HTN

Question 1

Optimal blood circulation requires ______ (of blood) that fills the blood vessels, and _______ to move the blood into all parts of the body

Answer 1

Optimal blood circulation requires volume (of blood) that fills the blood vessels, and pressure to move the blood into all parts of the body

Question 2

what is the inner wall of the arteries called and some risk factors associated with it?

Answer 2

the endothelium

o Endothelium injury is a factor in developing atherosclerosis or arteriosclerosis

Question 3

Atherosclerosis

Answer 3

is the deposition of fatty plaques in the endothelium

Question 4

Arteriosclerosis

Answer 4

is the hardening of the artery walls

Question 5

possible causes of arteriosclerosis (2)

Answer 5

1. increased blood sugar (DM)

2. smoking

Question 6

what is cardiac output (CO)? w/ normal CO

Answer 6

the amount of blood that flows from the heart’s left ventricle per minute

• about 5 L of blood per minute

Question 7

Blood pressure (arterial blood pressure) measures what?

Answer 7

measures the force against the walls of the arteries as the heart pumps blood

• higher in the arteries than in the veins

Question 8

describe Total Peripheral Vascular Resistance (PVR)

Answer 8

amount of obstruction to blood flow caused by vessel diameter, vessel length, and blood viscosity

Question 9

list the 2 equations for obtaining CO

Answer 9

1. BP / PVR (hard to compute)

2. SV x HR

Question 10

what do baroreceptors do? where are they located?

Answer 10

• regulate BP - it is a neural mechanism

- located along the walls of arteries particularly carotid artery and carotid arch

Question 11

describe systolic BP

Answer 11

max pressure that the heart exerts while beating - during contraction

Question 12

describe diastolic BP

Answer 12

pressure in the arteries in between beats - during relaxation

Question 13

describe the pathway of cardiovascular regulation in the brain (2)

Answer 13

1. pons and medulla

2. transmit sympathetic and parasympathetic signals to the heart and blood vessels

Question 14

describe stroke volume

Answer 14

the volume of blood ejected per ventricular contraction

• same thing as EF

Question 15

describe ejection fraction w/ example

Answer 15

how much blood the left ventricle pumps per contraction (%)

• at any given time there is 100ml of blood in the left ventricle
• ex: if patient has 70% EF then only 70% of blood is being ejected from the LV = 70ml

Question 16

describe orthostatic hypotension

Answer 16

significant drop of BP when changing position = decrease in cerebral perfusion = dizziness

Question 17

if HR is 68 and EF is 65%, what is the CO in L/min?

Answer 17

68 x 65 ml = 4,420 ml = 4.42 L/min

Question 18

what is RAAS?

Answer 18

Renin - Aldosterone - Aldosterone Syndrome

Question 19

what is the function of RAAS?

Answer 19

Raises BP in response to decreased blood circulation

- the kidney is very sensitive to the drop in blood pressure

Question 20

describe the pathway of RAAS to increase BP

Answer 20

1. kidney detects drop in BP
2. nephrons release Renin = stimulates the liver to secrete angiotensinogen
3. angiotensinogen reaches the lungs = is transformed into Angiotensin I
4. then ACE transforms Angiotensin I to Angiotensin II
5. Angiotensin II stimulates adrenal gland to release Aldosterone
6. Aldosterone works at nephrons to increase sodium and water reabsorption into the bloodstream (increases potassium excretion in the urine)

Question 21

what is important to note about Angiotensin II?

Answer 21

Angiotensin II is a strong arterial vasoconstrictor

Question 22

what is the anti-diuretic hormone (ADH) also called?

Answer 22

vasopressin

Question 23

what is the function of ADH?

Answer 23

secreted by posterior pituitary gland to increase water reabsorption

Question 24

what chemicals affect the arteries?

Answer 24

1. lipids
2. glucose
3. free radicals
4. nicotine
5. homocysteine

Question 25

describe natriuresis

Answer 25

sodium being excreted in the urine

Question 26

describe how lipids affect the arteries

Answer 26

Fats that circulate in the bloodstream; mainly composed of cholesterol 1. Cholesterol: comes from diet and also synthesized by the liver 2. Triglycerides: lipid molecules acquired through diet and stored as fat tissue - usually elevated in a high-carb diet 3. LDL; HDL - LDL: bad cholesterol, fatty plaques deposited along the walls of the arteries = inflammatory reaction which macrophages try to engulf but they get stuck - HDL: brings LDL back to the liver = lower blood LDL level

Question 27

describe how glucose affect the arteries

Answer 27

1. Chronic elevation of blood glucose can injure the endothelial walls of the arteries 2. uncontrolled diabetes = high risk for atherosclerosis and myocardial infarction

Question 28

describe how free radicals affect the arteries

Answer 28

Have high affinity to cell membranes | = can damage the endothelial lining of the arteries

Question 29

describe how nicotine affect the arteries

Answer 29

can cause vasoconstriction

Question 30

describe how homocysteine affect the arteries

Answer 30

1. Amino acid involved in metabolism Vitamin B complex but a deficiency in Vitamin B 2. decreased breakdown of homocysteine = high level of homocysteine can damage the endothelial walls of the arteries; also linked to increased thrombosis formation - homocysteine is high in meats

Question 31

describe HTN

Answer 31

The elevation of blood pressure to values that are correlated with cardiovascular damage

Question 32

AHA/AAC description of HTN

Answer 32

HTN exists when 2 or more diastolic blood pressure measurement on at least 2 or more clinical visits is 80 mmHg or higher; or when systolic blood pressure measurement is consistently 130 mmHg or higher

Question 33

what is the cause of primary HTN

Answer 33

exact cause is unknown

Question 34

what is the cause of secondary HTN

Answer 34

effect or complication of other systemic disorders; or side effects of some drugs/toxins

Question 35

what are some risk factors for HTN (9)

Answer 35

1. Family history 2. advancing age 3. race 4. obesity 5. tobacco use 6. high salt and saturated fat intake 7. *excessive* alcohol intake 8. sedentary lifestyle 9. chronic stress

Question 36

describe the pathologic changes of HTN (5)

Answer 36

1. changes in arterial bed/ endothelial lining = increased peripheral resistance 2. increased tone in the SNS = increased peripheral resistance 3. increased blood volume 4. arterial wall thickening = increased peripheral vascular resistance 5. abnormal release of renin, produces Angiotensin II = increased blood volume and increased constriction of arterioles = could lead to prolonged HTN

Question 37

describe the pathway of *prolonged* HTN

Answer 37

1. increases resistance to ventricular ejection and workload of heart increases 2. left ventricle hypertrophies = further increases workload of the heart

Question 38

complications of prolonged HTN (7)

Answer 38

1. Stroke 2. MI 3. heart failure 4. arrhythmias 5. retinopathy 6. encephalopathy 7. renal failure

Question 39

treatment of HTN

Answer 39

1. diet 2. moderate exercise 3. medications - α - adrenergic blocker like Doxazosin; terazosin (lowers BP) - β - adrenergic blocker like Atenolol, metoprolol, propranolol, carvedilol (lowers BP & *HR*) - Diuretics (lowers BP) - ARB/Ace-inhibitors/Ace-receptor blockers (lowers BP)

Question 40

s/s of HTN

Answer 40

it is asymptomatic except an elevated BP - in severe untreated cases = headaches or neck pain = organ specific s/s