Hypertensive Heart Disease & Cor Pulmonale Flashcards
if the radius of a blood vessle decreases, what happens to the resistance and blood flow
- poiseuille’s law
- resistance to blood flow increases
- blood flow decreases
- how can we preserve blood flow is the radius decreases?
- what does this mean for the heart?
- increase change in pressure
- it has to work harder
when you increase the radius of vasculature, what happens to afterload
decrease
double product
- amount of O2 used by the heart
- DP = HR x SBP
normal BP
less than 120 and less than 80
elevated BP
120-129 and less than 80
high blood pressure, HTN stage 1
130-139 or 80-89
high blood pressure, hypertension stage 2
140 or higher or 90 or higher
hypertensive crisis
higher than 180 and/or higher than 120
why do people stop taking their anti-hypertensive medication
- unpleasant side effects
- interference with sexual function
- cost
- taking anti-hypertensives does not change the way a pt feels so why take them
- increased age
- gender: women
- african american
what is the relationship between BP and risk of CVD event
- positive, continuous, consistent, independent of other risk factors
- higher chance of having a MI, HF, PVD, carotid atherosclerosis, stroke, left ventricular hypertrophy and kidney disease
what does controlling systolic HTN help do
- reduce total mortality, cardiovascular mortality, stroke, HF events
essential or primary HTN
- no known cause
- increases with age
- reduced vascular compliance
- progressive
- 90% of all cases
secondary HTN
- caused by conditions that affect your kidneys, arteries, heart or endocrine system
- 10% of all HTN cases
- treatment focuses on management of the underlying cause
how does uncontrolled HTN and kidney disease relate
- cause arteries around the nephron of the kidney to narrow, weaken and harden
- unable to deliver blood to kidney tissue
what happens to the filtration at the level of the nephron when you have HTN
reduced, GFR also declines
since you have decreased filtration, how do the kidneys respond?
- the kidneys perceive this as a reason to increase water and sodium reabsorption leading in increased blood pressure (hypervolemia & hypernatremia)
what is the net effect of HTN & kidney disease
- increase preload
- increase total peripheral resistance
- decrease ability to appropriately control whole body BP
- downward spiral of kidney fxn
diabetes, kidney disease, HTN; how are they related?
- elevated glucose levels damage glomerular filtration and reduce GFR
- kidneys respond by reabsorbing more water and sodium, increasing fluid volume and blood pressure
how does HTN result in a pathologic heart?
- increased afterload –> thickening of the heart muscle (compensated)
- as it continues, cellular, subcellular and vascular changes occur in the heart rendering it less effective (decompensated)
- lumen of the left ventricle progressively dilates and its walls thin
- LV EF declines
malignant HTN signs and symptoms
- > 180/120
- changes in vision
- cough
- nausea or vomitting
- numbness, weakness in arms, legs, face
- chest pain
- anxiety
- SOB
- headaches
cor pulmonale
- pulmonary heart disease
- enlargement of the right ventricle caused by a primary pulmonary disorder
- identifies the pathologic effects of pulmonary dysfunction on the right side of the heart
pulmonary HTN
MAP > 25mmHg or systolic pressure > 35mmHg
how can the right side of the heart move the same volume of blood at a much lower pressure?
- RV has the same stroke volume as LV
- shorter length of tubing
- more compliant vessels means less resistance to flow
- much lower impact of gravity on blood flow
cor pulmonae symptoms
- chest pain
- fatigue
- bilateral LE edema
- syncope/passing out
diseases associated with cor pulmonale
- COPD
- diffuse pulmonary interstitial fibrosis
- extensive, persistent atelectasis
- cystic fibrosis
- pulmonary embolism
diseases of pulmonary vessels associated with cor pulmonale
pulmonary vascular sclerosis
drug, toxin, XTR induced vascular sclerosis
diseases affecting chest wall movement
kyphoscolosis
marker obesity
neuromuscular disease
diseases inducing pulmonary arteriolar constriction
hypoxemia - airway obstruction, hypoventilation, chronic altitude sickness
what is exercise prescription for people with pulmonary artery HTN
- exercise can be good
- light resistance of small muscle groups and light to moderate aerobic activity is acceptable
- outdoor activity should be avoided during hot, humid or very cold weather
