Exam 2: Ch 18 Blood Pressure Disorders Flashcards Preview

Pathophysiology > Exam 2: Ch 18 Blood Pressure Disorders > Flashcards

Flashcards in Exam 2: Ch 18 Blood Pressure Disorders Deck (75):
1

aneurysm

abnormal dilation and outpouching of an artery

most common in aorta (any part)

2

berry aneurysm

spherical dilation at bifurcation

Circle of Willis

3

dissecting aneurysm

tear in intima allows blood to enter vessel wall

False aneurysm

4

1/2 of people with an aortic aneurysm

have HTN

5

if an aortic aneurysm is above the kidneys...

must cut off kidney blood supply to fix

6

symptoms of an aortic aneurysm

depends on size and location

AAA most common and 90% below renal arteries

can be asymptomatic

pain

7

diagnosis of aortic aneurysms

ultrasound

felt as pulsitile mass

8

treatment of aortic aneurysm

surgical resection

endovascular vs. open is the same chance of success

9

aortic dissecting aneurysm

acute and life threatening

seen in conn tissue disease (marfan's)

Excruciating pain

H&P most critical

lower BP and correct surgically

10

blood pressure

rapid rise in pressure during ejection of blood from left ventricle up aorta

11

dicrotic notch

closure of aortic valve

12

pulse pressure

SBP - DBP

Difference between systolic and diastolic pressures

13

mean arterial pressure

DBP + PP/3

Average pressure in arterial system during ventricular contraction and relaxation

14

calculate BP

CO x PVR

15

calculate CO

SV x HR

SV = (blood ejected per beat)

16

PVR

peripheral vascular resistance

reflects changes in the radius of arterioles

17

systolic BP

size and velocity of SV

compliance of large elastic arteries

18

systolic HTN

less compliance of large elastic arteries

stiff aorta

19

diastolic BP

properties of large arteries and size of SV

resistance of arterioles

competency of aortic valve

20

diastolic HTN

higher PVR slows runoff

21

pulse pressure

high when SV is high

low in hypovolemic shock (low SC and high PVR)

22

hypovolemic shock

high PVR (normal or high diastolic BP)

low SV (low systolic BP)

23

old person w/ stiff arteries will have...

high systolic BP (HTN forever)

24

short term BP regulation

keep BP constant for minutes-hours

neural

humoral

25

neural short term BP regulation has sensors in...

baroreceptors (pressure)

work via SNS and PNS

26

neural short term BP regulation mechanisms

sensors in carotid and aortic bodies

baro/chemo receptors

respond to low BP, pH, O2, high CO2

communicate to cardiovascular centers (SNS)

chemoreceptors up ventilation

27

neural responses brain stem

output to heart increases HR and contractility

output to vessels increases PVR

28

humoral short term BP regulation has sensors in...

JGA and elsewhere

uses RAA system

increases blood volume

29

humoral short term BP regulation mechanisms

low BP, blood volume, blood NA sensed by JGA

JGA releases renin, which converts angiotensin --> A1

A1 --> A2 by ACE (lung capillaries)

A2 is a vasoconstrictor --> aldosterone release from adrenal cortex

A2 --> ADH release from posterior pituitary

blood volume increased, BP restored

30

aldosterone

increases Na retention by kidneys

31

ADH

increases H2O retention by kidney

32

kidneys in long term BP regulation

vascular volume controls BP, and BP controls kidney filtration

some ppl with HTN respond to sodium restriction

many diuretics useful in BP regulation

kidney damage or chronic increases in Na/H2O intake (high BP)

33

ECF volume in long term regulation of BP

one time ECF increase = high CO and PVR --> high BP
urine output increases
diuresis returns blood volume and BP to normal

chronic high ECF causes persistent HTN with high PVR

34

indirect ascultation

Sphygmomanometer (bladder)

width of bladder > 40% of upper arm circumference

undersize bladder --> overestimation of BP

slower deflation = higher accuracy

35

automated methods of BP measurement

doller

microphone

pressure sensor

36

direct methods of BP measurement

arterial catheter

37

essential HTN

90% of cases

High BP without evidence of other disease

BP > 140/90

requires more than 1 elevated reading

38

stages of HTN

normal 120/80, recheck in 2 yrs

pre HTN 120-139/80-89, recheck in 1 yr

stage 1 HTN 140-159/90-99, confirm within 2mo

stage 2 HTN >160sys OR >100 dia, treat within 1mo

39

HTN risk factors

family history

age: SBP higher throughout life, DBP increases until 50

race: african americans have more and more severe HTN

metabolic problems: type 2 DM, obesity

40

lifestyle factors in HTN

Na intake

obesity

EtOH

K+ intake

41

Na intake

high salt and H2O intake increases blood volume and BP

salt restriction helps treat

75% of dietary salt in food processing

42

DASH

dietary approach to stop HTN

advocates fruits and veggies, and whole grains

43

obesity and HTN

distribution more important than weight

high waist/hips ratio associated with HTN

44

EtOH

3+ drinks/day increases SBP

45

K intake

low K increases SBP

mechanism unknown

46

HTN can be ____, ____ or ____

systolic, diastolic, or both

47

isolated systolic HTN

high complication risk

high shear stress (vessel damage)

