Echo 2 > Module 10 : Systemic Hypertension > Flashcards

Module 10 : Systemic Hypertension Flashcards

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1
Q

what is a normal BP

A

< 120/80

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2
Q

what must happen to diagnose HTN

A
  • high BP in 2 separate readings of >140/90
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3
Q

what is classified as pre hypertension

A

130-139 / 85-89

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4
Q

what is stage 1 HTN

A

140-159 / 90-99

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5
Q

what is stage 2 HTN

A

> 160 / 100

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6
Q

what is isolated HTN

A

> /= 140 and < 90

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7
Q

what are the 2 types of hypertension

A
  • essential HTN (primary) = multifactoral

- secondary HTN

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8
Q

what are the causes essential/primary HTN

A
  • hereditary
  • metabolic causes
    + metabolic syndrome
    + obesity
    + diabetes mellitus/ insulin resistance
    + sedentary lifestyle
    + mental stress
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9
Q

what are the causes of secondary HTN

A 
- renal disease 
  \+ renovascular disease
  \+ chronic renal disease
- endocrine/hormonal 
  \+ increased cathecolamines 
  \+ primary aldosteronism 
  \+ adrenal hyperplasia
  \+ increased cortisol 
- pituitary/hypothalmic = cushings 
- thyroid = hyperthyroidism 
- CNS = increased sympathetic tone
- aortic coarctation
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10
Q

what are 7 risk factors for getting essential hypertension

A
  • older age
  • ethnicity
  • male
  • obesity
  • dyslipidemia
  • diabetes mellitus
  • insulin resistance
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11
Q

what are 6 lifestyle factors that increase risk of essential hypertension

A
  • stress
  • excessive sodium intake
  • excessive alcohol intake
  • inadequate calcium and potassium intake
  • lack of physical activity
  • smoking
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12
Q

what is the mean pressure

A
  • average pressure over the cardiac cycle
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13
Q

what length of the cardiac cycle should systole and diastole occupy normally

A
  • systole = 1/3

- diastole = 2/3

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14
Q

in a tachycardic heart what length of the cardiac cycle does systole occupy

A

> 1/3

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15
Q

in a bradycardic heart what length of the cardiac cycle does systole occupy

A

< 1/3

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16
Q

how do you calculate mean arterial pressure MAP with systolic and diastolic pressure

A

MAP = [ ( 2 x diastolic ) + systolic ] / 3

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17
Q

how do you calculate pulse pressure

A

pulse pressure = SBP - DBP

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18
Q

what is the pulse pressure

A

difference between SBP and DBP

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19
Q

what would happen to the pulse pressure with severe AO regurge

A
  • pulse pressure increases

- starlings increases force of contraction so SBP increases but DBP decreases

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20
Q

how do you calculate MAP with cardiac output and systemic vascular resistance

A
  • MAP = CO x SVR
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21
Q

what change to cardiac output will increase average BP

A 
- any factor that increases CO 
  \+ obesity 
  \+ pregnancy 
  \+ regurgitation 
  \+ excessive salt intake
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22
Q

what changes to systemic vascular resistance will increases average BP

A 
- any factor that increases SVR 
  \+ stress
  \+ caffeine
  \+ nicotine 
  \+ alcohol 
  \+ inadequate potassium or calcium
  \+ lack of activity 
  \+ smoking
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23
Q

what occurs the heart with heart failure with preserved ejection fraction (HFpEF)

