Hyper/Hypotension Physiology

Question 1

What is another name for the right atrioventricular valve?

Why

Answer 1

Tricuspid valve

It has three flaps

Question 2

What is the only vein that carries oxygenated blood ?

Answer 2

Pulmonary vein

Question 3

What is the only artery that carries de-oxygenated blood ?

Answer 3

Pulmonary artery

Question 4

What is the valve that most commonly experiences stenosis?

Answer 4

Mitral valve

Question 5

When talking about systole and diastole what area of the heart does it refer to ?

Answer 5

Ventricle

Question 6

When do the coronary arteries get filled up, during systole or diastole?

Answer 6

Diastole

Question 6

What are the three layers of the heart ?

Answer 6

Endocardium - inner most
Myocardium - Middle
Epicardium - Outermost

Pericardium then surronds the heart.

Question 7

What are the layers of the pericardium?

Answer 7

The outer layer is fibrous and it just holds the heart to the diaphragm.

The inner layer is the serious pericardium - which contains the pericardial fluid

Your pericardium is a protective, fluid-filled sac that surrounds your heart and protects and lubricates it.

Question 8

What is a perfect blood pressure ?

Answer 8

120/80

Question 9

What is prehypertension range ?

Answer 9

Question 10

What is stage 1 hypertension range ?

Answer 10

Question 11

What is stage 2 hypertension range ?

Answer 11

Question 12

What can lead to the blood vessels ability to contract and relax

Answer 12

• Reduced elastic eg with age
• Atherosclerosis
• Calcium

Need to change my lifestyle!

Question 13

Why is smoking an issue for blood vessels ?

Answer 13

Basal release of nitric oxide ( NO ) from the vascular endothelium regulates the tone of muscular arteries and resistance vasculature.

Smoking reduced nitrous oxide supply - reduces the tunica media elastic.

Question 14

What can happen if someone drinks alcohol and does not eat?

Answer 14

hypoproteinaemia

Question 15

What happens if the aorta becomes narrow?

Answer 15

Left ventricular hypertrophy (LVH) means that the muscle of the heart’s main pump (left ventricle) has become thick and enlarged. This can happen over time if the left ventricle has to work too hard. This part of the heart needs to be strong to pump oxygen-rich blood to your entire body.

Think if you worked on your biceps for a month they are going to get bigger.

Question 16

What is the term that measures the blood in the ventricle when it’s relaxing?

Answer 16

End diastolic volume (120ml)

Question 17

What is the term that measured the blood in the ventricle when its relaxlaxing?

Answer 17

End systolic volume (50ml)

Question 18

How to measure stroke volume

Answer 18

End disastolic volume - End systolic volime

Question 19

What is cardiac output

Answer 19

About 5 L

Question 20

If stroke volume is reduced, cardiac output is reduced which will result in reduced coronary supply to arteries to heart risk of an MI… what medication will you want to give?

Answer 20

Vasodilator

Question 21

When would you likely see hypotension ?

Answer 21

Diarehhea
Vomiting

Question 22

What are the clinical issues with low blood pressure

Answer 22

No perfusion to the bodies !!

Dizzy

Question 23

What does Baro mean ?

Answer 23

Pressure

Question 24

Why are the baroreceptors places at the aortic arch and the carotids?

Answer 24

Checks quality leaving the ventricles and going to the brain.

Question 25

Where are Baroreceptors found ?

Answer 25

Aortic arch and carotid

Question 26

Nerve fibres relay impulses in cranial nerves IX and X from the baroreceptors to where?

Answer 26

Medulla oblongata The respiratory and cardiac system control

Question 27

What are the three volumes that stroke volume is based on?

Answer 27

preload contractility afterload

Question 28

what is the cardiac output

Answer 28

Stroke volume x Heart rate

Question 29

What is the HR if SA node is firing ?

Answer 29

60-100

Question 29

What is the HR is the SA node is not firing but the AV node is ?

Answer 29

40-60

Question 30

What happens if the sympathetic response on the heard and vessels ?

Answer 30

Heart: Increase heart rate Increase contractility (inotropy) Increase conduction in the heart Vessels: Coronary vasodilation Constriction of systemic vessels Fight and Flight

Question 31

What is the parasympathetic respons on the heart rate and vessels ?

