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Echo 2 > Module 10 : Systemic Hypertension > Flashcards

Module 10 : Systemic Hypertension Flashcards

1
Q

what is a normal BP

A

< 120/80

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2
Q

what must happen to diagnose HTN

A
  • high BP in 2 separate readings of >140/90
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3
Q

what is classified as pre hypertension

A

130-139 / 85-89

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4
Q

what is stage 1 HTN

A

140-159 / 90-99

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5
Q

what is stage 2 HTN

A

> 160 / 100

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6
Q

what is isolated HTN

A

> /= 140 and < 90

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7
Q

what are the 2 types of hypertension

A
  • essential HTN (primary) = multifactoral

- secondary HTN

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8
Q

what are the causes essential/primary HTN

A
  • hereditary
  • metabolic causes
    + metabolic syndrome
    + obesity
    + diabetes mellitus/ insulin resistance
    + sedentary lifestyle
    + mental stress
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9
Q

what are the causes of secondary HTN

A 
- renal disease 
  \+ renovascular disease
  \+ chronic renal disease
- endocrine/hormonal 
  \+ increased cathecolamines 
  \+ primary aldosteronism 
  \+ adrenal hyperplasia
  \+ increased cortisol 
- pituitary/hypothalmic = cushings 
- thyroid = hyperthyroidism 
- CNS = increased sympathetic tone
- aortic coarctation
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10
Q

what are 7 risk factors for getting essential hypertension

A
  • older age
  • ethnicity
  • male
  • obesity
  • dyslipidemia
  • diabetes mellitus
  • insulin resistance
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11
Q

what are 6 lifestyle factors that increase risk of essential hypertension

A
  • stress
  • excessive sodium intake
  • excessive alcohol intake
  • inadequate calcium and potassium intake
  • lack of physical activity
  • smoking
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12
Q

what is the mean pressure

A
  • average pressure over the cardiac cycle
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13
Q

what length of the cardiac cycle should systole and diastole occupy normally

A
  • systole = 1/3

- diastole = 2/3

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14
Q

in a tachycardic heart what length of the cardiac cycle does systole occupy

A

> 1/3

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15
Q

in a bradycardic heart what length of the cardiac cycle does systole occupy

A

< 1/3

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16
Q

how do you calculate mean arterial pressure MAP with systolic and diastolic pressure

A

MAP = [ ( 2 x diastolic ) + systolic ] / 3

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17
Q

how do you calculate pulse pressure

A

pulse pressure = SBP - DBP

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18
Q

what is the pulse pressure

A

difference between SBP and DBP

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19
Q

what would happen to the pulse pressure with severe AO regurge

A
  • pulse pressure increases

- starlings increases force of contraction so SBP increases but DBP decreases

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20
Q

how do you calculate MAP with cardiac output and systemic vascular resistance

A
  • MAP = CO x SVR
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21
Q

what change to cardiac output will increase average BP

A 
- any factor that increases CO 
  \+ obesity 
  \+ pregnancy 
  \+ regurgitation 
  \+ excessive salt intake
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22
Q

what changes to systemic vascular resistance will increases average BP

A 
- any factor that increases SVR 
  \+ stress
  \+ caffeine
  \+ nicotine 
  \+ alcohol 
  \+ inadequate potassium or calcium
  \+ lack of activity 
  \+ smoking
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23
Q

what occurs the heart with heart failure with preserved ejection fraction (HFpEF)

A
  • compensatory hyperdynamic contraction

- hypertensive hypertrophic cardiomyopathy

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24
Q

what is the main mechanism of HRpEF

A

diastolic dysfunction

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25
Q

what are the signs of diastolic dysfunction

A
  • dyspnea
  • imparted diastolic filling
  • LA overload leads to pulmonary venous congestion which leads to RV elevated pressure&raquo_space; RV enlargement&raquo_space; increasing TR
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26
Q

what is the number one way to change peripheral resistance

A

vessel diameter

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27
Q

what two techniques can cause vasodilation in high resistance vascular bed

A
  • exercise

- relaxation

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28
Q

does a compliant vessel have a higher or lower pulse pressure

A

lower

BP = 110/75

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29
Q

does a stiffer vessel have a higher or lower pulse pressure

A
  • lower
30
Q

does aortic stiffness increase with age

A

yes

31
Q

does aortic compliance increase with age

A

no decreases

32
Q

how does inspiration affect right heart filing

A
  • increases right heart filling
33
Q

how does expiration affect right heart filling

A
  • decreases right heart filling
34
Q

how does a muscle pump work

A
  • muscles contract around veins to compress the blood upward through valves
  • CHF patients must walk to augment flow
  • main reason why walking hopes pedal edema from CHF
35
Q

