Peripheral vascular disease, hypertension and dissection

Question 1

What are the primary determinants of blood pressure

Answer 1

volume status
sympathetic nervous system
RAAS

Question 2

positive chronotropes

Answer 2

increases heart rate

Question 3

negative chrotropes

Answer 3

decreases HR - Beta blockers

Question 4

what are factors that increase HR

Answer 4

sympathetic NS
increased thyroid
hypoxemia and acidosis

Question 5

what are factors that decrease HR

Answer 5

Parasympathetic innervation
athletes
medications: BB, CCB

Question 6

what determines stroke volume

Answer 6

EDV - amount in the ventricle right before contraction. typically 120mL

Question 7

what increases the afterload which increases how much the heart has to work/pump against

Answer 7

systemic vascular resistance
aka total peripheral resistance

Question 8

what determines the systemic vascular resistance

Answer 8

vasodilation and vasoconstriction

Question 9

what is elevated systolic BP

Answer 9

120-129 mmHG

Question 10

what is stage 1 systolic BP

Answer 10

130-139 mmHg

Question 11

what is stage 2 systolic BP

Answer 11

> 140mmHg

Question 12

what is stage 1 diastolic BP

Answer 12

80-89 mmHg

Question 13

what is stage 2 diastolic BP

Answer 13

> 90 mmHg

Question 14

what is released with parasympathetic nervous system stimulation

Answer 14

increase acetylcholine release from vagus nerve

Question 15

what occurs with the adrenal medulla during times of HTN

Answer 15

inhibits during HTN which will decrease production of catecholamines
decrease B1 and A1 receptor stimulation - decrease HR, decrease squeeze, decrease BP

Question 16

what is the elevated BP response

Answer 16

renal modulation during HTN will cause decreased RAAS activation
decreased vasoconstriction
decreased sodium excretion
heart strain from HTN will cause natriuretic peptide release (think BNP) which will also decrease RAAS

Question 17

what releases renin

Answer 17

kidney

Question 18

what releases angiotensin

Answer 18

liver

Question 19

what are risk factors of primary HTN

Answer 19

smoking, OSA, obesity, anxiety/stress, family hx of HTN, ETOH, DM

Question 20

what are likely causes of secondary HTN

Answer 20

renal disease
renovascular disorder
adrenal gland pathology
thyroid dysfunction
head trauma with decreased ICP (Cushings triad)
preeclampsia/eclampsia
aortic coarctation
medication SE

Question 21

what is malignant hypertension

Answer 21

severely elevated BP >180/110

Question 22

what is a hypertensive emergency

Answer 22

acute end-organ damage secondary to elevated BP

Question 23

what is hypertensive urgency

Answer 23

stable end-organ disease (LVH -> CHF)

Question 24

what is severe uncontrolled HTN

Answer 24

no end-organ damage but highly elevated BP

Question 25

what are the downstream effects of high blood pressure

Answer 25

ischemic heart disease - supply/demand mismatch AKI/CKD encephalopathy HTN retinopathy dissection, aneurysm atherosclerosis lunar infarcts, ruptured brain aneurysm, subarachnoid hemorrhage

Question 26

what are the vessel wall layers

Answer 26

Tunica intima tunica media tunica externa (adventitia) vasa vasorum

Question 27

what is aortic dissection

Answer 27

separation allowing for the accumulation of blood between the tunica intima and tunica media false lumen is created that will progressively increase in size os the blood spreads in the false tract

Question 28

what are the primary causes of aortic dissection

Answer 28

most commonly associated with HTN, smoking, advanced age and hyperlipidemia these increase sheer stresses

Question 29

what can happen with a false lumen with aortic dissection

Answer 29

rupture create down stream reentry site to connect with true lumen enlarge to compress or occlude the true lumen resulting in decreased perfusion form hematoma within the intimal defect

Question 30

what are risks for aortic dissection

Answer 30

hypertension connective tissues d/o: ehlers danlos, marfans bicuspid aortic valve - increased risk of turbulence coarctation of the aorta - increased risk of turbulence

Question 31

what are the most common trauma injuries associated with aortic dissection

Answer 31

acceleration/deceleration injuries trauma from iatrogenic sources

Question 32

what is the presentation of aortic dissection

Answer 32

abrupt onset of check of abdominal pain, often described as ripping or tearing pulse difference in extremities or BP difference between then of >20 mmHg widened mediastinum or aorta on imagine

Question 33

what are risk factors for aortic dissection

Answer 33

male >50yo HTN Cocaine or amphetamine use bicuspid aortic valve hx of aortic valve replacement connective tissue disorder pregnancy

Question 34

what are risk factors for aortic aneuryms

Answer 34

connective tissue disorders trauma dissection aortitis atheroscerosis*

Question 35

what is the ruptured AAA triad

Answer 35

abdominal or back pain hypotension pulsatile abdominal mass

Question 36

how quickly does mortality rate increase with AAA ruptures

Answer 36

increase by 1% per minute prior to arrival to the ED

Question 37

what is peripheral artery disease

Answer 37

occlusion/narrowing reduce the blood flow to distal tissues results in ischemia and can lead to nephrosis

Question 38

what is chronic venous disease

Answer 38

decrease functioning of the venous system resulting in obstruction, venous hypertension, varicose veins

Question 39

what occurs at the renal arteries

Answer 39

blood pressure regulation