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S3 - Pathophysiology > Hypertensive Heart Disease and Cor Pulmonale > Flashcards

Hypertensive Heart Disease and Cor Pulmonale Flashcards

1
Q

HYPERTENSIVE HEART DISEASE PART 1

A

HYPERTENSIVE HEART DISEASE PART 1

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2
Q

What is Poiseuille’s Law?

A

-Q=ΔP X r4

Flow=pressure gradient* radius^4

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3
Q
  • If the radius decreases, the resistance to blood flow __________ and blood flow _________.
  • How can we preserve blood flow if r decreases? What effect does this have on the heart?
A
  • increases
  • decreases

-Increase ΔP which means the heart has to work harder.

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4
Q

Why do we want to control BP?

A

Associated with decreased incidence of adverse cardiac events/disease.

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5
Q
  • Systolic BP is the ________ pressure exerted against the wall of a blood vessel, while diastolic BP is the _________ pressure exerted against the wall of a blood vessel.
  • What is a normal BP?
A
  • Maximum, Minimum

- 120/80

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6
Q
  • What is Double Product?

- What is the formula?

A
  • Noninvasive way of measuring heart work.

- DP = HR * SBP

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7
Q
  • What happens to the heart with HTN?

- Why is this problematic?

A
  • The heart myocardium will hypertrophy in an effort to meet the demands of HTN.
  • Problematic because it can lead to
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8
Q

List the BP Categories.

A 
Normal = <120/<80 (AND)
Elevated = 120-129/<80 (AND)
High (Stage 1 HTN) = 130-139/80-89 (OR)
High (Stage 2 HTN) = >140/>90 (OR)
Hypertensive Crisis = >180/>120 AND/OR)
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9
Q

List some pharmalogical management of HTN.

A
  • Diuretics
  • Beta Blockers
  • Calcium Channel Blockers
  • ACEi
  • Alpha1 blockers
  • Central agents
  • Aldosterone receptor blocker
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10
Q

What are the guidelines for using HTN medicine?

A

Using enough anti-HTN as needed to control BP.

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11
Q
  • Only __% of patients seeking care for stubborn high blood pressure take all the medicine they’re supposed to be taking
  • Another __% are not taking any of their blood pressure medications
  • __% are somewhere in the middle!!!
A
  • 20%
  • 20%
  • 60%
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12
Q

Why do people stop taking their anti-HTN medication?

A
  • Side effects (orthostatic hypotension)
  • Sexual function (B-blockers)
  • Cost
  • Doesn’t change the way they feel
  • Increased age
  • Gender: women greater non-adherence
  • African American race
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13
Q

What are the 2 types of HTN?

A
  • Essential

- Secondary

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14
Q
  • What is the cause of essential HTN?

- It represents __% of all HTN cases.

A
  • Unknown

- 90%

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15
Q
  • What is the cause of secondary HTN?

- It represents __% of all HTN cases and treatment focuses on management of what?

A
  • Caused by conditions of the kidneys, arteries, heart, or endocrine system.
  • 10%, underlying cause
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16
Q
  • Uncontrolled HTN can lead to ______ disease.

- The kidney gets about __% of cardiac output.

A
  • kidney

- 20% (doesn’t use it all)

17
Q

How does the kidney work?

A

Filtering fluids and molecules from the blood into the kidney tubule.

18
Q

What happens to kidney function with HTN?

A
  • Uncontrolled high blood pressure can cause arteries in the glomeruli to narrow, weaken or harden.
  • These damaged arteries deliver less and less filtrate to the nephron.
  • The kidneys perceive this reduce filtration as a reason to increase water and sodium reabsorption resulting in increased blood volume (preload) and therefore blood pressure.
19
Q
  • Reduced kidney filtration also activates the renin-angiotensin cascade which favors water and sodium ___________.
  • The net effect is _______ preload, __________ total peripheral resistance, and _________ ability to appropriately control whole body BP regulation. This creates a downward spiral of kidney function.
A
  • reabsorption

- increased, increased, decreased

20
Q

Know the ___ of ALL your patients with kidney disease!!!

A

BP

21
Q

Poorly controlled ________ can lead to kidney disease which can lead to HTN. How?

