Hypertension hypotension syncope Flashcards
” نمت وأدلج الناس” !
Definition of Hypertension
It is a Multifactorial disease due to interaction of environmental and genetic facrtors
Asymptomatic shoulde be repeatedly measurent many times to assure that there is a persisent increase in BP above 140/90 mm Hg
White Coat hypertension define .
ده ارتفاع الضغط بسبب توتر المرض لما شاف الممرض او الدكتور وميعتتبرش مرض ارتفاع ضغط
لانه لازم يتقاس لما يكون العيان مستريح نفسيا
Divisions of Hypertension
Essential hypertension 90%
Secondary Hupertension
Primary hypertension characterized by ?
no detecteble cause ! Runs in families men than females blacks thatn whites environmental factors sedentary life style Bad food intake salt intake psychological stress
Pathophysiology of hyper tension
1- increased cardiac output 2-increased TPR DUE TO VMC 3-Alodsterone and angiotenis2 4-reabsorption of na in kideny 5-Endothelial dysfunction and insulin resisteance
Explain the role of increased COP in hypertension
COP increased in case of additional blood flow the adipose tissue
ABP=COP X TPR
Explain role of VMC in hypertension ?
VMC has increased activity in hypertensives casuing sympathtatic outflow and VC of blood vessels espically arterioles increasing TPR AND ABP
Exaggaration of the response of smooth musles of arterioles to the VMC discharges casuing marked increasie in TPR and ABP
خلي باك ياعمر VMC يوثر سمبيثاوي علي القلب برضو \+INO + CHRONO +CONDUCTIVITY يزود COP يزود ABP
Kideny and hypertension ?
loss of excretion of Na from kident due to renal abpsotption of Na due to sympatathic out flow increased to the kideny
Renin >Ang2 > ADH > ALDOSTERONE !
Ang 2 in hypertension ?
increased VMC Increased sympathtaic activity to the Kideny Increasing Reinin >ANG2
MOST POTENT VC
ADH
ALDOSTERONE
Why the brain defenders baroreceptors in general stand without action in case of hypertension disease ?
This becasue the have the ability to adapt and reset to the New value of BP
seeking to maintaing the blood pressure at the new valure becasue in case of hyypertension
there the blood flow into it causing its stifness and less defomable and stretchable losing its sensitivity so it is resetted
2ndry hypertenison mean ?
This is hypertension due to identifible causes if it is remove it will be cured
Kideny and 2ry hypertension ? relation
-parnchymal kideny hypertension :
this is due to disease in kideny parenchyma like glomeulonephritis , polynephritis,nephrotic syndome
thus the kideny cannot do its function in excretion of Na and water leading to accumulation of excess Na and Water leading to high blood volume and VR and COP and BP
-Vacular kideny disease: Occlusion of one of two ob renal arterirs or both leading to renal ischemia low perfusion casuing high reinin then Angiotensin 2 :
Most potent VC
Aldosterone
ADH
Coarctation of Aorta and hypertension ?
this leads to 2ry hypertension
it its narrowing of descenfing aorta above level of renal arteries this casuing low renal perfusion and High reinin and Ang 2 and VC ALDOSTERONE AND ADH
THE BLOOD PRESSURE IS HIGH AT UPPER LIMB AND LOW AT LOWER LIMBS
GR/ Brain tumours casueshypertesnion
Brain tumours increase intracranial pressure casuing low perfusion to the brain and VMC
Hypercapnia and hypoxia and acidosis
and this will lead to overstimulation of VMC increaing VC effect on blood vessels increasing the Blood pressure casung hyper tension and baroreceptor reflex bradycardia !
this is called Cushing reflex
Nerogenic casues of hypertension ?
Higher activity of VMC Excessive stimulation of the sympathatic system casuing more Periphereal VC and increaing TPR !
Damage to Baroreceptors their buffer nerves or to the NTS
Genetic casuse of hypertesnion ?
this is because genetic mutations causing excessive reabsorption of Na and water from the kideny causing hypertension due to high volume cop
Endocaranial hypertension show the definition of primary hyperaldosteroism ?
It is hypertension due to hyperaldosternoism called conn’s disease this mean there is tumor in the adrenal cortex in zona glomerulosa
adrenocortical tumour !
alodsternone na water retension
cushing disease and hypertension show the relationship ! ?
