systemic hypertension Flashcards

1
Q

what is stage 1 hypertension

A

> 130/80

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2
Q

How is MAP derived

A

TRP x CO

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3
Q

how is CO derived

A

HR x SV

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4
Q

how is SV derived

A

diastolic - systolic

Volume of blood ejected from each ventricle per beat

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5
Q

what are the structural causes that induce sustained elevation of BP in essential hypertension

A
endothelial dysfunction (NO, endothelial)
vdmc constriction (calcium)
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6
Q

what are the functional causes that induce sustained elevation of BP in essential hypertension

A

increased wall mass (hypertrophy and hyperplasia)

wall remodeling with no increase in mass

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7
Q

describe functional and structural rarefaction

A

Rarefaction Decrease of number of vessels in parallel with increase resistance
In functional rarefaction the vessels are there but not being perfused  this can then turn into structural rarefaction where then the vessels degrade

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8
Q

what does a decrease in the number of
vessels in parallel do to the network
vascular resistance

A

increases the resistance

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9
Q

what happens to the chamber size in hypertension

A

decreases since the wall thickens

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10
Q

what happens to the diastolic filling in hypertension

A

decreases due to decreased ventricular compliance (stiffness)

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11
Q

define after load

A

Resistance that the left ventricle has to overcome to eject blood

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12
Q

what impact does insulin resistance have on the pathophysiology of hypertension

A

VSMC hypertrophy and increased resistance

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13
Q

what impact does obesity have on the development of hypertension

A

increases angiotensinogen, increased blood viscosity, augments blood volume

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14
Q

when do you assess for secondary hypertension

A
  • Age ( before 20 or after 50)
  • Severity – dramatic
  • Onset- acute
  • Associated symptoms – ie renal artery bruit
  • Family history – not common
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15
Q

is Reduced nephron number a risk factor for hypertension

A

yes

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16
Q

how does an Abdominal aortic aneurysm occur in hypertension

A

Usually below the renal artery so high perfusion leads to Prominent dialation then weakened by the high flow and atherosclerosis

17
Q

how does an aortic dissection occur in hypertension

A

weakened intima media is then collapsed by high pressures

18
Q

what are two pathologies of the kidney that develop with hypertension

A

renal failure
Hyaline arteriolosclerosis
Fibrinoid necrosis (SM hypertrophy and necrosis of cap walls)

19
Q

what does ischemia in the optic nerve result in

A

blurred vision

20
Q

what is a sign of acute hypertension

A

hemorrages, exudates

21
Q

what is a sign of very high BP with high ICP

A

Pailledema

22
Q

what is a sign of chronic hypertension

A

Increased light reflection- arterial sclerosis

23
Q

ID some things that can lead to increased BP

A
estrogens can lead to increased angiotensinogen
glucocorticoids
epo
cyclosporine
sympathetic activity
NSAids 
Ang II
24
Q

how does renal parenchymal disease lead to hypertension without impacting GFR

A

excessive renin elaboration

often causes fibromuscular lesions in the media of the vessel

25
how can you ID renovascular hypertension
renal artery bruit or unexplained hypokalemia
26
can you treat renovascular hypertension with ACEi
yes IF its not bilateral and they don't have an already reduced GFR
27
what are some symptoms of pheochromocytoma
NE secreting tumor resulting in | headaches, sweating, palpitations and tachycardia
28
what is cushings syndrome
``` excessive glucocorticoid secretion central obesity round face proximal muscle weakness hirsutism ```
29
what are Cotton Wool Spots on retina exam
Accumulations of debris within bundles of unmyelinated ganglion cell axons due to focal ischemia
30
what are some ways that Hyperinsulinemia / Insulin resistance can cause hypertension
Increased sympathetic activity, volume expansion from increased renal sodium reabsorption, upregulation of angiotensin II receptors, and decreased cardiac natriuretic peptide (protein released by heart to reduce arterial pressure)