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HHD 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Where does the apex beat of the heart take place?

A

in the left ventricle

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2
Q

Where is the apex (base of left ventricle) of the heart located?

A

in the 5th intercostal spaces
close to the mid clavicular line

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3
Q

How much does the heart weigh?

A

300g

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4
Q

The heart is the size of a ________.

A

fist

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5
Q

Where is the heart located?

A

middle mediastinum

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6
Q

The heart is protected by…

A

the rib cage

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7
Q

The heart is ________ to the lungs

A

medial

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8
Q

What is the function of the vena cava?

A

allows the influx of blood from the body in deoxygenated state

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9
Q

Arteries carry blood ________

A

away from the heart

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10
Q

The pericardium is divided into __________ and ___________ pericardium

A

fibrous
serous

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11
Q

Serous pericardium is divided into ___________ and ___________ pericardium

A

parietal
viseral

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12
Q

What is between the parietal and visceral pericardial layers of the serous pericardium?

A

pericardial fluid

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13
Q

The _________ serous pericardium is closest the the fibrous pericardium

A

parietal

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14
Q

The serous pericardium is designed to allow…

A

the heart to move against its surface

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15
Q

What are the chambers of the heart?

A

2 atria
2 ventricles

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16
Q

What separates the left and right ventricles?

A

the intraventricular septum

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17
Q

What ventricle has the thickest walls?

A

the left ventricle

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18
Q

Venous blood returns from which vessels into the right atrium?

A

superior vena cava
inferior vena cava

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19
Q

What valve is located between the right atrium and the right ventricle?

A

tricuspid valve

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20
Q

What valve is located between the left atrium and the left ventricle?

A

mitral valve
biscuspid valve

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21
Q

The heart sits within the ___________ space where it contracts and relaxes.

A

pericardial

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22
Q

The heart has a two pump system, namely…

A

pulmonary (to the lungs)
systemic (to rest of the body)

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23
Q

Briefly describe the two pump system of the heart

A

deoxygenated blood returned to heart by body
heart sends blood to lungs via pulmonary artery
gas exchange occurs in lungs
heart receives oxygenated blood via pulmonary vein
oxygenated blood is pumped to rest of the body via the aorta

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24
Q

What is diastole?

A

relaxation of the chamber
filling of chamber with blood

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25
Q

What prevents the heart from collapsing during diastole?

A

the resting pressure

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26
Q

What is systole?

A

contraction of the chamber
ejection of the blood

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27
Q

What is the normal blood pressure?

A

120/80 mmHg

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28
Q

What is the normal blood pressure?

A

120/80 mmHg

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29
Q

What are the atrioventricular valves?

A

[valves between the chambers of the heart]
tricuspid (right AVV)
Mitral/ bicuspid (left AVV)

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30
Q

What are chordae tendinae?

A

these are fibrous connections between the valve leaflets and the papillary muscles

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31
Q

What are papillary muscles?

A

these are pilar-like muscles which are seen within the cavity of the ventricles

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32
Q

What is the function of the chordae tendinae and papillary muscles?

A

they ensure that there is no backflow during ventricular contraction

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33
Q

Ventricles contract from the ________ upwards

A

apex

34
Q

What are the semilunar valves ?

A

Pulmonary valve (right hand side with pulmomary artery)

Aortic valve (left side)

35
Q

What is the function of the coronary arteries?

A

supply the myocardium

36
Q

Where do coronary arteries originate from?

A

the aortic root
aortic sinus

37
Q

Coronary arteries are ___________ diastole

A

open

38
Q

Innervation of coronary arteries is controlled by ______________.

A

autonomic vagus regulation
cranial nerve X

39
Q

The left coronary arteries tend to look after what part of the heart?

A

the front part of the heart

40
Q

The right coronary arteries tend to look after what part of the heart?

A

right ventricle
Distal right coronary artery looks specifically after the back of the heart (some of the front of the heart)

41
Q

Name the coronary arteries of the heart

A

Left main coronary artery; circumflex coronary artery, left anterior descending coronary artery

Right coronary artery: distal right coronary artery

42
Q

What is an end artery? Give examples

A

is an artery that is the only supply of oxygenated blood to a portion of tissue

coronary arteries
opthalamic arteries

43
Q

What are the layers of the heart?

A

Pericardium
Myocardium
Endocardium

44
Q

The endocardium is made up of …

A

squamous epithelium

45
Q

The myocardium consists of __________ and ______________.

A

cardiomyocytes
pacemaker cells (set electrical rhythm)

46
Q

The pericardium consists of _____________ and __________________ membranes

A

serous (parietal and visceral) membranes
fibrous membranes

47
Q

State the features of cardiomyocytes

A

short, fat cells
1 central nucleus
abundant mitochondria
intercalated discs
co-odrinated contraction

48
Q

What facilitates the co-ordinated contraction of cardio-myocytes?

A

they are joined by desmosomes

49
Q

Cardiomyocytes are joined end to end by _____________.

A

intercalated discs

50
Q

The action potential in the heart is generated by …

A

cells of the SAN (sinoatrial node)

51
Q

Action potential generation is automatic however it can be altered by ______________.

