PATHO-- alterations in cardiac function Flashcards
short term regulation of systemic blood pressure
baroreceptors monitor changes, activate SNS
parasympathetic system slows HR
long term regulation of systemic BP
regulated by neural, hormonal, renal systems. Increased cardiac output and stroke volume rate. increased serum Na levels, increased ADH secretion, RAAS system, connected to fluid volume
hypertension
defined as a sustained BP greater than normal, not a single disease but a syndrome with multiple causes
primary hypertension
also known as “essential hypertension”– cause is unknown
secondary hypertension
cause is known
non modifiable risk factors for hypertension:
family history, age, ethnicity, gender
modifiable risk factors for hypertension:
stress, food choices, caffeine intake, alcohol dependance, smoking, elevated total cholesterol, sedentary lifestyle
primary (essential) hypertension statistics
idiopathic disorder, most common form of hypertension, rare prior to age 10, major risk factor for CV disease
pathogenesis of primary (essential) hypertension
vasoconstriction of narrowed peripheral blood vessels, causes increased peripheral resistance, increased workload, and more pressure for the afterload
treatment of primary hypertension
lifestyle modifications: weight loss, exercise, alcohol modification, decreased Na+ intake. Drug treatment: for hypertension effects SV, SVR, and HR
outcomes related to primary hypertension
end-organ damage, renal failure, stroke, heart disease, damage to arterial system and acceleration of atherosclerosis lead to CV disease, increased myocardial work leads to heart failure, glomerular damage results in kidney failure, affects microcirculation of eyes, increased pressure in cerebral vasculature can result in hemorrhage.
secondary hypertension etiologies
renal artery sclerosis, pregnancy induced hypertension, pheochromocytoma, sleep apnea, hyperaldosteronism, obesity, renal disease, cushing syndrome, contraceptive use, drug induced, hyperthyroid, coarctation of aorta, polycythemia
hypertension clinical manifestations
may be asymptomatic, headache is common, dizziness, nausea and vomiting, visual disturbances, renal insuffiency
hypertensive emergency
sudden increase in either both systolic and diastolic BP with evidence of end organ damage
treatment of hypertensive emergency
rapid but controlled reduction of BP using parenteral anti-hypertensive agents under close monitoring (usually ICU)
hypertensive urgency
similar BP elevation without evidence of end organ damage
treatment of hypertensive urgency
oral prescriptions to bring BP under control in 24-48 hours
low blood pressure (orthostatic) postural hypertension
extreme response to change from supine to upright position; activation of short term control mechanisms is slow or inadequate
orthostatic hypotension results in..
dizziness, blurred vision, confusion, possible syncope
clinical manifestations of orthostatic hypotension
causes decrease in systolic blood pressure greater than or equal to 20 mmhg or 10 mmhg in 3 minutes, and increase in HR by 20/30 BPM when moving to upright position
orthostatic hypotension may be a result of
problem of vasomotor or baroreceptor response, adverse effect of drug therapy, arterial stiffness, volume depletion, secondary disease process, vasovagal reaction, cardiac dysrhythmias
treatment of orthostatic hypotension
review medication history, slow positional changes, avoid hot environments, avoid large/carb heavy meals, when experiencing symptoms have patient squat forward or cross legs to reduce effect. Use elastic compression stockings, abdominal binders, elevate HOB