Cushing disease is due to excessive secretion of cortisol from the adreanl cortex due to tumor in the zona fasciculate and this leads to Na and water retention and high blood volume and also causing
COP HIGH HIGH BLOOD PRESSURE
Pheochromocytoma Definition ?
it is the disease of excessive secretion of the catecholamine due to tumor in the adrenal medulla casuing episodes of hypertenison in exposure to stress
and causing sympathtatic effects like what ?
1-pallor
2-sweating
3-Hyperglycemia
Tumor in juxta glomerular of kideny what will do?
This will lead to hypersecretion of Renin causing ??>
Ang 2 :> most potent vc alod adh
in brief give examples of Endocarnial hypertension ?
نمت وأدلج الناس ^_^
1- primary hyperaldosteroism conns disease
2-cushing disease
3-pheochromocyroma
4-juxta glomerular tymour
Hypertension may increasr incidence in some women ?
due to contraceptive pills containging estrogen causing excessive reabsorption of Na and water
Toxemia of prgnanct ?
in some pregancies there is toxic factor from placenta released causing Increased Na water retention and severe hypertension
Polycythemia Vera and hypertension ?
increased bone marrow synthesis of RBC increaing blood viscosity and TPR AND consequently the ABP
Causes of hypertension 2ndry
mention them ?
Kideny diseases coarctaion neurogeinc genertic endocaranial pregnancy women polychythemia
ولا تيأسوا من روح الله إنه لا ييأس من روح الله إلا القوم الكافرون …!!!
والله ما يهديك الا ربنا والله
هو اضحك وابكي !!
ينسيك الماضي ويوفقك ربنا بس مش
تخطيطك مش عملك مش تعبك انت اضعف من كل ده اضعف!!!
وخلق الانسان ضعيفا !!
ولا تكلني الي نفسي طرفة عين ولا اصغر من ذلك
اطلب
اللهم رحمتك ارجو فلا تكلني لنفسي طرفة عين
اطلب بطمع انت رايح للمالك البارئ له مافي السماوات والارض ومابينهما وما تحت الثري
لا اله الا انت !!!!
1 - لازم يكون ليك حد اكبر منك تتعلم منه !
2 - في حد تحتك ؟ تصب عليه !
3- صحبة صالحة!!
متي تبلغ من العلم مبلغا ؟
وانت تؤثر النوم علي الدرس
والاكل علي القراءة ؟ تريد ان تكون طالب علم ؟
ذكاء حرص اجتهاد جرأة طول زمان ! لا يكفي الفهم في شئ
نمت وأدلج الناس !
Increaded ABP Hyper tension and effect on Heart ?
The increaed blood pressure increaes the afterolad and this will increae the resistance this will leads the left venricle to adapt by hypertrophy to increase contractility but with time hypertophy leadsto
- diastolic dysfunction leading to decreased pressure on venrticle and decreasing COP AND HF
- Ischemia to hypertrophied muscles due to no concurrent increase in the blood supply to them !
Hypertansion was modified major RF of what ?
Atheroscleorisi causing deposition of the lipid in the intima and inflammation and calcifcation atheroma may be complicated with thrombosis casusing partial or compolete occlusion
casuing angina oR MI
Brain and hypertension show the compilication ?
hypertension may lead to atherosclerosis in the carotid artery leading to formation of throbosis
which may broke into small fragments going to occlude the small arterirs in the brain this may leads to
1- Rupture of some vessels casuing hemohrrage
2-infarcrion of the part of the brain even if no rupture because of cut of blood supply
this is called stroke
blindeness may occur if happened in retina
hypertension and renal failure ?
hypertension leads to atherosclerosis on the renal aretery decreasing its blood supply may lead to renal failure !
Discuss hypertension effect on retina brain heart kideny ?
May cause atherosclerosis that leads to
1-occlusion of the retinal artery and blindeness
2-carotid artery atherosclerosis throbosis fragmented occluding cereberal artertis infarction and hemoohrage stroke mean
3-this leads to renal artery occlusion and renal failure inc BP
4- Heart will leads to increased afterload and hypertrophy and dystolic dysfunctions and heart failure and ischemia of heart
may casue coronary atherosclerosis and thrombosis and angina and MI
Hypotension
it is decreased bp below 100’/60 mm Hg may be acute or chronic
Chronic Hypotension
it is decraed blood pressure which not represents any problem to the patient and is contiunous for long period !
due to
1-decreased VMC activity leading to VD of vessels and decreasing Tpr
2-in some cases of anemia the viscosity is decraesed so tpr and abp
3-low oxygen casues Artriolar VD
But the compensatory mechanism is that the TPR decreased the VR ,COP is increased and this will lead to what ? Adequate perfusion to tissue !
