Week 2- Hypertensive Heart Disease

Question 1

PART 1

Answer 1

PART 1

Question 2

What is Poiseuille’s Law?

Answer 2

-Q=ΔP X r4

Flow=pressure gradient* radius^4

Question 3

• If the radius decreases, the resistance to blood flow __________ and blood flow _________.
• How can we preserve blood flow if r decreases? What effect does this have on the heart?

Answer 3

• increases
• decreases

-Increase ΔP which means the heart has to work harder.

Question 4

Why do we want to control BP?

Answer 4

Associated with decreased incidence of adverse cardiac events/disease.

Question 5

• Systolic BP is the ________ pressure exerted against the wall of a blood vessel, while diastolic BP is the _________ pressure exerted against the wall of a blood vessel.
• What is a normal BP?

Answer 5

• Maximum, Minimum

- 120/80

Question 6

• What is Double Product?

- What is the formula?

Answer 6

• Noninvasive way of measuring heart work.

- DP = HR * SBP

Question 7

• What happens to the heart with HTN?

- Why is this problematic?

Answer 7

• The heart myocardium will hypertrophy in an effort to meet the demands of HTN.
• Problematic because it can lead to

Question 8

List the BP Categories.

Answer 8

Normal = <120/<80 (AND)
Elevated = 120-129/<80 (AND)
High (Stage 1 HTN) = 130-139/80-89 (OR)
High (Stage 2 HTN) = >140/>90 (OR)
Hypertensive Crisis = >180/>120 AND/OR)

Question 9

List some pharmalogical management of HTN.

Answer 9

• Diuretics
• Beta Blockers
• Calcium Channel Blockers
• ACEi
• Alpha1 blockers
• Central agents
• Aldosterone receptor blocker

Question 10

What are the guidelines for using HTN medicine?

Answer 10

Using enough anti-HTN as needed to control BP.

Question 11

• Only __% of patients seeking care for stubborn high blood pressure take all the medicine they’re supposed to be taking.
• Another __% are not taking any of their blood pressure medications.
• __% are somewhere in the middle!!!

Answer 11

• 20%
• 20%
• 60%

Question 12

Why do people stop taking their anti-HTN medication?

Answer 12

• Side effects (orthostatic hypotension)
• Sexual function (B-blockers)
• Cost
• Doesn’t change the way they feel
• Increased age
• Gender: women greater non-adherence
• African American race

Question 13

What are the 2 types of HTN?

Answer 13

• Essential

- Secondary

Question 14

• What is the cause of essential HTN?

- It represents __% of all HTN cases.

Answer 14

• Unknown

- 90%

Question 15

• What is the cause of secondary HTN?

- It represents __% of all HTN cases and treatment focuses on management of what?

Answer 15

• Caused by conditions of the kidneys, arteries, heart, or endocrine system.
• 10%, underlying cause

Question 16

• Uncontrolled HTN can lead to ______ disease.

- The kidney gets about __% of cardiac output.

Answer 16

• kidney

- 20% (doesn’t use it all)

Question 17

How does the kidney work?

Answer 17

Filtering fluids and molecules from the blood into the kidney tubule.

Question 18

What happens to kidney function with HTN?

Answer 18

• Uncontrolled high blood pressure can cause arteries in the glomeruli to narrow, weaken or harden.
• These damaged arteries deliver less and less filtrate to the nephron.
• The kidneys perceive this reduce filtration as a reason to increase water and sodium reabsorption resulting in increased blood volume (preload) and therefore blood pressure.

Question 19

• Reduced kidney filtration also activates the renin-angiotensin cascade which favors water and sodium ___________.
• The net effect is _______ preload, __________ total peripheral resistance, and _________ ability to appropriately control whole body BP regulation. This creates a downward spiral of kidney function.

Answer 19

• reabsorption

- increased, increased, decreased

Question 20

Poorly controlled ________ can lead to kidney disease which can lead to HTN. How?

