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NancyMEDSCI203 > Lecture 23: Hypertension, Heart Failure And Haemodynamic Disorders > Flashcards

Lecture 23: Hypertension, Heart Failure And Haemodynamic Disorders Flashcards

0
Q

Give the formula of blood pressure

A

BP=COxPVR

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1
Q

What is blood pressure determined by?

A

Cardiac output

Peripheral vascular resistance

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2
Q

What does cardiac output depend on?

A

Heart rate, heart contractibility and blood volume

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3
Q

Where is peripheral vascular resistance determined?

A

At the level of arterioles by a combination of neural and hu oral factors

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4
Q

What are humoral factors of peripheral resistance?

A

Constrictors like
angiotensinII, catecholamines, thromboxane, leukotrienes, endothelin

And dilators like
Prostaglandins, kinins, nitric oxide

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5
Q

What are local factors of peripheral resistance

A

Autoregulation

Ionic (incl. pH and hypoxia

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6
Q

What are neural factors of peripheral resistance?

A

Constrictors
Like α-adrenergic

Dilators
Like β- adrenergic

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7
Q

Define hypertension

A

Abnormally high blood pressure in a vascular bed

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8
Q

What are some examples of hypertension

A

Systemic arterial hypertension
Pulmonary hypertension
Portal hypertension

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9
Q

What is portal hypertension?

A

Raised pressure in the hepatic portal vein and tributaries

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10
Q

How does systemic blood pressure vary?

A

Diurnally,
Posture,
Exercise
Stress

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11
Q

How can blood pressure be measured in spite of being influenced by so many things?

A

It is taken on at least 3 occasions over a 3-4 week period.

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12
Q

What is diastolic pressure?

A

intravascular pressure during left ventricular filling

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13
Q

What is systolic pressure?

A

Intravascular pressure during left ventricle contraction

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14
Q

What constitutes as systemic arterial hypertension?

A

Diastolic pressure >90mmHg and systolic pressure >140mmHg

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15
Q

How many people are affected by systemic arterial hypertension?

A

800million

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16
Q

What are the two categories of systemic hypertension?

A

Secondary hypertension and primary hypertension

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17
Q

What proportion of hypertension patients have secondary hypertension?

A

5%

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18
Q

What is secondary hypertension likely to be caused by?

A

As a result of other diseases like renal disease, endocrine disorders, neurological disorders and vascular disease

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19
Q

What is primary hypertension?

A

Essential hypertension.

Systemic arterial hypertension from no obvious cause.

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20
Q

What proportion of hypertensive patients have primary hypertension?

A

95%

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21
Q

Why is there a genetic predisposition to essential hypertension?

A

It is twice as common in black Americans than in whites

There is an increased risk if a relative has hypertension

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22
Q

What are the candidate genes recognised for essential hypertension?

A

Genes encoding for angiotensin converting enzyme, renin, nitric oxide synthase

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23
Q

Why are the most interesting findings about the gene for angiotensinogen?

A

Certain polymorphism s of twins gene is inked with elevated circulating levels of angiotensinogen protein which causes blood pressure to rise

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24
Q

Which environmental factors also play an important role?

A

High dietary sodium, stress, smoking, and inactivity

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25
Q

What does hypertension increase the risk of?

A

Atherosclerosis and related complications
Left ventricular hypertrophy
Cardiac failure
Cerebral haemorrhage
Aortic dissection (blood dissects along aortic media with risk of occlusion of major branch of vessels and aortic rupture)
Small blood vessel disease
Renal insufficiency and renal failure

26
Q

What is heart failure?

A

The failure of the heart to maintain an output of bloo that is adequate for the demands of the bdy

27
Q

What can heart failure be like?

A

Either acute or chronic

Can affect left side of the heart, or the right side, or both sides

28
Q

What happens in low output heart failure?

A

Failure to maintain normal cardiac output because of a disease affecting the Heart

29
Q

What is high output heart failure ?

A

Heart is unable to meet an increased demand for the pumping of blood.

30
Q

What happens when inadequate cardiac output occurs?

A

Adaptive mechanisms are initiated which maintain cardiac output at least temporarily w

31
Q

List the adaptive mechanisms which are activated when cardiac output is inadequate

A

Hypertrophy
Dilation of cardiac chambers
Increased circulating volume
Increased catecholamine release

32
Q

What is hypertrophy?

A

Slow increase in thickness of myocardial fibres

No longer most efficient state to contract efficiently

33
Q

Why does dilation of cardiac chambers occur?

A

To increase the mechanical advantage during pumping

34
Q

Why does increased circulating volume occur as an adaptive mechanism of inadequate cardiac output?

A

Due to activation of renin angiotensin aldosterone system

35
Q

What is the role of increased catecholamine release?

