Hypertension Flashcards
What is the most sensitive organ to any change in perfusion
Brain
What are 3 elements that need to stay the same in the brain
Oxygen
Blood pressure
Glucose
3 essential organs
Heart
Kidneys
Blood/brain
What are some signs something is wrong with perfusion
Pale, cyanotic, confusion, sweating, sob, dizzy, blurred vision
What is a blood glucose reading when a person starts to feel bad
60-70
The brain is responding to low blood glucose
1st sign or symptom of any change in cardiac output is r/t
Brain or LOC
Areas to put stethoscope
APTM
What is PMI? Where can you hear it?
Point of maximal impulse
It is a place to put your stethoscope
5th ICS MCL Left Side
What % or oxygen does room air give you
21%
When do the coronary arteries fill
During diastole
What percent of oxygen is 2L nasal cannula
24%
What is the normal shape of the heart
Football shaped
Why do we care about shape of the heart
Because if it enlarges we will have pumping problems
What return blood back to right side of heart
Vena cava
What are three things that make a heart beat happen
Calcium, sodium, potassium
Need to be in adequate supply
Is the mitral valve on the side with high or low pressure?
HIGH pressure
Has to have more strength because left side is a higher pressure system
What is mechanical function of the heart measured by
Blood pressure, O2 sat, pulse, LOC, oriented
Systole+diastole= _________ function
Mechanical
Depolarization and repolarization = _________ function
Electrical
When does depolarization happen
Just before systole
Electrical firing impulse. Wave of electrical impulse that will trigger contraction
Depolarization
Electrical recharging. The myocardial cells recharge and rest after a contraction.. And get ready for the next one
Repolarization
What is the heart rate regulated by
ANS
autonomic nervous system
What is stroke volume affected by
Preload
Afterload
Contractility
What does Frank Starling’s Law say
The more the myocardial fibers are stretched, the greater the force of contraction…to a point
What comes first electrical or mechanical activity
Electrical activity (depolarization) precedes mechanical activity (systole)
Chemical –> electrical –> mechanical conduction of the heart
CO= ____ x ______
CO= SV x HR
Exchange nutrients and metabolic waste
Capillaries
ANS= _____ and ______
What happens in the two components
ANS= parasympathetic and sympathetic
Parasympathetic- dilates arteries
Sympathetic- increase HR, vasoconstriction, mostly related to afterload
What is the most potent vasoconstrictor in body
Aldosterone
-trying to conserve volume
What triggers a response when there is hypovolemia
Kidneys
What controls BP min to min and sec to sec
Baroreceptors and chemoreceptors
What are baroreceptors sensitive to?
Stretch or pressure
What so chemoreceptors respond to
Decreased O2
Increased CO2
Decreased pH
Electrolyte content
Pulse pressure=
What increases/decreases?
Pulse Pressure= SBP-DBP
Increase- exercise,atherosclerosis
Decreased- hypovolemia, heart failure
Heart failure is also known as
Pump failure
The perfusion pressure to bring blood and oxygen to organs in the body
Mean Arterial Pressure
If the Mean Arterial Pressure is …
Too high =
Too low=
Too high= increased pressure
Too low= underperfused and ischemia
What is the pressure exerted on the walls of arteries
Arterial BP
Stage 2 hypertension criteria
SBP > 160
DBP > 100
How is arterial pressure elevated
By rise in CO or SVR
What is the most common cause of HTN
Primary HTN
Elevated BP without an identifiable cause
Work horse muscle of the heart
Left ventricle
What do Angiotension II and Aldosterone do in Renin-Angiotension -aldosterone system
Angiotension II- potent vasoconstrictor
Aldosterone- sodium retention
Complications of HTN
Major risk factor for CAD
Left Ventricular Hypertrophy
Heart Failure
Symptoms of HTN? When do you see them?