elevated PP strong risk indicator for elderly

48

target organ damage in systolic HTN

heart increased workload --> LVH (left ventricular hypertrophy)

risk factor for atherosclerosis, HF, CHD, stroke, PAD, renal failute

49

diagnosis of isolated systolic HTN

requires multiple elevated readings

person should be relaxed and seated

50

treatment of systolic HTN

drugs

TLC (theraputic lifestyle changes)

goals relaxed for 60+ years of age & DM

51

drug classes for HTN

diuretics lower blood volume and PVR

beta-blockers lower HR and SV to lower BP

ACE inhibitors block A1 --> A2

A2r blockers block A2 action (receptors)

calcium channel blockers dilate arteries

antagonists of A1 receptors

52

how to treat HTN

under 60 treat @ 140/90

60+ no DM treat at 150/90

if DM or chronic kidney disease treat at 140/90 regardless of age

53

theraputic lifestyle changes

DASH

exercise

less salt

moderate EtOH

lose weight

less stress

no smoking

54

secondary HTN (10%) due to another disease

renal HTN

steroid hormone abnormalities

pheochromocytoma

coarctation of aorta

oral contraceptives

55

renal HTN

type of 2ndary HTN

any disease that lowers salt and water excretion --> high BP

renovascular HTN activated RAA system

renal artery stenosis is usual cause

may require angioplasty or open surgery

56

steroid hormone abnormalities

type of 2ndary HTN

primary hyperaldosteronism (Na absorbed, K excreted) or glucocorticoids

often show hypokalemia

use Aldo blockers

57

pheochromocytoma

2ndary HTN

tumor of adrenal medulla or sympathetic chain

makes NE and Epi

produces headache, nervousness, sweating

measure carechole metabolisms in urine (VMAs)

use alpha and beta blockers --> surgery

58

coarctation of the aorta

2ndary HTN

often at takeoff of subclavian arteries

activates RAA system

59

oral contraceptives

2ndary HTN

major cause of HTN in young women

mechanism unk, but hormone induced volume expansion

generally resolves when drugs stopped

60

malignant HTN

sudden BP elecation to DBP > 120 -- seen in 2ndary HTN

cerebral vasospasm occurs to protect brain

cerebral edema, renal damage likely without aggressive treatment

61

HTN in pregnancy (6-8%)

good prenatal care mandatory

chronic HTN: high BP prior to 20 wks

preeclampsia/eclampsia

gestational HTN: high BP 1st seen in pregnancy w/o protinuria

62

preeclampsia/eclampsia

high BP after 20 wks

protinuria, high creatinine/liver enz, low platelet count

more common in women with chronic high BP, DM, multiple pregnancies

low placental blood flow --> toxins --> endothelial damage --> end organ damage

platelets aggregate at damages epithelium

definitive diagnosis at delivery

63

HELLP

hemolysis, elevated liver enzymes, and low platelets

variant of preeclampsia

classification system addresses lab abnormalities of blood vessels, liver and other organ systems (higher platelets is worse)

64

pediatric HTN

norms based on height and sex

most is 2ndary

primary seen in adolescents

should be treated

65

orthostatic hypotension

abnormal drop in HTN

occurs when blood pools in legs

cause dizziness and blackouts

cardiovascular reflexes are supposed to prevent this

66

causes of orthostatic hypotension

hypovolemia -- diuretics

other drugs like antihypertensives

aging -- poor cerebral circulation

prolonged bedrest -- low plasma volume

ANS disorders

67

treatment of orthostatic hypotension

physical exam and history

correct cause (fluid and electrolyte imbalance) if possible

support hose

mineralocorticoids or alpha agonists

68

diseases of venous circulation -- lower extremities

leg has superficial veins... saphenous and deep

incompetent veins can allow backflow (valves fail)

muscle pump & 1 way valves direct blood flow

69

varicose veins

dilated tortuous veins in legs

primary: originate in saphenous

2ndary: result from blockage of deep venous channels

70

etiology of varicose veins

prolonged standing and abdominal pressure (pregnancy)

71

diagnosis and treatment of varicose veins

physical exam

pressure stockings, surgical removal of superficial

72

chronic venous insufficiency

consequences of DVT and valve failure

produces tissue congestion and edema --> necrosis/ulceration

compression and surgery, skin grafting

73

venous thrombosis

thrombus (clot) in vein --> inflammation

can be deep or superficial

can produce a pulmonary embolism

statins may prevent

74

risk factors for venous thrombosis

venous stasis (bed rest, shock)

increased coagulation (dehydration, BCP/HRT)

vascular trauma (surgery/injury)

75

symptoms, diagnosis, treatment of venous thrombosis

pain, swelling, fever

venography, ultrasound

anticoagulants, maintain bedrest until no swelling

increase activity slowly with elastic hose

surgery