Hypotension and Shock - L14

Question 1

Systolic is?
Diastolic is?

Answer 1

Normally distributed - a continuous variable
80-230
40-100

Question 2

Perfusion

Answer 2

the amount of blood going into the tissue
Normally measured in mL per unit of weight
Get out metabolism and by products

Question 3

MAP?

Answer 3

CO X TPR

Question 4

CO?

Answer 4

HR X SV

Question 5

TPR?

Answer 5

Diameter of the vessel
radius of the vessel
Viscosity of blood
Elasticity of the vessel

Question 6

Little bump in pulse pressure valve?

Answer 6

Diachrotic notch: alveolar valve closing

Question 7

Severe hypertension?
Treatment - long term/short term?

Answer 7

230/100
ACE inhibitor takes like at least a month to kick in: 4-8 wks
Angiotensin 2 blocking
Beta blockers short term sympathetic drive so very fast acting
e.g. Labetalol via IV
Diuretics could also be used

Question 8

What can drive the hypertensive crisis?

Answer 8

Renal circuits
pre eclaymia
…

Question 9

B.P Historically in kenya, ireland and america?

Answer 9

Kenya more hypotensive
Ireland more normal
America more hypertensive

B.P. varies geographically over population based on environmental exposure, access to primary care, diet vary over societal places

Question 10

What is dangerous for diastolic, systolic stage 1 hypertension and pre hypertensive

Answer 10

115 is dangerous
130 is stage 1 in the US hypertension
120 is pre hypertension

Question 11

Pharmacologically - issues ?

Answer 11

Drugs are designed for high risk groups 50-70 years old, likely to have an event
They don’t recruit young people or healthy old people
Normally neglect non-white people
Lots of gaps

60-80% of complex relationship between genes and environment lots of which can be modifiable

Answer 12

1800 pay days - alcohol normalisation Ireland
Weekends nowadays
Travel patterns changed - more affordable to travel increased alcohol as well 60/70s pick up wine culture drinking everyday
1 in 5 drink
Binge drinking
Sugar taxes and Smoking tax
Economy around alcohol consumption - €200 billion yearly
Conservaitism went really anti-drugs which stopped research in the space: Ragenism - deficit in understanding biology: mental health
Social networks

Answer 13

Cholesterol used to reduce future risk
RISK

Question 14

Orthostatic challenge - why does your blood pressure reduce from lying down to standing up?

Answer 14

Gravitational effect
Pulling of blood in your lower limbs
Impacts stroke volume - EDV, thinking about preload, increased volume in left ventricle, impacts contractility - all contribute to stretch on myocyte
Transient drop in pre load: venous return has not kicked in yet
- those on medications or whatever are already lower so how do they accomodate
They do via baroreceptors and sympathetic response
Do they faint? or can they auto-regulate and increase CO by increase HR via sympathetic response to maintain perfusion and flow
Pressure volume loop diagram

Question 15

What is syncope?
Main cause?

Answer 15

SYNCOPE- Passing out/ fainting
Low BP

Question 16

What is atrial fibrillation?

Answer 16

Happens when abnormal electrical impulses suddenly start firing in the atria. These impulses override the heart’s natural pacemaker, which can no longer control the rhythm of the heart. This causes you to have a highly irregular HR

Question 17

Atrial contraction increases with?

Answer 17

Age

Question 18

Hypoperfusion

Answer 18

Reduced amount of blood flow

Question 19

Wilby Williamson JAMA - CVS pdf

Answer 19

Young males - B.P. driving due to sympathetic function
Short term management
Physiological drivers of BP are multiple
Drugs just affects 1aggressively
Context is hyperperfusion