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PHR2042 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define cardiovascular disease (CVDs)

A

A group of disorders affecting the heart and blood vessels

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2
Q

What is coronary heart disease (CAD) and what causes it

A

Condition where the heart is deprived of oxygen due to reduced blood supply due to blockage of the arteries supplying blood to the heart

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3
Q

What is CAD also known as

A

Ischemic heart disease (IHD)

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4
Q

What conditions are included in CAD

A

Stable angina
Angina
ACS
Myocardial infarction
Sudden cardiac death

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5
Q

What are the presentations of stable angina

A

Chest discomfort and symptoms precipitated by activity with minimal or no symptoms at rest

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6
Q

What is ACS

A

Syndrome where there is a lack of blood flow to the heart to supply the needs of myocytes often due to a blockage of a coronary artery. This may cause parts of the heart to not function properly or even die

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7
Q

Types of ACS

A

Unstable angina
NSTEMI
STEMI

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8
Q

How does angina pain develop?

A

When there is an increased blood supply demand in the setting of stable atherosclerosis plague but the vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial demand

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9
Q

What occurs in unstable angina?

A

Plague ruptured and a thrombus forms around the ruptured plague causing partial occlusion of the vessel resulting in angina pain

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10
Q

What occurs in NSTEMI

A

Plague ruptures and thrombus formations causes partial occlusion to the vessel resulting in injury and infarct to the subendocardial myocardium

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11
Q

What occurs in STEMI

A

Complete occlusion of the blood vessel resulting in transmural injury and infarct to the myocardium

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12
Q

What is atherosclerosis

A

Development of bulging fatty deposits called plagues j in n large arteries leading to reduced blood flow or blockage of an artery if plague breaks open and clotting occurs

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13
Q

What is dyslipidaemia

A

Presence of altered levels of lipoproteins in the blood

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14
Q

What lipoprotein levels are associated with artheroslerosis

A

Increased levels of low density lipoprotein particles and decreased levels of high density lipoprotein particles

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15
Q

Define ischaemic stroke

A

Condition where blockage from thrombus or a clot in blood vessel causes lack of adequate blood flow into the brain via cerebral arteries resulting in ischemia, hypoxia and neuronal death

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16
Q

Define haemorrhagic stroke

A

Rupturing of vessels and blood leaks out causing large thrombus within the area causing pressure on the brain leading to damage

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17
Q

Common mechanism of heart failure

A

Reduction of stroke volume which causes reduction in cardiac output

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18
Q

What is stroke volume

A

volume of blood ejected with each contraction of the heart

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19
Q

What are the 2 problems that result in heart failure

A

Contractile problem
Filling problem

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20
Q

What occurs in contractile problem heart failure

A

Damaged myocytes cant contract as hard as they should

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21
Q

What occurs in filling problem heart failure

A

Ventricles become stiff and do not receive enough blood

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22
Q

Heart failure classifications

A

Heart failure with reduced Ejection Fraction (HFrEF)
Heart failure with preserved Ejection Fraction (HFpEF)