A

Diabetes

  • Chronically elevated glucose levels damages glomerular filtration, reducing glomerular filtration
  • Kidney responds by reabsorbing more water and sodium, increasing fluid volume and blood pressure
22
Q

Know the __ of ALL your patients with diabetes.

A

BP

23
Q

How does HTN result in a pathological heart?

A
  • Results in pathologic cardiac hypertrophy
  • Causes fibrosis rendering the heart stiffer i.e. HFpEF
  • Myocyte hypertrophy
  • Accelerated myocyte death
  • Reduced capillarization/reduced blood flow
24
Q

What is malignant HTN?

A
  • BP > 180/120 mmHg

- Considered medical emergency

25
Q

HYPERTENSIVE HEART DISEASE PART 2/COR PULMONALE

A

HYPERTENSIVE HEART DISEASE PART 2/COR PULMONALE

26
Q

Cor Pulmonale (_______ _____ _________) is an enlargement/dysfunction of the right ventricle caused by a primary _________ disorder (_________ ____)

A
  • Pulmonary Heart Disease
  • pulmonary
  • pulmonary HTN
27
Q
  • What is a normal pulmonary artery pressure?

- Pulmonary HTN = MAP > ___ mmHg or systolic pressure > ___ mmHg

A
  • Normal = 20/10 or MAP=15mmHg

- Pulmonary HTN = MAP>25mmHg or SBP >35mmHg

28
Q

Why can the R side of the heart move the same amount of blood as the L side?

A
  • Remember the RV has the same stroke volume as the LV
  • Shorter length of tubing
  • More compliant vessels
  • Much lower impact of gravity on blood flow
  • Q = ΔP X r4
29
Q

Cor pulmonale is typically _______ and __________.

A

chronic and progressive

30
Q

What are the symptoms of cor pulmonale?

A
  • chest pain
  • fatigue
  • bilateral lower extremity edema
  • syncope or passing out
31
Q

What are some diseases of the lungs associated with cor pulmonale?

A
  • Chronic Obstructive Lung Disease (COPD)
  • Diffuse pulmonary interstitial fibrosis
  • Extensive persistent atelectasis (collapsed lung)
  • Cystic fibrosis
  • Pulmonary embolism
32
Q

What are some diseases of pulmonary vessels associated with cor pulmonale?

A
  • Pulmonary vascular sclerosis

- Drug,toxin, XTR induced vascular sclerosis

33
Q

What are some disorders affecting the chest wall movement that can lead to cor pulmonale?

A
  • Kyphoscolosis
  • Marked obesity
  • Neuromuscular Disease
34
Q

What are some diseases inducing pulmonary arteriolar constriction that can lead to cor pulmlonale?

A

-Hypoxemia (low levels of O2 in the blood) leading to airway obstruction, hypoventilation, and chronic altitude sickness.

35
Q

With cor pulmonale, PT interventions will have a ________ impact on the underlying pathology. For patients with lung pathologies, know if there is an accompanying ________ involvement.

A
  • negligible

- cardiac

36
Q

Can patients with Pulmonary Artery HTN exercise?

A

Some form of exercise is not harmful, but should speak with physician first. Care should be taken to not over exercise. Light resistance of small muscle groups and light to moderate aerobic activity is acceptable.

37
Q

What is the assessment criteria for medical professionals taking BP? (10)

A
  1. ) Resting patient for 5 mintes prior to the measurement or expressing intent to do so
  2. ) Legs uncrossed
  3. ) Feet on floor
  4. ) Arm supported
  5. ) Correct cuff size
  6. ) Cuff placed over bare arm
  7. ) No talking
  8. ) No phone or reading
  9. ) BP taken in both arms
  10. ) Correctly identifying arm to use for future readings (one with higher BP)
38
Q

Impact of incorrect BP measurements?

A
  • Incorrect classification of BP status

- Can make controlled HTN appear more uncontrolled or nonexistant HTN as existent

39
Q

Hypertension is a __________ pathology.

A

Whole Body

  • stroke
  • vision loss
  • HF
  • heart attack
  • kidney disease/failure
  • sexual dysfunction

S3 - Pathophysiology (14 decks)

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