Hypertension

Question 1

Blood flow through vessels is normally laminar (layered, straight) except when flow rate is ____ or the vessel surface is not straight or smooth

Answer 1

high

Question 2

what affects laminar flow?

Answer 2

Blood viscosity

Question 3

high viscosity does what to laminar flow?

Answer 3

loss of laminar flow

Question 4

High velocity / turbulent blood flow activates __________ (prothrombotic, adhesion molecule expression, etc.)

Answer 4

endothelial cells

Question 5

Blood flow varies directly and resistance varies inversely to the vessel _____.

Answer 5

radius

Question 6

Small changes in vessel radius (diameter) have large effects on what two things?

Answer 6

flow and resistance

Question 7

Blood flow varies inversely and resistance varies directly to ____.

Answer 7

blood viscosity

Question 8

________ (anemia) reduces vascular resistance and increases blood flow while elevated Hct (polycythemia) increases does the opposite

Answer 8

Reduced Hct

Question 9

_______ (e.g., starvation) reduces vascular resistance and increases blood

Answer 9

Hypoproteinemia

Question 10

_______ (e.g., multiple myeloma) reduces blood flow

Answer 10

hyperproteinemia

Question 11

elevated Hct (polycythemia) increases _____ and decreases blood flow

Answer 11

vascular resistance

Question 12

As _______ falls in vessels, flow ceases because vessels collapse due to surrounding tissue pressure and vessel wall resistance to compression (capillaries and small veins > small arteries) – called the critical closing pressure

Answer 12

perfusion pressure

Question 13

what happens when perfusion pressure falls in vessels?

Answer 13

flow ceases because vessels collapse due to surrounding tissue pressure and vessel wall resistance to compression

Question 14

The smaller the diameter of a vessel (artery, arteriole, or other chamber, like a ventricle), the smaller the ___ required to reduce the vessel radius (e.g., to increase vascular resistance or to eject blood from a chamber)

Answer 14

force

Question 15

_______ is determined by the perfusion pressure (mean arterial pressure – venous pressure) and vascular resistance

Answer 15

Tissue perfusion

Question 16

how is Tissue perfusion determined?

Answer 16

by the perfusion pressure (mean arterial pressure – venous pressure) and vascular resistance

Tissue perfusion = perfusion pressure / vascular resistance

Question 17

If vascular resistance increases (e.g., arteriolar constriction), perfusion pressure must do what?

Answer 17

increase to the same degree to maintain tissue perfusion

Question 18

If venous pressure increases (e.g., right heart failure), perfusion pressure falls, so without decreasing vascular resistance, tissue perfusion will do what?

Answer 18

will also decrease

Question 19

_____ is a function of cardiac output and peripheral vascular resistance

Answer 19

blood pressure

Question 20

when are the naturetic peptides released?

Answer 20

released with cardiac stretch

Question 21

The naturetic peptides (e.g., BNP), released with cardiac stretch, cause what 2 things to happen?

Answer 21

peripheral vasodilation

renal Na+ and water loss

Question 22

_______ (released with slow flow through nephron) transforms angiotensinogen to angiotensin 1, which is transformed to angiotensin 2 by endothelial cells

Answer 22

Renin

Question 23

what cells transform angiotensin I to angiotensin II?

Answer 23

endothelial cells

Question 24

_______ causes vasoconstriction and triggers aldosterone release

Answer 24

Angiotensin 2

Question 25

_______ results in renal Na+ and water reabsorption

Answer 25

Aldosterone

Question 26

In BP regulation, there is _____ and ______ regulation of cardiac output and vascular tone

Answer 26

Central and autonomic regulation of cardiac output and vascular tone

Question 27

_______ in carotid sinus and aortic arch send feedback to medulla oblongata

Answer 27

baroreceptors

Question 28

Low blood pressure (reduced stretch) stimulates sympathetic feedback, causing what two things to occur?

Answer 28

peripheral vasoconstriction, increased cardiac output (↑SA node pacing, ↓AV node delay, ↑ contractility)

Question 29

High blood pressure stimulates parasympathetic and inhibits sympathetic feedback, which reduces ______

Answer 29

reduces cardiac output | ↓SA node pacing, ↑AV node delay

Question 30

High blood pressure stimulates ________ nervous system

Answer 30

parasympathetic

Question 31

low blood pressure stimulates ________ nervous system

Answer 31

sympathetic

Question 32

do veins or arteries have highest compliance?

Answer 32

veins

Question 33

do veins or arteries have the largest volume within the vascular system?

Answer 33

veins

Question 34

Veins have highest compliance (stretch) and the largest volume within the vascular system so they are called “______ vessels”

Answer 34

capacitance

Question 35

Small arteries and arterioles have a small volume and the greatest ability to forcefully constrict, so they are called “______ vessels”

Answer 35

resistance

Question 36

do veins or arteries have the greatest ability to forcefully constrict?

