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Pathophysiology > Hypertension > Flashcards

Hypertension Flashcards

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1
Q

MAP = ___ * ____

A

CO * HR

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2
Q

CO = ___ * ___

A

HR * SV

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3
Q

Which three factors determine HR?

A
  1. Sympathetic NS
  2. Parasympathetic NS
  3. Catecholamines
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4
Q

True or False: Stroke volume is determined by cardiac filling

A

True

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5
Q

Which four factors affect cardiac filling?

A
  1. HR
  2. Venous return
  3. Afterload
  4. Ventricular compliance
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6
Q

True or False: Cardiac contractility is determined mainly by sympathetic nerve activity and circulating catecholamines

A

True

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7
Q

Vasoactive mediators (Ang II, Epinephrine, Vasopressin, Histamine) determine _____

A

TPR

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8
Q

True or False: Blood viscosity and sympathetic nerve innervation affect HR

A

False - TPR

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9
Q

Which two factors affect blood volume?

A
  1. Hormones (Vasopressin, aldosterone, ANP)
  2. Pressure natriuresis
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10
Q

Hypertension without a known cause is known as ____

A

primary HTN

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11
Q

Hypertension caused by renal, mechanical, or neuroendocrine abnormalities is known as: ____

A

secondary HTN

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12
Q

Which five organs systems can lead to development of primary HTN?

A
  1. CNS
  2. Pressure/volume receptors
  3. Kidney
  4. Adrenals
  5. Blood vessels
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13
Q

How does primary HTN (specifically CO and TPR) change as one ages?

A

CO decreases as one ages while TPR increases

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14
Q

How can renal parenchymal disease cause secondary HTN?

A

If kidneys cannot excrete enough water and salt….
1. more plasma volume
2. more CO
3. more BP

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15
Q

How can renal vascular disease lead to secondary HTN?

A

Reduced renal blood flow means more renin and Ang II released

Peripheral vasoconstriction and aldosterone release => Na retention and INCREASED plasma volume

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16
Q

How can primary hyperaldosteronism cause secondary HTN?

A

Increases blood volume

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17
Q

True or False: Primary HTN can be caused by sleep apnea

A

False - secondary

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18
Q

Coarctation of aorta is uncommonly seen in kids and causes….

A

2 HTN

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19
Q

In coarctation of aorta, reduced blood flow to kidneys activates RAAS, leading to peripheral ____ and increased _____

A

vasoconstriction; plasma volume

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20
Q

While rare, pheochromocytomas can cause 2 HTN. How?

A
  1. Increase CO
  2. Increased systemic vascular resistance
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21
Q

Excess glucocorticoids have mineralcorticoid effects and can lead to secondary HTN, as in _____

A

Cushing Syndrome

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22
Q

How can hyperthyroidism cause secondary HTN?

A

Increased blood volume, CO, and metabolism

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23
Q

True or False: Elevated plasma insulin and obesity, as well as OTC’s can cause secondary HTN