A

autonomic vagus innervation

52
Q

What is the normal resting heart rate ?

A

60-100 bpm

53
Q

What is the resting membrane membrane potential of the heart?

A

-90mV

54
Q

How is the resting membrane potential of the cell generated?

A

outside of the cell is more positive than inside of the cell
this is usually due to the action of Na+/K+ pumps; 3 Na+ out and 1 K+ in; this a potential difference

55
Q

Briefly describe mechanism of action of the SAN?

A

the “door” opens
allows diffusion of Na+ ions in an attempt to neutralises the inside of the cell

56
Q

What are the phases of action potentials of cardiac muscles?

A

phase 4
phase 0
phase 1
phase 2
phase 3

57
Q

Describe what occurs in phase 4 of an action potential

A

Na+, Ca2+ channels are closed
Open K+ rectifier channels to keep the membrane potential stable at -90mV

58
Q

Describe what occurs in phase 0 of an action potential

A

Rapid influx of Na+ through open fast Na+ channels
approaching 0mV

threshold potential of -50mV is reached (or not)
full depolarisation (+40mV)

59
Q

Describe what occurs in phase 1 of an action potential

A

Transient K+ channels open and K+ efflux occurs to return the membrane potential to 0mV

60
Q

Describe what occurs in phase 2 of an action potential

A

influx of Ca2+ through L type Ca2+ channels is electrically balanced by K+ efflux through delayed rectifer channels

61
Q

Describe what occurs in phase 3 of an action potential

A

Ca2+ channels close but the delayed rectifier channels remain open and the membrane potential can return to -90mV

62
Q

Briefly describe the electrophysiology of the heart (include how contraction is stimulated)

A

action potential generated by the SAN
atria depolarises then contracts

the signal reaches the AVN (atrioventricular node)
there is a delay at AVN to ensure ventricles are adequately filled
The action potential then travels down the bundle of His and then up through the purkinje fibres
This stimulates depolarisation of ventricles
Ventricles contract

63
Q

The atrioventricular node (AVN) is described to be the …

A

relay station

64
Q

Normal heart rate values are _________

A

60-100 bpm
number of times the heart beats per minute

65
Q

What is the standard/normal cardiac output value?

A

5L/min

66
Q

What is the stroke volume?

A

the amount of blood in ventricles at the moment it beats
volume of blood pumped out of the left ventricle during each systolic contraction

67
Q

Cardiac output can be calculated by…

A

HR x SV
the amount of blood the heart pumps in 1 minute

68
Q

Mean arterial pressure (mmHg) is calculated by

A

CO x SVR (systemic vascular resistance)

Pdias + 1/3 (Psyst - Pdias)

the average arterial pressure throughout the cardiac cycle (diastole and systole)

Pdias- pressure at diastole
Psyst- pressure at systole

69
Q

Define essential hypertension

A

Essential hypertension is defined as a BP of 140/90mmHg with no secondary cause identified

a blood test must be performed to eliminate secondary causes

70
Q

Give examples of secondary causes of hypertension

A

renal artery stenosis - renin released by kidneys as sensitive to hypotension/hypovolaemia
endocrine disorders
medication
cancers
pregnancy
heart injury

71
Q

What are the risk factors for hypertension

A

obesity
aerobic exercise <3x per week
alcohol intake
smoking
diabetes
afro-carribean
age >60 years
family history
sleep apnoea
dyslipidaemia
high salt intake

72
Q

What are the causes of hypertension?

A

excess sodium ions
dysregulation of renin- angiotensin- aldosterone
increases sympathetic drive (stress, catecholamine driven event)
insulin resistance
increased periperal resistance (narrow arteries)
endothelial dysfunction- high blood pressure can lead to endothelial damage

73
Q

What causes small vessel atherosclerosis?

A

thrombosis
endothelial injury
inflammatory cascade
oxidative stress (ROS)
autonomic regulation
genetic predisposition
age

(all increase peripheral resistance)

74
Q

What is small vessel atherosclerosis (SVA)?

A

occurs in microcirculation
building of atheroma
narrowing of the lumen

75
Q

What is the presentation of hypertension?

A

asymptomatic
usually picked up on picked up on opportunistic screening

76
Q

What are the end-organ damage symptoms of hypertension?

A

visual changes
renal failure
angina (ischaemic heart disease, chest pain)
sensory and/or motor deficit

77
Q

List some complications of hypertension

A

coronary heart disease
cerebrovascular accident
left ventricular hypertrophy
heart failure
retinopathy
peripheral artery disease (SVA)
Kidney disease - microvasculature of kidneys
vascular dementia

78
Q

What are the investigations for hypertension?

A

Electrocardiogram
fasting glucose (diabetes)
eGFR (kidney disorder?)
fasting lipid panel
urinalysis (cytology, culture, microscopy)

Check for endocrine disorders i.e. insulin

79
Q

What are some modifiable risk factors of hypertension ?

A

stop smoking
lose weight
diet modification
reduce alcohol intake
exercise

80
Q

What kinds of medication are administered for hypertension?

A

calcium channel blockers
E.g. nifedipine

HHD 2 (37 decks)

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