A
  • compensatory hyperdynamic contraction

- hypertensive hypertrophic cardiomyopathy

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24
Q

what is the main mechanism of HRpEF

A

diastolic dysfunction

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25
what are the signs of diastolic dysfunction
- dyspnea - imparted diastolic filling - LA overload leads to pulmonary venous congestion which leads to RV elevated pressure >> RV enlargement >> increasing TR
26
what is the number one way to change peripheral resistance
vessel diameter
27
what two techniques can cause vasodilation in high resistance vascular bed
- exercise | - relaxation
28
does a compliant vessel have a higher or lower pulse pressure
lower | BP = 110/75
29
does a stiffer vessel have a higher or lower pulse pressure
- lower
30
does aortic stiffness increase with age
yes
31
does aortic compliance increase with age
no decreases
32
how does inspiration affect right heart filing
- increases right heart filling
33
how does expiration affect right heart filling
- decreases right heart filling
34
how does a muscle pump work
- muscles contract around veins to compress the blood upward through valves - CHF patients must walk to augment flow - main reason why walking hopes pedal edema from CHF
35
what is volemia
total blood volume
36
does increase blood volume increase blood pressure
- yes
37
what are 2 factors that increase volemia
- water retention (kidney, liver) - total body mass + blood vessels designed for skeletal size not skin size
38
how does salt intake water content in blood
- high salt intake leads to decreased excretion of water and salt by kidneys to maintain proper salinity of blood + more water in vascular system + more outward pressure on arterial walls = higher BP
39
what is salinity
- sodium:water ratio
40
does sodium by itself raise BP if not what does
- no | - sodium chloride
41
how does high afterload / BP affect CHF
- increased work load for an already overloaded muscle | - diastolic dysfunction as well
42
how does high afterload /BP affect CAD
- endothelial damage in coronary artery accelerates plaque formation
43
how does high afterload / BP affect PVD
- endothelial damage in coronary artery accelerates plaque formation
44
how does high afterload/BP affect renal failure
- pressure to high for kidneys to function well >> endothelial damage
45
how does high afterload/BP affect angina
- increased workload of the muscle + decreased coronary perfusion
46
what does a release of nitric oxide do to the endothelium
- makes the endothelium release EDRF >> vasodilation
47
what does EDRF do
- allows the smooth muscle cells of the tunica intima and media to relax
48
what is EDRF
endothelium relaxation factor
49
how is HTN managed by addressing causes
- regulating blood volume - regulating CO - regulating peripheral arterial resistance
50
is medication or lifestyle changes done first to manage HTN
- life style changes
51
what are the lifestyle modification made to manage HTN
- exercise - control salt intake - lipids managment - smoking cessation - stress reduction techniques
52
how does smoking and stress lead to high BP
- smokings/toxins damage endothelium function - mental stress impairs endothelial function - smoking leads to elevated mental stress - smoking and mental stress lead to high BP
53
what are the 4 main types of medication to lower blood pressure and what do they do
- diuretics = lower total blood volume, reduce afterload and preload, excrete salt with water - beta blockers = lower HR reduce SBP and DBP block sympathetic stem - calcium channel blockers = block calcium from entering muscle cell - ACE inhibitors = prevent angiotensin from causing arterial constriction
54
what are the 4 roles of echo in hypertension
- determine presence and degree of hypertension - assess LV Systolic and diastolic function - exclude identifiable cause of hypertension - identify other cardiac anomalies associated with hypertensive heart disease
55
what are we evaluating the size of with HTN
- LV - LA - IVS - LVPW - AO root, asc, dsc
56
what are we evaluating with systolic function with HTN
EF
57
what are we evaluating with diastolic dysfunction with HTN
- E/A ratio - E/e ratio - pulmonary V profile - tissue doppler
58
what are we evaluating with LV or RV dilation and what would it cause with HTN
- MR - AI/AR - TR - RVSP
59
what could be 5 2D findings on a patient with HTN
- LV hypertrophy - Aortic root , asc ao dilation - aortic valve sclerosis or MAC - LA enlargmetn - arrhythmia - RV dilation due to high RVSP
60
what would a be finding on strain echo with HTN
- reduced global strain
61
what would be a finding on doppler with HTN
``` - diastolic dysfunction + increase LV filling pressure + pulmonary veins flow reversal + TDI reduced + RVSP increased - desc ao diástole flow reversal - regurge ```
62
what is normal LV geometry
- normal LV mass and normal relative wall thickness
63
what is concentric remodelling
- normal LV mass with increased relative wall thickness
64
what is concentric hypertrophy
- increased LV mass and increased relative wall thickness
65
what is eccentric hypertrophy
- increased LV mass with normal / decreased relative wall thickness
66
what is normal LV mass index in femal and male
= 95 female | = 115 male
67
what is normal relative wall thickness
= 0.42
68
what is the LV mass linear technique equation
LV mass = 0.8 [ 1.04{(PWd + LVIDd + IVSd)^3 LVID^3}] 0.6
69
what is the LV mass index equation
LVMI = total LV mass / BSA
70
how does obesity effect LV mass index
- LV mass may be too high but LV mass index normal due to increased BSA
71
what is the relative wall thickness equation
RWT = 2 (PWd/LVIDd)
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