HTN + Cardiac Pathologies

Question 1

what is the double product?

Answer 1

DP = HR X SBP

Question 2

describe the BP categories

Answer 2

Question 3

types of HTN

Answer 3

1. Essential or primary HTN
   
   • no known cause
   • 90% of cases
2. Secondary HTN
   
   • caused by conditions that affect your kidneys, arteries, heart or endocrine system
   • 10% of all HTN cases
   • treatment focuses on managment of the underlying cause

Question 4

how can HTN impact renal function?

Answer 4

• uncontrolled high BP can cause arteries in the glomeruli to narrow, weaken or harden
• these damaged arteries deliver less and less filtrate to the nephron
• the kidneys perceive this reduce filtration as a reason to increase water and sodium reabsorption resulting in increased blood volume and therefore BP

Question 5

how can diabetes impact renal function and thus BP?

Answer 5

• chronically elevated glucose levels damages glomerular filtration, reducing glomerular filtration
• kidney responds by reabsorping more water and sodium, increasing fluid volume and blood pressure

Question 6

how does HTN result in a pathologic heart?

Answer 6

1. results in pathologic cardiac hypertrophy
2. causes fibrosis rendering the heart stiffer
   
   • HFpEF
3. Myocyte hypertrophy
4. accelerated myocyte death
5. reduced capillarization/reduced blood flow

Question 7

what is cor pulmonale?

Answer 7

aks pulmonary heart disease

enlargement/dysfunction of the right ventricle caused by a primary pulmonary disorder like pulmonary HTN

Question 8

symptoms of cor pulmonale

Answer 8

1. chest pain
2. fatigue
3. bilateral LE edema
4. syncope or passing out

Question 9

diseases of the lung and pulmonary vessels associated with cor pulmonale

Answer 9

1. lung diseases
   
   • COPD
   • diffuse pulmonary interstitial fibrosis
   • extensive, persistent atelectasis (collapsed lung)
   • cystic fibrosis
   • pulmonary embolism
2. pulmonary vessel diseases
   
   • pulmonary vascular sclerosis
   • drug, toxin, XTR induced vascular stenosis

Question 10

diseases affecting chest wall movement

Answer 10

1. kyphoscolosis
2. marked obesity
3. neuromuscular disease

Question 11

diseases inducing pulmonary arteriolar constriction

Answer 11

1. hypoxemia
   
   • airway constriction
   • hypoventilation
   • chronic altitude sickness

Question 12

List the 11 steps for taking BP

Answer 12

1. pt rests for 5 minutes
2. legs uncrossed
3. feet flat on floor
4. arm supported
5. correct cuff size
6. cuff placed over bare arm
7. no talking
8. no mobile phone use or reading
9. BP measurements taken in both arms
10. correctly ID BP from arm with higher reading as being clincially more important
11. correctly ID which arm to use for future readings (arm with higher BP)

Question 13

what is a cardiomyopathy

Answer 13

disorder within the cardiac myocytes themselves which results in abnormal cellular and hence cardiac performance

reduced EF predicts mortality and morbidity

Question 14

list types of cardiomyopathies

Answer 14

1. dilated cardiomyopathy → enlarged ventricles
2. hypertrophic cardiomyopathy → thickened, stiffened walls
3. restrictive cardiomyopathy → stiffened walls

Question 15

describe dilated cardiomyopathy

Answer 15

characterized by abnormal cardiac morphology (ie chamber dilation) and contractile impairment resulting in decreased EF and/or SV

Question 16

describe what the results of remodeling look like in dilated cardiac myopathy

Answer 16

1. a heavier than normal heart weight
2. hypertrophied cardiac myocytes
3. loss of myofibrils
4. fibrosis
5. chamber walls are thinned
6. produces systolic dysfunction and reduced EF

most common form of cardiomyopathies

Question 17

list some causes of dilated cardiac myopathy

Answer 17

1. genetic mutations
2. various viral infections including HIV
3. various toxins
4. metabolic disorders
5. myocarditis

