Hypertension and shock

Question 1

How does the RAAS system react to a drop in BP?

Answer 1

kidney releases renin

Renin breaks down angiotensinogen into ANG1

ACE converts ANG1 –> ANG2

ANG2 –> vasoconstriction of blood vessels

Question 2

How does ANG2 restore BP?

Answer 2

a) Vasocontraction via PVR

b) Increased Blood volume using ADH and aldosterone

Question 3

what is the role of ADH, ANG2 and Aldosterone in BP restoration?

Answer 3

1- ANG2 –> ADH release –> increased water reabsorption –> increased blood V – increased Arterial Pressure

2. ANG2 –> aldosterone secretion –> increased sodium reabsorption –> water reabsorption –> increased BV –> increased arterial pressure

Question 4

How does ANP regulate BP?

Answer 4

Increased BV –> increased BP –> stretches RA wall –> release of ANP –> kidney excretes Na and water in urine –> decreased BV and BP

ADH and Aldosterone release —> SNS activity –> Strech RA relieved –> homeostasis

Question 5

What is hypertension?

Answer 5

Chronic elevation of adult MAP > 100mmHg

SBP >140, DBP> 90

Question 6

What are the consequences of hypertension?

Answer 6

Increased afterload –> heart failure, MI, Ischemia

Damage to cerebral blood vessel follower by cerebral infarct –> stroke

Destruction of renal glomeruli –> renal failure

Question 7

What are the 2 types of hypertension?

Answer 7

Primary/essential: idiopathic: associated w constitutional/ modifiable risk factors

Secondary: secondary to another medical condition or medication

Question 8

What are the non-modifiable risk factors of hypertension?

Answer 8

Conditions w age (atherosclerosis, loss of elasticity)

Less than 65 in men (lack of endogenous oestrogen)

Over 65 in women (hormonal shift)

Reace/family history

Question 9

How is pri hypertension managed?

Answer 9

lifestyle

Weight loss, exercise
Reduced alcohol, fat/ salt (DASH diet)
Quit smoking

Pharmacological

ACE inhibitors
Diuretics
CA2T blockers
a/b receptor blockers
ANG2/aldosterone blockers

Question 10

what value of SBP/SDP = type 3 (severe) hypertension?

Answer 10

SBP > 180
DBP > 110

Question 11

What are the 4 types of shock and what do they include?

Answer 11

Hypovolemia
Haemorrhage or dehydration

Cardiogenic effects
Decreased contractibility, dysrhythmias and heart disease

Obstructive effects
Cardiac tamponade, tension pneumothorax

Distributive effects
Abnormal blood distribution
Sepsis, anaphylaxis and neurogenic changes

Question 12

How does the body respond to Circulatory shock?

Answer 12

compensates via reducing blood flow/ O2 delivery (baroreceptor and chemoreceptor/ RAAS)

Question 13

What are the 3 phases of hypovolemic shock?

Answer 13

Non-progressive
progressive
irreversible

Question 14

Describe non-progressive shock

Answer 14

hypotension does not exceed the capacity of compensatory mechanisms to restore BP

resolves in hrs

• make the patient comfortable
• assess prognosis, cause of shock

Question 15

Describe progressive hypovolemic shock (what and consequnces)

Answer 15

compensatory mechanisms can no longer maintain sufficient BP to prevent cardiovascular deterioration and collapse

reduced perfusion starves the tissues of O2 and nutrients, causing the patient’s condition to deteriorate

Question 16

What are the characteristics of progressive hypovolemic shock?

Answer 16

cardiac depression
vasomotor failure
sludge blood
increased cap permeability
release of toxins from ischemic tissues

Question 17

What do you do for a person in progressive shock?

Answer 17

recovery is entirely dependent on medical interventions