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HDT 2.2 > regulation of BP and BV > Flashcards

regulation of BP and BV Flashcards

1
Q

what is the formula for ABP?

A

ABP = CO x TPR

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2
Q

what affects ABP?

A
  1. acutely
    - heart rate, SV and TPR changes
    - > your ABP will increase when you cough, exercise or sneeze or you’re responding to pain or stimuli
    - > ABP decreases cutaneous vasodilation when hot; when standing. haemorrhage or dehydration can cause decrease in BV
  2. chronically
    - > healthy ageing - loss of elasticity/increased stiffness of larger arteries
    - > essential hypertension; causes increase TPR and so increase ABP and renal disease have similar effects
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3
Q

what’s the formula for flow?

A

ABP-VR/ R

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4
Q

what affect does low ABP have on tissue blood flow?

A

low ABP means low blood flow so low oxygen delivery

  • can lose consciousness
  • decrease ABP can lead to fainting
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5
Q

how does heart failure affect ABP?

A

low CO so low ABP and low blood flow

ABP needs to be raised for tissues to receive oxygen

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6
Q

what does increase in ABP cause for the heart?

A

means hearts workload has to increase and has to increase force of contraction to maintain SV
e.g. coronary artery disease and so angina and infarction

if its chronically raised ABP; hypertension

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7
Q

what can affect blood volume acutely?

A

fluid intake and fluid loss

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8
Q

what can affect blood volume chronically?

A
  • fluid loss from gut through diarrhoea, vomiting and reduced BV
  • poor renal function - fluid retained - increased BV
  • heart failure - fluid retained and distends ventricle - increased BV
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9
Q

how does distribution of body fluid between CVS and interstitum?

A

i. supine vs standing - venous pooling so get oedema in the lower limbs
ii. between CVS and tissue fluid - oedema associated with inflammation, low plasma protein and impaired lymph drainage
low plasma protein means fluid filters out of the capillaries and doesn’t come back in easily due to low osmotic pressure bringing water back in

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10
Q

what do changes in blood volume or distribution of body fluid do for healthy people?

A

decreasing their central blood volume and so changes the central venous pressure, decreasing it; this reduces ABP and CO

vice versa if you increase the CBP and with this you have extra fluid that needs to be lost from the kidney

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11
Q

what do changes in blood volume or distribution of body fluid do for people with heart failure?

A

increases blood volume so increased CVP

- more distension of ventricle and exacerbates problems

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12
Q

what do changes in blood volume or distribution of body fluid do for people with oedema?

A

swelling will stop normal tissue function
this reduces ABP and BV
so exacerbates the problems

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13
Q

where do the pre-ganglionic sympathetic neurones sit?

A

T1-L2/3

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14
Q

where do the parasympthathetic nerves lead to?

A

the SAN and the AVN

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15
Q

where do the sympthathetic nerves lead to?

A

lead to the arterioles, venous vessels, AVN, SAN and ventricles

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16
Q

what does the baroreceptors do?

A

homeostatically regulates ABP
i.e. pressure in elastic and large arteries

they are stretch receptors that respond to stretch changes cause by ABP changes and are signalled via the sinus nerve

17
Q

which reflexes have a faster effect on their desired trait?

A

the baroreceptors has a faster effect on the ABP

18
Q

how does and increase/decrease in ABP affect afferent activity?

A

increase in ABP increases afferent activity and vice versa

19
Q

why is the baroreceptor reflex important?

A
  • reducing its sensitivity allows ABP to reach higher values
  • these reflexes have a higher set point in hypertension dye to increase in sympathetic neuronal activity in CNS
  • maintains ABP in heart failure as they have lower CO so lower ABP
20
Q

what is the volume receptor reflex?

A

stretch receptors in the right atrium
get affected by CVP changes
or real changes in BV

  • increase in stretch causes increase in afferent activity and vice versa
    regulates BV homeostatically
21
Q

why is the volume receptor reflex important?

A
  • continually monitoring central BV and changes it
    has an effect of 20-30 effect
    has a higher set point in heart or renal failure
    its sensitivity is reduced in heart and renal failure and so BV can reach much higher values
22
Q

if taking a ACE inhibitor and you get a dry cough what should you do?

A

give them an ARB

23
Q

what’s the upper limit normal for hypertension patients BP?

A

14090 mmHg

24
Q

what does high BP increase risk of?

A

heart failure
coronary artery disease
stroke

25
Q

what are the blood pressure of hypertension?

A

Stage 1; in clinic >140/90 mmHg and at home Bp is 135-149/85-94 mmHg
Stage 2; in clinic >160/100mmHg but less than 180.120 mmHg and ABPM is >150/95 mmHg
Stage 3 or severe hypertension; in clinic >180/120mmHg

26
Q

how should BP measurement be taken?

A

it should be seated especially older patients
arm being used should be supported and hand should be relaxed
for irregular pulses it should be taken manually

27
Q

if BP is >140/90 what should be done next?

A

they should be given an ABPM to do it at home

take 2 readings every hour for 24 hours and take an average of the measurements to see if hypertension is present

28
Q

how would you use a home BPM?

A

take two consecutive BP measurements that are 1 minute apart and person should be seated
take readings twice daily for at least 4 days

29
Q

when risk of hypertension what examinations can be done?

A

determine CV risk
and look at urinalysis for proteinuria, heamaturia or albuminuria
perform blood tests for creatinine, eGFR, lipids, electrolytes

30
Q

how do you calculate BP ?

A

BP = CO x TPR

31
Q

how do Ace inhibitors affect bradykinin?

A

ACE inhibitors stop the breakdown of bradykinin so this protein levels rise in blood and vessels dilate

32
Q

what are main side effects of ACE inhibitors, ARBs? what monitoring is needed for them?

A

cough, rash, renal failure, angioedema
- postural hypotension

monitor their renal function, potassium and their BP at the start and regularly
- monitor creatinine every 6-12 months after required dosage is reached

33
Q

what are the beta blockers properties?

A
  1. cardioselective so not specific
  2. intrinsic sympathomimetic activity
  3. some are lipid soluble and some water soluble
  4. membrane stabilising activity
34
Q

what common problems can you get from beta blockers?

A
  • CNS effects ; reduced sympathetic outflow
  • tiredness and fatigue
  • hypoglycaemia due to blunting of SNS activation or hyperglycaemia due to risk of new onset diabetes
35
Q

what are some calcium channel blockers?

A

dihydropyridine derivatives: amlodipine, felodipine, nifedipine
phenylakylamine ; verapamil

36
Q

what is first line treatment for HF patients with left ventricular systolic dysfunction?

A

can have beta blockers which are licensed for heart failure with heart failure due to left ventricular systolic dysfunction
start at low dose and increase slowly
assess HR and BP and clinical status after each titration

HDT 2.2 (10 decks)

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