Cardiovascular pathophysiology 2 Flashcards
(51 cards)
Pathophysiologic complications related to chronic systemic hypertension include all of the following EXCEPT:
a. left ventricular hypertrophy
b. increased myocardial oxygen consumption
c. dysrhythmias
d. decreased diastolic filling time
d. decreased diastolic filling time
Systemic hypertension is almost always caused by
increased SVR
Blood pressure is regulated by a feedback network consisting of
the SNS (baroreceptors)
RAAS
antidiuretic hormone
Chronic hypertension impacts
nearly every organ system in the body
Complications of chronic hypertension include
LVH
CAD
CHF
stroke
arterial aneurysm
renal disease
The cerebral autoregulation curve shifts ______________ to protect the brain from a higher blood pressure.
to the right
It ends up causing a chronic rightward shift where they do not tolerate a lower blood pressure
Classic teaching recommends maintaining MAP within _________
20% of the patient’s preoperative value
In the patient on ACEI/ARB therapy, hypotension that’s not responsive to conventional first-line therapy should be treated with
vasopressin, terlipressin, and methylene blue
Patients on a beta-blocker should ________________ throughout the perioperative period
continue therapy
Starting beta-blocker therapy on the day of surgery
increases the risk of hypotension, bradycardia, stroke, and death
Hypertension is classified as
primary or secondary
Primary hypertension has
no identifiable cause and accounts for 95% of all HTN cases
For the patient with hypertension, anticipate that the patient will have an
exaggerated hypotensive response to anesthetic induction, followed by an exaggerated hypertensive response to intubation and extubation
Hypertensive patients are
volume contracted–> adequate hydration before induction helps promote hemodynamic stability
What preoperative blood pressure merits delaying an elective surgical procedure?
SBP >180 mmHg
DBP >110 mmHg
Hypertensive crisis occurs when the blood pressure exceeds
180/120
A hypertensive emergency is declared when there’s evidence of
end-organ injury (otherwise we call it a hypertensive urgency)
What is the most common cause of secondary hypertension?
a. pregnancy-induced hypertension
b. coarctation of the aorta
c. renal artery stenosis
d. cigarette smoking
c. renal artery stenosis
Causes of secondary hypertension include
coarctation of the aorta
renovascular disease
Cushing’s syndrome
Conn’s disease
pheochromocytoma
pregnancy-induced hypertension
What should not be given to patients with bilateral renal artery stenosis?
do not give an ACEI b/c it will significantly reduce GFR and precipitate renal failure
What drug classes target the sympathetic nervous system?
alpha 1 antagonists
alpha 2 agonists
cardio-selective beta 1 antagonists
mixed alpha 1/beta 1 & 2 antagonists
Give a _______________________ to a patient in hypertensive crisis can precipitate heart failure.
non-selective beta-blocker (without the alpha-1 antagonist component)
What is the role of alpha 1 antagonists?
reduce afterload by causing vasodilation
What is the role of alpha-2 agonists?
reduce sympathetic outflow
