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Cardio Exam 1 > Lec 15 HTN > Flashcards

Lec 15 HTN Flashcards

1
Q

What are cutoff numbers for hypertension in normal person?

A

systolic BP > 140 mmHg and/or

diastolic BP > 90 mmHg

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2
Q

How do you diagnose hypertension?

A

2 readings separated apart

pt should not ingest caffeine or smoke for 30 min before reading

sit for 5 min with arm at heart level before BP is checked

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3
Q

What is prevalence of hypertension?

A

more prevalent with age

about 30% of population

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4
Q

What are the 4 systems determine of BP regulation?

A
  • heart [CO]
  • peripheral vasculature [tone]
  • kidney [regulate blood volume]
  • hormones/reflexes [modulate]
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5
Q

What is role of heart in BP regulation?

A

provides CO that fills the vascular tree

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6
Q

What is role of peripheral vasculature in BP regulation?

A

vascular tone/resistance –> modulates tone from heart

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7
Q

What is role of kidney in BP regulation?

A
  • regulates intravascular volume

- essential to maintain chronic HTN state –> w/out renal involvement cannot maintain HTN

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8
Q

What is equation for BP [MAP]?

A

MAP = CO * TPR

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9
Q

What is equation for CO?

A

CO = HR*SV

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10
Q

What factors determine SV?

A
  • contractility
  • venous return [preload]
  • afterload
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11
Q

What factors determine venous return [preload]?

A

blood volume

venous tone

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12
Q

What is renal regulation of BP?

A

kidneys sense drop in BP –> secrete renin –> converts angiotensinogen to AT1 –> ACE converts to AT II

ATII:

  • -> directly increase BP by constriction
  • -> causes aldosterone release –> Na/H2O retention –> increase volume
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13
Q

What is essential hypertension?

A

cause of HTN cannot be explained == multiple etiologies together increasing CO or TRP

makes of 90% of HTN

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14
Q

What is secondary hypertension?

A

hypertension attributed to definable cause

makes up 10% of HTN

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15
Q

What is pressure natriuresis?

A

homeostatic mechanism by which if you increase BP –> get increase urine volume and Na excretion –> decrease blood volume –> pressure back to normal

this process is blunted in kidneys of pt with HTN

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16
Q

What is baroreceptor reflex?

A

baroreceptors = in aortic arch and carotid sinuses; sense increase in stretch of aorta due to pressure –> baroreceptors stimulated –> increase PNS and inhibit SNS–> vasodilation + decrese HR and co –> BP drops back to normal

== moment to moment modulation of blood pressure

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17
Q

What nerves carry baroreceptor signals?

A

CN IX carries from carotid sinus

CN X from aortic arch

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18
Q

What are causes of essential hypertension?

A
  • genetics
  • black > white > asian
  • systemic abnormalities: sympathetic overactivity in response to stimulus, abnormally vasoconstricted
  • renal: excess Na/H2O retention, hormone dysregulation [normal renin level in HTN pt]
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19
Q

Is diastolic or systolic or both HTN most prevalent?

A
  • in young people mostly isolated diastolic HTN
  • as you get older = more and more isolated systolic HTN

b/c chronic exposure to hemodynamic stress, vessels stiffer, increase calcification –> higher systolic when push the blood into aorta but don’t have sufficient elastic recoil –> low diastolic

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20
Q

What are some clinical clues that should make you think it might be secondary HTN?

A
  • very young < 20 yo
  • new HTN after age 50 in someone who never had problem before
  • severe rapid onset
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21
Q

What are major causes of secondary HTN?

step1

A

mostly renal disease including fibromuscular dysplasia in young patient

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22
Q

What are renal causes of secondary HTN?

A
  • parenchymal damage to kidneys –> decrease # of functioning nephrons –> secrete less Na/H2O –> more blood volume –> CO/BP up
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23
Q

What lab findings if renal cause of secondary HTN?

A
  • high serum creatinine

- abnormal urinalysis

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24
Q

What is renovascular cause of 2ndary HTN?

A

renal artery stenosis due to atherosclerosis or fibromuscular dysplasia

stenosis –> reduced renal blood flow –> more renin –> RAAS = vasoconstriction + Na retention

