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CVS YR 2 HY > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the definition of hypertension?

A

A sustained diastolic pressure greater than 89 mm of Hg OR a sustained systolic pressure in excess of 139 mm of Hg

Defined by the National Heart, Lung and Blood Institute of the USA

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2
Q

What are the two classifications of hypertension?

A
  • Primary (essential hypertension)
  • Secondary hypertension
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3
Q

What is isolated systolic hypertension (ISH)?

A

SBP of ≥140 mmHg and DBP < 90 mm Hg

Common after age 50, associated with poor prognosis

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4
Q

What is masked hypertension?

A

Normal clinic blood pressure but elevated daytime ambulatory or home blood-pressure level (≥135/85 mmHg)

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5
Q

What are the renal causes of secondary hypertension?

A
  • Acute glomerulonephritis
  • Chronic renal failure
  • Polycystic kidney
  • Renal artery stenosis
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6
Q

What is the prevalence of hypertension in Malaysia?

A

35.5% in adults above 18 years of age

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7
Q

What major causes of death are associated with hypertensive patients?

A
  • Ischemic heart disease
  • Hemorrhagic stroke
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8
Q

What characterizes hypertensive emergency?

A

Severe hypertension (usually DBP > 110 mm Hg) associated with end organ damage

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9
Q

What are the manifestations of hypertensive emergency?

A
  • Papilledema
  • Encephalopathy
  • Cardiovascular abnormalities
  • Renal failure
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10
Q

What is the prognosis for patients with hypertensive emergency?

A

50% of the patients survive for 5 years

90% of the deaths are due to uremia

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11
Q

What is essential hypertension?

A

A complex multifactorial disorder resulting from interactions of genetic and environmental factors

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12
Q

List some environmental factors that can modify hypertension.

A
  • Stress
  • Obesity
  • Smoking
  • Physical inactivity
  • Excessive salt consumption
  • Diabetes
  • Dyslipidaemia
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13
Q

What are the basic laboratory tests for a person newly diagnosed with hypertension?

A
  • Fasting blood glucose
  • Complete blood count
  • Lipid profile
  • Basic metabolic panel
  • Thyroid stimulating hormone (TSH)
  • Urinalysis
  • ECG
  • Serum uric acid
  • Urine albumin/creatinine ratio
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14
Q

What is the risk associated with untreated hypertension?

A

Roughly half of patients die from ischemic heart disease or congestive heart failure; another third die from stroke

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15
Q

What are the pathological changes in blood vessels due to hypertension?

A
  • Accelerated atherosclerosis
  • Hyaline arteriosclerosis
  • Hyperplastic arteriosclerosis
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16
Q

What is hypertensive heart disease characterized by?

A

Left ventricular hypertrophy due to pressure overload

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17
Q

What criteria are used for diagnosing hypertensive heart disease?

A
  • LVH in the absence of any other cardiovascular pathology
  • History or pathological evidence of hypertension
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18
Q

What are the morphological changes in left ventricular hypertrophy (LVH)?

A
  • LV hypertrophy without dilatation
  • Increase in weight of heart (> 500 g)
  • Left ventricular free wall thickness > 2 cm
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19
Q

What is the concept of pressure natriuresis?

A

Reduced renal sodium excretion triggers the development of essential hypertension

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20
Q

True or False: Hypertensive urgency is associated with end organ damage.

A

False

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21
Q

What is the relationship between hypertension and ischemic heart disease?

A

Hypertension causes left ventricular hypertrophy and accelerates atherosclerosis leading to narrowing of coronary arteries

22
Q

What increases the risk of Ischaemic heart disease?

A

Hypertension

Long-standing systemic hypertension leads to various cardiovascular complications.

23
Q

What adaptive response occurs due to long-standing systemic hypertension?

A

Left ventricular hypertrophy (LVH)

This is an increase in the mass of the heart muscle as an adaptation to increased workload.

24
Q

What is the nutritional demand of hypertrophic myocardium?

A

High

Hypertrophic myocardium requires more oxygen and nutrients due to its increased mass.

