Hypertension Flashcards
The heart is driven by the ___ node
SA
How is the heart affected by external factors?
Stress, exercise, diet, hormones, drugs
3 forms of circulation
Systemic, pulmonary, coronary
Systemic circulation role
Largest loop. Provides oxygen and nutrients to tissues.
Removes waste products of metabolism, growth, and repair.
Pulmonary circulation role
Removes Co2, re oxygenates RBC
Coronary circulation role
Smallest loop. Circulates hormones and immune system components. Regulates body temp.
Blood pressure is referring to what?
Arterial pressure of systemic circulation
Perfusion
Constant blood flow to vital organs. Heart, brain, and kidneys. Without constant blood flow, death will occur.
Arterial pressure (blood pressure) is directly related to:
Cardiac output and peripheral resistance.
Peripheral resistance
Resistance heart encounters when pumping blood out of heart.
Cardiac output
Blood pumped throughout the body in 1 minute.
Cardiac output is directly related to?
Stroke volume and HR
Stroke volume is directly related to?
Myocardial contractility and size of vascular compartment (how much blood is in the body)
Stroke volume
Volume of blood ejected from the ventricle.
Peripheral resistance is directly related to:
Vascular structure and function.
Blood pressure generation depends on which factors
Intrinsic (cardiac output and peripheral resistance) and extrinsic factors such as diet, disease, obesity.
How does CO contribute to blood pressure as an intrinsic factor?
HR And SV
How does peripheral resistance contribute to blood pressure as an intrinsic factor?
Vessel diameter, length, integrity. Blood viscosity.
What extrinsic factors contribute to blood pressure?
Diet Exercise Emotional state sleep drugs alcohol stress *disease *Obesity
Normal heart rates (beat per min) for adult, children, and infants.
Adult: 60-80
Child: 80-100
Infant: 100-120
Normal blood pressure for adults
90-119/60-79
Diurnal variation of blood pressure
Highest in afternoon.
Lowest at night/during sleep.
Six things to keep in mind while taking BP on a patient
Correct cuff size Put cuff on bare arm Have support for arm Legs uncrossed Support back/feet Empty bladder Don't talk
Hypertension
Chronic, elevated pressure.
Average 2 or more readings over 2 or more visits.
Systolic: Over 130
Diastolic: Over 80
Spread of HTN in the population
Middle age more prevalent than middle age women
Older women more prevalent than older men
5 blood pressure categories
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
HTN is a key risk factor for
Stroke,* MI, heart failure, kidney disease, retinopathy, peripheral artery disease
How does CVD relate to HTN
CVD risk doubles for every 20/10 increase above 115/75
Primary essential hypertension
- What percentage of cases?
- What causes it?
- Associated factors?
95% of cases
Lots of factors contribute- unknown etiology
Age, sex, race, family Hx, smoking, obesity, diabetes, diet
3 systems that might contribute to primary HTN
- Autonomic system being over stimulated or hyper responsive.
- RAAS system not working properly
- Abnormal salt handling. Increased intracellular sodium levels or increased sensitivity to sympathetic stimulation.
How can elevated Bp head to Heart failure
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
Arteriosclerosis
Thickening and narrowing of arteries due to age, HTN, DM.
Loss of elasticity in vessels.
Umbrella term
Arteriolosclerosis
Hardening of the arterioles with thickening and narrowing or arteriole lumen
Atherosclerosis
Arteriosclerosis (thickening and narrowing of arteries) with deposition of cholesterol in artery walls.
How an angiotensin II cause damage to blood vessel walls?
Induces endothelial wall contraction, allowing plasma to leak through into inter endothelial spaces. Plasma deposits in the vessel wall may cause necrosis.
HTN Treatment
Goal is to get BP below 130/80
Modify lifestyle: Stop smoking Weight control Sodium restriction Alcohol restriction Diet changes Reduce stress Exercise
White coat HTN
Not actually HTN
Increase up to 20/10 above pt’s normal BP
Monitor BP at home.
Secondary hypertension
- How many cases
- Cause?
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.
Hypertensive Urgency
- Criteria
- Symptoms
- How to proceed?
- 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.
Hypertensive emergency
- Criteria
- Symptoms
- How to proceed?
- Potential complications
- 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
Why is the retina the target organ for HTN?
First sign: Retina microvascular changes. Tissues become ischemic/hypoxic. Gradual reduction of blood flow to retina.
__% increased risk of stroke with mild HTN retinopathy
__% increased risk of stroke with severe HTN retinopathy
35%
137%
Grade 1 of HTN retinopathy
Narrowing of arterioles
Decrease A/V ratio
Increase ALR (size of lumen is changing)
Grade 2 of HTN retinopathy
Grade 1 and
Tortuosity venules
AV crossings
Grade 3 of HTN retinopathy
Previous signs
Flame shape retinal hemorrhages
Cotton wool spots
Grade 4 of HTN retinopathy
Previous signs
Swelling of optic disc
Retinal edema
Macular star
Signs of chronic hypertensive retinopathy
Arterial macro aneurysms (ruptures of arterioles) Flame hems CRVO, BRVO CRAO, BRAO Choroidal infarction
Acute malignant hypertensive retinopathy
Usually associated with secondary HTN Retinal edema CWS Flame shaped hems Macular Star ONH edema
If HTN signs are unilateral, suspect
carotid artery obstruction on the side of the normal appearing eye.