- Rarely symptoms seen until late
- Later symptoms: headache upon awakening, dizziness, visual changes, epitaxis (nose bleeds)
What is laminar blood flow
Normal blood flow, forward flow through health silky arteries
What is turbulent blood flow
Intermittent blood flow, clots can develop
BUN and Creatinine
Kidney function and perfusion
BUN can look at volume how hydrated someone is
Cholesterol, serum lipids (HDL, LDL)
Lab test for atherosclerosis
What can cause high triglyceride levels
Alcohol and simple sugars
What can a chest x ray show
Oxygenation and size of heart
What do you use a EKG for
Electrical conduction of the heart
What is a Echocardiogram
Ultrasound to look at chamber and function of the heart
What is the first thing you can do for HTN management
Lifestyle modifications (diet, exercise)
When will you start symptoms with high blood pressure
Stage 2 hypertension
SBP > 160
DBP > 100
First symptom could be a headache
Normal circulating blood volume is where?
Intravascular
What space may you see circulating blood volume if a person has fluid? Where should it be?
You may see it in interstitial spaces instead of normal intravascular
What can high BP over a long period of time cause
Retinal damage
What is hallmark of Primary HTN
Persistent increased SVR
What is it called when you can actually feel turbulent of blood flow
Thrill
What do diuretics deal with
Preload
They help get rid of circulating volume
Act on kidneys
Examples of loop diuretics
Lasix
Bumex
Are thiazides or loop diuretics more potent
Loop diuretics
What do loop diuretics do
Prevent reabsorption of Na & Cl
Potassium depleting
Examples of thiazides
Diuril and Zaroxolyn
What must you have to use thiazides
Must have good kidney function
With a decrease BP or cardiac output what neurological symptoms would you see? What would be effected?
Brain is effected
Dizziness, light headedness, change in LOC, diaphoresis, pale
The brain has to have constant supply because it stores nothing
What is an example of a K+ sparing diuretic
Aldactone
What are some characteristics of Aldactone
Act on collecting duct
Weak diuretic
Does NOT deplete potassium
Long term maintenance only
Who is somebody you would use a K+ sparing diuretic on
Cardiac pts or renal failure
They already have something major going on. Trying to control electrolytes
What do ARBs deal with?
Afterload
What is the most potent vasoconstrictor in the body
Angiotension II
Suffix for ARBs
saratan
Who is somebody you would give ACE inhibitor to?
Diabetics to protect their kidney
Even when BP is normal they are given in a protective way
Suffix for Ace inhibitor
pril
Side effects of ACE inhibitor
Dry cough, K+ retention
What do beta blockers deal with
Afterload
They block effects of increased workload on the heart
What may sudden withdraw of beta blockers cause
Rebound HTN
What do calcium channel blockers deal with
Afterload
They cause vasodilation by decreasing entry of Ca and relaxing smooth muscle cells that surround the arteries
Common side effect of calcium channel blockers
Constipation
How long does it take to see a drop in BP after taking a oral dose of a calcium channel blocker
30 min
What could hypertensive crisis lead to
Massive heart attack or stroke from high pressure
What is a lab test that you could see increased with a dehydrated patient
BUN
Normal BUN
10-20
Normal Creatinine
Less than 2
Normal Serum potassium
3.5-5.5
What are symptoms of hypertensive crisis related to
Perfusion
BP to be classified as a hypertensive crisis
SBP > 250
DBP > 140
Characteristics of hypertensive crisis
Severe headache or dizziness Confusion/seizure/coma Blurred vision Nausea or vomiting Chest pain / sob Epitaxis
What are foods high in potassium
Bananas and dark green leafy vegetables
Drug of choice for hypertensive crisis? How do you give it?
Nipride
Given slowly because you want to slowly reduce the high pressure. The brain cannot handle huge changes in pressure
What are two important things to remember about treating a patient in a hypertensive crisis
Give everything through an IV and get oxygen on immediately
Also, have crash cart ready