25
What does hypertension cause in relation to coronary arteries?
Accelerated atherosclerosis and narrowing ## Footnote This results in reduced blood supply to the myocardium.
26
What is a key concept when considering the effects of hypertension on the heart?
Decreased blood supply due to coronary atherosclerosis and increased demand due to LVH ## Footnote This combination contributes to heart failure.
27
What can long-standing hypertension lead to in terms of heart failure?
Left-sided heart failure or sudden death ## Footnote This occurs when the left ventricle fails to contract effectively.
28
How does left ventricular hypertrophy affect diastolic filling?
It impairs diastolic filling ## Footnote This leads to volume overload of the left atrium.
29
What is the consequence of left atrial dilatation?
Increased risk of arrhythmia and thromboembolism ## Footnote This occurs due to the enlargement of the left atrium.
30
What is the sequence of events leading from systemic hypertension to pulmonary edema?
Systemic hypertension → Increased peripheral resistance → LV hypertrophy → Impaired diastolic filling → Volume overload in LA → Increased pressure in pulmonary circulation → Pulmonary edema ## Footnote This pathway illustrates the progression from hypertension to heart failure and pulmonary complications.
31
What can effective control of hypertension prevent?
Regression of LVH and related risks ## Footnote Proper management of hypertension can reverse some of the damage caused by high blood pressure.
32
What are the potential consequences of uncontrolled systemic hypertension?
* LVH * Ischaemic heart disease * Heart failure * Arrhythmia * Thromboembolism * Sudden death ## Footnote These conditions highlight the severe risks associated with untreated hypertension.
33
What pathological changes occur in the kidney due to hypertension?
* Benign nephrosclerosis * Malignant nephrosclerosis * Hyaline arteriosclerosis ## Footnote These changes affect renal function and can lead to chronic kidney disease.
34
What is the characteristic finding in small arterioles associated with benign nephrosclerosis?
Hyaline arteriosclerosis ## Footnote This results in thickening of the vessel walls, leading to luminal narrowing.
35
What is the gross appearance of a kidney affected by benign nephrosclerosis?
Symmetrically contracted kidney with a finely granular surface ## Footnote These features indicate chronic damage due to hypertension.
36
What is a common clinical manifestation of benign nephrosclerosis?
Mild proteinuria and mild reduction in GFR ## Footnote Patients may not experience significant symptoms until later stages.
37
What is the appearance of a kidney in malignant hypertension?
Flea-bitten kidney ## Footnote Characterized by small pinpoint hemorrhages on the renal surface.
38
What is fibrinoid necrosis?
Homogenous granular eosinophilic appearance of vessel wall ## Footnote This is a pathological finding associated with severe hypertension.
39
What is hyperplastic arteriosclerosis characterized by?
Onion skin appearance ## Footnote This occurs due to proliferation of intimal cells following acute injury.
40
What pathological changes occur in the brain due to hypertension?
* Accelerated atherosclerosis * Lacunar infarcts * Intracerebral hemorrhage * Hypertensive encephalopathy ## Footnote These changes can lead to significant neurological deficits.
41
What are lacunar infarcts?
Small cavitary infarcts about a few mm size ## Footnote They result from occlusion of small penetrating vessels.
42
What is the most common cause of intracerebral hemorrhage?
Hypertension ## Footnote It contributes significantly to the incidence of hemorrhagic strokes.
43
What is the peak age for intracerebral hemorrhage due to hypertension?
About 60 years ## Footnote This age group is particularly vulnerable to the effects of chronic hypertension.
44
How does chronic hypertension lead to intracerebral hemorrhage?
Weakening of vessel wall and rupture due to hyaline arteriosclerosis ## Footnote This process can also lead to the formation of minute aneurysms.
45
What characterizes hypertensive encephalopathy?
Sudden increase in diastolic BP >130 mm Hg ## Footnote Symptoms include headache, confusion, and seizures.
46
What are the characteristic findings in the retina due to hypertension?
* Arteriosclerosis of retinal arteries * Occlusion of retinal veins * Retinal infarcts * Retinal detachment ## Footnote These findings can be observed during an eye examination.
47
What are cotton wool spots?
Accumulation of mitochondria within axons of nerve fibers damaged by ischemia ## Footnote They appear as white patches on the retina.
48
What is the macular star?
Spoke-like arrangement of exudate from damaged blood vessels in the macula ## Footnote This is a notable finding in cases of retinal damage due to hypertension.
49
How is hypertension classified based on its mechanism?
* Primary (essential) * Secondary ## Footnote Essential hypertension accounts for 95% of cases and is multifactorial.
50
What are the target organs affected by chronic hypertension?
* Heart * Kidney * Brain * Retina ## Footnote These organs are particularly vulnerable to damage from high blood pressure.

CVS YR 2 HY (7 decks)

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