hypertension module 5

Question 1

what is Electrocardiography (ECG) used for?

Answer 1

ECG is used for determining irregular rhythyms (brady or tachycardia) and changes in ventricular or atrial size.

Question 2

what is exercise stress testing?

Answer 2

provides important information regarding the likelihood and severity of developing coronary artery disease.
it uses ECG, blood pressure and heart rate to assess the response to exercise.

Question 3

what is pharmacological stress testing?

Answer 3

this method is used when the patient can not perform exercise stress testing. the widely most common used agents are adenosine, dipyridamole and dobutamine.

Question 4

what are cardiac catheterization and angiography used for?

Answer 4

they are used to assess cardiac anatomy and ventricular function.
may be done through
wrist (radial) artery or groin (femoral) artery

Question 5

what is echocardiography used for?

Answer 5

it is used to assess heart valve structure and function as well as ventricular wall motion using ultrasound technology.

Question 6

which test is more sensitive for detecting thrombus and abnormality?

a. transesophageal echocardiography
b. transthoracic echocardiography
c. coronary angioplasty

Answer 6

a. transesophageal echocardiography

Question 7

what is radionuclide ventriculography?

Answer 7

it is used to assess wall motion and myocardial viability in patients with CAD and HF.

Question 8

what are the tracers used in RVG?

Answer 8

technetium-99m and thallium 201

Question 9

what is another name for radionuclide ventriculography?

Answer 9

MUGA (multi gated acquisition) scan

Question 10

why is radionuclide ventriculography called multi gated?

Answer 10

it is called multi gated because a gamma camera takes multiple pictures at specific times during each heart beat.

Question 11

Complications on the heart are primarily related to development of _____________________.
give 3 examples.

Answer 11

Hypertensive Heart Disease

1. atherosclerosis and CAD
2. left ventricular hypertrophy
3. heart failure

Question 12

Specific cause of hypertension can be established in ___________________.

Answer 12

max. 15% of patients.

Question 13

what is Essential or primary hypertension?

Answer 13

no cause of hypertension but risk factors increase.

Question 14

what are the modifiable risk factors for essential HTN?

Answer 14

• current or secondhand ciggarette smoking
• diabetes mellitus
• dyslipidemia/ hypercholesteromia
• overweight/ obesity
• inactivity/low fitness
• unhealthy diet

Question 15

what are non modifiable risk factors for essential HTN?

Answer 15

• chronic kidney disease
• family history
• increased age
• socioeconomic/ educational status
• male sex
• obstructive sleep apnea
• psychosocial stress

Question 16

what is secondary HTN?

Answer 16

secondary HTN is high blood pressure when it is caused by a secondary underlying disease.

Question 17

when should you screen for secondary causes of HTN?

Answer 17

• unctontrolled HTN despite 3 medications
• age < 30 years
• extensive organ damage

Question 18

what are the common causes for secondary underlying disease of HTN?

Answer 18

• renal parenchymal disease
• renovascular disease
• primary aldosteronism
• obstructive sleep apnea
• drug or alcohol induced

Question 19

what are the uncommon causes for secondary underlying disease of HTN?

Answer 19

• pheochromocytoma/ paraganglioma
• cushings syndrome
• hyperthyroidism
• hypothyroidism
• aortic coarctation
• primary hyperparathyroidism
• mineralocorticoid excess hormones
• congenital adrenal hyperplasia
• acromegaly

Question 20

what are the non specific signs and symptoms of asymptomatic HTN?

Answer 20

fatigue, intolerance to activity, dizziness, palpitations, angina, dyspnea.

Question 21

underlying Signs and symptoms for asymptomatic HTN?

Answer 21

1. pheochromocytoma - headaches, sweating, tachycardia, palpitations and orthostatic hypotension
2. primary aldosteronism - hypokalemia, weakness and cramps
3. cushings syndrome - weight gain, polyuria, hirsutism, menstrual irregularities

Question 22

when are more than 2 readings taken for blood pressure?

Answer 22

Minimum of two readings at least 1 minute apart need to be taken & then averaged. If measurements vary by more than 5 mm Hg between the two readings, then one or two additional BP measurements are collected and the multiple readings averaged.

Question 23

pathophysiology of blood pressure

Answer 23

1. cardiac output

2. peripheral vascular resistance ( the resistance to blood in passages by precapillary arterioles)

Question 24

COP and PVR are controlled by 2 main mechanisms

Answer 24

1. baroreflexes and SNS ( rapid moment to moment regualtion of BP)
2. renin angiotensin aldosterone system (kidney has short term and long term effect on BP by controlling the blood volume)