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74 Cards in this Set
- Front
- Back
Define systolic BP
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The pressure in mm Hg at the height of the pulse pressure (ventricular contraction)
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Define diastolic BP
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The pressure in the vascular system during the relaxation phase of cardiac contration. This pressure is maintained by the elastic recoil of the arterial walls.
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Pulse pressure
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the difference between the systolic and dialstolic preassure, usually around 40 mmHg
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Mean arterial pressure
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the average preassure in the arterial system during ventricular contraction and relaxation (90-100 mmHg). It is a good indicator of tissue perfusion
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conditions that effect diastolic BP
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the ability of the elastic arteries to stretch and store energy, the competency of the aortic valve. simpathetic stimulation increases diastolic BP by . periferal resistance.
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neural regulation of BP
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located in the reticular formation of the lower medulla and pons(autonomic nervous system)(cardiovascular center)
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describe cardiovascular center regulations
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parasympathetic impulsess are transmitted to the heart through the vegas nerve, and transmits sympathetic signals to the heart and blood vessels via the spinal cord and peripheral sympathetic nerves.
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effects of vagal stimulation
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slows the heart rate
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sympathetic stimulation
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increases HR and contractility (force of contraction)
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what are arterial chemoreceptors
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receptors that are sensitive to cahnges in O2, CO2, and H blood content. they are located in the carotid body and the aortic body and monitor blood for changes
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how is the ANS of BP mediated
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intrinsic circulatory reflexes,extrinsic reflexes, and chemoreceptor mediated reflexes. and are important in rapid and short term regulation of BP
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sensors for extrinsic are found
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outside the circulation, associated with BP responses to pain and cold.
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intrinsic regulation of BP
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channeled through the hypothalamus, which plays an essential role in the control of sympathetic NS response
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higher center responses
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are those caused by changes in mood and emotion.
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baroreceptors
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are pressure sensitive reseptors that are located n the walls of blood vessels and the heart. The carotid and aortic receptors are srategicly located between the heart and brain.
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Hummoral mechanisms
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hormone that effect BP
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renin-angiotensin-aldosterone mechanism
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play a entral role in BP regulation,
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renin
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an enzyme that is synthesuzed, stored, and released by the kidneys in respose to > in sympathetic NS activity or a < in BP ,extracellular volume, or extracellular Na concentrations
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renin-angiotensin
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renin enters the blood, where it is convertes an inactive plasma protein (angiotensin)to angiotensin I, this travels to the lungs where it is converted to angiotensin II. angiotensin II has a short t1/2, but renin remains in the blood for up to an hour producing angiotensin II
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Angiotensin II
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functions in the short and long term. it is a strong vasoconstrictor of arteriols and to a lesser extent veins.
stimulates aldosterone > Na and water retention. |
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vasopressin (ADH)
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is released from the posterior pituitary gland in response to a < in blood volume and BP, an > in osmolality of body fluids, and other stimuli. it has a direct vasoconstriction effect on blood vessels
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Long term regulation of BP
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hormonal mechanisms of BP regulation is short lived and unable to maintaineffectiveness over time. Long term BP regulation is largely maintained by the kidneys and their role in regulating extracellular fluid volume.
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Renal Mechanisms
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many hypertensive meds produce their BP < effects by > Na and water elimination
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discuss the two ways that arterial BP can be > by the kidneys
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by shifting the elimination of salt and water to a higher pressure level, and by changing the extracellular fluid level at which diuresis and naturiuresis occur.
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discuss kidney funtion in long term BP regulation
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excess sympathetic nerve activity or the releases of vasoconstrictor substances can alter the transmission of arterial pressure to the kidneys. Changes in neural and hormonal control of kidney function can shift the diuresis-natriuresis to a higher fluid pressure level, initiating an > in arterial pressure.
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BP effects of extracellular fluid
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a direct effects on cardiac output, or an indirect effect, resulting from an autoregulation of blood flow and it's effects on peripheral resistance.
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Bllod flow to tissue beds and its effect on BP
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when the blood flow to a particular tissue is in excesse, local blood vessels constrict, and when flow is deficient, local vessels dilate.
In situations of > volume and cardiac output, increased flow causes vasoconstriction, > peripheral resistance and BP. |
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Circadian rhythms and BP
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normal changes in BP follow a pattern. highest early in the morning and decreases gradually throughout the day. normatensive people decrease by 20% from waking to sleeping hours.
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describe the Korotkoffs Sounds
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Phase I - V
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Phase I
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marked by the first tapping sounds which gradually > in intensity
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Phase II
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a murmur or swishing sound is heard
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Phase III
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sounds are crisper and greater in intensity
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Phase IV
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distinct abrupt muffling or by a blowing sound
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Phase V
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sounds disappear
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Hypertension
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is propably the most common of all health problems in adults and is the leading risk factor for cardiovascular disorders.
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Primary (essential) Hypertension
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the chronic occurs without evidence of other disease.
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Secondary hypertension
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results from some other disorder, such as kidney disease.