Acute hypotension
It is sudden decreased blood pressure unlike chronic hypotension it leads to serious compilcations decreasing the COP and the tissue perfusion and this leads to shock and syncope !
casues :
1-sevre hemorrhage
2-severe loss of body fluids vomiting and diarrhea
3-VD DUE TO
A-VD DRUGS
-B ENDOGENOUS VD DUE TO histamine release
c-Loss of VMC DISCHARGE Leading to VD of peripheral artrioles
transient cerebral ischemia leads to ?
fainting suncope
Syncope defintion ?
Sudden temporary loss of consciuosness then retutrn back spontanuously unlike shock
syncope is due to interrupted perfusion to cerebral arteris to the brain
this is due to low ABP lasting for seconds then regaining the consciousness
and some people enters pre syncope some people don’t actually faint but come near to it like dimming of light
syncope 3% emegencies 6% visits to hospital
dangerous state changes the life style of the pathiemt
Mention vasuclar casuse of syncope
vasC PCM فأسك بكم ؟ 1-Vasovagal syncope 2-carotid sinus syndrome syncope 3-postural syncope 4-cough syncope 5-micturation syncope
explain Vasovagal syncope .
This is the most common vs , occurs due to severe pain , satinding in hot crowding place ,strong emotion like fear on seeing Blood
this is due to Dorsal vagal nucleus stimulation thus the cic and decelration of heart rate and decrasing vr and cop
Stimulation Symphathatic cholinergic fibers casuing VD and decreasr TPR decrasing vr and cop
THESE TWO FACTORS decrasie VR and COP AFFECT THE ABP DROOPING To a level that the blood flow to cerebral artery becomes inadequate Causing syncope .
this may be preceeded with grayout or blackout
this leads loss of muscle contraction and falling to ground deleting the gravity effect on blood so the VR returns normal and the cop so the cerberal perfusion go back to life >
falling to ground in vasovagal syncope is a good thing ?
because the gravity factor is deleted and The VR return normal thus COP and ABP
AND cerebral Perfusion !
ولقد كنت في حلاوة طلبي العلم ألقى من الشدائد ما هو.
عندي أحلى من العسل لأجل ما أطلب وأرجو. كنت زمان الصبا آخذ معي أرغفة يابسة فأخرج في طلب الحديث، وأقعد على نهر عيسى فلا أقدر على أكلها إلا عند الماء. فكلما أكلت لقمة شربت عليها، وعين همتي لا ترى إلا لذة تحصيل العلم
اذا كان يؤذيه حر المصيف و كرب الخريف وبرد الشتاء ويلهيه حسن جمال الربيع
؟ فاخذه للعلم قل لي متي
إن الله كتب الإحسان علي كل شئ !
لن يغلب عسر يسرين !
carotid sinus syndrome syncope Explain .
the carotid sinus baroreceptor is sensitive to external pressure like tight collar or due to shaving this leads to :
inhibiton of VMC casuing VD of peripheral arterioale vessels dropping tpr and abp
stimulation of cic casuing decrease HR VR COP and BP
STIMULAITON of sympahthatic cholinergic fibers in hypothalamus causing vd of skeletal and hepatic vessesls by b2 agonist cauign marked drop in abp
this leads to low perfusion to cerebral arterirs
never palpate carotid pulse at both sides
لا أبرح حتي أبلغ مجمع البحرين أو أمضي حقبا !
هذا سيدنا موسي ترك راحته و تحمل عناء السفر وقطع البحر ليصل الي رجل ليتعلم منه وهو النبي كليم الله عليه السلام
وفي النهاية خرج منه بثلاث دروس فقط كانت من اعظم الدروس عن حكمة الله في التدبير
هل سخط هل تضايق بل هذا هو الصبر في طلب العلم ! فاقتد بنبي الله موسي ولا تبرح حتي تبلغ مبتغاك يا عمر !
أعلل نفسي بالآمال أرقبها
ما أضيق العيش لولا فسحة الأمل !
