10
Q

Blood pressure category: systolic/diastolic:

Hypertensive crisis -

A

higher than 180 and/or higher than 120

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11
Q

pharmacologic management of hypertensive heart disease:

A 
Diuretics (decrease water intake)
Beta blockers
Calcium channel blockers
Angiotensin converting enzyme inhibitor 
Alpha 1 blockers
Central agents
Aldosterone receptor blocker
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12
Q

T/F Guidelines call for using enough anti-HTN as needed to control blood pressure

A

True

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13
Q

Why do people stop taking their anti-hypertensive medication?

A
  • Unpleasant side effects (orthostatic hypotension)
  • Interference with sexual function (β-blockers)
  • Cost
  • Taking anti-hypertensives does not change the way a patient feels so why take them?
  • Increased age
  • Gender: women exhibit greater non-adherence
  • African American race
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14
Q

What is essential or primary HTN caused by? Number of cases?

A

No known cause

90% of all cases

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15
Q

What is secondary HTN caused by? Number of all HTN cases? What is treatment focused on?

A
  1. Caused by conditions that affect your kidneys, arteries, heart or endocrine system
  2. 10% of all HTN cases
  3. Treatment focuses on management of the underlying cause
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16
Q

How does uncontrolled high blood pressure affect the arteries in the kidney?

A
  1. Uncontrolled high blood pressure can cause arteries in the glomeruli to narrow, weaken or harden.
  2. These damaged arteries deliver less and less filtrate to the nephron
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17
Q

When kidneys perceive reduced filtration due to damaged arteries, what will it result in?

A
  1. increase water and sodium reabsorption resulting in increased blood volume (preload) and therefore blood pressure
  2. activates renin-angiotensin cascade which favors water and sodium reabsorption

Net effect:↑preload, ↑ total peripheral resistance, and ↓ability to appropriately control whole body BP regulation.

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18
Q

Describe how poorly controlled diabetes can lead to kidney disease which can lead to HTN?

A
  1. Chronically elevated glucose levels damages glomerular filtration, reducing glomerular filtration
  2. Kidney responds by reabsorbing more water and sodium, increasing fluid volume and blood pressure
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19
Q

How does hypertension result in a pathologic heart?

A
  1. Results in pathologic cardiac hypertrophy
  2. Causes fibrosis rendering the heart stiffer i.e. HFpEF
  3. Myocyte hypertrophy
  4. Accelerated myocyte death
  5. Reduced capillarization/reduced blood flow
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20
Q

T/F The hypertensive heart is an ischemic organ.

A

True

21
Q

With hypertension you have an increased risk of what with the heart?

A
  1. ventricular arrhythmias
  2. decreased left ventricular ejection fraction
  3. myocardial infarction
22
Q

T/F Anti-HTN therapy will not help hypertrophy of the heart regress.

A

False, Anti-HTN therapy can cause some regression of the hypertrophy

23
Q

A HTN heart has increasing interstitial fibrosis with severity and duration. Implications of fibrosis?

A

1 .Myocyte disarray

  1. Mitochondrial dysfunction
  2. Reduced vascularity
24
Q

What are signs and symptoms of malignant hypertension? (8)

A
  1. changes in vision including blurred vision
  2. cough
  3. nausea or vomiting
  4. numbness or weakness in arms, legs, or face
  5. chest pain
  6. anxiety
  7. shortness of breath
  8. HA
25
Q

Pulmonary heart disease is also called what?

A

Cor pulmonale

26
Q

What is pulmonary heart disease/cor pulmonale?

A

Enlargement/dysfunction of the right ventricle caused by a primary pulmonary disorder.
(Pulmonary hypertension)

27
Q

What are the systolic/diastolic pulmonary artery pressures?

A

Systolic- 20 mmHg

diastolic-10 mmHg

28
Q

MAP > ___ or systolic > ____ for pulmonary HTN?

