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Med Path Fall 2020 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

The heart is driven by the ___ node

A

SA

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2
Q

How is the heart affected by external factors?

A

Stress, exercise, diet, hormones, drugs

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3
Q

3 forms of circulation

A

Systemic, pulmonary, coronary

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4
Q

Systemic circulation role

A

Largest loop. Provides oxygen and nutrients to tissues.

Removes waste products of metabolism, growth, and repair.

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5
Q

Pulmonary circulation role

A

Removes Co2, re oxygenates RBC

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6
Q

Coronary circulation role

A

Smallest loop. Circulates hormones and immune system components. Regulates body temp.

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7
Q

Blood pressure is referring to what?

A

Arterial pressure of systemic circulation

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8
Q

Perfusion

A

Constant blood flow to vital organs. Heart, brain, and kidneys. Without constant blood flow, death will occur.

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9
Q

Arterial pressure (blood pressure) is directly related to:

A

Cardiac output and peripheral resistance.

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10
Q

Peripheral resistance

A

Resistance heart encounters when pumping blood out of heart.

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11
Q

Cardiac output

A

Blood pumped throughout the body in 1 minute.

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12
Q

Cardiac output is directly related to?

A

Stroke volume and HR

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13
Q

Stroke volume is directly related to?

A

Myocardial contractility and size of vascular compartment (how much blood is in the body)

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14
Q

Stroke volume

A

Volume of blood ejected from the ventricle.

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15
Q

Peripheral resistance is directly related to:

A

Vascular structure and function.

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16
Q

Blood pressure generation depends on which factors

A

Intrinsic (cardiac output and peripheral resistance) and extrinsic factors such as diet, disease, obesity.

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17
Q

How does CO contribute to blood pressure as an intrinsic factor?

A

HR And SV

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18
Q

How does peripheral resistance contribute to blood pressure as an intrinsic factor?

A

Vessel diameter, length, integrity. Blood viscosity.

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19
Q

What extrinsic factors contribute to blood pressure?

A 
Diet
Exercise
Emotional state
sleep 
drugs
alcohol 
stress
*disease
*Obesity
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20
Q

Normal heart rates (beat per min) for adult, children, and infants.

A

Adult: 60-80
Child: 80-100
Infant: 100-120

21
Q

Normal blood pressure for adults

A

90-119/60-79

22
Q

Diurnal variation of blood pressure

A

Highest in afternoon.

Lowest at night/during sleep.

23
Q

Six things to keep in mind while taking BP on a patient

A 
Correct cuff size 
Put cuff on bare arm 
Have support for arm
Legs uncrossed
Support back/feet 
Empty bladder
Don't talk
24
Q

Hypertension

A

Chronic, elevated pressure.
Average 2 or more readings over 2 or more visits.
Systolic: Over 130
Diastolic: Over 80

25
Q

Spread of HTN in the population

A

Middle age more prevalent than middle age women

Older women more prevalent than older men

26
Q

5 blood pressure categories

A 
Normal: less than 120/80
Elevated: 120-129/less than 80 
Stage 1: 130-139/80-89
Stage 2: 140-159/90-99 
Hypertensive crisis: Higher than 180/higher than 120
27
Q

HTN is a key risk factor for

A

Stroke,* MI, heart failure, kidney disease, retinopathy, peripheral artery disease

28
Q

How does CVD relate to HTN

A

CVD risk doubles for every 20/10 increase above 115/75

29
Q

Primary essential hypertension

  • What percentage of cases?
  • What causes it?
  • Associated factors?
A

95% of cases
Lots of factors contribute- unknown etiology
Age, sex, race, family Hx, smoking, obesity, diabetes, diet

30
Q

3 systems that might contribute to primary HTN

A
  1. Autonomic system being over stimulated or hyper responsive.
  2. RAAS system not working properly
  3. Abnormal salt handling. Increased intracellular sodium levels or increased sensitivity to sympathetic stimulation.
31
Q

How can elevated Bp head to Heart failure

A

Elevated BP–> arteriolosclerosis (hardening/narrowing of arterioles) –> Reduced profusion leads to target organ damage due to ischemia –> Left ventricle hypertrophy due to increased peripheral resistance. Heart must work harder to get blood to organs –> heart failure

32
Q

Arteriosclerosis

A

Thickening and narrowing of arteries due to age, HTN, DM.
Loss of elasticity in vessels.
Umbrella term

33
Q

Arteriolosclerosis

A

Hardening of the arterioles with thickening and narrowing or arteriole lumen

34
Q

Atherosclerosis

A

Arteriosclerosis (thickening and narrowing of arteries) with deposition of cholesterol in artery walls.

35
Q

How an angiotensin II cause damage to blood vessel walls?

A

Induces endothelial wall contraction, allowing plasma to leak through into inter endothelial spaces. Plasma deposits in the vessel wall may cause necrosis.

36
Q

HTN Treatment

A

Goal is to get BP below 130/80

Modify lifestyle: 
Stop smoking
Weight control 
Sodium restriction
Alcohol restriction
Diet changes
Reduce stress
Exercise
37
Q

White coat HTN

A

Not actually HTN
Increase up to 20/10 above pt’s normal BP
Monitor BP at home.

38
Q

Secondary hypertension

  • How many cases
  • Cause?
A

5-10%
Etiology can be identified: usually due to disease that alters hormone levels or pregnancy.
-Renal disease
-Cushings
-Hyperthyroidism
-Pregnancy may cause preeclampsia in 3rd trimester.

39
Q

Hypertensive Urgency

  • Criteria
  • Symptoms
  • How to proceed?
A
  • Greater than 180/120
  • No end organ damage
  • Symptoms are variable: headache, severe anxiety
  • Dont discontinue exam. But need to do something soon. Have them seen within the next day or two.
40
Q

Hypertensive emergency

  • Criteria
  • Symptoms
  • How to proceed?
  • Potential complications
A
  • greater than 180/120.
  • End organ damage
  • Symptoms variable. Chest pain, shortness of breath, difficulty speaking.
  • Immediate hospitalization.
  • Potential complications: Stroke, pulmonary edema.

80% 1 year mortality rate without tx

41
Q

Why is the retina the target organ for HTN?

A

First sign: Retina microvascular changes. Tissues become ischemic/hypoxic. Gradual reduction of blood flow to retina.

42
Q

__% increased risk of stroke with mild HTN retinopathy

__% increased risk of stroke with severe HTN retinopathy

43
Q

Grade 1 of HTN retinopathy

A

Narrowing of arterioles
Decrease A/V ratio
Increase ALR (size of lumen is changing)

44
Q

Grade 2 of HTN retinopathy

A

Grade 1 and
Tortuosity venules
AV crossings

45
Q

Grade 3 of HTN retinopathy

A

Previous signs
Flame shape retinal hemorrhages
Cotton wool spots

46
Q

Grade 4 of HTN retinopathy

A

Previous signs
Swelling of optic disc
Retinal edema
Macular star

47
Q

Signs of chronic hypertensive retinopathy

A 
Arterial macro aneurysms (ruptures of arterioles) 
Flame hems
CRVO, BRVO
CRAO, BRAO 
Choroidal infarction
48
Q

Acute malignant hypertensive retinopathy

A 
Usually associated with secondary HTN
Retinal edema
CWS
Flame shaped hems
Macular Star
ONH edema
49
Q

If HTN signs are unilateral, suspect

A

carotid artery obstruction on the side of the normal appearing eye.

Med Path Fall 2020 (20 decks)

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