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42 Cards in this Set

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  • Back
Does pressure increase or decrease as it goes thru the vascular system?
Pressure decreases d/t resistance to flow. The further it goes, the more resistance it encounters.
What are the main determinants of BP?
CO and total peripheral resistance
mean arterial pressure =
diastolic pressure + 1/3 pulse pressure
What blood vessels are most resistant?
List 6 ways BP is controlled.
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)
norm for pulmonary BP:
systolic: 22-25 mmHg
diastolic: 8 mmHg
2 measurements of arterial BP:
1. indirect (cuff, palpitation, doppler)
2. direct (cath in artery)
systolic > 140 mmHg
diastolic > 90 mmHg
4 risk factors of HTN:
age, race, obesity, excess Na intake
2 classifications of HTN:
essential (primary) and secondary
Which classification of HTN is most common?
primary (90%)
5 causes of Essential HTN:
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)
secondary HTN:
-HTN results from an existing disorder
Name 5 disorders that can cause secondary HTN.
1. renal
2. endocrine
3. vascular
4. neurological
5. exogenous
How does a renal disorder cause secondary HTN?
1. renal artery stenosis
2. Wilm's tumor
3. renal failure
4. renal disease
renal artery stenosis:
-reduces renal perfusion causing an increase in renin production
How common are renal disorders in adults and children?
5% in adults
70-90% in children
Wilm's tumor:
-cancerous tumor in the kidney
-increases renin production
-common in children under 7 YO.
How do endocrine disorders cause secondary HTN?
-causes elevated levels of adrenocortical hormones
-can cause Cushings disease, pheochomocytomas and hyperthyroidism
Cushing's disease:
-overproduction of glucocorticoid causing fluid retention and HTN
-tumor of the adrenal medulla
-massive production of epineph and norepinepherine
What 2 vascular disorders cause secondary HTN?
1. arteriosclerosis
2. coarctation of aorta
coarctation of aorta:
-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
How do neurological disorders cause secondary HTN?
1. causes an increase intracranial pressure
2. increased pressure on the medulla or hypothalamus
What exogenous compounds cause secondary HTN?
-amphetamines, corticosteroids, oral contraceptives, tricyclic antidepressents
-caffeine and nicotine
isolated systolic HTN:
-reduced distensibility of aorta and large arteries
-common with elderly
10% ages 65-74
24% >80
-pregnancy induced HTN
-also causes proteinuria and edema
-usually after 20th week
-chronic HBP increases risk of this
malignant HTN:
-sudden increases of diastolic BP >120mmHg
-highest risk in African amer, males, middle-aged ppl
What disorders are most common with malignant HTN?
renal complications and bilateral renal artery stenosis
What type of disease is high blood pressure?
asymptomatic disease
What are the 2 major effects of high blood pressure?
1. cardiac (hypertrophy leading to CHF)
2. vascular (changes in walls of arteries/arterioles leading to arteriosclerosis)
What is a nickname for hypertension?
"silent killer"
List the S/S of HTN.
1. LV hypertrophy
2. development and rupture of aortic aneurysm
3. peripheral arteriosclerosis (occlusions)
4. cerebro-vascular accidents
5. hypertensive retinopathy
6. renal changes
hypertensive retinopathy:
-can see blood vessels in the eyes
-common in pts with diabetes
How to diagnose HTN:
-multiple readings for accuracy (could be a "white coat syndrome")
-evaluate end organs (?)
Lifestyle treatment of HTN:
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
Pharmacological treatment of HTN:
1. diuretics (watch K+ levels)
2. beta-blockers
3. Ca-channel blockers
List the types of hypertensive crisises:
1. perioperative HTN
2. increased intracranial pressure
3. dissecting aneurysms
4. intravenous agents in ICU setting
orthostatic hypotension:
-sudden decrease BP (sys >20, dia >10) caused by a change in body position
What are 2 causes of orthostatic hypotension?
1. Na depletion causing a decrease in blood volume; syncope results
2. cardiovascular-inadequate peripheral vasoconstriction or inadequate increase in HR
How does orthostatic hypotension affect the nervous system?
-interrupts normal sympathetic body reactions such as increased HR and contraction
-most common with pts on beta blockers
List 3 forms of treatment for orthostatic hypotension.
1. slow down position changes
2. treat the underlying problem
3. lower pressure can be normal for an individual (ie atheletes)