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Hypertension Flashcards

1
Q

MAP = ___ * ____

A

CO * HR

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2
Q

CO = ___ * ___

A

HR * SV

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3
Q

Which three factors determine HR?

A
  1. Sympathetic NS
  2. Parasympathetic NS
  3. Catecholamines
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4
Q

True or False: Stroke volume is determined by cardiac filling

A

True

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5
Q

Which four factors affect cardiac filling?

A
  1. HR
  2. Venous return
  3. Afterload
  4. Ventricular compliance
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6
Q

True or False: Cardiac contractility is determined mainly by sympathetic nerve activity and circulating catecholamines

A

True

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7
Q

Vasoactive mediators (Ang II, Epinephrine, Vasopressin, Histamine) determine _____

A

TPR

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8
Q

True or False: Blood viscosity and sympathetic nerve innervation affect HR

A

False - TPR

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9
Q

Which two factors affect blood volume?

A
  1. Hormones (Vasopressin, aldosterone, ANP)
  2. Pressure natriuresis
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10
Q

Hypertension without a known cause is known as ____

A

primary HTN

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11
Q

Hypertension caused by renal, mechanical, or neuroendocrine abnormalities is known as: ____

A

secondary HTN

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12
Q

Which five organs systems can lead to development of primary HTN?

A
  1. CNS
  2. Pressure/volume receptors
  3. Kidney
  4. Adrenals
  5. Blood vessels
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13
Q

How does primary HTN (specifically CO and TPR) change as one ages?

A

CO decreases as one ages while TPR increases

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14
Q

How can renal parenchymal disease cause secondary HTN?

A

If kidneys cannot excrete enough water and salt….
1. more plasma volume
2. more CO
3. more BP

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15
Q

How can renal vascular disease lead to secondary HTN?

A

Reduced renal blood flow means more renin and Ang II released

Peripheral vasoconstriction and aldosterone release => Na retention and INCREASED plasma volume

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16
Q

How can primary hyperaldosteronism cause secondary HTN?

A

Increases blood volume

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17
Q

True or False: Primary HTN can be caused by sleep apnea

A

False - secondary

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18
Q

Coarctation of aorta is uncommonly seen in kids and causes….

A

2 HTN

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19
Q

In coarctation of aorta, reduced blood flow to kidneys activates RAAS, leading to peripheral ____ and increased _____

A

vasoconstriction; plasma volume

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20
Q

While rare, pheochromocytomas can cause 2 HTN. How?

A
  1. Increase CO
  2. Increased systemic vascular resistance
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21
Q

Excess glucocorticoids have mineralcorticoid effects and can lead to secondary HTN, as in _____

A

Cushing Syndrome

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22
Q

How can hyperthyroidism cause secondary HTN?

A

Increased blood volume, CO, and metabolism

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23
Q

True or False: Elevated plasma insulin and obesity, as well as OTC’s can cause secondary HTN

A

True

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24
Q

Estrogen stimulates hepatic production of ____

A

angiotensinogen

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25
Q

What three symptoms are typically seen in HTN patients?

A

Flushing
Sweating
Blurry Vision

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26
Q

True or False: Increased right ventricle afterload is a consequence of HTN

A

False - increased LEFT ventricle afterload

27
Q

In HTN, how does the left ventricle compensate for increased afterload/increased stress it faces?

A

Hypertrophy to reduce wall stress

28
Q

What are the two types of hypertrophy that occur in left ventricle in response to increased left ventricle afterload?

A
  1. Concentric Hypertrophy
    - no dilation
    - most common
    - walls thicken, but volume decreases
  2. Eccentric
    - dilation
    - volume increases or stays same
    - remodeling occurs
    2.
29
Q

How does increased left ventricle afterload affect myocardial o2 demand? Effect?

A

Increases myocardial O2 demand (increases pressure-rate product), leads to myocardial ischemia

30
Q

True or False: In HTN, increased left ventricle afterload can lead to decompensation and systolic dysfunction

A

True
- as a result of decreased systolic dysfunction, there is decreased stroke volume

31
Q

Why can left ventricular hypertrophy lead to diastolic dysfunction?