Answer 31

Parasympathetic Response is: Heart: Decrease heart rate Vessels: Dilation of systemic vessels Rest and Digest

Question 31

Why does blood pressure drop when standing?

Answer 31

Most of the blood pressure is in the calf muscle. When you stand you are pumping that blood and then there will be a circulation and perfusion to kidneys etc. and reduction of the blood vessels.

Question 31

What is the term known for when BP drops when standing

Answer 31

Orthostatic hypotension

Question 32

What is the range for orthostatic hypotension?

Answer 32

Decrease in BP: ≥ 20mm mmHg SBP, ≥ 10mm mmHg DBP

Question 33

What can you quickly do if patient has orthostatic hypotension?

Answer 33

Move legs Lie on the left and let the blood refill for 5 minutes Sit on the side of the bed for 5 minutes

Question 34

Causes of orthostatic hypotension?

Answer 34

Low blood volume Drug use - anti-hypertensive and psychotropic Ageing Orthostatic tolerance decreases after 70. Post-prandial BP can drop. Change in ability to increase HR, decrease in muscle Disorders affecting Sympathetic control Parkinson’s, Diabetic neuropathy

Question 35

What can cause Hypovalemic shock?

Answer 35

Loss of ≥20% of blood volume Bleeding, burns, fluid loss (V+D), perspiration, internal haemorrhage

Question 36

How much blood do we have in our body at any time? How much is lost for hypovalemic shock?

Answer 36

5l in our body 1l is 20%

Question 37

What presentations can be shown during hypovalemic shock ?

Answer 37

Pale, clammy skin, weak pulse, unconsciousness, in severe cases. Related to poor blood flow Also thirst and decreased urination Change in pH levels (anaerobic metabolism) Agitation

Question 38

What is treatment for hypovalmeia

Answer 38

Replacement D+V - fluid replacement Blood - Transfusion

Question 39

Why should you immediately get a IV line in during hypovalemia ?

Answer 39

Viens shut down quickly

Question 40

Explain Septic shock

Answer 40

Bacterial infection produces endotoxins that increase inflammation and produce Nitric oxide. NO → vasodilation Vasodilation → wider lumen and decreased BP

Question 41

Explain Anaphylactic Shock

Answer 41

Vasodilation as a result of histamine production Lips and tongue will be swollen - patient will be unable to breathe

Question 42

Treatment for anaphalaxis

Answer 42

EPIPEN last line - tracheostomy

Question 43

What is nuerogenic shock

Answer 43

Damage to the sympathetic nervous system. Loss of vascular tone.

Question 44

What is Hypotension Compensatory mechanisms ?

Answer 44

Baroreceptors stimulate sympathetic nervous system: Constricts vascular beds and stimulate the heart This is rapid but unsustainable (sympathetic control) Kidneys influence BP by regulating Blood Volume Renin-Angiotensin-Aldosterone: increase blood volume and maintain vasoconstriction (angiotensin II production, vasopressin release) Venous return increased by stimulating veins Fluid also retained by a drop in capillary hydrostatic pressure

Question 45

What organ is not working if a patient has low BP ?

Answer 45

Kidneys

Question 46

How does the Kidney respond to low BP ?

Answer 46

remember sodium (aka aldosterone) increases water absorption !!

Question 47

What hormones are involved in increasing BP ?

Answer 47

Renin Angiotensis Aldosterone and ADH

Question 47

What are the issues with hypertension ?

Answer 47

Hypertension: linked to MI, stroke, renal problems, visual disturbances - multifactorial

Question 48

Explain primary and secondary hypertension

Answer 48

Primary and secondary hypertension Primary (essential): 90% of cases Secondary hypertension: Renal artery stenosis, renal disease, hyperaldosteronism, Aortic coarctation, pregnancy, hyper and hypothyroidism, Cushing syndrome, Sleep apnoea

Question 49

Explain how HTN can be acute and chronic

Answer 49

Temporary (acute): stress Chronic: Increase in vascular resistance and Cardiac Output (renal retention)

Question 50

What is the reference range for hypotension ?

Answer 50

A drop in systolic arterial pressure <90mmHg and <60mmHg diastolic pressure