Hypertension

Question 1

The heart is driven by the ___ node

Answer 1

SA

Question 2

How is the heart affected by external factors?

Answer 2

Stress, exercise, diet, hormones, drugs

Question 3

3 forms of circulation

Answer 3

Systemic, pulmonary, coronary

Question 4

Systemic circulation role

Answer 4

Largest loop. Provides oxygen and nutrients to tissues.

Removes waste products of metabolism, growth, and repair.

Question 5

Pulmonary circulation role

Answer 5

Removes Co2, re oxygenates RBC

Question 6

Coronary circulation role

Answer 6

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

Question 7

Blood pressure is referring to what?

Answer 7

Arterial pressure of systemic circulation

Question 8

Perfusion

Answer 8

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

Question 9

Arterial pressure (blood pressure) is directly related to:

Answer 9

Cardiac output and peripheral resistance.

Question 10

Peripheral resistance

Answer 10

Resistance heart encounters when pumping blood out of heart.

Question 11

Cardiac output

Answer 11

Blood pumped throughout the body in 1 minute.

Question 12

Cardiac output is directly related to?

Answer 12

Stroke volume and HR

Question 13

Stroke volume is directly related to?

Answer 13

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

Question 14

Stroke volume

Answer 14

Volume of blood ejected from the ventricle.

Question 15

Peripheral resistance is directly related to:

Answer 15

Vascular structure and function.

Question 16

Blood pressure generation depends on which factors

Answer 16

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

Question 17

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

Answer 17

HR And SV

Question 18

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

Answer 18

Vessel diameter, length, integrity. Blood viscosity.

Question 19

What extrinsic factors contribute to blood pressure?

Answer 19

Diet
Exercise
Emotional state
sleep 
drugs
alcohol 
stress
*disease
*Obesity

Question 20

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

Answer 20

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

Question 21

Normal blood pressure for adults

Answer 21

90-119/60-79

Question 22

Diurnal variation of blood pressure

Answer 22

Highest in afternoon.

Lowest at night/during sleep.

Question 23

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

Answer 23

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

Question 24

Hypertension

Answer 24

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

Question 25

Spread of HTN in the population

Answer 25

Middle age more prevalent than middle age women | Older women more prevalent than older men

Question 26

5 blood pressure categories

Answer 26

``` 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 ```

Question 27

HTN is a key risk factor for

Answer 27

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

Question 28

How does CVD relate to HTN

Answer 28

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

Question 29

Primary essential hypertension - What percentage of cases? - What causes it? - Associated factors?

Answer 29

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

Question 30

3 systems that might contribute to primary HTN

Answer 30

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.

Question 31

How can elevated Bp head to Heart failure

Answer 31

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

Question 32

Arteriosclerosis

Answer 32

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

Question 33

Arteriolosclerosis

Answer 33

Hardening of the arterioles with thickening and narrowing or arteriole lumen

Question 34

Atherosclerosis

Answer 34

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

Question 35

How an angiotensin II cause damage to blood vessel walls?

Answer 35

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

Question 36

HTN Treatment

Answer 36

Goal is to get BP below 130/80 ``` Modify lifestyle: Stop smoking Weight control Sodium restriction Alcohol restriction Diet changes Reduce stress Exercise ```

Question 37

White coat HTN

Answer 37

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

Question 38

Secondary hypertension - How many cases - Cause?

Answer 38

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.

Question 39

Hypertensive Urgency - Criteria - Symptoms - How to proceed?

Answer 39

- 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.

Question 40

Hypertensive emergency - Criteria - Symptoms - How to proceed? - Potential complications

Answer 40

- 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

Question 41

Why is the retina the target organ for HTN?

Answer 41

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

Question 42

__% increased risk of stroke with mild HTN retinopathy | __% increased risk of stroke with severe HTN retinopathy

Answer 42

35% | 137%

Question 43

Grade 1 of HTN retinopathy

Answer 43

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

Question 44

Grade 2 of HTN retinopathy

Answer 44

Grade 1 and Tortuosity venules AV crossings

Question 45

Grade 3 of HTN retinopathy

Answer 45

Previous signs Flame shape retinal hemorrhages Cotton wool spots

Question 46

Grade 4 of HTN retinopathy

Answer 46

Previous signs Swelling of optic disc Retinal edema Macular star

Question 47

Signs of chronic hypertensive retinopathy

Answer 47

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

Question 48

Acute malignant hypertensive retinopathy

Answer 48

``` Usually associated with secondary HTN Retinal edema CWS Flame shaped hems Macular Star ONH edema ```

Question 49

If HTN signs are unilateral, suspect

Answer 49

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