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Malignant Hypertension
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is an excellerated form of hypertension
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What are the values of
Normal Prehypertensive stage I hyper stage II hyper |
norm = systolic < 120 and diastolic <80
Prehyper =systolic 120-139 OR diastolic 80-89 stage I = systolic 140-159 OR diastolic 90-99 stage II hyper = systolic > or = 160 OR diastolic > or = 100 |
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Name risk factors for hypertension
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family history, race, age related factors,diabetes type II, obesity
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What are dippers and nondippers
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dippers have a normal circadian profile in which BP falls during the night, and nondippers profile is flattened
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What conditions are related to nondippers
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malignant hypertension, cushing syndrome, preeclampsia, orthostatic hypotension, congestive heart failure, sleep apnea
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Lifestyle risk factors
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high Na, excesse calorie intake, obesity, inactivity, excessive alcohol, low potassium intake, oral contraseptives
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how can weight loss effect hypertension
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weight reduction as little as 4.5 kg(10lb)can produce a decrease in BP in overweight people.
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which is more dangerous, systolic or diastolic hypertension
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historically diastolic hypertension was thought to confer a greater risk factor, however there is mounting evidence that elevated systolic BP is at least as important, if not more so
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discuss the two aspects of systolic hypertension that confer increasd risk of cardiovascular disease.
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the actual elevation in systolic pressure, and the disproportionate rise in pulse pressure. elevated systolic pressure favor LV hypertrophy, > myocardial O2 demands, and eventual left heart failure. elevated pulse pressure produce greater arterial stretch, causing vessel damage and possible anyerism or thrombis formation.
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What are the manifestations of hypertension
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essential hypertesion is typically asymptomatic. when symptoms do occur they are usually related to the long term effects on target organs.
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what are the target organs
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heart, brain, kidney, peripheral vascular, and retina
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define nephrosclerosis
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a common cause of renal insufficiency. sclerotic changes to the blood supply of the nephron inhibit the kidneys ability to consentrate urine.
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How is hypertension diagnosed
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the diagnosis of hypertension in a person who is not taking antihypertensive meds should be based on two or more blood pressure readings taken at two or more visits after an initial screening visit. no caffeine or smoking for at least thirty minutes bfore testing.
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treatment goals
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main goal in essential hypertension is to achieve and maintain BP < 140/90. with diabetes or renal disease < 130/80
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treatment options
without compelling indications |
lifestyle modifications. If not at goal antihypertensive meds. stage I thiazide - type diuretics maybe ACEI, ARB, BB, CCB. stage II two drug combo thiazide and ACEI, ARB, BB, CCB.
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with compelling indications
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other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB.
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weight reduction
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maintain normal body weight (BMI, 18.5-24.9)
5 - 20 mmHg/10 Kg weight loss |
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eating plan
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consume a diet rich in fruits, vegetables, low fat. 8-14 mmHg reduction
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sodium reduction
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2.4g or 6g chloride. 2-8 mmHg reduction
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physical activity
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brisk walking at least 30 minutes a day most days. 4-9 mmHg decrease
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moderate alcohol intake
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no more than 2 drinks per day in men and 1 per day for women. 2-4 mmHg decrease
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common causes of secondary hypertension
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kidney disease (renovascular hypertension), adrenal cortical disorders, pheochromocytoma, coartation of the aorta, and sleep apnea.
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renovascular hypertension
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reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism. the reduced renal flow causes the effected kidney to release excessive renin, which increases angiotensin II causing vasoconstriction
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what are the two major types of renovascular disease.
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atherosclerotic artery stenosis and fibromuscular dysplasia
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Atherosclerotic artery stenosis
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accounts for 70 - 90% of cases and is seen most often in older people, particularly those with diabetes, aortoliliac disease, coronarey artery disease,or hypertension
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fibromuscular dysplasia
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is more common in women and tends to occur in younger age groups, often in their third decade. genetic factors may be involved and is increased with smoking and hyperlipidemia.
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Disorders of adrenocorticosteroid hormones
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hyperaldosteronism and excess levels of glucocorticoid raise BP by fasilitating Na and water retention by the kidneys.Aldosterone increases Na absorption in exchange for potassium.(treat with potassium sparing diuretics)
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Characteristics of malignant hypertention
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sudden marked elevations in BP with diasolic values > 120mmHg complicated by evidence of acute life threatening organ disfunction. effects younger people, often blacks, women with toxemia pregnancy, and people with renal collagen disease.
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Malignant hypertension problems
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spasm of cerbral arteries with hypertensive encephalopathy, cerebral edema, papilladema, headache, restlessness, confusion, stupor, motor and sensory deficits, convulsions and coma.
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Gestational hypertension
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BP elevation, without proteinuria, that is detected for the first time during midpregnancy and returns to normal by 12 weeks postpartum
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Chronic hypertension
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BP > or = 140 mmHg systolic or > or = 90mmHg diastolic that is present and observable before the 20th week. Hypertension that is diagnosed for the first time during pregnancy and does not resolve after is classified as chronic.
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Preeclampsia-eclampsia
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pregnancy specific syndrome. BP > 140 mmHg systolic or > 90 diasolic that occurs after the first 20 weeks and is accompanied by proteinuria(0.3g protein in a 24 hr specimen)
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Preeclampsia superimposed on chronic hypertension
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chronic hypertension BP > or = 140 mmHg systolic or > or = 90 mmHg diastolic prior to the 20th week, with superimposed protinuria and with or without signs of the peeclampsia syndrome.
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isolated systolic hypertension
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most common type of hyretension in elderly, systolic BP is elevated while diastolic is normal
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risks of ISH
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important risk factor for cardiovascular morbitity and mortality in elderly. stroke is 2 - 3 times more common
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orthostatic hypotension
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or postural hypotension is an abnormal drop in BP upon standing
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causes of orthostatic hypotension
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reduced blood volume,drug induced hypotension, altered vascular responses associated with aging, bed rest, and ANS disfunction.
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