A

Reduced ventricular compliance

32
Q

True or False: Pressure overload of the left ventricle can increase wall thickness, leading to increased wall stress during asystole and diastole

A

True
- Concentric Hypertrophy

33
Q

True or False: Wall stress is greater during concentric hypertrophy

A

False - eccentric

34
Q

Arterial damage can result due to HTN. More specifically, chronic damage to the endothelium favors ____ (possibly by reducing NO), medial degeneration , and weakening of ____ walls

A

atherogenesis; vessel

35
Q

True or False: Increased afterload, a consequence of HTN, can lead to left ventricular hypertrophy, ___ dysfunction, and ___

A

diastolic; heart failure

36
Q

True or False: HTN can lead to increased afterload, which can cause systolic dysfunction and heart failure

37
Q

Arterial damage from HTN can lead to: ____ and ____

A

Accelerated atherosclerosis

Weakened vessel walls

38
Q

Arterial damage and increased afterload can cause ____

A

myocardial ischemia and MI

39
Q

____ reduces peripheral vascular resistance

A

ACE Inhibitors

40
Q

How does ACE inhibitors work?

A

Reduce venous/arterial pressure, which leads to: decreased preload and afterload

41
Q

ACE Inhibitors will increase plasma concentration of ____

A

bradykinin

42
Q

How do angiotensin receptor blockers work?

A

Block AT1-R on adrenal cortex and vasculature

43
Q

True or False: Angiotension receptor blockers cause vasoconstriction and increase aldosterone secretion

A

False - cause vasodilation and decrease aldosterone secretion

44
Q

Which drugs decrease blood volume?

45
Q

True or False: Diuretics decrease preload and CO

46
Q

How do diuretics decrease peripheral vascular resistance?

A

Decrease Na content of arteriolar SM

47
Q

CCB’s, direct vasodilators, and aldosterone antagonists belong to which drug class?

A

Peripheral Vasodilators

48
Q

True or False: CCB’s have a significant effect on venous capacitance

A

False - they do not

49
Q

How do calcium channel blockers decrease peripheral vascular resistance?

A

Relax vascular SM

50
Q

Hydrazaline and Minoxidil are examples of which drug class?

A

Direct vasodilators

51
Q

True or False: Spironolactone is a Aldosterone antagonist

52
Q

Spironolactone, used for resistant HTN, increase secretion of ___ and ___

53
Q

Which drug should be used for HTN crisis?

A

Nitroprusside

54
Q

Nitroprusside reduces: ___,____, and ___

A
  1. preload
  2. afterload
  3. peripheral vascular resistance
55
Q

True or False: Nitroprusside relaxes VSM of veins and arterioles

56
Q

How do peripheral alpha 1 receptor antagonists treat HTN?

A

Reduce peripheral vascular resistance

57
Q

Beta-adrenergic receptor antagonists reduce CO by decreasing ___ and ___; also decreases release of ___

A

HR, contractility; renin

58
Q

Which drugs reduce sympathetic n. activity to heart/peripheral vasculature, leading to decreased CO and peripheral vascular resistance?

A

Centrally acting alpha-2 adrenergic agonists

59
Q

____: Inability of heart to pump forward enough blood to meet metabolic demands of body or the ability to do so only at abnormally elevated filling pressure, or both

60
Q

Two main causes of CHF?

A
  1. Defect in myocardial contraction
    - systolic dysfunction
  2. Impaired filling
    - diastolic dysfunction
61
Q

True or False: Preload has a negative effect on stroke volume

A

False - preload and contractility have positive impact while afterload has a negative impact

62
Q

What four factors increased preload?

A
  1. HR
  2. Compliance
  3. Atrial Systole
  4. Pericardial Constraint
63
Q

Which 6 factors affect afterload?

A
  1. Arterial Pressure
  2. Systemic Vascular Resistance
  3. Aortic/Pulm Valve Stenosis
  4. Blood viscosity
  5. Mass of blood column in aorta
  6. Aortic compliance
64
Q

Which 3 factors affect contractility?

A
  1. Catecholamines
  2. HR
  3. Sympathetic Nerve Activity

Pathophysiology (26 decks)

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