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Cardiology and Respiratory SA Med > Diastolic Dysfunction - Hypertension > Flashcards

Diastolic Dysfunction - Hypertension Flashcards

1
Q

What are primary causes of diastolic dysfunction?

A
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
  • Hypertrophic obstructive cardiomyopathy
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2
Q

Secondary causes of diastolic dysfunction

A
  • Pressure overload diseases

- Pericardial diseases

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3
Q

What are the categories of pressure overload diseases?

A

Hypertension and stenosis

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4
Q

What are categories of diseases causing hypertension?

A
  • Pulmonic vs systemic
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5
Q

What are categories of diseases causing stenosis?

A
  • usually congenital

- Either pulmonic stenosis or aortic stenosis

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6
Q

What type of hypertrophy occurs with diastolic dysfunction or pressure overload?

A
  • Concentric hypertrophy
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7
Q

What happens if BP is too low?

A
  • Not enough vascular tone to perfuse brain and kidneys

- Badness

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8
Q

What happens if blood pressure is too high

A
  • Impact on capillary beds
  • Capillary beds are very thin walled
  • If they are high pressure, they will rupture
  • Heart is also unhappy with this
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9
Q

Definition of systemic hypertension?

A
  • Systolic BP > 160 mmHg
  • persistent elevation
  • Can be elevated with stress, but even so shouldn’t be higher than 180 mmHg
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10
Q

Diagnosing systemic hypertension

A
  • Measure BP

- Doppler ideally over oscillometric

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11
Q

Where to measure blood pressure?

A
  • Front limb, hind limb, or tail

- You just need to be consistent

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12
Q

What can happen is cuff size is too big?

A
  • Decrease your blood pressure
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13
Q

What can happen if cuff size is too small?

A
  • Artificially increase your blood pressure
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14
Q

Causes of primary systemic hypertension

A
  • never been reported
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15
Q

Causes of secondary systemic hypertension

A
  • Renal disease
  • Hyperadrenocorticism (Cushing’s)
  • Hypothyroidism or hyperthyroidism
  • Diabetes mellitus
  • Medications
  • Acromegaly
  • Pheochromocytoma
  • Hyperaldosteronism
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16
Q

Who gets systemic hypertension: age?

A
  • Older animals
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17
Q

What diseases do only cats generally get that can lead to systemic hypertension?

A
  • Hyperthyroidism
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18
Q

What diseases do only dogs generally get that can lead to systemic hypertension?

A
  • Hypothyroidism
  • Hyperadrenocorticism
  • Pheochromocytoma
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19
Q

What diseases can either dogs or cats generally get that can lead to systemic hypertension?

A
  • Renal disease
  • Diabetes mellitus
  • Hyperaldosteronism
  • Acromegaly
  • medications
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20
Q

Which diseases can directly lead to concentric hypertrophy based on direct effect on the heart?

A
  • Hyperthyroidism
  • Hyperaldosteronism
  • Pheochromocytoma
  • Acromegaly
21
Q

What target organs must you worry about with systemic hypertension?

A
  • Kidneys
  • Brain
  • Eye
  • Heart
22
Q

What can happen to the brain with systemic hypertension?

A
  • Hypertensive encephalopathy
  • Hemorrhage into the brain
  • Seizures
  • Ataxia
  • Stupor
  • Blindness
23
Q

What can happen to the eyes with systemic hypertension?

A
  • Hypertensive retinopathy or hypertensive choroidopathy or hypertensive optic neuropathy
  • More often with cats
24
Q

Hypertensive retinopathy findings on fundic exam

A
  • Vascular distension and tortuosity

- Retinal hemorrhage

25
Q

Hypertensive choroidopathy findings on fundic exam?

A
  • Focal necrosis and hypopigmentation
  • Retinal detachment
  • Fat retinal arteries due to dilation
26
Q

Hypertensive optic neuropathy findings on fundic exam

A
  • Optic nerve ischemia (no retinal vessels)
  • Edema
  • Atrophy
27
Q

What should you do if an animal suddenly becomes blind?

A
  • Check a blood pressure
28
Q

What can happen with concentric hypertrophy of the LV?

A
  • Blood supply to the heart changes
  • Epicardial surfaces are supplied with coronary artery, but as the heart thickens inward, your blood supply does not change
  • HIGH RISK FOR ISCHEMIC INJURY
29
Q

What does systemic hypertension do to the heart?

A
  • Causes concentric hypertrophy of the left ventricle

- Morphologically will look like an HCM like heart

30
Q

What leads to the other: heart disease and systemic hypertension?

A
  • Systemic hypertension leads to secondary cardiac remodeling***
  • Do not diagnose as HCM
  • Heart disease would generally lead to hypotension as it gets worse
31
Q

Appearance of concentric hypertrophy on echocardiogram

A
  • Very thick wall and small lumen
32
Q

Kidney disease and systemic hypertension

A
  • Increased glomerular pressure
  • Proteinuria, glomerular ischemia
  • Dysregulation of autoregulatory mechanisms
  • Interstitial inflammation and fibrosis
  • Kidney disease worsens!!
  • One of IRIS substages is with systemic hypertension
33
Q

Geriatric screening should include what?

A
  • CBC/Chem/UA/T4

- BLOOD PRESSURE!

34
Q

Treatment for systemic hypertension

A
  • Treat underlying disease

- Give drugs to decrease Blood Pressure

35
Q

Drugs for decreasing SVR?

A
  • ACE inhibitors to block Ang II
  • Phenoxybenazamine to block alpha 2
  • Amlodipine to block calcium channels
  • SEE CHART
36
Q

Drugs to decrease heart rate

A
  • Beta blockers

- Decrease contractility too

37
Q

Drugs to decrease preload to decrease blood pressure

A
  • Diuretics to decrease vascular volume
38
Q

Amlodipine MOA

A
  • Calcium channel blocker
  • Blocks L-type Calcium channel
  • Targets vessels directly
39
Q

Who gets amlodipine?

A
  • Cats with renal disease

- Decreases blood pressure

40
Q

ACE inhibitors MOA

A
  • Block ACE which converts Ang I to Ang II

- Ang II causes peripheral vasoconstriction and efferent arteriolar vasoconstriction

41
Q

When to give ACE inhibitors?

A
  • Kidney and glomerular disease

- Especially if proteinuria is present

42
Q

Who gets beta-blockers?

A
  • Hyperthyroid cats

- Not sotalol or amiodarone

43
Q

Hyperthyroid effects on the heart

A
  • Increased T3 –> increased beta-receptors on the heart

- This leads to tachycardia and concentric hypertrophy

44
Q

Phenoxybenzamine MOA

A
  • Alpha antagonist
45
Q

Who gets phenoxybenzamine?

A
  • Secretes norepinephrine, which binds to alpha 1

- Alpha 1 leads to peripheral vasoconstriction and high blood pressures

46
Q

PPA

A
  • Urethral sphincter constricts

-

47
Q

Diuretics for treatment of systemic hypertension

A
  • Diuretics are not a first line drugs, especially with kidney disease
48
Q

Goals of treatment for systemic hypertension

A
  • Target BP: 100-160 mmHg
  • Ameliorate clinical signs (might be PU/PD)
  • Prevent progression to end-organ damage
49
Q

Prognosis for systemic hypertension

A
  • Underlying disease
  • Severity of hypertension
  • Severity of clinical signs

Cardiology and Respiratory SA Med (15 decks)

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