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2- SA- Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

is systemic arterial hypertension usually a primary or secondary disease

A

secondary disease

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2
Q

what is systemic hypertension

A

persistently elevated systemic blood pressure

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3
Q

why is systemic arterial pressure saved during LCHF

A

compensation from the SNS keeps the pressure normal

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4
Q

What systolic and diastolic pressures warrant further investigations

A

systolic >160mmHg
Diastolic >100mmHg

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5
Q

how can kidney disease lead to systemic (arterial) hypertension

A

Areas of ischaemia of the kidneys leads to activation of RAAS
Reduced sodium excretion with subsequent volume expansion and increased CO

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6
Q

what are some initiating causes of systemic (arterial) hypertension

A

chronic fluid accumulation
persistently increased heart rate
chronic vasoconstriction

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7
Q

What are some perpetuating causes of systemic (arterial) hypertension

A

small artery changes: hyaline arteriosclerosis, vascular smooth muscle hypertrophy
renal disease

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8
Q

What is hyaline arteriosclerosis

A

High pressure fluid hitting the walls of the arteries resulting in the thickening and hardening of the walls

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9
Q

What 4 conditions in systemic (arterial) hypertension commonly secondary to

A

Renal disease
Hyperadrenocorticism
Hyperthyroidism
Diabetes mellitus

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10
Q

How can hyperadrenocorticism lead to systemic (arterial) hypertension

A

increased renal retention of salt and water
overproduction of renin –> vasoconstriction

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11
Q

How can hyperthyroidism lead to systemic (arterial) hypertension

A

increased sensitivity of myocardium to cathecolamines

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12
Q

How can diabetes mellitus lead to systemic (arterial) hypertension

A

volume expansion due to hyperglycaemia
overproduction of renin –> vasoconstriction

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13
Q

At what point does end organ damage occur

A

systolic >180mmHg
30mmHg rise within 48 hours

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14
Q

What are some examples of end organ damage and their clinical findings

A

Eye- Hypertensive retinopathy- acute onset blindness, intraocular haemorrhage
CNS- Hypertensive encephalopathy - Ataxia, seizures, strokes
Renal- proteinuria, PU/PD
Cardiac- left ventricular hypertrophy- murmurs arrhythmias

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15
Q

What is the difference between Doppler and oscillometric measurement of BP

A

Doppler only gives systolic
Oscillometric gives systolic, diastolic and mean

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16
Q

How is cuff size for blood pressure measurement selected

A

Cuff width size 40% of cuff site circumference

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17
Q

At what systolic blood pressure should treatment be started

A

systolic 160 to 179mmHg is repeatable findings of evidence of end organ damage
systolic >180mmHg even if no clinical signs

18
Q

How is high systemic (arterial) blood pressure treated

A

treat underlying cause
beta blockers
ACE inhibiters
Ca channel blockers

19
Q

In what hypertensive patients are Beta blockers the treatment of choice

A

Hyperthyroid cats

20
Q

In what hypertensive patients are ACE inhibiters the treatment of choice

A

Patients that have proteinuria

21
Q

Which pathologies causing hypertension are ACE inhibitors better in the treatment of

A

Those that lead to elevated renin levels
Renal failure
Cushings
Diabetes

22
Q

What is the first choice for treatment of systemic (arterial) hypertension in cats

A

Ca channel blockers

23
Q

List 3 examples of ACE inhibitors

A

Benazepril
Enalapril
Imidapril

24
Q

What are the goals of treatment of systemic arterial hypertension

A

Reduce blood pressure
- <150/95 mmHg
reduce end organ damage risk
decrease proteinuria
prevent further deterioration of organ function

25
Q

How are increases in pulmonary blood flow accommodated by the pulmonary circulation with minimal increases in pulmonary pressure

A

Highly distensible thin walls of pulmonary vasculature
Recruitment of under perfused vessels
Large pulmonary capillary SA

26
Q

How is pulmonary hypertension defined

A

systolic pulmonary arterial pressure >35mmHg
diastolic pulmonary arterial pressure >10mmHg

27
Q

List the 5 causes of pulmonary (arterial) hypertension

A
  1. Alveolar hypoxia with pulmonary vasoconstriction/ remodelling
  2. Pulmonary vascular obstructive disease
  3. Pulmonary over circulation
  4. High pulmonary venous pressure
  5. Idiopathic
28
Q

How can severe respiratory disease lead to pulmonary (arterial) hypertension

A

Arterial vasoconstriction due to hypoxia increasing pulmonary vascular resistance which increases pulmonary hypertension
Pulmonary hypertension inducing angioproliferative changes

29
Q

What are some examples of pulmonary vascular obstructive disease

A

pulmonary thromboembolism
Herat worm disease

30
Q

How can congenital shunts lead to pulmonary (arterial) hypertension

A

increased volume of blood in pulmonary circulation
Raised perfusion pressure damaging pulmonary vessels and leading to remodelling

31
Q

How does pulmonary (arterial) hypertension effect the Right ventricle?

A

Hypertrophy and dilation

32
Q

What is meant by cor pulmonale?

A

Right sided changes induced by pulmonary (arterial) hypertension caused by pulmonary vascular/parenchymal changes

33
Q

How does decline in RV function lead to decreased cardiac output?

A

Reduced blood into pulmonary circulation
Reduced LA preload
Reduced LV stroke volume
Reduced CO

34
Q

What breeds is pulmonary (arterial) hypertension more commonly seen in?

A

Breeds predisposed to airway/valvular disease: WHWT, CKCS

35
Q

What age of dog is pulmonary (arterial) hypertension more commonly seen in?

A

Middle to older age

36
Q

When should you suspect pulmonary (arterial) hypertension?

A

See the following without an obvious cause:
Persistent respiratory difficulty
Fatigue
Exercise intolerance

37
Q

What are the most common clinical signs of pulmonary (arterial) hypertension?

A

Exercise intolerance
Cough
Respiratory difficulty
Syncope
Ascites

38
Q

What heart sounds can severe pulmonary (arterial) hypertension result in?

A

Split S2 due to pulmonic valve closing earlier than aortic valve

39
Q

What are some thoracic radiography findings indicative of pulmonary (arterial) hypertension?

A

Cardiomegaly (esp R sided)
Enlarged pulmonary arteries
R sided heart failure signs: hepatomegaly, large CVC, pleural effusion

40
Q

Where are veins located on thoracic DV radiographs?

A

Ventral and central

41
Q

What are some echocardiograph findings indicative of pulmonary (arterial) hypertension?

A

RV hypertrophy (>1/2 thickness of LV wall) and dilation
Pulmonary artery dilation
RA enlargement
Flattened IVS

42
Q

How is pulmonary (arterial) hypertension treated?

A

Treat underlying disease
Sildenafil (viagra)
Pimobendan
Oxygen therapy

2- SA- Cardiology (15 decks)

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