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TCD Cases > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Recall the stages of hypertension as well as their corresponding systolic parameters

A
  1. Grade 1 - 140-159
  2. Grade 2 - 160-179
  3. Grade 3 - >180
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2
Q

What is the main risk of Grade 3 hypertension?

A

Risk of precipitating malignant hypertension

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3
Q

What blood pressure parameters are characteristic of hypertensive urgency?

A

Systolic BP > 180 or diastolic BP > 110

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4
Q

Suggest 4 clinical symptoms that can be associated with hypertensive urgency

A
  1. Epistaxis
  2. Headache
  3. SOB
  4. Severe anxiety
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5
Q

What is the difference between hypertensive urgency and a hypertensive emergency?

A

There is no end organ damage in hypertensive urgency

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6
Q

Suggest 6 symptoms that can be associated with malignant hypertension

A
  1. Chest pain
  2. SOB
  3. Back pain
  4. Numbness/weakness
  5. Visual changes
  6. Difficulty speaking
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7
Q

What is the pathophysiology of encephalopathy in malignant hypertension?

A

Elevate cerebral BP leads to cerebral oedema and in turn raised ICP

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8
Q

What is the ‘QRISK’ calculator used for?

A

To estimate a patient’s 10 year risk of developing cardiovascular disease

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9
Q

Recall the equation used for calculating cardiac output

A

CO = HR * SV

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10
Q

Recall the equation that relates cardiac output and BP

A

BP = CO * PR

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11
Q

Where in the body is angiotensinogen synthesised?

A

Liver

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12
Q

What are the 2 main biochemical consequences of the release of Renin by the kidneys in response to a reduction in blood flow?

A
  1. Conversion of angiotensinogen into angiotensin I

2. Induces secretion of aldosterone

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13
Q

What are principle biochemical effects of aldosterone release?

A

Increased sodium and water reabsorption

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14
Q

Outline the 3 main components of the body’s short term response to changes in blood pressure

A
  1. Central nervous system response
  2. Baroreceptors
  3. Chemoreceptors
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15
Q

From which sections of the spine to sympathetic vasomotor nerve fibres leave the spinal cord?

A

Thoracic and lumber spine

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16
Q

Which vasomotor nerve fibres originate from the vasoconstrictor area?

A

Excitatory preganglionic vasoconstrictor neurons

17
Q

What is the function of the vasodilatory area of the brainstem?

A

Internal inhibition of the vasoconstrictor area

18
Q

The sensory component of the vasomotor area of the brainstem is supplied by which 2 cranial nerves?

A
  1. Vagus

2. Glossopharyngeal

19
Q

Name 4 brain structures that influence the vasomotor centre

A
  1. Reticular substance
  2. Hypothalamus
  3. Cerebral cortex
  4. Cingulate gyrus
20
Q

Define myogenic tone

A

State of muscle tone from the muscle itself i.e. not mediated by the autonomic nervous system or a reaction to a hormonal process

21
Q

Compare the effects of activation of beta adrenoreceptors in the heart and in the peripheral vasculature respectively

A
  1. Heart - increased contractility

2. Peripheral vasculature - reduced contractility

22
Q

Why is dobutamine used in the treatment of heart failure patients?

A

Preferential beta1-adrenoreceptor agonist, thereby increasing cardiac contractility more effectively than pan adrenoreceptor agonists such as adrenaline

23
Q

Describe the conduction pathway between the carotid baroreceptors and the brainstem

A

Hering’s nerve –> Glossopharyngeal nerve –> Tractus solitarius in the brainstem

24
Q

What is the consequence of arterial baroreceptors detecting an abnormal increase in blood pressure?

A

Stimulation of the tracts solitarius leads to inhibition of the vasoconstrictor centre and excitation of the vagal parasympathetic centre

25
Q

What happens in the atrial volume reflex?

A
  1. Atrial stretching due to increased systemic BP leads to reflex dilation of renal afferent arterioles, thus increasing glomerular capillary pressure and increasing the rate of fluid filtration into the renal tubule.
  2. Also leads to reduced secretion of ADH from the hypothalamus
26
Q

What are the 2 components of long term control of BP

A
  1. Renin-aldosterone-angiotensin system

2. Vascular remodelling and contractility

27
Q

Name the 3 cellular components of the juxtaglomerular apparatus

A
  1. Macula densa
  2. Juxtaglomerular cells
  3. Extraglomerular mesangial cells
28
Q

Which cell type allows connection between the glomerular arterioles and the distal convoluted tubule?

A

The extraglomerular mesangial cells as part of the juxtaglomerular apparatus

29
Q

What are the 5 main actions of angiotensin II

A
  1. Increased sympathetic activity
  2. Increased reabsorption of Na and water + increased excretion of K
  3. Stimulates the release of aldosterone from the adrenal cortex
  4. Arteriolar vasoconstriction
  5. Increased secretion of ADH from the posterior pituitary
30
Q

Name the 3 sections of the renal tubule that aldosterone acts on to increase absorption of Na +and excretion of K + and H +

A
  1. Principle cells of the collecting tubules
  2. Distal tubules
  3. Collecting ducts
31
Q

Which biochemical imbalance is associated with primary hyperaldosteronism?

A

Hypokalaemic Alkalosis

32
Q

Outline the 2 main causes of primary hyperaldosteronism

A
  1. Unilateral aldosterone producing adenoma

2. Bilateral adrenal hyperplasia

33
Q

What is synacthen?

A

Synthetic ACTH used in the diagnosis of Addison’s disease

34
Q

What is the systemic effects of adiponectin released by adipose tissue? (3)

A
  1. Glucose regulation
  2. Fatty acid breakdown
  3. Dilation of small arteries
35
Q

Name 3 renal diseases that can cause secondary hypertension

A
  1. Polycystic kidney disease
  2. Glomerular disease
  3. Renovascular disease
36
Q

Name 3 adrenal conditions that can cause secondary hypertension

A
  1. Cushing’s syndrome
  2. Primary aldosteronism
  3. Phaeochromocytoma
37
Q

Name 5 drug types that can cause secondary hypertension

A
  1. Oral contraceptives
  2. NSAIDS
  3. Stimulants (cocaine, methylphenidate)
  4. Calcineurin inhibitors
  5. Antidepressants

TCD Cases (25 decks)

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