Hypertension and Vascular

Question 1

Whats the equation for MAP?

Answer 1

MAP = SVR x CO

Question 2

How is blood pressure controlled? (3)

Answer 2

• autonomic nervous system
• renin-angiotension-aldosterone system
• renal changes

Question 3

how does the autonomic nervous system control arterial blood pressure?

Answer 3

ANS controls arterial blood pressure by:

• brainstem centrally
• baroreceptors in the carotid sinus peripherally

Question 4

in a HYPERtensive state, how will the baroreceptors in the aortic arch and carotid sinus affect vagal tone and sympathetic tone?

Answer 4

• increase vagal tone
• decrease sympathetic tone
• to decrease HR and vasodilate

Question 5

in a HYPOtensive state, how will baroreceptors in the aortic arch and carotid sinus affect vagal and sympathetic tone?

Answer 5

• decrease vagal tone
• increase sympathetic tone
• to increase HR, vasoconstriction, and increase contractility

Question 6

what will activate the renin-angiotensin-aldosterone system?

Answer 6

• hypotension

- decreased sympathetic tone

Question 7

what will the renin-angiotensin-aldosterone system result in?

Answer 7

• increased vasopressin

- increased angiotensin II

Question 8

what will angiotensin II do to act as a vasoconstrictor?

Answer 8

ATII stimulates aldosterone production, leading to sodium and water reabsorption by the kidneys

Question 9

what can the renal system do to manipulate arterial blood pressure?

Answer 9

control total body sodium and water

Question 10

what is hypertension?

Answer 10

elevation of arterial BP

Question 11

what can hypertension lead to if uncontrolled?

Answer 11

MI, CVA, renal failure and death

Question 12

goals for hypertensive therapy?

Question 13

what is essential HTN (or primary HTN)?

Answer 13

the most common form of hypertension (>90%), not secondary to an underlying cause

Question 14

what are risk factors for developing hypertension?

Answer 14

• age
• family history
• obesity
• insulin resistance
• diet and lifestyle

Question 15

what is secondary hypertension?

Answer 15

• less than 10% of all causes of HTN

- secondary to another cause, often either a renal or endocrine disorders

Question 16

what renal disorders can lead to secondary hypertension?

Answer 16

• fibromuscular dysplasia

- renal artery stenosis

Question 17

what endocrine disorders can lead to secondary hypertension?

Answer 17

• pheochromocytoma
• cushing’s syndrome
• hyperaldosteronism
• hyperthyroidism

Question 18

other than renal and endocrine disorders, what can cause secondary hypertension?

Answer 18

• meds
• neuro disorders
• scleroderma

Question 19

what organs autoregulate blood flow?

Answer 19

• brain
• heart
• kidneys

Question 20

what does it mean for an organ to autoregulate blood flow?

Answer 20

the organ can maintain constant blood flow with changing perfusion pressures

Question 21

chronic hypertension can lead to microvascular changes resulting in what?

Answer 21

ischemic strokes

Question 22

the majority of CVAs occur due to what etiology?

Answer 22

ischemia

Question 23

what can occur as the vasculature becomes less compliant?

Answer 23

causing LVH

• > diastolic dysfunction
• > angina/MI
• > heart failure

Question 24

what can HTN do to the kidneys?

Answer 24

causing glomerulal damage

• -> albuminuria (protein lost in the urine due to impaired kidney function)
• -> overt renal failure

Question 25

What are normal creatinine levels?

Answer 25

men 0.8-1.3 | women 0.6-1.0

Question 26

HTN emergencies imply what?

Answer 26

acute end organ damage

Question 27

what are some examples of HTN emergencies?

Answer 27

- CVA - encephalopathy - LV failure - MI - aortic dissection - renal failure

Question 28

what is HTN urgency imply?

Answer 28

high blood pressure without signs of end organ damage

Question 29

HTN emergency should be attenuated by...

Answer 29

IV anti-hypertensives | BP should be lowered by 20% within 4-6 hours and then gradually normalized over a few days

Question 30

HTN ugency can be attenuated by...

Answer 30

PO medications

Question 31

what should be used for HTN PTs with chronic kidney disease (CKD)?

Answer 31

- ACE inhibitor or - ARB

Question 32

what can be used for general population in treating HTN?

Answer 32

- thiazide diuretic - ACE inhibitor or ARB - calcium channel blocker * black people NO ACE inhibitors or ARB

Question 33

how do thiazide diuretics work?