A

MAP > 25 mmHg or systolic pressure > 35 mmHg

29
Q

The RV has the same stroke volume as the LV, how is it possible that the right side of the heart move the same volume of blood at a much lower pressure?

A

1 .Shorter length of tubing

  1. More compliant vessels
  2. Much lower impact of gravity on blood flow
30
Q

Why use smooth muscle relaxants as Pharmacologic Management of pulmonary HTN?

A

reduce vessel tone -> increase r -> increase blood flow

31
Q

T/F Cor pulmonale (pulmonary HTN) is typically chronic and progressive

A

True

32
Q

What are signs/symptoms of cor pulmonale? (4)

A

1 .Chest pain

  1. Fatigue
  2. Bilateral lower extremity edema
  3. Syncope or passing out
33
Q

What diseases of the lungs are associated with cor pulmonale (pulmonary HTN)?

A
  1. Chronic Obstructive Lung Disease (COPD)
  2. Diffuse pulmonary interstitial fibrosis
  3. Extensive, persistent atelectasis (collapsed lung)
  4. Cystic fibrosis
  5. Pulmonary Embolism
34
Q

What diseases of pulmonary vessels associated with cor pulmonale (pulmonary HTN)?

A
  1. Pulmonary vascular sclerosis

2. Drug, toxin, XTR induced vascular sclerosis

35
Q

What disorders will affect chest wall movement that associated with cor pulmonale (pulmonary HTN)?

A
  1. Kyphoscolosis
  2. Marked obesity (Pickwickian syndrome)
  3. Neuromuscular disease
36
Q

What diseases inducing pulmonary arteriolar constriction (hypoxemia - low levels of O2 in blood) associated with cor pulmonale (pulmonary HTN)?

A
  1. Airway obstruction
  2. Hypoventilation
  3. Chronic altitude sickness
37
Q

T/F PT interventions will have large impact on underlying pulmonary pathology.

A

False, Physical therapy interventions will have only a negligible impact on the underlying pulmonary pathology

38
Q

T/F For patients with lung pathologies know if there is accompanying cardiac involvement

A

True

39
Q

T/F Care should be taken not to over exercises patient with PAH (Pulmonary Artery HTN)

A

True

40
Q

What type of exercise is acceptable with patient with Pulmonary Artery HTN?

A

Light resistance of small muscle groups and light to moderate aerobic activity is acceptable

41
Q

What type of activity should be avoided for patients with Pulmonary Artery HTN?

A

Outdoor activity should be avoided during hot or humid weather or very cold weather

42
Q

T/F In study of correlations among blood pressure (BP) attitudes, practice behaviors, and knowledge among physical therapists (PTs) practicing in the outpatient (OP) settings:
52% respondents did not feel it important to measure BP and 85% did not even though 94% felt confident in their ability to correctly measure

A

True

43
Q

What is the most frequently cited barrier to measuring BP by respondants?

A

Time contraints

44
Q

T/F As the number of years worked increases, a positive attitude regarding BP increased.

A

False, a positive attitude regarding BP decreased.

45
Q

Assessment criteria for medical professionals taking BP:

A
  1. resting the patient for 5 minutes prior to the measurement
  2. legs uncrossed
  3. feet on floor
  4. arm supported
  5. Correct cuff size
  6. Cuff placed over bare arm
  7. no talking/no phone/no reading
  8. BP measurement taken in both arms
  9. BP from arm with higher reading as being clinically more important when asked
46
Q

Which arm would you use for future BP readings?

A

arm with higher BP

47
Q

Common errors when measuring BP? (4)

A
  1. Rest prior to measurement
  2. Ensuring that subjects feet were flat on the ground
  3. Subject not actively using a cell phone
  4. Failed to check BP in both arms
48
Q

T/F Each single error increased a BP reading and errors compound one another

A

True

49
Q

T/F HTN is a whole body pathology

A

True

Pathophys (16 decks)

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