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Case 4: Infective Endocarditis > Systemic Hypertension > Flashcards

Systemic Hypertension Flashcards

1
Q

Which body systems does systemic hypertension exclude

A

Liver/portal & lungs

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2
Q

Blood pressure definition

A

Pressure excerted by blood against the wall of artery through which the blood flows

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3
Q

3 factors regulating blood pressure

A
  1. Endocrine factors: RAAS, ANP & AHD controls blood volume
  2. Neural factors: sympathetic & parasympathetic nervous system
  3. Cardiac factors: HR & contractility
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4
Q

What is the 3 classifications of systemic hypertension

A

Primary: no identifiable cause
Secondary: identifiable cause
Malignant/accelerated: rapid onset causing acute organ damage when BP is above 200/120mmHg

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5
Q

What is the causes of primary systemic hypertension

A

Environmental: smoking, high sodium intake, obesity, stress & increase serum lipid levels
Genetic: RAAS, Na homeostasis & sympathetic nervous system

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6
Q

What is the 6 causes of secondary systemic hypertension

A
  1. Renal
  2. Endocrine
  3. Cardiovascular
  4. Pregnancy
  5. Neurologic
  6. Drugs
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7
Q

What is the 2 renal pathologies with systemic hypertension

A
  1. Benign hypertension:
    Small & granular
  2. Malignant hypertension:
    Enlarged & pinpoint haemorrhage
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8
Q

What is the 3 cardiac pathologies with systemic hypertension

A
  1. Left ventricular hypertrophy
  2. IHD
  3. Can lead to congestive heart failure
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9
Q

What is the 3 cerebrovascular pathologies with systemic hypertension

A
  1. Stroke causing infarction
  2. Charcot Bouchard aneurysm causing haemorrhage that appears black
  3. Lacunar infarct that appear white that is small caviar infarcts due to arteriosclerosis
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10
Q

What is the vascular pathologies seen in larger arteries in systemic hypertension

A

Accelerated atherosclerosis causing medial necrosis & predispose to ischaemia & infarction

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11
Q

What is normal blood pressure & what is seen as systemic hypertension

A

120/80mmHg normal values
Systemic hypertension >140/90mmHg

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12
Q

How does RAAS effect blood pressure

A

RAAS is activated by decrease renal perfusion & increase blood pressure

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13
Q

How does ANP effect blood pressure

A

Cardiac distention, sympathetic stimulation or angiotensin 2 stimulate ANP production inhibiting renin causing decrease blood volume & vasodilation. Both actions decrease blood pressure

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14
Q

How does SNS effect blood pressure

A
  1. Heart rate increase & force of contraction increase resulting in increased cardiac output
  2. Arteries dilate increasing arterial blood flow
  3. Veins vasoconstrict causing increase cardiac output
    All 3 factors increase arterial blood pressure
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15
Q

What is the affect of malignant/accelerated hypertension

A

Changes are more dramatic & rapid with acute target organ damage

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16
Q

What is the pathogenesis of primary systemic hypertension

A

Complex multi factorial disorder involving interaction between genetics & environment

17
Q

What is 3 renal causes of secondary systemic hypertension

A
  1. Glomerulonephritis
  2. Renal artery stenosis (decrease renal perfusion activating RAAS)
  3. Renin producing tumour
18
Q

What is 3 endocrine causes of secondary systemic hypertension

A
  1. Pheochromocytoma (adrenal medulla tumour producing epinephrine)
  2. Conn’s syndrome (excessive mineralcorticosteriod from adrenal cortex)
  3. Cushing’s syndrome (excessive cortisol from adrenal cortex)
19
Q

What is 2 cardiovascular causes of systemic secondary hypertension

A
  1. Aortic coarctation
  2. Vasculitis due to RA or SLE
20
Q

What is a cause of neurological systemic secondary hypertension

A

Raised intracranial pressure

21
Q

What is a pregnancy cause of systemic secondary hypertension

A

Eclampsia due to abnormal placental vasculature

22
Q

What is 2 drugs causing systemic secondary hypertension

A
  1. Corticosteroids
  2. Contraceptive
23
Q

What is hypertensive encephalopathy in systemic hypertension

A

Malignant hypertension can show diffused cerebral dysfunction & cerebral oedema & herniation due to raised intracranial pressure

24
Q

What is the 2 types of vascular pathologies in arterioles in systemic hypertension

A
  1. Hyaline arteriosclerosis
  2. Hyperplastic arteriosclerosis
25
Q

What is hyaline arteriosclerosis

A

Caused by benign systemic hypertension
Endothelial damage causing leaking of plasma components
SMC proliferate & eosinophilia hyalin thickens narrowing lumen

26
Q

What is vascular arteriosclerosis

A

Due to malignant hypertensions
Acute & severe increase blood pressure causing fibrinoid necrosis & onion skin appearance (concentric lamination of SMC & BM) narrowing lumen

Case 4: Infective Endocarditis (10 decks)

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