Hypertension

Question 1

hypertensive heart disease

Answer 1

old, AA
concentric LVH: diastolic dysfunction (impaired compliance and filling)
myocytes: expanded cytoplasm and enlarged boxcar nuclei
Tx: medical

Question 2

hypertrophic cardiomyopathy

Answer 2

young (genetic)
autosomal dominant: structural protein, beta myosin heavy chain most common
asymmetric hypertrophy of septum, sometimes murmur
can get fibrosis and myocyte disarray
Tx: varies

Question 3

aortic stenosis

Answer 3

old, male
LVH, murmur
cause: calcifications on sinuses of valsalva, rheumatic valvulitis (young-mid adults, fibrosis), bicuspid valve (young-mid adults, calcifications)
Tx: surgical or stent

Question 4

cor pulmonale

Answer 4

acute or chronic pulmonary HTN disease
RVH
cause: lung disease (emphysema, chronic pulmonary embolisms, foreign material from IV drugs, tumor)
chronic: elderly
acute: dilation without hypertrophy
NO angina
Tx: medical

Question 5

types of hypertrophic heart disease

Answer 5

1. hypertensive heart disease
2. hypertorphic cardiomyopathy
3. aortic stenosis
4. cor pulmonale

Question 6

presentation of hypertrophic heart disease

Answer 6

dyspnea, angina, sudden death

all chronic

Question 7

interstitial myocardial fibrosis

Answer 7

TGF-B, hypertrophic heart disease

Question 8

HCOM

Answer 8

hypertrophic obstructive cardiomyopathy
1/3 of of hypertrophic cardiomyopathies
valves meet at bodies rather than tips: anterior leaflet overlap is dragged in front of aorta and obstructs flow into it and get mitral regurgitation
fibrosis: mitral valve and subaortic upper septum
Tx: surgery, inject EtOH into septum to infarct upper hypertrophied part

Question 9

How thick should LV be? RV?

Answer 9

1.5 cm or less

1/3 of LV

Question 10

Why would a person with hypertrophic cardiomyopathy die after an intense workout?

Answer 10

obstruction is relieved by exercise because the heart dilates to accommodate venous return
after exercise myocardial O2 demand remains high, but the dilation subsides causing ischemia and fatal heart arrhythmia

Question 11

normal BP

Answer 11

120/80

Question 12

HTN Tx goals

Answer 12

140/90

older 150/90

Question 13

causes of HTN

Answer 13

most: primary or essential multifactorial: genetic predisposition, salt, alcohol, obesity
secondary: renal disease, excess mineralocorticoids, pheochromocytoma

Question 14

Why is HTN a problem?

Answer 14

leading cause of preventable death

MI, CHF, Stroke, end stage renal disease

Question 15

prehypertension

Answer 15

120-139/80-89

Question 16

stage 1 hypertension

Answer 16

140-159/90-99

Question 17

stage 2 hypertension

Answer 17

> /= 160/100

Question 18

lifestyle changes that Tx HTN

Answer 18

diet, weight loss, exercise

no alcohol or tobacco

Question 19

DASH diet

Answer 19

reduced salt
fruits, vegetables, low fat dairy
as effective as mono therapy drug tx

Question 20

What things are important in obtaining an accurate BP?

Answer 20

1. proper technique: cuff, position, timing, both arms, avoid caffeine and tobacco, device
2. properly record
3. repeat on multiple occasions

Question 21

Causes elevated BP not due to HTN

Answer 21

stress, anxiety, pain, drugs, nicotine, alcohol, caffeine, white coat

Question 22

How do you assess the significance of elevated BP?

Answer 22

1. magnitude of BP
2. end organ damage: heart, brain, kidney, eye, vasculature
3. other CVD risk factors: hyperlipidemia, DM, tobacco, older, male
   obtain: targeted Hx and physical, serum electrolytes, creatine, fasting glucose, fasting lipid panel, Hct, urinalysis (with micro albumin), resting EKG

Question 23

How would you identify secondary causes of HTN?

Answer 23

1. age of onset less than 20 or greater than 50 yrs
2. target organ damage
3. poor response to Tx (3 or more drugs)
4. Fam or personal Hx of renal disease
5. labile pressure with tachycardia, sweating, tremor: pheochromocytoma
6. unprovoked hyopkalemia: hyperaldoseronism
7. abdominal bruit/extensive vascular disease: renal artery stenosis

Question 24

HTN emergency

Answer 24

ongoing end target organ damage, BP >180/120
parenteral drugs: reduce no more than 25% of pretreatment level in 2 hours
gradually reduce over 24 hours to avoid compromising perfusion