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Cardio > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is chronotropy?

A

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

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2
Q

What controls the SA node?

A

Pacemaker cells controlled by the autonomic nervous system

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3
Q

What is dromotropy?

A

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

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4
Q

What is inotropy?

A

The force of cardiac contractions

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5
Q

What factors influence inotropy?

A

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

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6
Q

What is preload?

A

The end diastolic volume

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7
Q

What happens to sarcomere length as preload increases?

A

It increases (like a rubberband) which increase contractility

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8
Q

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

A

The Frank Starling Mechanism

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9
Q

What is afterload?

A

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

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10
Q

What is the responsibility of an artery?

A

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

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11
Q

What is the greatest pressure exerted on arteries?

A

Systolic blood pressure (affected by cardiac output)

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12
Q

What is the lowest pressure exerted on arteries?

A

Diastolic blood pressure (affected by elasticity)

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13
Q

What is pulse pressure?

A

The difference between systolic and diastolic blood pressure?

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14
Q

What is the significance of a wide pulse pressure?

A

It shows decreased elasticity or increased stiffness

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15
Q

What is the mean arterial pressure?

A

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

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16
Q

What are the catecholamines?

A

NE, DA, and EPI

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17
Q

Which catecholamine is most important in hypertension?

A

Norepinephrine

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18
Q

Where are alpha 1 receptors located?

A

In the heart and vasculature

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19
Q

What do alpha 1 receptors do in the heart?

A

Increase inotropy

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20
Q

What do alpha 1 receptors do in the vasculature?

A

Cause vasoconstriction of smooth muscle

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21
Q

Where are alpha 2 receptors located?

A

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

22
Q

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

A

They inhibit the release of NE

23
Q

What do alpha 2 receptors do in the kidneys?

A

Inhibit the release of renin

24
Q

Where are beta 1 receptors located?

A

In the heart and kidneys

25
Q

What do beta 1 receptors do in the heart?

A

Increase heart rate, contractility, cell growth, and hypertrophy

26
Q

What do beta 2 receptors do in the kidneys?

A

stimulate the release of renin

27
Q

Where are beta 2 receptors located?

A

On the bronchial smooth muscle

28
Q

What do beta 2 receptors do?

A

Relax bronchial smooth muscle

29
Q

What controls renin release from the kidney?

A
  1. Renal baroreceptors
  2. Macula densa
  3. Sympathetic outflow
  4. Humoral factors
30
Q

What is the rate limiting step in the RAAS system?

A

The production of renin

31
Q

What does renin do?

A

It converts angiotensin into angiotensin 1

32
Q

What does angiotensin converting enzyme do?

A

Converts angiotensin 1 into angiotensin 2

33
Q

What does angiotensin 2 do?

A

It acts on two different receptors to increase blood pressure

34
Q

What does angiotensin 2 do on the AT1 receptor?

A
  1. Vasoconstricts
  2. Secretes aldosterone
  3. Increases sodium reabsorption
  4. Releases ADH
  5. Stimulates formation of superoxide to deactivate NO
35
Q

What does angiotensin 2 to on the AT2 receptor?

A

Antagonizes the effects of AT1

36
Q

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

A

Isolated systolic hypertension

37
Q

What is the primary cause of isolated systolic hypertension?

A

Increased stroke volume

38
Q

What happens to isolated systolic HTN in patients over 50?

A

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

39
Q

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

A

Systolic blood pressure

40
Q

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

A

Diastolic hypertension due to increased vascular resistance and prolonged ejection time

41
Q

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

A

Diastolic blood pressure

42
Q

What type of obesity is more closely associated with hypertension?

A

Central obesity

43
Q

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

A
  1. Insulin resistance
  2. Increased fluid volume
  3. SNS activation in the muscle and kidneys
  4. Leptin resistance
  5. Increased RAAS
  6. Inflammation
44
Q

What is one common cause of RESISTANT hypertension?

A

Sleep apnea

45
Q

What are the signs and symptoms of hypertension?

A

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

46
Q

What is resistant hypertension?

A

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

47
Q

What is masked hypertension?

A

BP appears fine in the office but is high at home

48
Q

What is whitecoat hypertension?

A

BP is high in the office but appears fine at home

49
Q

What is secondary hypertension?

A

Hypertension secondary to a known cause (rare)

50
Q

When should you screen for secondary hypertension?

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

Cardio (11 decks)

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