Lectures 11 & 12 - Vascular disorders and circulatory shock Flashcards
what is essential hypertension?
no underlying cause
what is secondary hypertension?
kidney disease, renovascular disease, alcoholism
what are the four theories of underlying disease development of HTN?
- excessive SNS activity
- overactive renin-angiotensin-aldosterone system
- altered neurohormonal control
- metabolic disturbances
what are lifestyle management options to control HTN?
physical activity
dietary modification
relaxation techniques
salt restriction
decrease dietary fat
decrease alcohol intake
stop smoking
weight control
what are the short term responses to stress?
- Increased HR
- Increased BP
- Glycogen converted to glucose and released in blood
- Dilation of bronchioles
- Changes in blood flow patterns = decreased digestive activity and reduced urine output
- Increased metabolic rate
what are long term stress responses when mineralocorticoids are involved?
- Retention of sodium and water by kidneys
- Increased blood volume and BP
what are long term stress responses when glucocorticoids are involved?
- Proteins and fats converted to glucose or broken down for energy
- Increased blood glucose
- Suppression of immune system
What are common medications for HTN
- Diuretics
- Beta blockers
- ACE inhibitors
- ARBS
- Calcium channel blockers
how do diuretics work to lower BP?
Thiazide diuretics block reabsorption of Na and H2O and lower BV hence lowering BP, but also cause excretion of K
how do beta blockers work to lower BP?
slow down heart by blocking hormones such as adrenaline
how do ACE inhibitors work to lower BP?
- Used for HTN in heart failure
- Side effects include dry cough
- stop angiotensin 2 thus lower BP
how do ARBS work to lower BP?
angiotensin receptor blocking drugs – blocks angiotensin 2
Alternative to ACE inhibitors if side effects are not tolerated
how do CCBs work to lower BP?
By blocking calcium they allow blood vessels to relax and open
how do CCBs work to lower BP?
By blocking calcium they allow blood vessels to relax and open
what is peripheral vascular disease?
disruption of peripheral perfusion due to obstruction of blood vessels and increased blood clot formation
can affect both veins and arteries
what are the main causes of peropheral vascular disease?
thromboangititis or Raynaud’s disease
what can result from peripheral vascular disease?
reduces perfusion in peripheries leading to ischemia and tissue necrosis
How is peripheral vascular disease diagnosed?
Dopplers to listen to blood flow
angiogram
venogram
how is peripheral vascular disease treated?
angioplasty
endarterectomy
bypass grafts
medications (platelet inhibitors)
What are arterial manifestation of PVD?
- Diminished or absent pulses
- Smooth, shiny, dry skin, no hair
- No oedema
- Round, painful ulcers on distal foot or toes
- Dependent rubour
- Pallor and pain when legs elevated – fighting gravity to get blood to tissues
what are venous manifestations of PVD?
- Normal pulses
- Brown patches of discolouration on lower legs
- Dependent oedema
- Irregular shaped, painless ulcers on lower legs and ankles
- Pain relief when legs elevated
- No intermittent claudication
- Normal nails
- Basically getting good oxygen to areas but not returning it as well
what is DVT and how is it caused?
clot that forms in deep veins
caused from pooling blood, platelets gather, clot forms and breaks off which may head to heart or brain
how is a DVT diagnosed?
ultrasound
if found pt not to move as clot may break off
how is a DVT treated?
Heprine - breaks down clots
warfarin - stop clotting cascade
may need prophylactic treatment like clexane after to stop another DVT