Question 18

S/S of dilated cardiac myopathy

Answer 18

1. symptoms
   
   • fatigue
   • dyspnea on exertion, SOB, cough
   • orthopnea, parozysmal noctural dyspnea
   • increased edema, weight, or abdominal girth
2. signs
   
   • tachypnea
   • tachycardia
   • HTN or hypotension

Question 19

T/F: hypertrophic cardiomyopathy is the single most common cause of death in apparently healthy young people

Answer 19

TRUE

Question 20

describe hypertrophic cardiomyopathy

Answer 20

• normal BPs are percieved as excessive by functionally defective myocytes
• LV free wall hypertrophy occurs as a compensatory mechanism
• septal wall can hypertrophy disrupting normal LV outflow tract
• ultimately heart decompensates (decreases functional capacity) and fails

Question 21

T/F: the majority of hypertrophic cardiomyopathy cases are asymptomatic

Answer 21

TRUE

first clinical manifestation is often sudden death

Question 22

what is the difference between obstructive and nonobstructive HCM?

Answer 22

1. Obstructive
   
   • the septal wall thickens and the LV free wall of the ventricles stiffen, obstructing blood flow into the aorta
2. Nonobstructive
   
   • the walls of the LV stiffens, reducing LVEDV and SV
   • blood flow is not blocked

Question 23

S/S of HCM

Answer 23

1. chest pain
2. SOB
3. fatigue
4. arrhytmias
5. dizziness
6. lightheadedness
7. fainting (syncope)
8. swelling in the ankles, feet, legs, abdomen and veins in the neck

Question 24

what is restrictive/infiltrative cardiomyopathy?

Answer 24

• characterized by restricted diastolic filling/loss of compliance
• characterized by idiopathic fibrosis-rigid heart walls/reduced compliance
• systolic function is normal
• EDVs are diminished/chambers cannot expand
• ESVs and EFs are normal; SV is compromised
• ventricular filling pressures are very high

Question 25

symptoms of restrictive/infiltrative cardiomyopathy

Answer 25

1. extertional dyspnea 2. abdominal swelling 3. ankle edema

Question 26

causes of restrictive cardiomyopathy

Answer 26

1. scleroderma 2. amyloidosis 3. sarcoidosis 4. DM 5. hemochromatosis 6. chemo agents 7. radiation

Question 27

list other types of cardiac pathologies

Answer 27

1. valvular heart disease 2. arrhythmias/dysrhymias 3. myocarditis 4. diabetic heart disease 5. diseases of pericardium 6. aneurysm

Question 28

list types of valvular disease

Answer 28

1. regurgitation 2. stenosis

Question 29

list diseases impacting the pericardium

Answer 29

1. pericarditis 2. constrive pericarditis 3. pericardial effusion

Question 30

what is an aneursym?

Answer 30

an abnormal stretching (dilation) in the wall of an artery, a vein, or the heart with a diameter that is at least 50% greater than normal

Question 31

cardiac structures unique to fetal circulation

Answer 31

1. foramen ovale → allows a R to L atrial shunt 2. ductus arteriosus → pulmonary artery to aorta shunt 3. ductus venosus → umbilical cord to IVC in order to bypass the liver

Question 32

embyrologic defects

Answer 32

1. ventricular septal defect (SD) * hole in the wall separating the two lower chambers of the heart * eventually the L ventricle can work so hard that it starts to fail * pulmonary HTN 2. tetralogy of fallot

Question 33

what is HLHS?

Answer 33

hypoplastic left heart syndrome an underdeveloped left side of the heart. The aorta and left ventricle are too small and the holes in the artery and septum did not properly mature and close

Question 34

what is tetralogy of fallot?

Answer 34

congenital heart defect involving 4 anatomical abnormalities * RV hypertrophy * ventricular septal defect (VSD) * overriding aorta * pulmonary infunibular stenosis

Question 35

list S/S of congenital defects

Answer 35

1. increased pulse 2. increased respirations 3. retarded growth 4. dyspnea, orthopnea 5. fatigue 6. URI