Patho 2- Htn And Pulm Htn

Front 1

Systemic HTN is categorized by a BP reading of greater than ___ on 2 occasions. Only ___% of americans are adequately treated for their HTN.

Back 1

140/90, 30%

Front 2

HTN is more common in _____ and is a major risk factor for...

Back 2

afroamericans,

CAD, CHF, CVA, ESRD

Front 3

Greater than 95% of cases of HTN are ______, occurring with familial incidence.

Back 3

essential HTN

Front 4

In essential HTN, there is an incr _____ activity, and an overproduction of _____.

Back 4

SNS activity,
overprod. of Na-retaining hormones and vasoconstrictors, renin

Front 5

Essential HTN pts often have deficiencies of endogenous ______ such as ____.

Back 5

vasodilators, NO

Front 6

____ and ____ are often seen comorbidities in essential HTN pts.

Back 6

DM and obesity

Front 7

The final common pathway of essential HTN is _______ Retention, leading to .....

Back 7

salt and water retention,
incr vol and BP

Front 8

Essential HTN can also be caused by _____ abuse and obstructive ______.

Back 8

etoh and tobacco abuse, OSA

Front 9

Metabolic syndrome is comprise of...

Back 9

HTN, insulin resistance, dyslipidemia, obesity

Front 10

What are the long term effects of poor BP control?

Back 10

CAD, CHF, CVA, PVD, ESRD

Front 11

Less than 5% of cases are considered secondary HTN, and the usual cause is...

Back 11

renal artery stenosis

Front 12

Other possible causes of secondary HTN besides renal artery stenosis include...

Back 12

hyperaldosteronism, pheochromocytoma, cushing's syndrome, pregnancy-induced HTN,, aortic coarctation, aging-associated

Front 13

Treatment of HTN includes ____ modification

Back 13

lifestyle mod.,

Front 14

____ are the first line of drug therapy in HTN

Back 14

thiazide diuretics

Front 15

HTN crisis is classified as a BP greater than ____, and is better tolerated in pts with ____.

Back 15

>180/120,
chronic HTN

Front 16

Hypertensive emergency can lead to target organ damage, including...

Back 16

- encephalopathy
- pulm edema
- angina
- aortic dissection
- in pregs, DBP over 109 is an emergency

Front 17

When treating HTN crises, you should avoid _____ drops in BP, and lower BP by ___% in the first hour.

Back 17

precipitous, 20%

Front 18

This condition has no target organ damage in HTN, but the pt may experience headache, epistaxis or anxiety, and is treatable in some cases with oral meds.

Back 18

HTN urgency

Front 19

In HTN crisis, how is encephalopathy treated?

Back 19

nitroprusside (Very potent, narrow margin of safety), nicardipine, fenoldopam, labetalol

Front 20

In HTN crisis, how is cardiac ischemia treated?

Back 20

NTG (venodilator, dilates coronary arteries)

Front 21

In HTN crisis, how is pulm edema treated?

Back 21

nitroprusside, NTG, fenoldopam

Front 22

In HTN crisis, how is renal insufficiency treated?

Back 22

fenoldopam, nicardipine

Front 23

In HTN crisis, how is preeclampsia treated?

Back 23

methyldopa (direct acting vasodilator), hydralazine, mag sulfate, labetalol, nicardipine

Front 24

In HTN crisis, how are pheochromocytoma pts treated?

Back 24

phentolamine, phenoxybenzamine, propranolol

Front 25

In HTN crisis, how are cocaine ingestion pts treated?

Back 25

NTG, nitropruside, phentolamine

Front 26

What are anesthesia strategies for pts with HTN?

Back 26

- control BP prior to surgery
- no evidence that complications incr w DBP up to 110 mmHg
- "White Coat syndrome"- exaggerated BP response to laryngoscopy or periop myocardial ischemia
- HTN pts presumed to have CAD until proven otherwise

Front 27

Hypotension after induction is more common in pts taking what kind of drugs?

Back 27

- ace inhibitors or ARBs

risk of hypotension reduced if meds discontinued day prior to OR

Front 28

______ is the essential action of hypovolemia.

Back 28

hemodynamic instability

Front 29

Preop eval of HTN pts should include

Back 29

- determine adequacy of pre op BP control
- review meds
- eval for evidence of end organ damage
- continue BP meds periop.

