Hypertension

Question 1

What is chronotropy?

Answer 1

The change in heart rate by an increase or decrease in the firing of the SA node

Question 2

What controls the SA node?

Answer 2

Pacemaker cells controlled by the autonomic nervous system

Question 3

What is dromotropy?

Answer 3

Changes in conduction velocity in the pacemaker cells at the AV node

Question 4

What is inotropy?

Answer 4

The force of cardiac contractions

Question 5

What factors influence inotropy?

Answer 5

preload, afterload, free cytosolic calcium, and norepinephrine from the sympathetic nervous system

Question 6

What is preload?

Answer 6

The end diastolic volume

Question 7

What happens to sarcomere length as preload increases?

Answer 7

It increases (like a rubberband) which increase contractility

Question 8

What is the mechanism that states end diastolic volume increases contractility?

Answer 8

The Frank Starling Mechanism

Question 9

What is afterload?

Answer 9

The pressure of the aorta that the heart has to overcome to pump blood into systemic circulation

Question 10

What is the responsibility of an artery?

Answer 10

To transition blood from a pulsatile flow into a smooth, continuous flow

Question 11

What is the greatest pressure exerted on arteries?

Answer 11

Systolic blood pressure (affected by cardiac output)

Question 12

What is the lowest pressure exerted on arteries?

Answer 12

Diastolic blood pressure (affected by elasticity)

Question 13

What is pulse pressure?

Answer 13

The difference between systolic and diastolic blood pressure?

Question 14

What is the significance of a wide pulse pressure?

Answer 14

It shows decreased elasticity or increased stiffness

Question 15

What is the mean arterial pressure?

Answer 15

The average blood pressure over time, usually set at 100 mmHg

Question 16

What are the catecholamines?

Answer 16

NE, DA, and EPI

Question 17

Which catecholamine is most important in hypertension?

Answer 17

Norepinephrine

Question 18

Where are alpha 1 receptors located?

Answer 18

In the heart and vasculature

Question 19

What do alpha 1 receptors do in the heart?

Answer 19

Increase inotropy

Question 20

What do alpha 1 receptors do in the vasculature?

Answer 20

Cause vasoconstriction of smooth muscle

Question 21

Where are alpha 2 receptors located?

Answer 21

In the brain and sympathetic nerve endings as well as the kidneys

Question 22

What do alpha 2 receptors do in the brain and nerve endings?

Answer 22

They inhibit the release of NE

Question 23

What do alpha 2 receptors do in the kidneys?

Answer 23

Inhibit the release of renin

Question 24

Where are beta 1 receptors located?

Answer 24

In the heart and kidneys

Question 25

What do beta 1 receptors do in the heart?

Answer 25

Increase heart rate, contractility, cell growth, and hypertrophy

Question 26

What do beta 2 receptors do in the kidneys?

Answer 26

stimulate the release of renin

Question 27

Where are beta 2 receptors located?

Answer 27

On the bronchial smooth muscle

Question 28

What do beta 2 receptors do?

Answer 28

Relax bronchial smooth muscle

Question 29

What controls renin release from the kidney?

Answer 29

1. Renal baroreceptors 2. Macula densa 3. Sympathetic outflow 4. Humoral factors

Question 30

What is the rate limiting step in the RAAS system?

Answer 30

The production of renin

Question 31

What does renin do?

Answer 31

It converts angiotensin into angiotensin 1

Question 32

What does angiotensin converting enzyme do?

Answer 32

Converts angiotensin 1 into angiotensin 2

Question 33

What does angiotensin 2 do?

Answer 33

It acts on two different receptors to increase blood pressure

Question 34

What does angiotensin 2 do on the AT1 receptor?

Answer 34

1. Vasoconstricts 2. Secretes aldosterone 3. Increases sodium reabsorption 4. Releases ADH 5. Stimulates formation of superoxide to deactivate NO

Question 35

What does angiotensin 2 to on the AT2 receptor?

Answer 35

Antagonizes the effects of AT1

Question 36

What is the predominant form of hypertension in adolescents and young adults?

Answer 36

Isolated systolic hypertension

Question 37

What is the primary cause of isolated systolic hypertension?

Answer 37

Increased stroke volume

Question 38

What happens to isolated systolic HTN in patients over 50?

Answer 38

The risk increases again due to vascular stiffness (decreased elastin, increased collagen, and calcium deposits)

Question 39

After age 60, what becomes more important in determining IHD?

Answer 39

Systolic blood pressure

Question 40

What is the predominant form of hypertension in those age 20-50?

Answer 40

Diastolic hypertension due to increased vascular resistance and prolonged ejection time

Question 41

Before age 50, what is a good predictor of IHD risk?

Answer 41

Diastolic blood pressure

Question 42

What type of obesity is more closely associated with hypertension?

Answer 42

Central obesity

Question 43

What are several effects related to obesity that contribute to HTN?

Answer 43

1. Insulin resistance 2. Increased fluid volume 3. SNS activation in the muscle and kidneys 4. Leptin resistance 5. Increased RAAS 6. Inflammation

Question 44

What is one common cause of RESISTANT hypertension?

Answer 44

Sleep apnea

Question 45

What are the signs and symptoms of hypertension?

Answer 45

Most patients are asymptomatic, some present with headache, fatigue, and visual changes. All present with elevated BP.

Question 46

What is resistant hypertension?

Answer 46

The inability to reach BP goals with 3 or more antihypertensive agents including a diuretic

Question 47

What is masked hypertension?

Answer 47

BP appears fine in the office but is high at home

Question 48

What is whitecoat hypertension?

Answer 48

BP is high in the office but appears fine at home

Question 49

What is secondary hypertension?

Answer 49

Hypertension secondary to a known cause (rare)

Question 50

When should you screen for secondary hypertension?

Answer 50

1. Resistant HTN 2. Extremely elevated BP of abrupt onset 3. Young patients <30 4. End-organ damage not consistent with BP levels