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Anesthesia Practice T3 > Hypertension and Vascular > Flashcards

Hypertension and Vascular Flashcards

1
Q

Whats the equation for MAP?

A

MAP = SVR x CO

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2
Q

How is blood pressure controlled? (3)

A
  • autonomic nervous system
  • renin-angiotension-aldosterone system
  • renal changes
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3
Q

how does the autonomic nervous system control arterial blood pressure?

A

ANS controls arterial blood pressure by:

  • brainstem centrally
  • baroreceptors in the carotid sinus peripherally
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4
Q

in a HYPERtensive state, how will the baroreceptors in the aortic arch and carotid sinus affect vagal tone and sympathetic tone?

A
  • increase vagal tone
  • decrease sympathetic tone
  • to decrease HR and vasodilate
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5
Q

in a HYPOtensive state, how will baroreceptors in the aortic arch and carotid sinus affect vagal and sympathetic tone?

A
  • decrease vagal tone
  • increase sympathetic tone
  • to increase HR, vasoconstriction, and increase contractility
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6
Q

what will activate the renin-angiotensin-aldosterone system?

A
  • hypotension

- decreased sympathetic tone

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7
Q

what will the renin-angiotensin-aldosterone system result in?

A
  • increased vasopressin

- increased angiotensin II

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8
Q

what will angiotensin II do to act as a vasoconstrictor?

A

ATII stimulates aldosterone production, leading to sodium and water reabsorption by the kidneys

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9
Q

what can the renal system do to manipulate arterial blood pressure?

A

control total body sodium and water

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10
Q

what is hypertension?

A

elevation of arterial BP

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11
Q

what can hypertension lead to if uncontrolled?

A

MI, CVA, renal failure and death

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12
Q

goals for hypertensive therapy?

A
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13
Q

what is essential HTN (or primary HTN)?

A

the most common form of hypertension (>90%), not secondary to an underlying cause

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14
Q

what are risk factors for developing hypertension?

A
  • age
  • family history
  • obesity
  • insulin resistance
  • diet and lifestyle
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15
Q

what is secondary hypertension?

A
  • less than 10% of all causes of HTN

- secondary to another cause, often either a renal or endocrine disorders

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16
Q

what renal disorders can lead to secondary hypertension?

A
  • fibromuscular dysplasia

- renal artery stenosis

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17
Q

what endocrine disorders can lead to secondary hypertension?

A
  • pheochromocytoma
  • cushing’s syndrome
  • hyperaldosteronism
  • hyperthyroidism
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18
Q

other than renal and endocrine disorders, what can cause secondary hypertension?

A
  • meds
  • neuro disorders
  • scleroderma
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19
Q

what organs autoregulate blood flow?

A
  • brain
  • heart
  • kidneys
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20
Q

what does it mean for an organ to autoregulate blood flow?

A

the organ can maintain constant blood flow with changing perfusion pressures

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21
Q

chronic hypertension can lead to microvascular changes resulting in what?

A

ischemic strokes

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22
Q

the majority of CVAs occur due to what etiology?

A

ischemia

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23
Q

what can occur as the vasculature becomes less compliant?

A

causing LVH

  • > diastolic dysfunction
  • > angina/MI
  • > heart failure
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24
Q

what can HTN do to the kidneys?

A

causing glomerulal damage

  • -> albuminuria (protein lost in the urine due to impaired kidney function)
  • -> overt renal failure
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25
Q

What are normal creatinine levels?

A

men 0.8-1.3

women 0.6-1.0

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26
Q

HTN emergencies imply what?

A

acute end organ damage

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27
Q

what are some examples of HTN emergencies?

A
  • CVA
  • encephalopathy
  • LV failure
  • MI
  • aortic dissection
  • renal failure
28
Q

what is HTN urgency imply?

A

high blood pressure without signs of end organ damage

29
Q

HTN emergency should be attenuated by…

A

IV anti-hypertensives

BP should be lowered by 20% within 4-6 hours and then gradually normalized over a few days

30
Q

HTN ugency can be attenuated by…

A

PO medications

31
Q

what should be used for HTN PTs with chronic kidney disease (CKD)?

A
  • ACE inhibitor
    or
  • ARB
32
Q

what can be used for general population in treating HTN?

A
  • thiazide diuretic
  • ACE inhibitor or ARB
  • calcium channel blocker
  • black people NO ACE inhibitors or ARB
33
Q

how do thiazide diuretics work?