Front 30

Induction and maintenance techniques for HTN pts include...

Back 30

- anticipate exaggerated response
- quick laryngoscopy
- balanced anesthetic technique
- monitor leads 2 and 5 for myocardial ischemia

Front 31

Post op mgmt of HTN pts should anticipate ____ and continue _____. It is important to monitor for ____ function.

Back 31

HTN, continue BP meds, monitor end-organ fcn

Front 32

If meds that affect ANS (B blockers and Clonidine) are abruptly discontinued, then _____ can occur. However _____ meds are not assoc w rebound HTN.

Back 32

rebound HTN, ace inhibitors

Front 33

What are the 3 BP control systems?

Back 33

SNS, vasopressin system, RAAS

Front 34

After induction of anesthesia, pts on ace inhibitors rely on their ____ system. ____ is key to maintaining BP.

Back 34

vasopressin system, intravascular volume

Front 35

Why is it a good idea to discontinue ACE inhibitors 24-48 hrs prior to OR?

Back 35

less intraop hypotension, risk of loss of BP control

Front 36

What is normal PA pressure?

Back 36

18-25/6-10 mmHg

Front 37

What is normal PA MAP?

Back 37

12-16 mmHg

Front 38

In primary pulmonary HTN, PA mean pressure is >

Back 38

25 mmHg

Front 39

Idiopathic primary pulm artery HTN occurs in ___ Cases per million, and it has ____ inheritance in 10% of cases.

Back 39

1-2, autosomal dominant

Front 40

What are the s/s of primary PA HTN?

Back 40

dyspnea, fatigue, low CO, abdominal distension (Due to RV failure, ascites), "like aortic stenosis of the RV"

Front 41

How is primary PA HTN diagnosed?

Back 41

- pulm catheterization
- vasodilator test (prostacyclin)
- echocardiography

Front 42

In primary PA HTN, there is increased RV Wall stress, leading to ___ and ___, with decreased RV ____.

Back 42

hypertrophy, dilatation, stroke volume

Front 43

In primary PA HTN, annular dilatation of the ____ valve leads to regurg, and pulmonary insufficiency from ____ dilation.

Back 43

tricuspid, pulmonary artery

Front 44

Right to left shunting through a patent ____ occurs because tricuspid regurg increases _____ pressures, shunting blood across heart without first oxygenating it.

Back 44

foramen ovale, R atrial pressures

Front 45

Why does hypoxemia occur as a result of PA HTN?

Back 45

fixed cardiac output leads to inr O2 extraction w exertion, incr VQ mismatch

Front 46

The baseline hypoxemia that occurs with PA HTN is made even worse during episodes of hypoxia and hypercarbia, because...

Back 46

these both cause vasoconstriction, making RV performance worse

Front 47

What are the treatment strategies for primary PA HTN?

Back 47

- O2
- anticoagulation (due to risk of mural thrombi formation in RV)
- diuretics
- Ca channel blockers
- Phosphodiesterase inhibitors (sildenafil, rivashio)
- inhaled NO (dilates pulm vasculature)
- prostacyclins
- endothelin receptor antagonists (Bosentan)

Front 48

What are the anesthesia considerations for a pt with primary PA HTN?

Back 48

- incr risk of periop morbidity and mortality due to RV failure, dysrhythmia, and embolism
- avoid hypoxia, acidosis, hypercarbia!!
- maintain intravasc. volume
- maintain sinus rhythm (avoid bradycardia)
- avoid negative inotropes (propofol can cause acute RV failure - use etomidate instead!)
- avoid hypotension and optimize preload
- use controlled ventillation to avoid hyperCO2 (spontaneous modes blunt hypercarbic response to stimulate blowing off CO2)
- PEEP incr pulm vascular resistance (use 5)

Front 49

For treatment of HTN _______ are used in patients with CHF?

Back 49

ACE inhibitors

Front 50

For treatment of HTN _______ are added in patients with CAD

Back 50

beta blockers

Front 51

For treatment of HTN _______ are added in patients with CHF, DM, Renal disease

Back 51

angiotensin receptors blockers (ARBs)

Front 52

For treatment of HTN _______ are useful in patients with post MI and CHF

Back 52

aldosterone agonists

Front 53

For treatment of HTN _______ are used in patients with CAD and DM

Back 53

calcium channel blockers