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Block 4: Pathophys > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Blood flow through vessels is normally laminar (layered, straight) except when flow rate is ____ or the vessel surface is not straight or smooth

A

high

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2
Q

what affects laminar flow?

A

Blood viscosity

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3
Q

high viscosity does what to laminar flow?

A

loss of laminar flow

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4
Q

High velocity / turbulent blood flow activates __________ (prothrombotic, adhesion molecule expression, etc.)

A

endothelial cells

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5
Q

Blood flow varies directly and resistance varies inversely to the vessel _____.

A

radius

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6
Q

Small changes in vessel radius (diameter) have large effects on what two things?

A

flow and resistance

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7
Q

Blood flow varies inversely and resistance varies directly to ____.

A

blood viscosity

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8
Q

________ (anemia) reduces vascular resistance and increases blood flow while elevated Hct (polycythemia) increases does the opposite

A

Reduced Hct

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9
Q

_______ (e.g., starvation) reduces vascular resistance and increases blood

A

Hypoproteinemia

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10
Q

_______ (e.g., multiple myeloma) reduces blood flow

A

hyperproteinemia

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11
Q

elevated Hct (polycythemia) increases _____ and decreases blood flow

A

vascular resistance

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12
Q

As _______ falls in vessels, flow ceases because vessels collapse due to surrounding tissue pressure and vessel wall resistance to compression (capillaries and small veins > small arteries) – called the critical closing pressure

A

perfusion pressure

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13
Q

what happens when perfusion pressure falls in vessels?

A

flow ceases because vessels collapse due to surrounding tissue pressure and vessel wall resistance to compression

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14
Q

The smaller the diameter of a vessel (artery, arteriole, or other chamber, like a ventricle), the smaller the ___ required to reduce the vessel radius (e.g., to increase vascular resistance or to eject blood from a chamber)

A

force

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15
Q

_______ is determined by the perfusion pressure (mean arterial pressure – venous pressure) and vascular resistance

A

Tissue perfusion

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16
Q

how is Tissue perfusion determined?

A

by the perfusion pressure (mean arterial pressure – venous pressure) and vascular resistance

Tissue perfusion = perfusion pressure / vascular resistance

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17
Q

If vascular resistance increases (e.g., arteriolar constriction), perfusion pressure must do what?

A

increase to the same degree to maintain tissue perfusion

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18
Q

If venous pressure increases (e.g., right heart failure), perfusion pressure falls, so without decreasing vascular resistance, tissue perfusion will do what?

A

will also decrease

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19
Q

_____ is a function of cardiac output and peripheral vascular resistance

A

blood pressure

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20
Q

when are the naturetic peptides released?

A

released with cardiac stretch

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21
Q

The naturetic peptides (e.g., BNP), released with cardiac stretch, cause what 2 things to happen?

A

peripheral vasodilation

renal Na+ and water loss

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22
Q

_______ (released with slow flow through nephron) transforms angiotensinogen to angiotensin 1, which is transformed to angiotensin 2 by endothelial cells

A

Renin

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23
Q

what cells transform angiotensin I to angiotensin II?

A

endothelial cells

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24
Q

_______ causes vasoconstriction and triggers aldosterone release

A

Angiotensin 2

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25
Q

_______ results in renal Na+ and water reabsorption

A

Aldosterone

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26
Q

In BP regulation, there is _____ and ______ regulation of cardiac output and vascular tone

A

Central and autonomic regulation of cardiac output and vascular tone

27
Q

_______ in carotid sinus and aortic arch send feedback to medulla oblongata

A

baroreceptors

28
Q

Low blood pressure (reduced stretch) stimulates sympathetic feedback, causing what two things to occur?

A

peripheral vasoconstriction,

increased cardiac output

(↑SA node pacing, ↓AV node delay, ↑ contractility)

29
Q

High blood pressure stimulates parasympathetic and inhibits sympathetic feedback, which reduces ______

A

reduces cardiac output

↓SA node pacing, ↑AV node delay

30
Q

High blood pressure stimulates ________ nervous system

A

parasympathetic

31
Q

low blood pressure stimulates ________ nervous system

A

sympathetic

32
Q

do veins or arteries have highest compliance?

A

veins

33
Q

do veins or arteries have the largest volume within the vascular system?

A

veins

34
Q

Veins have highest compliance (stretch) and the largest volume within the vascular system so they are called “______ vessels”

A

capacitance

35
Q

Small arteries and arterioles have a small volume and the greatest ability to forcefully constrict, so they are called “______ vessels”

A

resistance

36
Q

do veins or arteries have the greatest ability to forcefully constrict?

