FINAL: CARDIO Flashcards
Normal blood pressure is defined as
systolic BP (SBP) < 120 mm Hg and a diastolic BP (DBP) < 80 mm Hg.
Elevated blood pressure
SBP between 120 -129 mm Hg and a DBP < 80 mm Hg.
Hypertension (stage 1)
SBP between 130-139 mm Hg and a DBP between 80-89 mm Hg.
Hypertension (stage 2)
SBP > 140 mm Hg and a DBP > 90 mm Hg
If either the SBP or DBP is outside of a range…
the higher measurement determines the classification
how to calculate cardiac output
Cardiac output= HR X Stroke volume (amount of blood ejected w/ each beat)
B-Adrenergic receptors cause
vasodilation
A-adrenergic receptors cause
vasoconstriction
define prostaglandin
lipid messenger secreted by cells right next to target cells to increase/decrease action, last around for 30 sec and die. Different ones for different systems. often affect BP depending on what the system needs.
define Nitric oxide
chemical released by vasculature that causes increased blood flow to heart. Not produced as much with age which stiffens vasculature. Can increase with nitrite rich foods (leafy greens) and exercise.
define endothelin
most potent vasoconstrictor secreted by the most inner part of the blood vessel. The receptors for it are also found on the most inner part of the blood vessel.
What is Mean Arterial Pressure (MAP)
the average pressure in a patient’s arteries during one cardiac cycle.
An MAP of ______ is necessary to perfuse the coronary arteries, brain, and kidneys
60-65
Normal MAP range
70-110
How to calculate MAP
MAP = SBP + 2(DBP)
3
90% to 95% of all cases of hypertension are classified as
Primary hypertension
Elevated BP without an identified cause
Define secondary hypertension
Secondary hypertensionis elevated BP with a specific cause that often can be identified and corrected.
Secondary hypertension can become resistant, causing cardiovascular complications if left untreated.
This type of hypertension accounts for 5% to 10% of hypertension in adults.
Secondary hypertension should be suspected in people who suddenly develop high BP, especially if it is severe. Findings that suggest secondary hypertension relate to the underlying cause.
nonmodifiable risk factors for hypertension
Age: Systolic BP rises progressively with age.
* After age 50, SBP >140 mm Hg is a more important cardiovascular risk factor than diastolic BP
Ethnicity* The incidence of hypertension is 2 times higher in blacks than in whites
Family history* History of a close blood relative (e.g., parents, sibling) with hypertension is associated with an ↑ risk for developing hypertension
Gender* Hypertension is more prevalent in men in young adulthood and early middle age
* After age 64, hypertension is more prevalent in women (See Gender Differences box on p.679)
Socioeconomic status* Hypertension is more prevalent in lower socioeconomic groups and among the less educated
modifiable risk factors for hypertension
Alcohol* Excess alcohol intake is strongly associated with hypertension
* Moderate intake of alcohol has cardioprotective properties; males should limit their daily intake of alcohol to 2 drinks per day, and 1 drink per day for females
Diabetes* Hypertension is more common in patients with diabetes
* When hypertension and diabetes coexist, complications (e.g., target organ disease) are more severe
Elevated serum lipids* ↑ Levels of cholesterol and triglycerides are primary risk factors for atherosclerosis
* Hyperlipidemia is more common in people with hypertension
Excess dietary sodium* High sodium intake can
* Contribute to hypertension in salt-sensitive patients
* Decrease the effectiveness of certain antihypertensive drugs
Obesity* Weight gain is associated with ↑ frequency of hypertension
* Risk increases with central abdominal obesity
Sedentary lifestyle* Regular physical activity can help control weight and reduce cardiovascular risk
* Physical activity may ↓ BP
Stress* People exposed to repeated stress may develop hypertension more often than others
* People who develop hypertension may respond differently to stress than those who do not develop hypertension
Tobacco use* Smoking tobacco greatly ↑ risk for CVD
* People with hypertension who smoke tobacco are at even greater risk for CVD
symptoms of hypertension
patients with hypertensive crisis may have severe headaches, dyspnea, anxiety, and nosebleeds
Fatigue, reduced activity tolerance
Dizziness
Palpitations, angina
Dyspnea
Hypertension: Diagnostic Studies
Urinalysis, creatinine clearance (Creatinine clearance reflects the glomerular filtration rate. Decreases in creatinine clearance indicate renal insufficiency.)
Serum electrolytes (, especially potassium, is essential to detect hyperaldosteronism), glucose (diabetes)
BUN and serum creatinine
Serum lipid profile
ECG
Echocardiogram
Begin measurement after the patient has rested quietly for __min.
5
Deflate the cuff at a rate of ______mmHg/sec.
2–3
Nonpharmacologic interventions to reduce and control BP
weight loss (if appropriate), a DASH diet, and potassium supplementation; regular physical activity; and limiting women to no more than 1 alcohol drink per day.
The potential impact of each lifestyle change is a 4-5 mm Hg decrease in SBP and 2-4 mm Hg decrease in DBP.
Initial therapy for hypertension
Thiazide diuretics
Calcium-channel blockers
ACE inhibitors
Angiotensin Receptor Blockers
Most hypertensive patients will need to take 2 or more medications on a long-term basis to achieve their goal BP, in addition to lifestyle changes.
Isolated systolic hypertension (ISH)
Older adults have varying degrees of impaired baroreceptor reflex mechanisms.
Consequently, orthostatic hypotension occurs often, especially in patients with ISH.
7 reasons older adults struggle to obtain normal BP
(1) loss of elasticity in large arteries from atherosclerosis, (2) increased collagen content and stiffness of the myocardium, (3) increased peripheral vascular resistance, (4) decreased adrenergic receptor sensitivity, (5) blunting of baroreceptor reflexes, (6) decreased renal function, and (7) decreased renin response to sodium and water depletion.
Pharmacological considerations for older adults
In the older adult who is taking antihypertensive drugs, absorption of some agents may be altered because of decreased blood flow to the gut. Metabolism and excretion may be prolonged.
Drugs should be started at low doses and increased slowly to reduce the chance of orthostatic hypotension. Measure BP and HR in the supine, sitting, and standing positions at every visit.
