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42 Cards in this Set
- Front
- Back
Does pressure increase or decrease as it goes thru the vascular system?
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Pressure decreases d/t resistance to flow. The further it goes, the more resistance it encounters.
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What are the main determinants of BP?
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CO and total peripheral resistance
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mean arterial pressure =
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diastolic pressure + 1/3 pulse pressure
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What blood vessels are most resistant?
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arterioles
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List 6 ways BP is controlled.
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1. sympathetics (maintain baseline vasoconstriction)
2. baroreceptors (in the medulla) 3. hormones (epi and norepi) 4. renin (angiotensin from a decrease in renal perfusion) 5. atrial natriuretic factor (from response to stretch receptors) 6. ADH (causes vasoconstriction, retains water) |
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norm for pulmonary BP:
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systolic: 22-25 mmHg
diastolic: 8 mmHg |
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2 measurements of arterial BP:
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1. indirect (cuff, palpitation, doppler)
2. direct (cath in artery) |
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hypertension:
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systolic > 140 mmHg
diastolic > 90 mmHg |
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4 risk factors of HTN:
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age, race, obesity, excess Na intake
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2 classifications of HTN:
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essential (primary) and secondary
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Which classification of HTN is most common?
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primary (90%)
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5 causes of Essential HTN:
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1. genetic (no indication of disease)
2. elevation of renin activity (not very common) 3. aldosterone increase 4. vasopressin 5. Non-insulin Dependent Diabetes Mellitus (NIDDM) |
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secondary HTN:
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-HTN results from an existing disorder
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Name 5 disorders that can cause secondary HTN.
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1. renal
2. endocrine 3. vascular 4. neurological 5. exogenous |
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How does a renal disorder cause secondary HTN?
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1. renal artery stenosis
2. Wilm's tumor 3. renal failure 4. renal disease |
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renal artery stenosis:
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-reduces renal perfusion causing an increase in renin production
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How common are renal disorders in adults and children?
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5% in adults
70-90% in children |
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Wilm's tumor:
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-cancerous tumor in the kidney
-increases renin production -common in children under 7 YO. |
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How do endocrine disorders cause secondary HTN?
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-causes elevated levels of adrenocortical hormones
-can cause Cushings disease, pheochomocytomas and hyperthyroidism |
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Cushing's disease:
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-overproduction of glucocorticoid causing fluid retention and HTN
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pheochomocytomas:
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-tumor of the adrenal medulla
-massive production of epineph and norepinepherine |
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What 2 vascular disorders cause secondary HTN?
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1. arteriosclerosis
2. coarctation of aorta |
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coarctation of aorta:
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-narrowing of aorta
-typically thoracic -increases pressure in the brain -BP is taken on upper and lower extremities -decreases perfusion to the lower part of the body |
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How do neurological disorders cause secondary HTN?
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1. causes an increase intracranial pressure
2. increased pressure on the medulla or hypothalamus |
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What exogenous compounds cause secondary HTN?
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-amphetamines, corticosteroids, oral contraceptives, tricyclic antidepressents
-caffeine and nicotine |
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isolated systolic HTN:
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-reduced distensibility of aorta and large arteries
-common with elderly 10% ages 65-74 24% >80 |
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pre-eclampsia:
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-pregnancy induced HTN
-also causes proteinuria and edema -usually after 20th week -chronic HBP increases risk of this |
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malignant HTN:
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-sudden increases of diastolic BP >120mmHg
-highest risk in African amer, males, middle-aged ppl |
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What disorders are most common with malignant HTN?
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renal complications and bilateral renal artery stenosis
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What type of disease is high blood pressure?
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asymptomatic disease
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What are the 2 major effects of high blood pressure?
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1. cardiac (hypertrophy leading to CHF)
2. vascular (changes in walls of arteries/arterioles leading to arteriosclerosis) |
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What is a nickname for hypertension?
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"silent killer"
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List the S/S of HTN.
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1. LV hypertrophy
2. development and rupture of aortic aneurysm 3. peripheral arteriosclerosis (occlusions) 4. cerebro-vascular accidents 5. hypertensive retinopathy 6. renal changes |
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hypertensive retinopathy:
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-can see blood vessels in the eyes
-common in pts with diabetes |
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How to diagnose HTN:
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-multiple readings for accuracy (could be a "white coat syndrome")
-evaluate end organs (?) |
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Lifestyle treatment of HTN:
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1. lose weight
2. restrict alcohol intake 3. resrict Na intake (1.5-2.5 g/day) 4. stop smoking 5. restrict fat intake 6. aerobic exercise |
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Pharmacological treatment of HTN:
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1. diuretics (watch K+ levels)
2. beta-blockers 3. Ca-channel blockers |
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List the types of hypertensive crisises:
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1. perioperative HTN
2. increased intracranial pressure 3. dissecting aneurysms 4. intravenous agents in ICU setting |
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orthostatic hypotension:
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-sudden decrease BP (sys >20, dia >10) caused by a change in body position
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What are 2 causes of orthostatic hypotension?
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1. Na depletion causing a decrease in blood volume; syncope results
2. cardiovascular-inadequate peripheral vasoconstriction or inadequate increase in HR |
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How does orthostatic hypotension affect the nervous system?
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-interrupts normal sympathetic body reactions such as increased HR and contraction
-most common with pts on beta blockers |
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List 3 forms of treatment for orthostatic hypotension.
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1. slow down position changes
2. treat the underlying problem 3. lower pressure can be normal for an individual (ie atheletes) |