Final_Week 3

Question 1

Primary HTN

Answer 1

“essential HTN”
95% of all HTN
pathogenic factors: familial/inherited biochemical abnormalities

Question 2

Secondary HTN

Answer 2

• renovascular dx
• cushings syndrome
• hyperaldosteronism
• aortic coarctation
• pregnancy induced HTN
• pheochromocytoma
• renal parynchymal dz

Question 3

Primary HTN: pathophysiology

Answer 3

• specific etiology is unclear
• contributing factors: sympathetic nervous system activity, dysregulation of RAAS, deficient production of endogenous vasodilators

Question 4

PAH

Answer 4

Mean PAP > 25

Question 5

PAH crisis - Tx

Answer 5

• Oxygen, anticoagulation, diuretics
• CCBs
• Phosphodiesterase inhibitors (Viagra)
• Inhaled NO
• Prostacyclins (Flolan, Remodulin, Ventavis)
• Endothelin receptor agonists (Tracleer)
• Surgical tx (Balloon atrial septostomy, Lung TX)

Question 6

Frank-Starling relationship

Answer 6

• Increased filling pressure stretches the heart and increases the force of contraction
• Increasing the force of contraction expels more blood from the LV, so that CO increases when preload increases
• SV increases as LVEDV increases
• SV increases as tension on the cardiac muscle increases
• Magnitude of SV increase depends on myocardial contractility

Question 7

Stages of HF

Answer 7

I (Mild): asymptomatic
II (Mild): s/s w/ ordinary exertion
III (Moderate): s/s with less than ordinary exertion
IV (severe): s/s at rest

Question 8

Tx - severe HF

Answer 8

-ACEI + BB
-Na+ restriction, diuretics, digoxin
-if BBB present: cardiovert
-revascularization/mitral valve surgery
-aldosterone antagonist, nesiritide
Special intvn: isotopes, VAD, transplant, hospice

Question 9

HTN emergency S/S

Answer 9

*evidence of target organ damage 
•Angina Pectoris
•LVH
•CHF
•Cerebrovascular disease
•Stroke
•PVD
•Renal Insufficiency

Question 10

HTN Urgency S/S

Answer 10

S/s: H/A, epistaxis, anxiety

Question 11

HTN Crisis: Tx

Answer 11

•Lower BP 20% in 1st hour
•More gradually over 2 – 6 hrs
-SNP, Nicardipine, fenoldopam, esmolol, labetolol

Question 12

HTN Crisis: DOC

Answer 12

-Sodium nitroprusside: 0.5-10 mcg/kg/min

Question 13

HTN Crisis: Rx for any type

Answer 13

Labetolol

Question 14

PAH anesthesia

Answer 14

• avoid hypoxia, hypercarbia, acidosis
• have NO available
• opioids + prop ok
• avoid ketamine/etomidate