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Cardiopulmonary > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Hypertension Epidemiology

A

HTN is the leading risk factor for CVD mortality (13% of global deaths)

Leading cause of CVD worldwide

“Silent killer” often asymptomatic even at extremes

Only about 50% of people with HTN are compliant with medications

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2
Q

Physiologic Factors Influencing Blood Pressure

A

Cardiac output

Peripheral vascular resistance

Volume of circulating blood

Viscosity of blood

Elasticity of vessels

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3
Q

Poiseuille’s

Law flow rate

A 
Q= (3.14 or pie)*P*r^4/ 8nl 
Q= flow rate
P= pressure
r=radius
n= fluid viscosity
l= length 
radius has the biggest effect on flow rate
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4
Q

Poiseuille’s

Law resistance

A 
R= 8nl/ (3.14 or pie)*r^4
R= resistance
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5
Q

Regulation of Blood Pressure

Fast

A

Baroreceptor (Aortic Arch and Carotid Sinuses)

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6
Q

Regulation of Blood Pressure

slow

A

Renin-Angiotensin System (Kidneys)
Natriureticpeptides (Atrial natriuretic peptide
and Brain natriuretic peptide) (Heart)

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7
Q

Renin

A

is an enzyme that is released into the circulation by the kidneys.

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8
Q

Renin is stimulated by

A

Sympathetic nerve activation (acting through β1-adrenoceptors)
Renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
Decreased sodium delivery to the distal tubules of the kidney.

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9
Q

Essential hypertension

A

(cause unknown) accounts for 95-99% of cases

Interaction between environmental factors and genetics.

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10
Q

Secondary hypertension

A

(1-5%)** of cases

Result of some sudden biochemical or mechanical pathology, potentially reversible.

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11
Q

Normal blood pressure

A

<120/<80

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12
Q

Elevated blood pressure

A

120-129/<80

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13
Q

Hypertension stage 1

A

130-139/80-89

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14
Q

Hypertension stage 2

A

> 140/<90

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15
Q

Hypertension crisis

A

> 180/>120

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16
Q

SPRINT trial

A

targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg (the previous JNC guidelines), resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause

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17
Q

JNC 8 Guidelines

A

pharmacologic treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.

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18
Q

Pulse Pressure

A 
Pulse pressure (PP=SBP-DBP) is normally ~40-60mmHg
Might be a better predictor of CV risk than systolic blood pressure
19
Q

Low pulse pressure

A

<40mmHg may indicate pulse narrowing

20
Q

Elevated pulse pressure

A

> 60mmHg PP associated with higher CVD morbidity and mortality rates

21
Q

Hypotension

A

Systolic blood pressure <90mmHg OR Diastolic <60 mmHg
Mean Pressure <70mmHg
<60mmHg concerning for shock

22
Q

Causes of hypotension

A

Depletion of blood volume (hemorrhage, dehydration)
Cardiogenic insufficiency
Acute Myocardial Infarction
Anti-Hypertensive Medications

23
Q

Concerns with hypotension

A

Generally only concerning if present with signs or symptoms or in patients with preexisting medical (i.e., heart disease)

24
Q

Signs and symptoms of hypotension

A

dizziness, fainting, cold and sweaty skin, fatigue, blurred vision, or nausea.

25
Q

Issues with Brachial Blood Pressures

A

Brachial BP may not accurately reflect central pressure
A lot of cuffs underestimate systolic and over estimate diastolic
Static/Rest BP is only a snap shot, doesn’t reflect response to load

26
Q

Common Errors To Avoid when measuring BP

A 
Full Bladder
Unsupported back
Unsupported feet
Crossed legs
Cuff over clothing
Unsupported arm
Patient talking
27
Q

Normal Cardiovascular Response to Exercise

A

Cardiac output increases in proportion to oxygen consumption

Substantial increases in heart rate

Modest increases in stroke volume (SV).

28
Q

High sympathetic nervous system (SNS) activity during exercise:

A

Withdrawal of baroreceptor mediated and vagal control
Increase SA node firing rate
Increases HR (chronotropic effect), SV (inotropic effect)
Increases vascular constriction (alpha receptors)
Increases venous return slightly due to reduced venous compliance
Small increase in Q (~7 L/min)

29
Q

BP response during exercise

A

SBP: ~10mmHg increase per change in workload (1MET)
DBP: Minimal Increase (<10mmHg), none or slight decrease
BP response steeper with UE activities compared to LE activities

30
Q

Heart Rate Response during exercise

A

~10bpm increase per change in workload

31
Q

Normal Recovery heart rate

A

Heart Rate
Recovery >12bpm within 1min,
Resting levels 2-3min

32
Q

Normal Recover Blood Pressure

A

Approximately 10mmHg decrease Systolic within 1min,
After 3 minutes Systolic should decrease to <90% of peak exercise values
Return to normal in approximately 5-6min post

33
Q

Resistance Training blood pressure

A 
Resistance training (RT) elicits a more pronounced pressure response 
BP increases to max values (due to load of weight) are encountered during the concentric lifting phase.
34
Q

Eccentric Loading/Exercise

A

Improves strength comparable to concentric training.
May increase muscle soreness more than concentric training
Lower perceived exertion, systemic vascular resistance, oxygen consumption, Cardiac Index, peak SBP and HR at similar workloads to concentric.

35
Q

Post Exercise Hypotension (PEH)

A

The presence of a prolonged decrease in resting blood pressure in the minutes and hours following acute exercise.

36
Q

The magnitude of PEH

A

has been found to be dose-dependent

Higher intensity exercise results in greater reductions in BP post exercise

37
Q

Hypertensive response

A

(SBP) >220mmHg for men; >190mmHg for women.

(DBP) >10 mmHg or >90 mmHg

38
Q

Exercise and HTN adverse events

A

Vigorous exercise increases the risk of a cardiovascular event during or soon after exertion in both young subjects with inherited cardiovascular disease and adults with undiagnosed or diagnosed congenital heart disease
The relative risk of cardiac arrest was greater during exercise than at rest for all levels of habitual physical activity

39
Q

Pain and Hemodynamics

A

Acute pain has been shown to result in tachycardia and elevated blood pressure in experimental models. However, the research on this is limited

40
Q

Experimental Pain and Blood Pressure

A

SBP has been shown to increase by 15-25mmHg to experimental pain.

DBP has been shown to increase by by 10-20mmHg

41
Q

Experimental Pain and Heart Rate

A

Pain evoked a 7% rise in HR after only 15 seconds and an additional 4% rise in HR to elicit a total of 11% rise in HR after 120 seconds, mean 8.87 beats/min increase.

Higher HR increase (>20%) was associated with mod-high pain level (≥50/100)

42
Q

Chronic Pain and Hemodynamics

A

Higher (HR) than healthy subjects at baseline and to painful stimuli
Lower parasympathetic and increased sympathetic activity
Chronic pain intensity is a significant predictor of hypertensive status independent age, race/ethnicity, and family history.

43
Q

Screening Recommendations in PT

A

At least take resting vitals on each patient
>140/90 proceed with usual care
Contact PCP
Monitor closely

> 160/100mmHg Hold resistance exercise, consider aerobic exercise
Contact PCP
Monitor closely

> 180/120mmHg; Hold Exam
Examine for organ damage
Contact PCP
Consider contacting EMS

Cardiopulmonary (7 decks)

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