Module 10 : Systemic Hypertension Flashcards
(71 cards)
1
Q
what is a normal BP
A
< 120/80
2
Q
what must happen to diagnose HTN
A
- high BP in 2 separate readings of >140/90
3
Q
what is classified as pre hypertension
A
130-139 / 85-89
4
Q
what is stage 1 HTN
A
140-159 / 90-99
5
Q
what is stage 2 HTN
A
> 160 / 100
6
Q
what is isolated HTN
A
> /= 140 and < 90
7
Q
what are the 2 types of hypertension
A
- essential HTN (primary) = multifactoral
- secondary HTN
8
Q
what are the causes essential/primary HTN
A
- hereditary
- metabolic causes
+ metabolic syndrome
+ obesity
+ diabetes mellitus/ insulin resistance
+ sedentary lifestyle
+ mental stress
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
10
Q
what are 7 risk factors for getting essential hypertension
A
- older age
- ethnicity
- male
- obesity
- dyslipidemia
- diabetes mellitus
- insulin resistance
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
12
Q
what is the mean pressure
A
- average pressure over the cardiac cycle
13
Q
what length of the cardiac cycle should systole and diastole occupy normally
A
- systole = 1/3
- diastole = 2/3
14
Q
in a tachycardic heart what length of the cardiac cycle does systole occupy
A
> 1/3
15
Q
in a bradycardic heart what length of the cardiac cycle does systole occupy
A
< 1/3
16
Q
how do you calculate mean arterial pressure MAP with systolic and diastolic pressure
A
MAP = [ ( 2 x diastolic ) + systolic ] / 3
17
Q
how do you calculate pulse pressure
A
pulse pressure = SBP - DBP
18
Q
what is the pulse pressure
A
difference between SBP and DBP
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
20
Q
how do you calculate MAP with cardiac output and systemic vascular resistance
A
- MAP = CO x SVR
21
Q
what change to cardiac output will increase average BP
A
- any factor that increases CO \+ obesity \+ pregnancy \+ regurgitation \+ excessive salt intake
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
23
Q
what occurs the heart with heart failure with preserved ejection fraction (HFpEF)
A
- compensatory hyperdynamic contraction
- hypertensive hypertrophic cardiomyopathy
24
Q
what is the main mechanism of HRpEF
A
diastolic dysfunction
25
what are the signs of diastolic dysfunction
- dyspnea
- imparted diastolic filling
- LA overload leads to pulmonary venous congestion which leads to RV elevated pressure >> RV enlargement >> increasing TR
26
what is the number one way to change peripheral resistance
vessel diameter
27
what two techniques can cause vasodilation in high resistance vascular bed
- exercise
| - relaxation
28
does a compliant vessel have a higher or lower pulse pressure
lower
| BP = 110/75
29
does a stiffer vessel have a higher or lower pulse pressure
- lower
30
does aortic stiffness increase with age
yes
31
does aortic compliance increase with age
no decreases
32
how does inspiration affect right heart filing
- increases right heart filling
33
how does expiration affect right heart filling
- decreases right heart filling
34
how does a muscle pump work
- 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
what is volemia
total blood volume
36
does increase blood volume increase blood pressure
- yes
37
what are 2 factors that increase volemia
- water retention (kidney, liver)
- total body mass
+ blood vessels designed for skeletal size not skin size
38
how does salt intake water content in blood
- 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
what is salinity
- sodium:water ratio
40
does sodium by itself raise BP if not what does
- no
| - sodium chloride
41
how does high afterload / BP affect CHF
- increased work load for an already overloaded muscle
| - diastolic dysfunction as well
42
how does high afterload /BP affect CAD
- endothelial damage in coronary artery accelerates plaque formation
43
how does high afterload / BP affect PVD
- endothelial damage in coronary artery accelerates plaque formation
44
how does high afterload/BP affect renal failure
- pressure to high for kidneys to function well >> endothelial damage
45
how does high afterload/BP affect angina
- increased workload of the muscle + decreased coronary perfusion
46
what does a release of nitric oxide do to the endothelium
- makes the endothelium release EDRF >> vasodilation
47
what does EDRF do
- allows the smooth muscle cells of the tunica intima and media to relax
48
what is EDRF
endothelium relaxation factor
49
how is HTN managed by addressing causes
- regulating blood volume
- regulating CO
- regulating peripheral arterial resistance
50
is medication or lifestyle changes done first to manage HTN
- life style changes
51
what are the lifestyle modification made to manage HTN
- exercise
- control salt intake
- lipids managment
- smoking cessation
- stress reduction techniques
52
how does smoking and stress lead to high BP
- 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
what are the 4 main types of medication to lower blood pressure and what do they do
- 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
what are the 4 roles of echo in hypertension
- 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
what are we evaluating the size of with HTN
- LV
- LA
- IVS
- LVPW
- AO root, asc, dsc
56
what are we evaluating with systolic function with HTN
EF
57
what are we evaluating with diastolic dysfunction with HTN
- E/A ratio
- E/e ratio
- pulmonary V profile
- tissue doppler
58
what are we evaluating with LV or RV dilation and what would it cause with HTN
- MR
- AI/AR
- TR
- RVSP
59
what could be 5 2D findings on a patient with HTN
- LV hypertrophy
- Aortic root , asc ao dilation
- aortic valve sclerosis or MAC
- LA enlargmetn - arrhythmia
- RV dilation due to high RVSP
60
what would a be finding on strain echo with HTN
- reduced global strain
61
what would be a finding on doppler with HTN
```
- diastolic dysfunction
+ increase LV filling pressure
+ pulmonary veins flow reversal
+ TDI reduced
+ RVSP increased
- desc ao diástole flow reversal
- regurge
```
62
what is normal LV geometry
- normal LV mass and normal relative wall thickness
63
what is concentric remodelling
- normal LV mass with increased relative wall thickness
64
what is concentric hypertrophy
- increased LV mass and increased relative wall thickness
65
what is eccentric hypertrophy
- increased LV mass with normal / decreased relative wall thickness
66
what is normal LV mass index in femal and male
= 95 female
| = 115 male
67
what is normal relative wall thickness
= 0.42
68
what is the LV mass linear technique equation
LV mass = 0.8 [ 1.04{(PWd + LVIDd + IVSd)^3 LVID^3}] 0.6
69
what is the LV mass index equation
LVMI = total LV mass / BSA
70
how does obesity effect LV mass index
- LV mass may be too high but LV mass index normal due to increased BSA
71
what is the relative wall thickness equation
RWT = 2 (PWd/LVIDd)