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25
What is treatment of renovascular secondary HTN?
ACE inhibitors | renal artery revascularization
26
What are clinical signs of renovascular hypertension?
abdominal bruit | unexplained hypokalemia [due to overactive aldosterone]
27
What is aortic coarctation?
congenital narrowing of aorta
28
What should you think it pt with HTN and way higher BP in arms than legs?
aortic coarctation causing secondary HTN coarctation located distal to left subclavian
29
What should you think if pt with HTN and lower BP in left vs right arm?
aortic coarctation causing secondary HTN coarctation located at origin of left subclavian
30
What happens in aortic coarctation associated hypertension?
- reduced blood flow to kidneys --> stimulate RAAS --> higher level Ang II and vasoconstriction
31
What are signs that hypertension might be due to aortic coarctation?
- blood pressure discrepancy - midsystolic murmur - rib notching on CXR= collaterals
32
What is pheochromocytoma? how does it cause HTN?
- catecholamine-secreting tumor - release NE/E --> vasoconstriction + tachycardia - have palpitations/tachy/headache - diagnose based on catecholamine level in serum/urine
33
What is treatment for pheochromocytoma?
surgical resection | alpha and beta blockade
34
What are endocrine causes of secondary hypertension?
too much Ne/E --> pheochromocytoma too much aldosterone --> primary [conn syndrome] or secondary [renin secreting tumor] too much cortisol [Cushing]
35
How do you differentiate between primary and secondary aldosteronism as cause for HTN
primary = conn syndrome = adrenal adenoma or hyperplasia adrenal glands --> high aldosterone so suppresses renin = high ratio aldosterone:renin secondary = renin secreting tumor --> lots of renin --> causes lots of aldosterone = low ration ald:renin
36
Why does cushing syndrome cause HTN?
- excess cortisol stimulates RAAS also have: round face, central obesity, prox muscle weakness
37
how does hyperthyroidism cause HTN?
- cardiac hyperactivity/high HR --> increase BP/blood volume
38
how does hypothyroidism cause HTN?
diastolic hypertension | increase in peripheral vascular resistance
39
What medications/drugs cause HTN?
- oral contraceptives - glucocorticoids - erythropoetin - sympathetomimetics [OTC cold remedies] - alcohol - cocain
40
What are consequences of chronic HTN?
physio/structural derangements - increase work of heart, arterial damage, loss of elasticity, endothelial dysfunction
41
How much does CV risk change with each increase in 20/10 mmHG BP increment?
doubles
42
What are cardiac effects of HTN?
ventricular hypertrophy due to high afterload --> ventricular stiffness --> diastolic HF CAD: HTN --> development atherosclerosis --> decreased myocardial O2 supply --> increased work
43
Is most common form of heart failure in elderly diastolic or systolic?
diastolic
44
What is hemorrhagic stroke?
rupture microaneurysms induced by long-standing HTN
45
What is ischemic stroke?
thrombosis of atherosclerotic plaque in cerebral vessel --> get embolism of plaque which causes ischemia
46
What is aortic aneurysm? Where is it usually found?
prominent abnormal aortic dilation most common in abdominal below level of renal arteries if it ruptures you die associated with HTN
47
What is aortic dissection?
ripping between intima and media in aorta; can be in ascending or descending aorta high mortality associated wtih HTN
48
What is a hypertensive urgency?
SBP > 180 or DBP > 110 without evidence of end-organ damage need immediate evaluation but does not need hospital admission
49
What is hypertensive emergency?
severe HTN [SBP > 180, DBP > 110] with evidence of acute organ damage need immediate hospitalization
50
What are symptoms of hypertensive emergency
- hypertensive encephalopathy = mental status changes, headache, blurred vision - SOB [pulm edema] - papilledema on fundoscopy
51
What does it mean if abnormal K in HTN?
sign of too much aldosterone --> may be primary or secondary aldosteronism or renovascular problem
52
What are non-pharm treatments for HTN?
- weight [each 10 kg = 5-20 mmHG drop in BP] - exercise - diet - salt restriction < 6g/day
53
Why give a diuretic in HTN? For who?
- decrease circulating volume, CO - give in mild-moderate HTN with normal renal function - good for uncomplicated HTN
54
Why give Beta blocker in HTN? For who?
- reduce HR and contractility --> reduce CO + decrease renin | - reduces mortality if you've had MI or in heat failure
55
What are side effects of beta blockers?
bronchospasm [asthma], fatigue, sex effects
56
Why give alpha-2 adrenergic agonists in HTN?
Reduce sympathetic outflow | poor side effects, dont usually use
57
Why give alpha 1 antagonists in HTN?
sympatholytic relaxes smooth muscle + reduces prostatic enlargement = good for older men
58
What meds do you give if primary essential uncomplicated HTN?
- diuretics - ACE inhibitors/ARBs - Ca channel blockers
59
What meds do you give f HTN with CHF? step1
- diuretics - ACE inhibitors/ARBs - beta blockers in compensated - aldosterone antagonists [spirinolactone]
60
What meds do you give if HTN with DM? step1
- ACEI/ARBs = main b/c protects against diabetic nephropathy - Ca channel blockers - diuretics - b blcokers - a blockers
61
Why do you give ACE inhibitor in HTN?
reduce mortality in pts with acute MI, chronic HF or at high risk for vascular disease good for diabetic nephropatyn side effects = dry cough, hyperkalemia
62
When do you use spironolactone?
in symptomatic heart failure for HTN | mech = aldosterone blockade
63
When do you use eplerenone?
in pt with acute MI complicated by heart failure | = aldosterone blockade
64
What med for HTN pt pos-MI?
give beta blocker
65
What med for HTN if chronic kidney disease?
ACEI/ARB
66
What med for HTN might you avoid in woman of child bearing age
ACE-I = teratogenic
67
Who should you be cautious about prescribing diuretics?
elderly = susceptible to dehydration

Cardio Exam 1 (16 decks)

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