Lecture 2 - HTN and Hypertensive Heart Disease

Question 1

define ‘blood pressure’

Answer 1

pressure generated by the left ventricle ejecting blood into the aorta

Question 2

define ‘cardiac output’

Answer 2

the volume of blood pumped per minute by each ventricles of the heart (5L) (HRxSV = CO)

Question 3

how does kidney failure result in hypertension?

Answer 3

kidney failure prevents the elimination of excess fluid that over burdens the circulatory system, increasing the volume, so blood has to be pumped at a higher pressure

Question 4

what 2 factors can increase cardiac output?

Answer 4

increased contractility

tachycardia

Question 5

what does adrenaline increase?

Answer 5

contractility of the heart (secreted by adrenal glands during stress)

Question 6

what does the thyroid hormone increase?

Answer 6

heart rate

Question 7

what is peripheral resistance mainly regulated by?

Answer 7

arterioles (constriction = stronger ventricle contraction = higher BP)

Question 8

what is the most important regulator of arteriolar tonus?

Answer 8

renin- angiotensin- aldosterone system

Question 9

angiotensin II produces what outcome?

Answer 9

arteriolar constriction = HTN

Question 10

what is does atrial natriuretic peptide do?

Answer 10

lowers BP (natural antagonist of angiotensin II)

Question 11

what is the BP range for mild/stage 1 HTN?

Answer 11

140-159/ 90-99

Question 12

what is the BP range for moderate/stage 2 HTN?

Answer 12

160-179 / 100-109

Question 13

what is the BP range for severe/stage 3 HTN?

Answer 13

> 180 / >110

Question 14

what are 4 NON modifiable risk factors of essential hypertension?

Answer 14

family hx
over 55
gender
black, Hispanic

Question 15

what are 5 causes of secondary HTN?

Answer 15

underlying disease (kidneys)
medication (the pill)
physiological events (pregnancy)
endocrine (adreno-cortical tumors)
neurogenic (psychological)

Question 16

how can diuretics help treat secondary HTN caused by kidney failure?

Answer 16

the may increase urine output, which drops the blood volume and lowers BP

Question 17

what are 5 main complications of HTN?

Answer 17

stroke
HTN retinopathy
cardiac hypertrophy (cardiomegaly) 
renal disease
accelerated atherosclerosis

Question 18

what is the principal consequence of HTN?

Answer 18

cardiomegaly - enlargement of the heart as a consequence of LV hypertrophy

Question 19

what happens physiologically when the left ventricle becomes hypertrophic?

Answer 19

cardiac cells die by ischemia and replaced by fibrous tissue and RV becomes insufficient (veins overloaded) causing PULMONARY HTN

Question 20

what does renal ischemia trigger?

Answer 20

renin-angiotensin-aldosterone system (due to renal arteries atherosclerosis)

Question 21

what change is the first sign of HTN?

Answer 21

retinal changes (HTN retinopathy)

Question 22

what is the most common complication and a major feature of the rheumatic fever?

Answer 22

rheumatic heart disease

Question 23

define ‘rheumatic fever’

Answer 23

inflammatory, systemic disease affective children and young adults that develops some time after infection by the streptococcus pyogens (via throat or skin)

Question 24

what can result from antibody cross-reactivity due to rheumatic fever?

Answer 24

damage to heart valves, joints, skin and brain

Question 25

what valves are most commonly affected by lesions due to acute rheumatic fever?

Answer 25

mitral and aortic (possibly permeant)

Question 26

what is the most common valvular lesion?

Answer 26

mitral stenosis

Question 27

what are two main complications of rheumatic heart disease?

Answer 27

bacterial endocarditis (bacterial infection of heart valves)
embolism

Question 28

with endocarditis the bacteria may form thrombi which may produce….

Answer 28

septic emboli and new foci of infection

Question 29

what are 5 clinical features of bacterial endocarditis?

Answer 29

sudden fever
heart murmurs
heart failure
peripheral embolization
septicemia

Question 30

list 3 viruses that most commonly cause myocarditis

Answer 30

coxackie virus A and B
entero-viruses
HIV

Question 31

list 3 vague symptoms of myocarditis

Answer 31

mild fever
dyspnea
signs of heart failure (tachy, cyanosis, pulmonary edema)

Question 32

define ‘pericarditis’

Answer 32

inflammation of pericardium and epicardium

Question 33

list 5 possible causes of pericarditis

Answer 33

bacteria (TB)
viruses
rarely fungi
uremia
traumatism or radiation

Question 34

what is pericarditis always associated with?

Answer 34

pericardial effusion, including exudates (serous, serofibrous, purulent)

Question 35

name 3 types of cardiomyopathies

Answer 35

dilated
hypertrophic
restrictive

Question 36

define ‘dilated cardiomyopathy’

Answer 36

ventricles are dilated, myocardium thinner and partially replaced by fibrous tissue and caused by alcohol abuse, viral myocarditis, and cardiotoxic chemo drugs

Question 37

define ‘hypertrophic cardiomyopathy’

Answer 37

extensive thickening of LV; often familial and inherited

Question 38

define ‘restrictive cardiomyopathy’

Answer 38

myocardium infiltrated with abnormal substance (amyloid) so the heart cannot expand enough

Question 39

give an example of a primary cardiac tumor

Answer 39

atrial myxoma - benign tumor that attaches to the mitral valve and may occlude

Question 40

define ‘iatrogenic heart lesions’

Answer 40

doctor-induced lesion to heart via drugs, radiation (breast and lung cancer treatment), and surgery

Question 41

list 2 complications of iatrogenic heart lesions

Answer 41

pericarditis and immune reactions (via heart transplant)