Answer 20

Diabetes

• Chronically elevated glucose levels damages glomerular filtration, reducing glomerular filtration
• Kidney responds by reabsorbing more water and sodium, increasing fluid volume and blood pressure

Question 21

Know the BP of ALL your patients with _______ and _______ disease.

Answer 21

diabetes and kidney disease

Question 22

How does HTN result in a pathological heart?

Answer 22

• Results in pathologic cardiac hypertrophy.
• Causes fibrosis rendering the heart stiffer i.e. HFpEF
• Myocyte hypertrophy.
• Accelerated myocyte death.
• Reduced capillarization/reduced blood flow.

Question 23

What is malignant HTN?

Answer 23

• BP > 180/120 mmHg

- Considered medical emergency

Question 24

PART 2

Answer 24

PART 2

Question 25

Cor Pulmonale, also called ________________ is an enlargement/dysfunction of the right ventricle caused by a primary pulmonary disorder (_________ ____)

Answer 25

- Pulmonary Heart Disorder | - pulmonary HTN

Question 26

- What is a normal pulmonary artery pressure? | - Pulmonary HTN = MAP > ___ mmHg or systolic pressure > ___ mmHg

Answer 26

- Normal = 20/10 or MAP=15mmHg | - Pulmonary HTN = MAP>25mmHg or SBP >35mmHg

Question 27

Why can the R side of the heart move the same amount of blood as the L side with a much lower pressure?

Answer 27

- RV SV = LV SV - Shorter length of tubing - More compliant vessels - Much lower impact of gravity on blood flow - Q = ΔP X r4

Question 28

Cor pulmonale is typically _______ and __________.

Answer 28

chronic and progressive

Question 29

What are the symptoms of cor pulmonale?

Answer 29

- chest pain - fatigue - bilateral lower extremity edema - syncope or passing out

Question 30

What are some diseases of the lungs associated with cor pulmonale? (5)

Answer 30

- Chronic Obstructive Lung Disease (COPD) - Diffuse pulmonary interstitial fibrosis - Extensive persistent atelectasis (collapsed lung) - Cystic fibrosis - Pulmonary embolism

Question 31

What are some diseases of pulmonary vessels associated with cor pulmonale? (2)

Answer 31

- Pulmonary vascular sclerosis | - Drug, toxin, XTR induced vascular sclerosis

Question 32

What are some disorders affecting the chest wall movement that can lead to cor pulmonale? (3)

Answer 32

- Kyphoscolosis - Marked obesity - Neuromuscular Disease

Question 33

What are some diseases inducing pulmonary arteriolar constriction that can lead to cor pulmlonale?

Answer 33

-Hypoxemia (low levels of O2 in the blood) leading to airway obstruction, hypoventilation, and chronic altitude sickness.

Question 34

With cor pulmonale, PT interventions will have a ________ impact on the underlying pathology. For patients with lung pathologies, know if there is an accompanying ________ involvement.

Answer 34

- negligible | - cardiac

Question 35

Can patients with Pulmonary Artery HTN exercise?

Answer 35

Some form of exercise is not harmful, but should speak with physician first. Care should be taken to not over exercise. Light resistance of small muscle groups and light to moderate aerobic activity is acceptable.

Question 36

What is the assessment criteria for medical professionals taking BP? (10)

Answer 36

1. ) Resting patient for 5 mintes prior to the measurement or expressing intent to do so 2. ) Legs uncrossed 3. ) Feet on floor 4. ) Arm supported 5. ) Correct cuff size 6. ) Cuff placed over bare arm 7. ) No talking 8. ) No phone or reading 9. ) BP taken in both arms 10. ) Correctly identifying arm to use for future readings (one with higher BP)

Question 37

Impact of incorrect BP measurements?

Answer 37

- Incorrect classification of BP status | - Can make controlled HTN appear more uncontrolled or nonexistant HTN as existent

Question 38

Hypertension is a __________ pathology.

Answer 38

Whole Body - stroke - vision loss - HF - heart attack - kidney disease/failure - sexual dysfunction