Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathophysiology > Vascular Hypertension > Flashcards

Vascular Hypertension Flashcards

1
Q

How is Vascualar hypertension defined?

What is the incidence?

A
  • Sustained diastolic of 90 mmHg or above
  • Sustained systolic of 140 mmHg or above
    • Average of 3 different measurements
  • Incidence: 30% of general public
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the systolic and diastolic limits for:

Normal BP

prehypertension

Stage 1 hypertension

Stage 2 HTN

(chart)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is hypertension the most important risk factor in?

A
  • CAD
  • CVA
  • Cardiac hypertrophy
  • renal failure
  • aortic dissection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of HTN?

A
  • 90% of HTN is idiopathic primary
  • 5-10% is mostly secondary to renal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is so bad about HTN?

A
  • leads to increased myocardial wall tension which then leads to Left ventricular hypertrophy
  • LV hypertrophy then leads to increased myocardial oxygen demand which leads to coronary insufficiency
  • If this goes on long enough it leads to heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we regulate BP?

A
  • BP = CO x PVR
  • CO is impacted by
    • flood volume
    • cardiac factors- enlarged muscle, etc.
  • PVR is impacted by:
    • humoral factors- constrictors, dilators (genetics predispose pple to have more of one or the other)
    • neural factors
    • local release of constrictors or dilators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the different types of hypertension?

A
  • Essential hypertension- 95%
  • Secondary hypertension- 5%
    • renal
    • endocrine
    • CV
    • neurologic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risk factors of Essential HTN?

A
  • Genetic
    • polygenic and heterogenous
    • polymorphism is lots of different genes
  • Environmental
    • stress
    • obesity
    • smoking
    • salt consumption (really need a genetic predispostion along with a high Na diet)
    • sedentary life style
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some of the pathophysiological causes of Primary HTN?

A
  • Increased SNS activity in response to stress
  • overproduction of Na retaining hormones and vasoconstrictors
  • Underproduction of vasodilators (NO, prostaglandins)
  • Increase Na intake/ Na retention
  • inadequate intake of Ca and K
  • DM
  • obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do diretics act as effective antihypertensives?

A

by promoting Na excretion

*Also, Na restricted diet will help decrease BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the pathologies of secondary hypertension?

(6)

A
  • Oral contraceptives
  • renal parenchymal disease
  • Renin-secreting tumors
  • primary aldosteronism
  • cushing’s syndrome
  • pheochromocytoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some treatments for hypertension?

A
  • Drugs- possibly combination of two for Stage 2 HTN
    • Diuretics
    • Ca channel blockers
    • ACE inhibitors
    • Beta blockers
    • Angiotensin receptor blockers
  • Non-Drug
    • lifestyle changes- wt loss, smoking cessation, physical activity
    • Na restriction, diets
    • decrease ETOH
    • relaxation techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which BP meds would you used for different diseases? (chart)

Previous MI

Heart failure

CAD

DM

CKD

Recurrent stroke prevention

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the definition of a hypertensive crisis?

How is it treated?

A
  • Sudden increase in diastolic BP above 130 mmHG due to activation of RAAS
  • Treatment:
    • Prompt but controlled reduction with NTP
      • 0.5-10 mcg/kg/min IV
    • Monitor UOP and arterial BP
    • Decrease DBP to 100-110 over 30 min-1 hour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What other meds (and doses) can you give to treat a hypertensive crisis?

A
  • Nitroprusside 0.5-10 mcg/kg/min
    • drug of choice; short DOA
  • Nitroglycerin 5-200 mcg/min
  • Labetalol 40-80 mg q 10 min
  • Esmolol 50-300 mcg/kg/min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do you need to consider regarding the anesthesia management of essential HTN?

A
  • Is it controlled or uncontrolled?
  • Is the surgery emergent or elective?
  • Is there evidence of end organ damage?
    • angina
    • CHF
    • CVA
    • Renal insufficiency
    • PVD
  • What is their medication regimen?
17
Q

If your patient has poorly controlled HTN, what should you expect during induction, maintenance, and Post-op managment?

A
  • Induction
    • Exaggerated systemic blood pressure changes
    • try to limit time of DVL and SNS response
  • Maintenance:
    • monitor for myocardial ischemia
    • monitor end-organ function (art line, foley)
    • adjust dept of anesthesia to minimize wide shifts in hemodynamics
  • Post op
    • goal to minimize SNS response to surgical pain and N/V
18
Q

How can you minimize SNS stimulation with DVL?

A
  • Any induction agent is appropriate except Ketamine
  • Lidocaine 1-1.5 mg/kg
  • Topical Lidocaine 2-4% (5 ml)
  • Opioids
  • Volatile agents
19
Q

How can you be prepared to adjust dept of anesthesia during maintenance to accomodate wide hemodynamic shifts?

A
  • Choose an IA that is easily adjusted- Sevo or Des
    • d/t low B/G coefficient
    • Des can cause increased HR d/t SNS outflow when put on fast
  • use a balanced technique
  • have ephedrine, Phenylephrine readily available
  • consder phenylephrine gtt if unable to get adequate dept of anesthesia
  • **Cardiac IA of choice is usually Isoflurane
20
Q

How do you treat intraoperative hypertension?

A
  • It is usually caused by pain!
    • incidence is higher in pts with essential HTN
  • treatment
    • narcotics- esp if pain is obvious
    • IA’s
    • BB
    • NTG
    • nipride
21
Q

How do you treat intraoperative hypotension?

A
  • Treatment
    • decrease anesthetic depth
    • Fluids or blood
    • Sympathomimetics
    • Check rhythm–> is it junctional?
      • maintain normocapnia
      • avoid high concentrations of IA’s
  • **hypotension is worse for pts who are normally hypertensive b/c they are not used to having low BPS
22
Q

How would you want to monitor pts with HTN?

A
  • 5 leak EKG
  • A-line, CVP, PA cath if the surgery is extensive and ventricular dysfunction
  • TEE
23
Q

How should you emerge a pt with HTN?

A
  • Controlled emergence
  • minimize sympathetic outflow
    • use narcotics
    • lidocaine
    • labetalol, esmolol, NTG
    • Deep extubation
24
Q

How can you control post-op hypertension?

A
  • First ensure pain is adequately controlled
  • If yes, then treat HTN with:
    • Hydralazine 2.5-10 mg IV q 20-30 min
    • Labetalol 5-20 mg IV q10 min
    • Nipride 0.5-10 mcg/kg/min

Pathophysiology (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions