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PHR2042 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define cardiovascular disease (CVDs)

A

A group of disorders affecting the heart and blood vessels

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2
Q

What is coronary heart disease (CAD) and what causes it

A

Condition where the heart is deprived of oxygen due to reduced blood supply due to blockage of the arteries supplying blood to the heart

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3
Q

What is CAD also known as

A

Ischemic heart disease (IHD)

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4
Q

What conditions are included in CAD

A

Stable angina
Angina
ACS
Myocardial infarction
Sudden cardiac death

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5
Q

What are the presentations of stable angina

A

Chest discomfort and symptoms precipitated by activity with minimal or no symptoms at rest

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6
Q

What is ACS

A

Syndrome where there is a lack of blood flow to the heart to supply the needs of myocytes often due to a blockage of a coronary artery. This may cause parts of the heart to not function properly or even die

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7
Q

Types of ACS

A

Unstable angina
NSTEMI
STEMI

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8
Q

How does angina pain develop?

A

When there is an increased blood supply demand in the setting of stable atherosclerosis plague but the vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial demand

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9
Q

What occurs in unstable angina?

A

Plague ruptured and a thrombus forms around the ruptured plague causing partial occlusion of the vessel resulting in angina pain

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10
Q

What occurs in NSTEMI

A

Plague ruptures and thrombus formations causes partial occlusion to the vessel resulting in injury and infarct to the subendocardial myocardium

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11
Q

What occurs in STEMI

A

Complete occlusion of the blood vessel resulting in transmural injury and infarct to the myocardium

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12
Q

What is atherosclerosis

A

Development of bulging fatty deposits called plagues j in n large arteries leading to reduced blood flow or blockage of an artery if plague breaks open and clotting occurs

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13
Q

What is dyslipidaemia

A

Presence of altered levels of lipoproteins in the blood

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14
Q

What lipoprotein levels are associated with artheroslerosis

A

Increased levels of low density lipoprotein particles and decreased levels of high density lipoprotein particles

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15
Q

Define ischaemic stroke

A

Condition where blockage from thrombus or a clot in blood vessel causes lack of adequate blood flow into the brain via cerebral arteries resulting in ischemia, hypoxia and neuronal death

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16
Q

Define haemorrhagic stroke

A

Rupturing of vessels and blood leaks out causing large thrombus within the area causing pressure on the brain leading to damage

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17
Q

Common mechanism of heart failure

A

Reduction of stroke volume which causes reduction in cardiac output

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18
Q

What is stroke volume

A

volume of blood ejected with each contraction of the heart

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19
Q

What are the 2 problems that result in heart failure

A

Contractile problem
Filling problem

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20
Q

What occurs in contractile problem heart failure

A

Damaged myocytes cant contract as hard as they should

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21
Q

What occurs in filling problem heart failure

A

Ventricles become stiff and do not receive enough blood

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22
Q

Heart failure classifications

A

Heart failure with reduced Ejection Fraction (HFrEF)
Heart failure with preserved Ejection Fraction (HFpEF)

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23
Q

What does Ejection Fraction measure

A

How much blood the left ventricle pumps out with each contraction

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24
Q

What problem occurs in HFrEF

A

Contractile problem - the damaged myocytes cannot contract as hard

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25
Q

What problem occurs in HFpEF

A

Filling problem - the ventricles are stiff and do not receive enough blood

26
Q

Why do patients with heart failure experience fatigue

A

they have reduced blood flow to tissues such as skeletal muscles due to low stroke volume

27
Q

Why can oedema occur in patients with heart failure

A

Blood is not being cleared out of the ventricles efficiently causing it to build up in veins and capillaries therefore water will leak out to surrounding tissue and increases tissue fluid.

28
Q

What is arrhythmia

A

irregular or altered rate of action potential movement throughout the heart causing disturbance to the electrical activity in the heart

29
Q

Common cause of arrhythmia

A

ischaemia and death of myocytes causing damage to an area and deposition of collagen that impairs the normal spread of action potentials throughout the heart

30
Q

Types of arrthymia

A

Atrial fibrillation

31
Q

Define hypertension

A

Sustained elevation in systolic blood pressure of greater or equal to 140 mmHg and or diastolic blood pressure of greater than or equal to 90mmHg in people not taking antihypertensive medications

32
Q

What are symptoms in uncomplicated primary hypertension

A

asymptomatic although some patients with very high blood pressure may feel headache

33
Q

What does the term secondary hypertension describe

A

high blood pressure that is a result of underlying diseases or use of medicines and substances

34
Q

3 ways hypertension is diagnosed

A

Doctors office
Ambulatory blood pressure monitor
home blood pressure monitor

35
Q

How to receive a diagnosis of hypertension

A

Patient’s blood pressure must be taken 3 times on one occasion, discard first reading and average second and third
High readings on different occasions 1-2 weeks apart

36
Q

What does systolic pressure measure

A

pressure in arteries when heart beats

37
Q

What does diastolic pressure measure

A

pressure in arteries when heart rests between beats

38
Q

What is blood pressure measured as

A

The force exerted by the blood against the inner walls of blood vessels

39
Q

What is the blood pressure equation

A

BP= Cardiac output X total peripheral resistance - central venous pressure

40
Q

What is the cardiac output equation

A

CO= Heart rate X Stroke Volume

41
Q

Why do we need blood pressure

A

Blood flow to organs relies on the pressure gradient between arteries and veins so if blood pressure is low there is not enough pressure to drive blood to organs

42
Q

What is mean arterial pressure

A

Estimate of the average pressure during the cycle

43
Q

According to the BP equation, what can cause blood pressure to rise

A

Cardiac output and total peripheral resistance can cause bp to rise

44
Q

What can cause cardiac output to rise

A

Heart rate
Stroke Volume
CO= HR x SV

45
Q

What causes stroke volume to rise

A

increased blood volume
increased contractility

46
Q

What causes Total Peripheral resistance

A

net vasoconstriction- more arterioles constrict than dilate
sympathetic nerve activation- more arterioles constrict when sympathetic nerves activate
Vasoconstriction means contraction of vascular smooth muscle cells –> arteriole diameter reduction –> increase resistance –> increases TPR and therefore increases BP

47
Q

How does sympathetic nerve activation cause increase BP

A

More arterioles have a adrenoceptors causing vasoconstriction, e.g. GI tract than there are arterioles that have b2 adrenoceptors, e.g. skeletal muscle, which cause vasodilation

48
Q

Factors that causes BP to rise

A

Sex
Environmental- stress
Genetic- elevated angiotenin II levels, elevated aldosterone levels
CNS- sympathetic activation
Cardiac- cardiac output
Renal- sodium retention
Gastrointestinal- obesity, micronutrients, alcohol
Endocrine- insulin, aldosterone
Age
Endothelium- nitric oxide

49
Q

What is a hypertensive emergency

A

blood pressure is so high patients have start to have symptoms such as headache, chest pain, nausea, vomiting

50
Q

Do patients notice they have high BP

A

no, most patients don’t notice they have high BP for years

51
Q

What can hypertension result in

A

morbidity and mortality

52
Q

What changes occur in the heart in hypertension

A

Cardiac Remodelling- changes to the heart structure and function
Macro and microvascular effects- changes to large and small blood vessel structure and function

53
Q

What does changes in heart structure and function lead to

A

Increase risk of:
Stroke
Heart failure
Myocardial infarction
kidney failure

53
Q

What are the types of load on the heart

A

Preload (wall stress): load on the myocyte prior to contraction, how stretched it is at the end of the filling period
Afterload: pressure that the heart must work against in order to eject blood.

54
Q

What causes greater afterload

A

High total peripheral resistance causing higher arterial pressure means the heart must exert a greater force to eject the same amount of blood

55
Q

Stages of cardiac cycle

A
  1. ventricular filling
  2. ventricular contraction
  3. ventricular ejection
  4. ventricular relaxation
56
Q

What does remodelling refer to

A

Changes in the structure of the heart that can affect the function

57
Q

How does hypertension affect load on the heart

A

Hypertension causes increased load on the heart

58
Q

How does the heart respond to increased load on the heart

A

Increases the size and strength of myocytes (hypertrophy)

59
Q

What signalling molecules are released under conditions of higher mechanical load on the heart

A

angiotensin II and antrial natriuretic peptide are released

60
Q

What does angiotensin II act on and to cause what

A

AT1 receptors on
Cardiomyocytes: cardiomyocyte enlargement resulting in hypertrophy
Vascular smooth muscle cells: resulting in hypertrophy
Fibroblasts in between cardiac or vascular smooth muscle cells: collagen deposition

61
Q

What happens to the heart in hypertrophy and fibrosis

A

Heart stiffens causing decreased compliance, reducing efficiency of blood filling into the ventricles

PHR2042 (4 decks)

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