A
  • HCTZ (hydrochlorothiazide) acts to reduce sodium reabsorption in the distal convuluted tubule, causing water loss
34
Q

how do loop diuretics work?

A

loop diuretics inhibit sodium and chloride reabsorption in the loop of henle leading to water loss, increasing prostaglandin levels.

35
Q

what are two loop diuretics?

A

furosemide

torsemide

36
Q

name two ACE inhibitors

A

lisinopril

enalapril

37
Q

what will ACE inhibitors cause?

A
  • vasodilation
  • vascular smooth muscle relaxation
  • natriuresis
  • decreased vasopressin release
38
Q

what are ARBs? Name two.

A

angiotensin receptor blockers

  • losartan
  • valsartan
39
Q

what do ARBs cause?

A

block the AGII receptor causing:

  • vasodilation
  • vascular smooth muscle relaxation
  • natriuresis
  • decreased vasopressin release
40
Q

what is natriuresis?

A

the process of secreting sodium by the kidneys

41
Q

name two CCBs (calcium channel blockers)

A

amlodipine

nicardipine

42
Q

what do CCBs cause?

A

decreased intracellular Ca2+ causing

  • vasodilation
  • negative inotropy
  • negative chronotropy
  • reduced aldosterone production
43
Q

name the 3 kinds of B receptors

A
  • B1 - heart, kidneys
  • B2 - muscle
  • B3 - adipose tissue
44
Q

what do B blockers cause?

A
  • negative chronotropy
  • negative inotropy
  • antiarrhythmic
  • reduced aldosterone production
  • smooth muscle relaxation
45
Q

would you use B-blockers first for HTN treatment?

A

NO!

46
Q

what are the three layers of the aorta?

A
  • intima
  • media
  • adventilla
47
Q

whats an aneurysm of the aorta?

A

a dilation of the aorta

48
Q

whats the difference between a true and pseudoaneurysm?

A

pseudoaneurysm does not involve all 3 layers of aortic tissue

49
Q

what is the possible etiology of an aortic aneurysm?

A
  • HTN
  • Atherosclerosis
  • collagen vascular disease
  • bicuspid aortic valve
  • syphilis
  • HLD
  • mycotic
  • inflammatory
50
Q

whats an aortic dissection?

A

intimal tear creating a false lumen for blood to enter.

51
Q

What is the DeBakey classification for aortic dissections?

A

I - originating in ascending aorta and extends to aortic arch or further
II - originates and confined to ascending aorta
III - originates in descending aorta

52
Q

what is the Stanford classification for aortic dissections?

A

A - any dissection involving the ascending aorta regardless of origin
B - all other dissections of the aorta

53
Q

what is the possible etiology for aortic dissection?

A
  • HTN
  • collagen vascular disease
  • bicuspid aortic valve
  • inflammatory
  • trauma
  • complication from heart surgery
54
Q

what does carotid artery stenosis primarily involve?

A

the internal carotid arteries, due to atherosclerotic disease

55
Q

intervention is needed in what % of carotid stenosis cases?

A

> 70%

56
Q

What does TIA stand for?

A

transient ischemic attack

57
Q

what are risk factors for CAD?

A
  • HTN
  • HLD
  • DM
  • PAD
  • tobacco use
58
Q

what surgeries can be done for carotid artery disease?

A
  • stenting

- endarterectomy

59
Q

what do the carotid bodies do?

A

act as chemoreceptors to maintain homeostasis during hypoxia.
damage could lead to blunted hypoxic drive and labile BP

60
Q

what do you do if there is a hematoma?

A
  • call for help
  • get a scalpel
  • open the neck
  • hope surgery gets there fast
61
Q

what is raynaud’s?

A

vasoconstriction of the extremeties during cold or stress

  • mostly seen in females
  • may reduce peripheral extremety blood flow
  • maybe related to connective tissue disorders
62
Q

where does deep vein thrombosis (DVT) usually occur?

A

lower extremities

63
Q

how do you treat DVT?

A

anticoagulation and maybe a IVC filter (inferior vena cava)

64
Q

what might need to be done for a pulmonary embolism (PE)?

A

emergency embolectomy

65
Q

what can lead to a thrombus/embolus developing?

A
  • vessel wall injury
  • hypercoagulability
  • stasis (inactivity)

Anesthesia Practice T3 (6 decks)

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