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23 Cards in this Set

  • Front
  • Back
General characteristics of Hypertension
Elevated blood pressure, may be defined operationally, convetionally, or realistically but point is "the lower the better"

major cause of morbiddity and mortality, affects multiple organ systems

single most prevelant risk factor for developing heart disease and stroke (20% of US)

most common heritable disease among blacks (35% have HT)
what are the 3 major determinants of blood pressure?
CO = SV x Heart rate they are CO, SV, and Heart rate

*TPR is controlled at arteriol level
What are genetic determinants of HT?
family history, prevelance in people of african descent

single gene mutations have been linked to HT

angiotensin gene has been linked to essential HT
What are some environmental determinants of HT?
increased dietary sodium intake


lifestyle = obesity, cigarette smoking, physical inactivity

*metabolic syndrome = obesity, type II diabetes, dyslipidemia often with HT all increase the risk of Heart disease
What are the 2 types of HT?
Essential HT: of unknown etiology accounts for majority of cases; represents interaction of predisposing determinants w/ a number of exogenous factors

Secondary HT: several known casuses inc renal, endocrine, renovascular, neurogenic, and iatrogenic pathology
Essential HT may take 2 forms, describe them?
BENIGN: most common, slow progressing asymptomatic

MALIGNANT: only about 5% of all cases, fulminant course with extreme elevations in BP; associated w/ acute organ dysfunction; in absence of treatment patients may die w/in a year

*Hypertensive emergency - fibrinoid necrosis, thrombotic arteritis, organs suffer ischemic injury
What structural changes occur at the level of the small vessels during HT?
Endothelium --> inc. permeability, decreased vasodilatory, damage/ denudation in arterioles

Vascular Smooth Muscle --> medial hypertrophy, medial hyperplasia in arterioles, increased synthesis of ECM components,
accelerated intimal proliferation in artherosclerosis
What anatomical changes occur in the elastic amd muscular arteries as a result of HT?
accelerated artherosclerosis

inc. frequency of aortic dissection
What anatomical changes occur in the small muscular arteries and arterioles as a result of HT?
intimal and medial thickening due to smooth muscular proliferation and/or increased ground substance

Hyaline sclerosis: thickening of the vesssel wall w/ deposition of a variety of proteins and lipids <-- benign neprhosclerosis

Hyperplastic arteriosclerosis, fibrinoid necrosis and necrotizing arteriolitis <-- malignant neprhosclerosisis

microaneurysm formation
What is Benign nephrosclerosis?
renal disease associated with benign HT = hyaline sclerosis, arterial intimal hyperplasia, changes of chronic ischemia
describe malignant nephrosclerosis?
renal disease associated with malignant HT = hyperplastic arteriosclerosis (onion skinning)
What anatomical changes occur in the kidney as a result of HT?

2 types - benign and malignant
What pathological changes occur in the brain as a result of HT?
increased incidence of intracerebral hemorrhage (CVA, stroke)

hypertensive encephalopathy
What disease states can HT cause in the eyes?
hypertensive retinopathy --> blindness

vascular sclerosis
hemorrhages (flame shaped)
exudates (macular star)
foci of axonal degeneration (cotton-wool spots)
necrotizing arteriolotis in malignant HT

Keith-Waggoner classification is based on the severity of the above changes
What disease states occur in the heart as a result of HT?
accelerated coronary artherosclerosis

left ventricular hypertrophy

predisposition to MI, angina pectoris, cardiac failure
What is cardiac failure?
the condition in which cardiac output is inadequate to meet the metabolic requirements of the body

typically accompanied by organ congestion and thus termed congestive heart failure (CHF)
What are syptoms of CHF?
dyspnea (shortness of breath) most common

orthopnea(dyspnea on lying down)

paraxosymal nocturnal dyspnea
What are the basic causes of CHF?
hemodynamic overload from too much pressure or volume

disorders of contractility

disturbances of ventricular filling --> dont allow diastole to occur
Describe the pathogenesis of CHF?
increased end diastolic volume producing dilation

adaptive changes to minimize wall stress

hypertrophy of myocardial cells

changes in gene expression and cellular biochemistryto accomodate hypertrophy (growth factors)
What are the mechanisms by which CHF produces organ dysfunction?
forward effect: decreased arterial perfusion and hypoxia of peripheral organs esp kidney and brain

backward effect: increased vascular pressure of pulmonary and systemic venous circulation resulting in congestion and angina
What are compensatory mechanisms that occur in response to CHF?
increased heart rate

increased in blood volume

increase in peripheral vascular resistance

redistrubution of blood flow
What are causes of clinical manisfestations of Left sided heart failure?
ischemic heart disease
aortic and mitral valvular disease
myocardial diseases

first affects the pulmonary circulation
leads to dyspnea and orthopnea, pleural effusion with hydrothorax, reduction in renal perfusion, cerebral anoxia
What are the causes and clinical manisfestations of Right sided heart failure?
left sided heart failure
left sided lesions
pulmonary HT
cardiomyophathyand diffuse myocarditis
tricuspid or pulmonary valvular disease

pure RV failure caused by hemodynamic overlaod, smoking related diseases

effects are congestion, edema, focal hemorrhage in systemic organs but not in lung