A

Increased Release of catecholamine from the adrenal medulla and sympathetic nervous system results in increased heart rate and myocardial contractility

36
Q

When will cardiac decompensation occur?

A

If cause of heart failure is progressive and/or prolonged and adaptation is no longer adequate to maintain cardiac function

37
Q

The increased circulating volume may produce a volume overload. What can this lead to?

A

Coronary blood supply unable to cope with increased metabolic demands of hypertrophied and dilated heart muscle

Excessive cardiac dilation may lead to mechanical disadvantage during pumping

38
Q

What are the end results of heart failu?

A

Reduced cardiac output with hypoxic effects on other organs

Damming back of blood in veins with congestive effects on multiple organs

39
Q

What does normal fluid homeostasis include?

A

Maintenance of vessel wall integrity and maintenance of intravascular pressure and osmolarity

40
Q

What is the net movement of substances across blood vessel walls determined by?

A

The balance if pressure and osmolarity within vessels and pressure and osmolarity outside vessels in the interstitial spaces.

41
Q

What does this balance result in most healthy tissues?

A

Small net movement of fluid across vessel walls into interstitial spaces.

42
Q

What are the small net movements of water into interstitial spaces removed by?

A

Lymphatics and returned to the circulation via the thoracic duct.

43
Q

What happens if a large net movement of fluid from vessels into interstitial space occurs?

A

Capacity of lymphatics to remove fluid may be exceeded resulting in tissue oedema

44
Q

What is oedema?

A

An increase of fluid within interstitial tissue spaces.

45
Q

How can oedema develop

A

In various conditions, it can occur in dependent tissues like ankles, lungs, bran, or

Fluid can accumulate within body cavities (like in the peritoneal cavity as ascites)

46
Q

What does local oedema occurring during inflammation caused by?

A

Increased blood flow and local increases in vs urad permeability

The oedema fluid is a protein rich exudate with a specific gravity > 1.02

47
Q

How is oedema caused by non-inflammatory causes different?

A

The oedema fluid is a protein poor transudate with a specific gravity of < 1.02

48
Q

What are the causes of non inflammatory oedema?

A 
Increased intravascular hydrostatic pressure
Reduced plasma osmotic pressure (hypoproteinaemia)
Lymphatic obstruction (e.g. Neoplasia, post surgical, post-irradiation)
Sodium retention (e.g. Renal hypo perfusion, excess salt intake, rennin-angiotensin system increase)
49
Q

What is hyperaemia?

A

Active process with increases in flow to a capillary bed as a result of arteriolar dilatation

E.g. In skeletal Muscle during increased exercise

50
Q

What is congestion?

A

Passive process with decreased outflow from a capillary bed

51
Q

What can cause congestion?

A 
Systemic process (like heart failure)
Local process e.g. Isolated venous obstruction or oedema
52
Q

What is haemorrhage?

A

Extravasation of blood due to vessel rupture

Usually follows vessel injury due to trauma, atherosclerosis, or erosion (by inflammation or neoplasm)

53
Q

What are haemorrhagic diatheses?

A

Disorders which increase the likelihood of haemorrhage

Like
Thrombocytopenia - low platelet counts
Clotting factor defects
Amyloidosis - Increased vessel fragility

54
Q

What is hematoma?

A

Haemorrhage enclosed within tissues

55
Q

What are the multiple, small haemorrhages seen in haemorrhagic diatheses ?

A

Petechiae: 1-2mm
Purapura: >3mm
Ecchymoses: >10mm

56
Q

What do the clinical symptoms of haemorrhage depend on?

A

Volume - rapid loss of 20% of blood volume is tolerated well by most healthy adults.

General health

Site of haemorrhage e.g. Brain….

57
Q

What is shock?

A

Cardiovascular collapse

Potentially lethal systematic hypoperfusion due to reduction in cardiac output and/or reduction in effective circulating blood volume.

58
Q

What does shock result in?

A

Hypotension, impaired tissue perfusion, cellular hypoxia

Irreversible cell injury occurs if shock persists

59
Q

What are the causes of shock categorised as ?

A

Cardiogenic - arise from problem related to inadequate cardiac output

Hypovolaemic - arise from problem related to inadequate effective circulating volume

Septic - arising from problem related to infection

60
Q

What are some clinical examples of cardiogenic cause of shock?

A

Myocardial infarction, ventricular rupture, arrhythmia, cardiac tamponade, pulmonary embolism

61
Q

What are the clinical examples of hypovolaemic causes to shock?

A

Haemorrhage

Fluid loss e.g. Vomiting, diarrhoea, burns, trauma

62
Q

What are the clinical examples of septic causes of shock?

A 
Overwhelming microbial infections
Endotoxin shock
Gram-positive septicaemia
Fugal sepsis
Super antigens

NancyMEDSCI203 (12 decks)

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