what is volemia

A

total blood volume

36
Q

does increase blood volume increase blood pressure

A
  • yes
37
Q

what are 2 factors that increase volemia

A
  • water retention (kidney, liver)
  • total body mass
    + blood vessels designed for skeletal size not skin size
38
Q

how does salt intake water content in blood

A
  • high salt intake leads to decreased excretion of water and salt by kidneys to maintain proper salinity of blood
    + more water in vascular system
    + more outward pressure on arterial walls
    = higher BP
39
Q

what is salinity

A
  • sodium:water ratio
40
Q

does sodium by itself raise BP if not what does

A
  • no

- sodium chloride

41
Q

how does high afterload / BP affect CHF

A
  • increased work load for an already overloaded muscle

- diastolic dysfunction as well

42
Q

how does high afterload /BP affect CAD

A
  • endothelial damage in coronary artery accelerates plaque formation
43
Q

how does high afterload / BP affect PVD

A
  • endothelial damage in coronary artery accelerates plaque formation
44
Q

how does high afterload/BP affect renal failure

A
  • pressure to high for kidneys to function well&raquo_space; endothelial damage
45
Q

how does high afterload/BP affect angina

A
  • increased workload of the muscle + decreased coronary perfusion
46
Q

what does a release of nitric oxide do to the endothelium

A
  • makes the endothelium release EDRF&raquo_space; vasodilation
47
Q

what does EDRF do

A
  • allows the smooth muscle cells of the tunica intima and media to relax
48
Q

what is EDRF

A

endothelium relaxation factor

49
Q

how is HTN managed by addressing causes

A
  • regulating blood volume
  • regulating CO
  • regulating peripheral arterial resistance
50
Q

is medication or lifestyle changes done first to manage HTN

A
  • life style changes
51
Q

what are the lifestyle modification made to manage HTN

A
  • exercise
  • control salt intake
  • lipids managment
  • smoking cessation
  • stress reduction techniques
52
Q

how does smoking and stress lead to high BP

A
  • smokings/toxins damage endothelium function
  • mental stress impairs endothelial function
  • smoking leads to elevated mental stress
  • smoking and mental stress lead to high BP
53
Q

what are the 4 main types of medication to lower blood pressure and what do they do

A
  • diuretics = lower total blood volume, reduce afterload and preload, excrete salt with water
  • beta blockers = lower HR reduce SBP and DBP block sympathetic stem
  • calcium channel blockers = block calcium from entering muscle cell
  • ACE inhibitors = prevent angiotensin from causing arterial constriction
54
Q

what are the 4 roles of echo in hypertension

A
  • determine presence and degree of hypertension
  • assess LV Systolic and diastolic function
  • exclude identifiable cause of hypertension
  • identify other cardiac anomalies associated with hypertensive heart disease
55
Q

what are we evaluating the size of with HTN

A
  • LV
  • LA
  • IVS
  • LVPW
  • AO root, asc, dsc
56
Q

what are we evaluating with systolic function with HTN

A

EF

57
Q

what are we evaluating with diastolic dysfunction with HTN

A
  • E/A ratio
  • E/e ratio
  • pulmonary V profile
  • tissue doppler
58
Q

what are we evaluating with LV or RV dilation and what would it cause with HTN

A
  • MR
  • AI/AR
  • TR
  • RVSP
59
Q

what could be 5 2D findings on a patient with HTN

A
  • LV hypertrophy
  • Aortic root , asc ao dilation
  • aortic valve sclerosis or MAC
  • LA enlargmetn - arrhythmia
  • RV dilation due to high RVSP
60
Q

what would a be finding on strain echo with HTN

A
  • reduced global strain
61
Q

what would be a finding on doppler with HTN

A 
- diastolic dysfunction 
   \+ increase LV filling pressure
   \+ pulmonary veins flow reversal 
  \+ TDI reduced 
  \+ RVSP increased 
- desc ao diástole flow reversal 
- regurge
62
Q

what is normal LV geometry

A
  • normal LV mass and normal relative wall thickness
63
Q

what is concentric remodelling

A
  • normal LV mass with increased relative wall thickness
64
Q

what is concentric hypertrophy

A
  • increased LV mass and increased relative wall thickness
65
Q

what is eccentric hypertrophy

A
  • increased LV mass with normal / decreased relative wall thickness
66
Q

what is normal LV mass index in femal and male

A

= 95 female

= 115 male

67
Q

what is normal relative wall thickness

A

= 0.42

68
Q

what is the LV mass linear technique equation

A

LV mass = 0.8 [ 1.04{(PWd + LVIDd + IVSd)^3 LVID^3}] 0.6

69
Q

what is the LV mass index equation

A

LVMI = total LV mass / BSA

70
Q

how does obesity effect LV mass index

A
  • LV mass may be too high but LV mass index normal due to increased BSA
71
Q

what is the relative wall thickness equation

A

RWT = 2 (PWd/LVIDd)

Echo 2 (18 decks)

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