Answer 33

- HCTZ (hydrochlorothiazide) acts to reduce sodium reabsorption in the distal convuluted tubule, causing water loss

Question 34

how do loop diuretics work?

Answer 34

loop diuretics inhibit sodium and chloride reabsorption in the loop of henle leading to water loss, increasing prostaglandin levels.

Question 35

what are two loop diuretics?

Answer 35

furosemide | torsemide

Question 36

name two ACE inhibitors

Answer 36

lisinopril | enalapril

Question 37

what will ACE inhibitors cause?

Answer 37

- vasodilation - vascular smooth muscle relaxation - natriuresis - decreased vasopressin release

Question 38

what are ARBs? Name two.

Answer 38

angiotensin receptor blockers - losartan - valsartan

Question 39

what do ARBs cause?

Answer 39

block the AGII receptor causing: - vasodilation - vascular smooth muscle relaxation - natriuresis - decreased vasopressin release

Question 40

what is natriuresis?

Answer 40

the process of secreting sodium by the kidneys

Question 41

name two CCBs (calcium channel blockers)

Answer 41

amlodipine | nicardipine

Question 42

what do CCBs cause?

Answer 42

decreased intracellular Ca2+ causing - vasodilation - negative inotropy - negative chronotropy - reduced aldosterone production

Question 43

name the 3 kinds of B receptors

Answer 43

- B1 - heart, kidneys - B2 - muscle - B3 - adipose tissue

Question 44

what do B blockers cause?

Answer 44

- negative chronotropy - negative inotropy - antiarrhythmic - reduced aldosterone production - smooth muscle relaxation

Question 45

would you use B-blockers first for HTN treatment?

Answer 45

NO!

Question 46

what are the three layers of the aorta?

Answer 46

- intima - media - adventilla

Question 47

whats an aneurysm of the aorta?

Answer 47

a dilation of the aorta

Question 48

whats the difference between a true and pseudoaneurysm?

Answer 48

pseudoaneurysm does not involve all 3 layers of aortic tissue

Question 49

what is the possible etiology of an aortic aneurysm?

Answer 49

- HTN - Atherosclerosis - collagen vascular disease - bicuspid aortic valve - syphilis - HLD - mycotic - inflammatory

Question 50

whats an aortic dissection?

Answer 50

intimal tear creating a false lumen for blood to enter.

Question 51

What is the DeBakey classification for aortic dissections?

Answer 51

I - originating in ascending aorta and extends to aortic arch or further II - originates and confined to ascending aorta III - originates in descending aorta

Question 52

what is the Stanford classification for aortic dissections?

Answer 52

A - any dissection involving the ascending aorta regardless of origin B - all other dissections of the aorta

Question 53

what is the possible etiology for aortic dissection?

Answer 53

- HTN - collagen vascular disease - bicuspid aortic valve - inflammatory - trauma - complication from heart surgery

Question 54

what does carotid artery stenosis primarily involve?

Answer 54

the internal carotid arteries, due to atherosclerotic disease

Question 55

intervention is needed in what % of carotid stenosis cases?

Answer 55

>70%

Question 56

What does TIA stand for?

Answer 56

transient ischemic attack

Question 57

what are risk factors for CAD?

Answer 57

- HTN - HLD - DM - PAD - tobacco use

Question 58

what surgeries can be done for carotid artery disease?

Answer 58

- stenting | - endarterectomy

Question 59

what do the carotid bodies do?

Answer 59

act as chemoreceptors to maintain homeostasis during hypoxia. damage could lead to blunted hypoxic drive and labile BP

Question 60

what do you do if there is a hematoma?

Answer 60

- call for help - get a scalpel - open the neck - hope surgery gets there fast

Question 61

what is raynaud's?

Answer 61

vasoconstriction of the extremeties during cold or stress - mostly seen in females - may reduce peripheral extremety blood flow - maybe related to connective tissue disorders

Question 62

where does deep vein thrombosis (DVT) usually occur?

Answer 62

lower extremities

Question 63

how do you treat DVT?

Answer 63

anticoagulation and maybe a IVC filter (inferior vena cava)

Question 64

what might need to be done for a pulmonary embolism (PE)?

Answer 64

emergency embolectomy

Question 65

what can lead to a thrombus/embolus developing?

Answer 65

- vessel wall injury - hypercoagulability - stasis (inactivity)