Hypertension Flashcards Preview

SS- Cardio > Hypertension > Flashcards

Flashcards in Hypertension Deck (24):
1

hypertensive heart disease

old, AA
concentric LVH: diastolic dysfunction (impaired compliance and filling)
myocytes: expanded cytoplasm and enlarged boxcar nuclei
Tx: medical

2

hypertrophic cardiomyopathy

young (genetic)
autosomal dominant: structural protein, beta myosin heavy chain most common
asymmetric hypertrophy of septum, sometimes murmur
can get fibrosis and myocyte disarray
Tx: varies

3

aortic stenosis

old, male
LVH, murmur
cause: calcifications on sinuses of valsalva, rheumatic valvulitis (young-mid adults, fibrosis), bicuspid valve (young-mid adults, calcifications)
Tx: surgical or stent

4

cor pulmonale

acute or chronic pulmonary HTN disease
RVH
cause: lung disease (emphysema, chronic pulmonary embolisms, foreign material from IV drugs, tumor)
chronic: elderly
acute: dilation without hypertrophy
NO angina
Tx: medical

5

types of hypertrophic heart disease

1. hypertensive heart disease
2. hypertorphic cardiomyopathy
3. aortic stenosis
4. cor pulmonale

6

presentation of hypertrophic heart disease

dyspnea, angina, sudden death
all chronic

7

interstitial myocardial fibrosis

TGF-B, hypertrophic heart disease

8

HCOM

hypertrophic obstructive cardiomyopathy
1/3 of of hypertrophic cardiomyopathies
valves meet at bodies rather than tips: anterior leaflet overlap is dragged in front of aorta and obstructs flow into it and get mitral regurgitation
fibrosis: mitral valve and subaortic upper septum
Tx: surgery, inject EtOH into septum to infarct upper hypertrophied part

9

How thick should LV be? RV?

1.5 cm or less
1/3 of LV

10

Why would a person with hypertrophic cardiomyopathy die after an intense workout?

obstruction is relieved by exercise because the heart dilates to accommodate venous return
after exercise myocardial O2 demand remains high, but the dilation subsides causing ischemia and fatal heart arrhythmia

11

normal BP

120/80

12

HTN Tx goals

140/90
older 150/90

13

causes of HTN

most: primary or essential multifactorial: genetic predisposition, salt, alcohol, obesity
secondary: renal disease, excess mineralocorticoids, pheochromocytoma

14

Why is HTN a problem?

leading cause of preventable death
MI, CHF, Stroke, end stage renal disease

15

prehypertension

120-139/80-89

16

stage 1 hypertension

140-159/90-99

17

stage 2 hypertension

>/= 160/100

18

lifestyle changes that Tx HTN

diet, weight loss, exercise
no alcohol or tobacco

19

DASH diet

reduced salt
fruits, vegetables, low fat dairy
as effective as mono therapy drug tx

20

What things are important in obtaining an accurate BP?

1. proper technique: cuff, position, timing, both arms, avoid caffeine and tobacco, device
2. properly record
3. repeat on multiple occasions

21

Causes elevated BP not due to HTN

stress, anxiety, pain, drugs, nicotine, alcohol, caffeine, white coat

22

How do you assess the significance of elevated BP?

1. magnitude of BP
2. end organ damage: heart, brain, kidney, eye, vasculature
3. other CVD risk factors: hyperlipidemia, DM, tobacco, older, male
obtain: targeted Hx and physical, serum electrolytes, creatine, fasting glucose, fasting lipid panel, Hct, urinalysis (with micro albumin), resting EKG

23

How would you identify secondary causes of HTN?

1. age of onset less than 20 or greater than 50 yrs
2. target organ damage
3. poor response to Tx (3 or more drugs)
4. Fam or personal Hx of renal disease
5. labile pressure with tachycardia, sweating, tremor: pheochromocytoma
6. unprovoked hyopkalemia: hyperaldoseronism
7. abdominal bruit/extensive vascular disease: renal artery stenosis

24

HTN emergency

ongoing end target organ damage, BP >180/120
parenteral drugs: reduce no more than 25% of pretreatment level in 2 hours
gradually reduce over 24 hours to avoid compromising perfusion