Flashcards in Cardiology Deck (43)
definition of HTN
sustained elevation of resting systolic BP (≥ 140 mmHg), diastolic BP (≥ 90 mmHg), or both
etiology of HTN
- primary (unknown cause; 85-95% of cases)
probably MCC of secondary HTN
pathophysiology of HTN must involve what 2 mechanisms?
1. increased CO
2. increased TPR
what are the possible pathophysiological causes of HTN?
- abnormal sodium transport
- sympathetic nervous system
- renin-angiotensin-aldosterone system
- vasodilator deficiency
4 mechanisms controlled renin secretion
1. afferent arteriolar wall tension
2. macula densa receptor
3. circulating angiotensin (negative feedback)
4. sympathetic nervous system (stimulates secretion)
do pathologic changes occur early in HTN?
what are the risks of severe or prolonged HTN?
- CAD and MI
- stroke (particularly hemorrhagic)
- renal failure
what is the mechanism resulting in HTN's complications?
arteriolosclerosis and atherogenesis
sxs of HTN
usually asymptomatic until complications develop
sxs of complicated HTN
- flushed facies
what are the cardiovascular, neurologic, renal, and retinal symptoms caused by severe HTN (hypertensive emergencies)?
- symptomatic coronary atherosclerosis
- hypertensive encephalopathy
- renal failure
- hypertensive retinopathy
what is one of the earliest signs of hypertensive heart disease?
4th heart sound
what are the retinal changes seen in hypertensive pts based on the 4 groups of the Keith, Wagener, and Barker classification?
- grade 1: constriction of arterioles only
- grade 2: constriction and SCLEROSIS of arterioles
- grade 3: hemorrhages and exudates (in addition to vascular changes)
- grade 4: PAPILLEDEMA
diagnosis of HTN
> 2 readings on 2 or more visits
testing for evaluation of hypertensive pt
- UA and spot urine albumin:creatinine ratio
if UA detects albuminuria, cylindruria, or microhematuria, or if serum creatinine is elevated (1.4 mg/dL or more in men, and 1.2 mg/dL or more in women), what test should be done next?
renal US to evaluate kidney size
if pt is hypokalemic unrelated to diuretic use, what should the pt be evaluated for?
primary aldosteronism and high salt intake
on ECG, a broad, notched P-wave indicates what, and why is it significant?
- atrial hypertrophy
- may be one of the earliest signs of hypertensive heart disease
which signs of hypertensive heart disease may occur later and indicate what?
- sustained apical thrust and elevated QRS voltage w/ or w/o evidence of ischemia
pts w/ what signs and sxs should be screened for pheochromocytoma?
- labile, significantly elevated BP
- excessive perspiration
pts screened for pheochromocytoma, should also be screened for what and how?
- sleep d/o
- sleep study
does systolic or diastolic BP better predict fatal and nonfatal cardiovascular events?
w/o tx, what is the 1-yr survival for pts w/ retinal sclerosis, cotton-wool exudates, arteriolar narrowing, and hemorrhage (grade 3 retinopathy)?
w/o tx, what is the 1-yr survival for pts w/ retinal sclerosis, cotton-wool exudates, arteriolar narrowing, hemorrhage, and papilledema (grade 4 retinopathy)?
what is the MCC of death among TREATED hypertensive pts?
what is the MCC of death among INADEQUATELY treated hypertensive pts?
ischemic or hemorrhagic stroke
does effective control of HTN prevent most complications and prolong life?
initial tx for HTN
- weight loss and exercise
- smoking cessation
- diet; increased fruits and vegetables, decreased salt, limited alcohol