A

arteries

37
Q

Vessel pressure below heart level is increased and above heart level is decreased by the effect of ____

A

gravity

38
Q

Vessel pressure below heart level is ______.

A

increased

39
Q

Vessel pressure above heart level is ______

A

decreased

40
Q

In an upright position, when the mean arterial pressure at heart level is constant, the mean pressure in a large artery in the head will be lower and the pressure in a large artery in the foot will be_______.

A

increased

41
Q

hypotension is generally defined as BP less than?

A

BP < 90/60

42
Q

when should you be concerned about hypotension?

A

when pt is symptomatic

43
Q

hypotension is Caused by inadequate ___, ____. or_____?

A

cardiac output (e.g., heart failure, AMI, medications),

inadequate peripheral resistance (e.g., CNS, endocrine or other effect on vascular resistance, medications), or

inadequate blood volume (e.g., hypovolemia)

44
Q

examples of Hypotension Acute symptoms primarily related to CNS dysfunction caused by hypoxia

A

lightheadedness, dizziness, syncope, seizure

45
Q

Severe hypotension associated with what?

A

shock, multiple system organ failure (kidney, GI tract frequently first affected)

46
Q

A syndrome associated with elevated blood pressure is known as _____

A

HTN

47
Q

secondary causes of hypertension (4)

A
  1. Renal: Acute glomerulonephritis, chronic renal disease, polycystic disease, renal artery stenosis, renal vasculitis, renin-producing tumors
  2. Endocrine: Pheochromocytoma, acromegaly, adrenocortical hyperfunction (e.g., Cushing, primary aldosteronism), exogenous hormones (e.g., estrogen, glucocorticoids), hypo and hyperthyroidism, pregnancy
  3. Cardiovascular: Coarctation of the aorta, polyarteritis nodosa, increased intravascular volume, increased cardiac output, arteriosclerosis
  4. Neurologic: Psychogenic, increased intracranial pressure, sleep apnea, acute stress (physical and psychological)
48
Q

primary hypertension accounts for what percentage of HTN diagnoses?

A

90-95%

49
Q

what is considered elevated BP in adults?

A

systolic: 120–129 mm Hg
diastolic: <80 mm Hg

50
Q

what is considered stage 1 HTN in adults?

A

systolic: 130–139 mm Hg
diastolic: 80–89 mm Hg

51
Q

what is considered stage 2 HTN in adults?

A

systolic: ≥140 mm Hg
diastolic: ≥90 mm Hg

52
Q

To determine a patients BP, you use have ana average of ___ readings, on ____ different occasions

A

based on an average of ≥2 careful readings obtained on ≥2 occasions

53
Q

HTN is Most frequently caused by increased _______, may also be caused by increased cardiac output (increased HR)

A

peripheral vascular resistance

54
Q

Systolic pressure normally rises throughout life but diastolic pressure rises until age 50-60 and then begins to fall –this is related to loss of _______?

A

arterial recoil (“hardening of the arteries”)

55
Q

Left-Sided Hypertensive Heart Disease is In response to increased intraventricular pressure, the ventricular wall will undergo_____ hypertrophy

A

concentric

56
Q

in Left-Sided Hypertensive Heart Disease, concentric hypertrophy due to increased ______.

A

Due to increased afterload = aortic pressure or resistance to ventricular emptying (e.g., valve stenosis or regurgitation)

57
Q

Hypertrophy reduces what 4 things?

A

ventricular volume, end-diastolic volume, stroke volume and cardiac output

58
Q

Increased tissue mass increases_______ demand, may precipitate ischemic events and exacerbate IHD

A

oxygen

59
Q

Increased tissue mass increases oxygen demand, this may precipitate/exacerbate what two things?

A

may precipitate ischemic events and exacerbate IHD

60
Q

Left-Sided Hypertensive Heart Disease May be caused by ____ stenosis (increased afterload), or may cause _____stenosis (valve injury)

A

aortic

May be caused by aortic stenosis (increased afterload), or may cause aortic stenosis (valve injury)

61
Q

Right-Sided Hypertensive Heart Disease is Characterized by ?

A

right ventricular hypertrophy, dilation, and potential heart failure

62
Q

what is Right-Sided Hypertensive Heart Disease usually caused by?

A

Usually caused by disorders of the pulmonary vasculature or left ventricular heart failure resulting in increased right ventricular diastolic and systolic pressure

63
Q

Right ventricular hypertrophy due to pulmonary hypertension is called _______.

A

Cor Pulmonale

Block 4: Pathophys (5 decks)

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