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ECHO 325 > Systemic Hypertension > Flashcards

Systemic Hypertension Flashcards

1
Q

Describe the categories of HTN and their pressures?

A 
Normal = <120 / <80
Pre = 120-139 / 80-89
Stage 1 = 140-159 / 90-99
Stage 2 = >160 / 100
Isolated Systolic = ≥140 / <90 (only the systolic number is high)
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2
Q

What is considered a hypertensive blood pressure?

A

2 readings of >140/90

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3
Q

Essential hypertension is also known as what?

A

Primary hypertension

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4
Q

Primary hypertension is caused by what?

A

Idiopathic but related to hereditary and metabolic causes

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5
Q

Secondary hypertension is caused by what? (6)

A

HTN is secondary to a known disease:

  • Renal disease
  • Endocrine/hormonal
  • CNS: Increased sympathetic tone (fight/flight)
  • Pituitary/Hypothalamic (Cushing Disease)
  • Hyperthyroidism
  • Aortic coarctation
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6
Q

What is mean pressure?

A

Average pressure over the cardiac cycle

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7
Q

What is the formula for MAP?

A
  1. (2 x DBP + SBP) ÷ 3

2. CO x SVR

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8
Q

How is pulse pressure calculated?

A

PP = SBP - DBP

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9
Q

Any factor which increases CO will increase what?

A

Average blood pressure

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10
Q

Any factor which increases systemic vascular resistance will increase what?

A

Mean arterial blood pressure

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11
Q

What is the main mechanism of HPnEF (HFpEF)?

A

Diastolic dysfunction

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12
Q

What is the number one symptom of diastolic dysfunction?

A

Dyspnea

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13
Q

Resistance increases with an increase of what factors?

A

Length of vessel, viscosity, and decreased radius

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14
Q

A compliant vessel has what kind of pulse pressure?

A

Lower pulse pressure

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15
Q

A stiffer vessel has what kind of pulse pressure?

A

Wider pulse pressure

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16
Q

What happens to right heart filling with inspiration?

A

Increased right heart filling

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17
Q

What happens to right heart filling with expiration?

A

Decreased right heart filling

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18
Q

What is volemia?

A

Total blood volume

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19
Q

What two factors increase volemia?

A

Water retention and total body mass

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20
Q

What mechanism causes CHF?

A

Increased work load (afterload) on an overloaded muscle and diastolic dysfunction

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21
Q

What mechanism causes CAD?

A

Endothelial damage in coronary artery accelerates plaque formation

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22
Q

What mechanism causes PVD?

A

Endothelial damage accelerates plaque formation

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23
Q

What mechanism causes renal failure?

A

Pressure too high for kidneys to function well which leads to endothelial damage

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24
Q

What mechanism causes angina?

A

Increased workload of the muscle and decreased coronary perfusion

25
Q

What is EDRF?

A

Endothelium relaxation factor

26
Q

Nitric oxide is a product of what?

A

Metabolism

27
Q

What does nitric oxide do?

A

Makes the endothelium release EDRF which leads to vasodilation

28
Q

What does EDRF allow the smooth muscle cells of the tunica intima and media to do?

29
Q

What is endothelial function analysis based on?

A

Nitric oxide measurement

30
Q

What needs to be modified first for hypertension management?

31
Q

Name three diuretics and their main effect:

A
  1. Dyazide
  2. Hydrochlorothiazide
  3. Metazone

Lowers volemia by promoting urination (excreting salt with water) which reduces afterload and preload

32
Q

Name three beta blockers and their main effect:

A
  1. Acebutolol
  2. Metoprolol
  3. Propranolol

Blocks the sympathetic stimulation to reduce HR by 25% and allow better contraction and profusion (reduces BP)

33
Q

Name three calcium channel blockers and their main effect:

A
  1. Dil-zem
  2. Ni-pine
  3. Vera-mil

Block calcium from entering the muscle cells which reduces contraction/inotropy lowering afterload

34
Q

Name three ACE inhibitors and their main effect:

A
  1. Captopril
  2. Lisinopril
  3. Ramapril

Prevent angiotensin from causing arterial constricting which lowers afterload

35
Q

EF measures what type of function?

36
Q

E/A ratio measures what type of function?

37
Q

E/e prime ratio measures what type of function?

38
Q

Pulmonary v profile measures what type of function?

39
Q

Tissue doppler measures what type of function?

40
Q

Explain concentric remodeling:

A

Normal LV mass with increased relative wall thickness

41
Q

Explain concentric hypertrophy:

A

Increased LV mass and increased relative wall thickness

42
Q

Explain eccentric hypertrophy:

A

Increased LV mass with normal or decreased relative wall thickness (Why? Starting to ‘bag out’)

43
Q

LV mass linear technique can be done with what?

A

M-mode or 2D

44
Q

LV Mass index formula?

A

Total LV mass/BSA

45
Q

What is RWT and state the formula for?

A

Relative Wall Thickness relates wall thickness to chamber size in diastole

2PWTd/LVIDd

46
Q

What is a normal relative wall thickness?

47
Q

What are risk factors for HTN? (12)

A
  • Age
  • African
  • Male
  • Smoking
  • Obesity
  • Inactivity
  • Diabetes
  • Stress
  • Dyslipidemia
  • Sodium
  • Alcohol
  • Inadequate calcium or potassium
48
Q

How do higher heart rates affect mean pressure?

A

Higher heart rates equal higher pressure because there is more time spent in systole

49
Q

What happens to the pulse pressure during AR?

A

The PP gets larger because the systolic component goes up (contracting harder - starlings law) and the diastolic component goes down (inability to fill) creating a bigger diff between SBP and DBP

PP = SBP - DBP

50
Q

What does SVR sand for?

A

Systemic Vascular Resistance

51
Q

Describe BP regulation?

A

The peripheral resistance, SV(inotropy) and HR determine CO which is regulated by the baroreceptors in the carotid bulb/aorta that either tell the heart to pump more to profuse the brain or less. (As we age baroreceptors need help from medication to regulate)

52
Q

How does volemia affect BP?

A

Increased blood volume increases blood pressure

53
Q

Explain the relationship of salt and BP?

A

Increased sodium chloride (Na+Cl-) = increased water retention (to dilute) = increased volemia = increased BP

54
Q

What diseases are caused by HTN?

A
  1. CHF
  2. CAD
  3. PVD (peripheral vascular disease)
  4. Renal failure
  5. Angina
55
Q

What 3 things need to be regulated to manage HTN?

A
  1. Blood Volume regulation
  2. CO regulation (SV and HR)
  3. Peripheral Resistance regulation
56
Q

Describe the effect of exercise on HTN management?

A
  1. Muscle contraction
  2. Vasodilation of vessels supplying the muscles
  3. Increased O2 supply and CO2 removal
  4. Lower SVR
  5. Lowers BP
57
Q

Describe the effect of smoking on HTN and how quitting helps? (2)

A
  1. Smoking decreases O2 to the brain and releases catecholamine which increases HR and BP
  2. 50% reduction for MI and CVA in the 1st year after quitting, another 50% after 5 years
58
Q

How does ASE recommend indexing LV mass with obese patients and why?

A

Indexing with height only instead of BSA

because their huge BSA will make an enlarged LV mass appear normal when indexed

ECHO 325 (19 decks)

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