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Pathophysiology > module 10 blood pressure > Flashcards

module 10 blood pressure Flashcards

1
Q

short term regulation

A 
occurs quickly to accomodate behavior change
- position change
- exercise
- fear
- anxiety 
pathologic change
- fever
- volume depletion
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2
Q

Short term SNS regulation

A

increase HR and systemic vascular resistance (SVR)

  • baroreceptors
    • increase Epi and NE
  • Chemoreceptors
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3
Q

Epi and NE alpha 1 and A2 receptors

A

vasoconstriction in arterial system

A2 receptor in brain: negative feedback

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4
Q

Epi and NE B1 receptors

A

in heart -> increased rate of SA node firing

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5
Q

short term regulation SNS negative feedback

A

how often baroreceptors fire

- inc. MAP = inc. fire rate

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6
Q

chemoreceptors

A

central: within medullary center
- respond to changes in CO2 and pH
Peripheral: aortic arch and carotid bodies
- respond to dec. in arterial O2 concentration
-> SNS activation

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7
Q

Long term blood pressure regulation

A

neural
hormonal
renal
- all work together

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8
Q

Renal regulation of blood pressure

A

Balance of Na and H2O

Renin-angiotensin-aldosterone system (RAAS)

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9
Q

Renin-angiotensin-aldosterone system (RAAS)

A

juxtaglomerular cells: stimulated by dec. arterial pressure

  • > renin release -> acts on circulating angiotensinogen
  • > release of angiotensin I
  • > angiotensin converting enzyme (ACE) in lungs
  • > angiotensin II (vasoconstriction)
  • > adrenal cortex -> aldosterone release
  • > Na and H2O retention
  • > increased blood volume and BP
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10
Q

Neural regulation of blood pressure

A

ADH

  • increased osmolality -> Inc. ADH
  • > inc. H2O resorption -> dec. osmolality
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11
Q

other influences of longterm blood pressure regulation

A

SNS activation
natriuretic peptides
regulation of intrarenal mechanisms
- renin releases inc when SNS binds to B1 in kidney
- dec. GFR r/t arteriolar constriction and inc. resorption
- ANP

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12
Q

hypertension

A

normal 120/80
Prehypertension: systolic between 120-140
diastolic between 80-90

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13
Q

Stage 1 hypertension

A

systolic: 140
diastolic: 90

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14
Q

primary hypertension (essential)

A

idiopathic

subtypes:
- isolated systolic HTN: S > 140, D < 90
- isolated diastolic HTN: S < 140, D > 90
- combo systolic and diastolic HTN

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15
Q

Risk factors for primary HTN

A 
western population
black
increasing age
family Hx
Modifiable
- obesity
- sedentary lifestyle
- metabolic syndrome
- dietary factors (inc. fat and Na, dec. K and Ca)
- tobacco
- lab data (inc. BG, cholesterol, triglycerides, and LDL. Dec. HDL)
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16
Q

primary HTN Tx

A

lifestyle alterations
- modifiable risk factors
pharmacologic interventions

17
Q

secondary HTN

A

has specific identifiable cause
- ingestion of drugs, food, chemicals
- conditions
risk of: end-organ damage

18
Q

common causes of secondary HTN

A 
Renal
- artery stenosis
- renal failure
- polycystic kidney disease
- glomerulonephritis
Cardiovascular
- coarctation of the aorta
Tumors
- pheochromocytoma
- neuroblastoma
- wilms tumor
- adrenal adenocarcinoma
endocrine
- hyperthyroid
- cushing disease
- congenital adrenal hyperplasia
- primary hyperaldosteronism 
Neurologic
- Guillain- Barre syndrom
- inc ICP 
other
- systemic arteries 
- sleep apnea
19
Q

hypertensive crisis

A 
rapid onset HTN
- secondary HTN
- uncontrolled primary
- autonomic dysfunction 
-- guillian- barre
-- autonomic dysreflexia
Diastolic > 120
Emergency
- spike in BP with end-organ damage
Urgency
- spike in BP without end-organ damage
20
Q

End organ damage HTN

A

CNS

  • ischemic stroke
  • encephalopathy
  • subarachnoid and intracerebral hemorrhage
  • acute HF
  • pulmonary edema
  • MI
21
Q

Low BP

A

SNS activation

orthostatic hypotension: dec. BP upon standing

22
Q

Orthostatic hypotension s/s

A 
dizzy
blurred vision
fainting 
falls -> injury
cardiovascular disease -> stroke, cognitive impairment, death
dec. systolic > 20
dec. diastolic >10 
inc. HR by 20-30
23
Q

risk factors for orthostatic hypotension

A 
vasovagal reaction
dec. circulating volume
dysrhythmias 
adverse drug therapy 
eldery
24
Q

orthostatic hypotension Tx

A

education on moving slowly
avoid hot baths, saunas (vasodilation)
compression stockings
increase Na and fluids

25
Q

reactive hyperemia

A

when blood flow is reestablished after occlusion

  • build up of vasodilatory metabolies: CO2, H+, K+, lactic acid -> relaxation of arterioles.
  • > period of increased blood flow upon reperfusion
26
Q

active hyperemia

A

increased blood flow to a tissue when metabolism in the tissue is elevate (exercise)
- r/t inc. production of vasodilatory metabolites

27
Q

myogenic regulation

A

autoregulation of blood flow that occurs when perfusion pressure is inc. (no change in metabolic activity)
- initially flow to tissue rises but returns toward baseline

28
Q

low pressure baroreceptors

A

in heart and pulmonary circulation

- respond to changes in blood volume and modulate SNS activity and ADH release

29
Q

circle of willis

A

collateral circulation

- ensures blood flow to all tissue sin brain

30
Q

coronary circulation

A

supplied by coronary arteries
pressure gradient affected by
- tissue pressure in wall of heart during systole
Contraction of heart -> compression of heart vessels

31
Q

local effects during bloodflow

A

though systemic vasoconstriction
local
- metabolic vasodialtion
– use of O2 -> inc. CO2 -> vasodialation

32
Q

vessels 3 layers

A

tunicae

  • intima
  • media
  • adventitia
33
Q

tunicae intima

A

a layer of endothelial cells in direct contact of blood flow

  • in veins protrudes into lumen to create valves
  • arterial intima
    • inner elastic membrane next to endothelial cells
34
Q

tunicae media

A

greatest difference between arteries and veins
Arteries: thickest layer
- smooth muscle fibers all around and interspersed with elastic fibers (circular)
- elastic fiber disappears in smaller arterioles
- smooth muscle -> firmness and limits distensibility
Veins
- smooth muscle in circular pattern
- quantity of smooth muscle decreased with vein size increase
- has collagenous CT

35
Q

tunica Adventitia

A

arteries: predominately collagenous CT
- external elastic membrane in large arteries
Veins: thickest layer
- collagenous CT and longitudinal smooth muscle

Pathophysiology (80 decks)

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