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CABS2: Cardiology > Peripheral vascular disease, hypertension and dissection > Flashcards

Peripheral vascular disease, hypertension and dissection Flashcards

1
Q

What are the primary determinants of blood pressure

A

volume status
sympathetic nervous system
RAAS

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2
Q

positive chronotropes

A

increases heart rate

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3
Q

negative chrotropes

A

decreases HR - Beta blockers

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4
Q

what are factors that increase HR

A

sympathetic NS
increased thyroid
hypoxemia and acidosis

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5
Q

what are factors that decrease HR

A

Parasympathetic innervation
athletes
medications: BB, CCB

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6
Q

what determines stroke volume

A

EDV - amount in the ventricle right before contraction. typically 120mL

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7
Q

what increases the afterload which increases how much the heart has to work/pump against

A

systemic vascular resistance
aka total peripheral resistance

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8
Q

what determines the systemic vascular resistance

A

vasodilation and vasoconstriction

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9
Q

what is elevated systolic BP

A

120-129 mmHG

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10
Q

what is stage 1 systolic BP

A

130-139 mmHg

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11
Q

what is stage 2 systolic BP

A

> 140mmHg

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12
Q

what is stage 1 diastolic BP

A

80-89 mmHg

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13
Q

what is stage 2 diastolic BP

A

> 90 mmHg

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14
Q

what is released with parasympathetic nervous system stimulation

A

increase acetylcholine release from vagus nerve

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15
Q

what occurs with the adrenal medulla during times of HTN

A

inhibits during HTN which will decrease production of catecholamines
decrease B1 and A1 receptor stimulation - decrease HR, decrease squeeze, decrease BP

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16
Q

what is the elevated BP response

A

renal modulation during HTN will cause decreased RAAS activation
decreased vasoconstriction
decreased sodium excretion
heart strain from HTN will cause natriuretic peptide release (think BNP) which will also decrease RAAS

17
Q

what releases renin

A

kidney

18
Q

what releases angiotensin

A

liver

19
Q

what are risk factors of primary HTN

A

smoking, OSA, obesity, anxiety/stress, family hx of HTN, ETOH, DM

20
Q

what are likely causes of secondary HTN

A

renal disease
renovascular disorder
adrenal gland pathology
thyroid dysfunction
head trauma with decreased ICP (Cushings triad)
preeclampsia/eclampsia
aortic coarctation
medication SE

21
Q

what is malignant hypertension

A

severely elevated BP >180/110

22
Q

what is a hypertensive emergency

A

acute end-organ damage secondary to elevated BP

23
Q

what is hypertensive urgency

A

stable end-organ disease (LVH -> CHF)

24
Q

what is severe uncontrolled HTN

A

no end-organ damage but highly elevated BP

25
Q

what are the downstream effects of high blood pressure

A

ischemic heart disease - supply/demand mismatch
AKI/CKD
encephalopathy
HTN retinopathy
dissection, aneurysm
atherosclerosis
lunar infarcts, ruptured brain aneurysm, subarachnoid hemorrhage

26
Q

what are the vessel wall layers

A

Tunica intima
tunica media
tunica externa (adventitia)
vasa vasorum

27
Q

what is aortic dissection

A

separation allowing for the accumulation of blood between the tunica intima and tunica media
false lumen is created that will progressively increase in size os the blood spreads in the false tract

28
Q

what are the primary causes of aortic dissection

A

most commonly associated with HTN, smoking, advanced age and hyperlipidemia
these increase sheer stresses

29
Q

what can happen with a false lumen with aortic dissection

A

rupture
create down stream reentry site to connect with true lumen
enlarge to compress or occlude the true lumen resulting in decreased perfusion
form hematoma within the intimal defect

30
Q

what are risks for aortic dissection

A

hypertension
connective tissues d/o: ehlers danlos, marfans
bicuspid aortic valve - increased risk of turbulence
coarctation of the aorta - increased risk of turbulence

31
Q

what are the most common trauma injuries associated with aortic dissection

A

acceleration/deceleration injuries
trauma from iatrogenic sources

32
Q

what is the presentation of aortic dissection

A

abrupt onset of check of abdominal pain, often described as ripping or tearing
pulse difference in extremities or BP difference between then of >20 mmHg
widened mediastinum or aorta on imagine

33
Q

what are risk factors for aortic dissection

A

male
>50yo
HTN
Cocaine or amphetamine use
bicuspid aortic valve
hx of aortic valve replacement
connective tissue disorder
pregnancy

34
Q

what are risk factors for aortic aneuryms

A

connective tissue disorders
trauma
dissection
aortitis
atheroscerosis*

35
Q

what is the ruptured AAA triad

A

abdominal or back pain
hypotension
pulsatile abdominal mass

36
Q

how quickly does mortality rate increase with AAA ruptures

A

increase by 1% per minute prior to arrival to the ED

37
Q

what is peripheral artery disease

A

occlusion/narrowing reduce the blood flow to distal tissues
results in ischemia and can lead to nephrosis

38
Q

what is chronic venous disease

A

decrease functioning of the venous system resulting in obstruction, venous hypertension, varicose veins

39
Q

what occurs at the renal arteries

A

blood pressure regulation

CABS2: Cardiology (11 decks)

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