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23
Q

What does Ejection Fraction measure

A

How much blood the left ventricle pumps out with each contraction

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24
Q

What problem occurs in HFrEF

A

Contractile problem - the damaged myocytes cannot contract as hard

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25
What problem occurs in HFpEF
Filling problem - the ventricles are stiff and do not receive enough blood
26
Why do patients with heart failure experience fatigue
they have reduced blood flow to tissues such as skeletal muscles due to low stroke volume
27
Why can oedema occur in patients with heart failure
Blood is not being cleared out of the ventricles efficiently causing it to build up in veins and capillaries therefore water will leak out to surrounding tissue and increases tissue fluid.
28
What is arrhythmia
irregular or altered rate of action potential movement throughout the heart causing disturbance to the electrical activity in the heart
29
Common cause of arrhythmia
ischaemia and death of myocytes causing damage to an area and deposition of collagen that impairs the normal spread of action potentials throughout the heart
30
Types of arrthymia
Atrial fibrillation
31
Define hypertension
Sustained elevation in systolic blood pressure of greater or equal to 140 mmHg and or diastolic blood pressure of greater than or equal to 90mmHg in people not taking antihypertensive medications
32
What are symptoms in uncomplicated primary hypertension
asymptomatic although some patients with very high blood pressure may feel headache
33
What does the term secondary hypertension describe
high blood pressure that is a result of underlying diseases or use of medicines and substances
34
3 ways hypertension is diagnosed
Doctors office Ambulatory blood pressure monitor home blood pressure monitor
35
How to receive a diagnosis of hypertension
Patient's blood pressure must be taken 3 times on one occasion, discard first reading and average second and third High readings on different occasions 1-2 weeks apart
36
What does systolic pressure measure
pressure in arteries when heart beats
37
What does diastolic pressure measure
pressure in arteries when heart rests between beats
38
What is blood pressure measured as
The force exerted by the blood against the inner walls of blood vessels
39
What is the blood pressure equation
BP= Cardiac output X total peripheral resistance - central venous pressure
40
What is the cardiac output equation
CO= Heart rate X Stroke Volume
41
Why do we need blood pressure
Blood flow to organs relies on the pressure gradient between arteries and veins so if blood pressure is low there is not enough pressure to drive blood to organs
42
What is mean arterial pressure
Estimate of the average pressure during the cycle
43
According to the BP equation, what can cause blood pressure to rise
Cardiac output and total peripheral resistance can cause bp to rise
44
What can cause cardiac output to rise
Heart rate Stroke Volume **CO= HR x SV**
45
What causes stroke volume to rise
increased blood volume increased contractility
46
What causes Total Peripheral resistance
net vasoconstriction- more arterioles constrict than dilate sympathetic nerve activation- more arterioles constrict when sympathetic nerves activate Vasoconstriction means contraction of vascular smooth muscle cells --> arteriole diameter reduction --> increase resistance --> increases TPR and therefore increases BP
47
How does sympathetic nerve activation cause increase BP
More arterioles have a adrenoceptors causing vasoconstriction, e.g. GI tract than there are arterioles that have b2 adrenoceptors, e.g. skeletal muscle, which cause vasodilation
48
Factors that causes BP to rise
Sex Environmental- stress Genetic- elevated angiotenin II levels, elevated aldosterone levels CNS- sympathetic activation Cardiac- cardiac output Renal- sodium retention Gastrointestinal- obesity, micronutrients, alcohol Endocrine- insulin, aldosterone Age Endothelium- nitric oxide
49
What is a hypertensive emergency
blood pressure is so high patients have start to have symptoms such as headache, chest pain, nausea, vomiting
50
Do patients notice they have high BP
no, most patients don't notice they have high BP for years
51
What can hypertension result in
morbidity and mortality
52
What changes occur in the heart in hypertension
Cardiac Remodelling- changes to the heart structure and function Macro and microvascular effects- changes to large and small blood vessel structure and function
53
What does changes in heart structure and function lead to
Increase risk of: Stroke Heart failure Myocardial infarction kidney failure
53
What are the types of load on the heart
Preload (wall stress): load on the myocyte prior to contraction, how stretched it is at the end of the filling period Afterload: pressure that the heart must work against in order to eject blood.
54
What causes greater afterload
High total peripheral resistance causing higher arterial pressure means the heart must exert a greater force to eject the same amount of blood
55
Stages of cardiac cycle
1. ventricular filling 2. ventricular contraction 3. ventricular ejection 4. ventricular relaxation
56
What does remodelling refer to
Changes in the structure of the heart that can affect the function
57
How does hypertension affect load on the heart
Hypertension causes increased load on the heart
58
How does the heart respond to increased load on the heart
Increases the size and strength of myocytes (hypertrophy)
59
What signalling molecules are released under conditions of higher mechanical load on the heart
angiotensin II and antrial natriuretic peptide are released
60
What does angiotensin II act on and to cause what
AT1 receptors on Cardiomyocytes: cardiomyocyte enlargement resulting in hypertrophy Vascular smooth muscle cells: resulting in hypertrophy Fibroblasts in between cardiac or vascular smooth muscle cells: collagen deposition
61
What happens to the heart in hypertrophy and fibrosis
Heart stiffens causing decreased compliance, reducing efficiency of blood filling into the ventricles

PHR2042 (4 decks)

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