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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
How are increases in pulmonary blood flow accommodated by the pulmonary circulation with minimal increases in pulmonary pressure
Highly distensible thin walls of pulmonary vasculature Recruitment of under perfused vessels Large pulmonary capillary SA
26
How is pulmonary hypertension defined
systolic pulmonary arterial pressure >35mmHg diastolic pulmonary arterial pressure >10mmHg
27
List the 5 causes of pulmonary (arterial) hypertension
1. Alveolar hypoxia with pulmonary vasoconstriction/ remodelling 2. Pulmonary vascular obstructive disease 3. Pulmonary over circulation 4. High pulmonary venous pressure 5. Idiopathic
28
How can severe respiratory disease lead to pulmonary (arterial) hypertension
Arterial vasoconstriction due to hypoxia increasing pulmonary vascular resistance which increases pulmonary hypertension Pulmonary hypertension inducing angioproliferative changes
29
What are some examples of pulmonary vascular obstructive disease
pulmonary thromboembolism Herat worm disease
30
How can congenital shunts lead to pulmonary (arterial) hypertension
increased volume of blood in pulmonary circulation Raised perfusion pressure damaging pulmonary vessels and leading to remodelling
31
How does pulmonary (arterial) hypertension effect the Right ventricle?
Hypertrophy and dilation
32
What is meant by cor pulmonale?
Right sided changes induced by pulmonary (arterial) hypertension caused by pulmonary vascular/parenchymal changes
33
How does decline in RV function lead to decreased cardiac output?
Reduced blood into pulmonary circulation Reduced LA preload Reduced LV stroke volume Reduced CO
34
What breeds is pulmonary (arterial) hypertension more commonly seen in?
Breeds predisposed to airway/valvular disease: WHWT, CKCS
35
What age of dog is pulmonary (arterial) hypertension more commonly seen in?
Middle to older age
36
When should you suspect pulmonary (arterial) hypertension?
See the following without an obvious cause: Persistent respiratory difficulty Fatigue Exercise intolerance
37
What are the most common clinical signs of pulmonary (arterial) hypertension?
Exercise intolerance Cough Respiratory difficulty Syncope Ascites
38
What heart sounds can severe pulmonary (arterial) hypertension result in?
Split S2 due to pulmonic valve closing earlier than aortic valve
39
What are some thoracic radiography findings indicative of pulmonary (arterial) hypertension?
Cardiomegaly (esp R sided) Enlarged pulmonary arteries R sided heart failure signs: hepatomegaly, large CVC, pleural effusion
40
Where are veins located on thoracic DV radiographs?
Ventral and central
41
What are some echocardiograph findings indicative of pulmonary (arterial) hypertension?
RV hypertrophy (>1/2 thickness of LV wall) and dilation Pulmonary artery dilation RA enlargement Flattened IVS
42
How is pulmonary (arterial) hypertension treated?
Treat underlying disease Sildenafil (viagra) Pimobendan Oxygen therapy

2- SA- Cardiology (16 decks)

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