Answer 36

arteries

Question 37

Vessel pressure below heart level is increased and above heart level is decreased by the effect of ____

Answer 37

gravity

Question 38

Vessel pressure below heart level is ______.

Answer 38

increased

Question 39

Vessel pressure above heart level is ______

Answer 39

decreased

Question 40

In an upright position, when the mean arterial pressure at heart level is constant, the mean pressure in a large artery in the head will be lower and the pressure in a large artery in the foot will be_______.

Answer 40

increased

Question 41

hypotension is generally defined as BP less than?

Answer 41

BP < 90/60

Question 42

when should you be concerned about hypotension?

Answer 42

when pt is symptomatic

Question 43

hypotension is Caused by inadequate ___, ____. or_____?

Answer 43

cardiac output (e.g., heart failure, AMI, medications), inadequate peripheral resistance (e.g., CNS, endocrine or other effect on vascular resistance, medications), or inadequate blood volume (e.g., hypovolemia)

Question 44

examples of Hypotension Acute symptoms primarily related to CNS dysfunction caused by hypoxia

Answer 44

lightheadedness, dizziness, syncope, seizure

Question 45

Severe hypotension associated with what?

Answer 45

shock, multiple system organ failure (kidney, GI tract frequently first affected)

Question 46

A syndrome associated with elevated blood pressure is known as _____

Answer 46

HTN

Question 47

secondary causes of hypertension (4)

Answer 47

1. Renal: Acute glomerulonephritis, chronic renal disease, polycystic disease, renal artery stenosis, renal vasculitis, renin-producing tumors 2. Endocrine: Pheochromocytoma, acromegaly, adrenocortical hyperfunction (e.g., Cushing, primary aldosteronism), exogenous hormones (e.g., estrogen, glucocorticoids), hypo and hyperthyroidism, pregnancy 3. Cardiovascular: Coarctation of the aorta, polyarteritis nodosa, increased intravascular volume, increased cardiac output, arteriosclerosis 4. Neurologic: Psychogenic, increased intracranial pressure, sleep apnea, acute stress (physical and psychological)

Question 48

primary hypertension accounts for what percentage of HTN diagnoses?

Answer 48

90-95%

Question 49

what is considered elevated BP in adults?

Answer 49

systolic: 120–129 mm Hg diastolic: <80 mm Hg

Question 50

what is considered stage 1 HTN in adults?

Answer 50

systolic: 130–139 mm Hg diastolic: 80–89 mm Hg

Question 51

what is considered stage 2 HTN in adults?

Answer 51

systolic: ≥140 mm Hg diastolic: ≥90 mm Hg

Question 52

To determine a patients BP, you use have ana average of ___ readings, on ____ different occasions

Answer 52

based on an average of ≥2 careful readings obtained on ≥2 occasions

Question 53

HTN is Most frequently caused by increased _______, may also be caused by increased cardiac output (increased HR)

Answer 53

peripheral vascular resistance

Question 54

Systolic pressure normally rises throughout life but diastolic pressure rises until age 50-60 and then begins to fall –this is related to loss of _______?

Answer 54

arterial recoil (“hardening of the arteries”)

Question 55

Left-Sided Hypertensive Heart Disease is In response to increased intraventricular pressure, the ventricular wall will undergo_____ hypertrophy

Answer 55

concentric

Question 56

in Left-Sided Hypertensive Heart Disease, concentric hypertrophy due to increased ______.

Answer 56

Due to increased afterload = aortic pressure or resistance to ventricular emptying (e.g., valve stenosis or regurgitation)

Question 57

Hypertrophy reduces what 4 things?

Answer 57

ventricular volume, end-diastolic volume, stroke volume and cardiac output

Question 58

Increased tissue mass increases_______ demand, may precipitate ischemic events and exacerbate IHD

Answer 58

oxygen

Question 59

Increased tissue mass increases oxygen demand, this may precipitate/exacerbate what two things?

Answer 59

may precipitate ischemic events and exacerbate IHD

Question 60

Left-Sided Hypertensive Heart Disease May be caused by ____ stenosis (increased afterload), or may cause _____stenosis (valve injury)

Answer 60

aortic May be caused by aortic stenosis (increased afterload), or may cause aortic stenosis (valve injury)

Question 61

Right-Sided Hypertensive Heart Disease is Characterized by ?

Answer 61

right ventricular hypertrophy, dilation, and potential heart failure

Question 62

what is Right-Sided Hypertensive Heart Disease usually caused by?

Answer 62

Usually caused by disorders of the pulmonary vasculature or left ventricular heart failure resulting in increased right ventricular diastolic and systolic pressure

Question 63

Right ventricular hypertrophy due to pulmonary hypertension is called _______.

Answer 63

Cor Pulmonale