A

True

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24
Q

Estrogen stimulates hepatic production of ____

A

angiotensinogen

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25
What three symptoms are typically seen in HTN patients?
Flushing Sweating Blurry Vision
26
True or False: Increased right ventricle afterload is a consequence of HTN
False - increased LEFT ventricle afterload
27
In HTN, how does the left ventricle compensate for increased afterload/increased stress it faces?
Hypertrophy to reduce wall stress
28
What are the two types of hypertrophy that occur in left ventricle in response to increased left ventricle afterload?
1. Concentric Hypertrophy - no dilation - most common - walls thicken, but volume decreases 2. Eccentric - dilation - volume increases or stays same - remodeling occurs 2.
29
How does increased left ventricle afterload affect myocardial o2 demand? Effect?
Increases myocardial O2 demand (increases pressure-rate product), leads to myocardial ischemia
30
True or False: In HTN, increased left ventricle afterload can lead to decompensation and systolic dysfunction
True - as a result of decreased systolic dysfunction, there is decreased stroke volume
31
Why can left ventricular hypertrophy lead to diastolic dysfunction?
Reduced ventricular compliance
32
True or False: Pressure overload of the left ventricle can increase wall thickness, leading to increased wall stress during asystole and diastole
True - Concentric Hypertrophy
33
True or False: Wall stress is greater during concentric hypertrophy
False - eccentric
34
Arterial damage can result due to HTN. More specifically, chronic damage to the endothelium favors ____ (possibly by reducing NO), medial degeneration , and weakening of ____ walls
atherogenesis; vessel
35
True or False: Increased afterload, a consequence of HTN, can lead to left ventricular hypertrophy, ___ dysfunction, and ___
diastolic; heart failure
36
True or False: HTN can lead to increased afterload, which can cause systolic dysfunction and heart failure
True
37
Arterial damage from HTN can lead to: ____ and ____
Accelerated atherosclerosis Weakened vessel walls
38
Arterial damage and increased afterload can cause ____
myocardial ischemia and MI
39
____ reduces peripheral vascular resistance
ACE Inhibitors
40
How does ACE inhibitors work?
Reduce venous/arterial pressure, which leads to: decreased preload and afterload
41
ACE Inhibitors will increase plasma concentration of ____
bradykinin
42
How do angiotensin receptor blockers work?
Block AT1-R on adrenal cortex and vasculature
43
True or False: Angiotension receptor blockers cause vasoconstriction and increase aldosterone secretion
False - cause vasodilation and decrease aldosterone secretion
44
Which drugs decrease blood volume?
Diuretics
45
True or False: Diuretics decrease preload and CO
True
46
How do diuretics decrease peripheral vascular resistance?
Decrease Na content of arteriolar SM
47
CCB's, direct vasodilators, and aldosterone antagonists belong to which drug class?
Peripheral Vasodilators
48
True or False: CCB's have a significant effect on venous capacitance
False - they do not
49
How do calcium channel blockers decrease peripheral vascular resistance?
Relax vascular SM
50
Hydrazaline and Minoxidil are examples of which drug class?
Direct vasodilators
51
True or False: Spironolactone is a Aldosterone antagonist
True
52
Spironolactone, used for resistant HTN, increase secretion of ___ and ___
Na/H2O
53
Which drug should be used for HTN crisis?
Nitroprusside
54
Nitroprusside reduces: ___,____, and ___
1. preload 2. afterload 3. peripheral vascular resistance
55
True or False: Nitroprusside relaxes VSM of veins and arterioles
True
56
How do peripheral alpha 1 receptor antagonists treat HTN?
Reduce peripheral vascular resistance
57
Beta-adrenergic receptor antagonists reduce CO by decreasing ___ and ___; also decreases release of ___
HR, contractility; renin
58
Which drugs reduce sympathetic n. activity to heart/peripheral vasculature, leading to decreased CO and peripheral vascular resistance?
Centrally acting alpha-2 adrenergic agonists
59
____: Inability of heart to pump forward enough blood to meet metabolic demands of body or the ability to do so only at abnormally elevated filling pressure, or both
CHF
60
Two main causes of CHF?
1. Defect in myocardial contraction - systolic dysfunction 2. Impaired filling - diastolic dysfunction
61
True or False: Preload has a negative effect on stroke volume
False - preload and contractility have positive impact while afterload has a negative impact
62
What four factors increased preload?
1. HR 2. Compliance 3. Atrial Systole 4. Pericardial Constraint
63
Which 6 factors affect afterload?
1. Arterial Pressure 2. Systemic Vascular Resistance 3. Aortic/Pulm Valve Stenosis 4. Blood viscosity 5. Mass of blood column in aorta 6. Aortic compliance
64
Which 3 factors affect contractility?
1. Catecholamines 2. HR 3. Sympathetic Nerve Activity

Pathophysiology (26 decks)

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