-postural syncope
due to decrease blood pressure while standing from recumebent position causing pooling of blood in lower limbs dewcrasing cerebral perfusion RAHL
a-long reumbency why ? weakens baroreceptors
b-Hemohrrhage decrasing the cop and blood pressure so gravity when standing decreases it more
c-alpha blockers preventing vasoconstriction whic is antigravity mechanism
d-reutrining from space flight becasuse microgravity weakens antigravity mechanisms
long reumbency why post hypo ?
weakens baroreceptors
Hemohrrhage cause postural hypotension why?
decrasing the cop and blood pressure so gravity when standing decreases it more casuing cerebral ischemia
alpha blockers causes postural hypotension why ?
preventing vasoconstriction whic is antigravity mechanism
I MEANT preventing baroreflex in increasing ABP
reutrining from space flight cause pos hypotension why?
becasuse microgravity weakens antigravity mechanisms
antigravity mechanisms ?
Musle contraction
Venoconstriction by baroreceptors reflex
Why the loss of sympathatic tone causes pos syncope ?
why taking alpha blockers cause»_space;»»>?
because there is loss of its vasocontstiction venoconstriction tone decrasing vr and cop and abp and cerebral perfusion
Why integrity of baroreceptors is imp to not fall in syncope ?
why DM may cause syncope ?
why dehydration may cause syncope ?
because if there is problem and weakness in baroreceptor or theri buffer nerves in DM
will lead to loss of reflex vasoconstriction while senation of low pressure or
dehydration decrasing antgravity mecahnisms
decrased cardiac preload lead to pos syncope ?
decraseing preload decrasing the COP and with the Decrasing TPR decrasing the ABP
AND PERFUSION OF CEREBRAL Arteries
The arterial hypotension leads to pos syncope despite the baro reflex?
When baroreceptors sene the decrease in the ABP this will leads to reflex causing vc and incrasing cardiac HR and COP and ABP but the high pressure receptores in the ventricle casues reflex bradycardia decrasing COP and ABP
وكأنك يا أبو زيد ما غزيت @@
Pathophysiology of syncope postural show it >
this is pooling of blood in the lower limbs due to ?
1-loss of sympathahtic tone due to alphablockers causing loss of venoconstriction and decrasing vr cop and abp
2- Barorfelx is not avtive normally this occure in damadge to buffer nerve DM OR dehydration
3-decreased cadrdiac preload then cop and abp
4-arterial hypotension>baroreflex > high pressure ventricular receptor reflex >bradycardia
يا زيد ما غزيت @@
5- the low abp causeing low cerebral perfusion more than its ability to autoregulation >
syncope > muslces cease contraction >falling > increasing VR > COP > ABP > Reperfusion > regain consciuosness
Mechanism of action of ACEI Illustrate
Ө ACE → ↓Angiotensin II & ↑Bradykinin ( →↑ endothelial PG & NO) →
1. Vasodilatation of both arteries (↑COP) & veins (↓venous congestion)
2. ↓ Aldosterone → loss of Na+ & H2O in urine with K
+
retention in blood
3. ↓Myocardial hypertrophy and remodeling after Myocardial infarction
4. Ө NE release induced by Ang II → ↓BP without reflex ↑ HR
incdications of ACEI
Mention 4
- Hypertension
- Heart failure: all cases & all stages
- Acute MI: (in first 24 hours with β-blockers, aspirin and fibrinolytics) →
• ↓ Sudden death (prevent arrhythmia 2
ry to hypokalemia and ↑ sympathetic activity).
• Post MI: ↓ aldosterone induced remodeling & prevent Heart failure - Nephropathy: diabetic or non-diabetic
Explain coughing reflex ?
Increased intrathoracic pressure during cough cmopresses veins so
VR and COP and ABP are decreased ?»low perfusion
Explain mictuarion syncope ,
There is Over stimulation of paraymapthatic system during micturation dereasing ABP
+ Orthostasis standing up will decrese it more by gravity
Cardiac casues of syncope mentio the 4
1- sick sinus syndrome def ? the SAN stop discharging no COP ?
2-Stokes Adam syndrome 3rd degree Heart block causing ventricular ectopic focus 20bpm no cop ?
3-SHORT RUNS OF ventricular fibrillation
4-obstruction of blood flow out of the heart this is casued by aortic stenosis or hypertrophied muscle
casuing syncope on exertion
syncope on exertion mean ?
one of cardiac syncopes
-obstruction of blood flow out of the heart this is casued by aortic stenosis or hypertrophied muscle
رحل جابر بن عبدالله مسيرة شهر في طلب حديث واحدمن عبدالله بن أنيس
-Stokes Adam syndrome definition
3rd degree Heart block causing ventricular ectopic focus 20bpm no cop ?
PHYSIOOLOGICAL BASIS IN TREATMENT OF HYPER TENSION
DIURETICS
ACEI
BB
