Hypertensive Diseases Flashcards
What blood pressure values define hypertensive heart disease?
140+/90+
What is normal blood pressure?
90/60 to 120/80
What is the most prevalent cause of coronary artery and myocardial disease in the US?
Chronic hypertension
The term hypertensive heart disease is used when the heart is enlarged with no other pathology present (TRUE/FALSE)?
TRUE
What are the two types of hypertension?
Essential (Primary)
Secondary
What is essential (Primary) hypertension?
Hypertension with no other pathology present related to soft risks such as genetics, poor diet, lack of exercise, and obesity
Primary hypertension increases with age and soft risks (TRUE/FALSE)?
TRUE
48 year old male patient with a blood pressure of 142/95. He claims to work 9-5 and stop at McDonalds on the way home from work 3-4 days a week to watch TV for the remainder of the night. He spends his weekends driving to his mom’s house five hours away to take care of her. He is overweight. What type of hypertension is described?
Primary (Essential) hypertension
What is secondary hypertension?
Increased blood pressure with a specific cause or a consequence of another primary condition (pathology)
What renal diseases can cause secondary hypertension?
Polycystic kidney
Renin-secreting tumor
Renal artery stenosis
Chronic glomerulonephritis
What is polycystic kidney disease? Does it cause primary or secondary hypertension?
Kidney is replaced by cysts and causes secondary hypertension
How does a renin-secreting tumor of a kidney cause secondary hypertension?
The tumor will cause increased renin secretion which converts more angiotensinogen into angiotensin I and then II which causes more aldosterone to be released from the Zona glomerulosa leading to hypertension.
How does renal artery stenosis cause secondary hypertension?
Atherosclerosis of the kidney will cause the macula densa to sense low kidney blood pressure (which the kidney needs to release urine). The kidneys will activate the RAAS system to increase blood pressure systemically when it it already hypertensive.
What is chronic glomerulonephritis? Does it cause primary or secondary hypertension?
Scarring of the kidney and causes secondary hypertension
What adrenal diseases can cause secondary hypertension?
Cushing syndrome
Conn
Pheochromocytoma
What is Cushing syndrome?
Hypercortisolemia (increased cortisol) in the blood often as a result of increased ACTH causing an increase in aldosterone and a decrease in sex hormones
What are signs of Cushing syndrome?
Moon face, truncal obesity, pencil thin arms and legs, purple striae (stretch marks), buffalo hump
Patient presents with a blood pressure of 150/92, truncal obesity, and stretch marks. The patient’s cortisol levels are in normal ranges. What is a working diagnosis for this patient?
Conn syndrome
What is a pheochromocytoma?
Adrenal medulla tumor that causes increased secretion of catecholemines such as epinephrine and norepinephrine (increased sympathetics)
What is Von Hippl Lindow syndrome?
Increased secretion of catecholamines and increased sympathetics resulting in fits of anger and hypertension often caused by a pheochromocytoma or genetic defect
How can a pheochromocytoma be tested?
Urine test for presence of catecholemines
What is a symptom of all renal diseases causing secondary hypertension?
Oliguria, increased BUN and BV
What effect does a pituitary adenoma secreting growth hormone have on blood pressure and how?
Increases blood pressure by growing the tunica media of blood vessels causing lumina narrowing
What is Conn syndrome?
Primary hyperaldosteronism with normal cortisol levels and an idiopathic etiology
What pathologies present with increased growth hormone and a pituitary adenoma resulting in secondary hypertension?
Gigantism and acromegaly
How can a pituitary adenoma that causes increased TSH cause secondary hypertension?
Increased TSH from a pituitary adenoma can cause increased T3/T4 resulting in hyperthyroidism leading to increased blood pressure and vasoconstriction
What pathology can be caused by increased ACTH from a pituitary adenoma?
Cushing syndrome
What is Grave’s disease? How does it cause secondary hypertension?
Type II hypersensitivity reaction where the body creates an antibody to the TSH receptor and causes hyperactivity of the receptor and thyroid resulting in hyperthyroidism. Patient’s with Graves’ disease have increased metabolism, neural conduction, heart rate, and as a result increased blood pressure
How does sleep apnea cause secondary hypertension?
A person who stops breathing at night suffers from fits of hypoxia in which the body responds with a reflexive vasoconstriction to increase blood volume to the vital organs
What drugs can cause secondary hypertension?
Sympatheticohometic drugs such as cocaine and methamphetamines
What is pre-eclampsia and how can it cause secondary hypertension?
Increased blood pressure during pregnancy where the placenta makes an anti-angiogenic factor so the body cannot make capillaries to compensate for an increase in blood volume resulting in increased blood pressure
What can hypertensive heart disease lead to?
Heart failure
Atherosclerosis
Thrombosis
Embolism
Aneurysm
Cerebral/cognitive/retina emboli
Renal Disease
Where will a left ventricular embolus spread to?
Systemic circulation
Copper wire arterioles and Roth spots can indicate what?
Hypertensive left heart failure
What are copper wire arterioles in the retina indicative of?
Left heart failure
What is a Roth spot? What type of heart failure can cause this?
Retinal hemorrhage usually due to an embolus from left heart failure
A Roth spot is usually due to an _______________?
Embolus
What is cor pulmonale?
Right ventricular hypertrophy and dilation due to pulmonary hypertension
Cor pulmonale is generally due to ________________________?
Pulmonary hypertension caused by a DVT throwing a saddle embolism
Acute Cor Pulmonale is associated with what blood vessel pathology?
Deep vein thrombosis and pulmonary saddle embolus
What is the main etiologic agent of acute cor pulmonale?
DVT causing a saddle embolus in the pulmonary artery
What is chronic cor pulmonale primarily caused by?
Chronic obstructive pulmonary disease (COPD) such as chronic bronchitis or emphysema
Chronic cor pulmonale causes both concentric and eccentric hypertrophy (TRUE/FALSE)?
TRUE
Chronic cor pulmonale causes (Concentric/Eccentric) hypertrophy early on and (Concentric/Eccentric) hypertrophy in later stages?
Concentric, eccentric
Chronic cor pulmonale causes (Pressure/Volume) overload early and (Pressure/Volume) overload later?
Pressure, volume
A patient with chronic cor pulmonale will experience what anatomical shift in the heart?
Interventricular septum becomes concave to the right and the left ventricle becomes crescent like
