PHRM3550 CVS & Blood

What type of hypertension do most patients have?

Essential (primary) hypertension

What is secondary hypertension?

High blood pressure due to an identifiable cause (renal, endocrine, drugs)

What is isolated systolic hypertension (ISH)?

SBP >160 with DBP <90, common in older adults

What is malignant/accelerated hypertension?

Rapid BP rise with acute target-organ damage

What is benign hypertension?

Slowly rising BP over years; damage appears late

What is labile hypertension?

Intermittent BP spikes; DBP can fall below 90 between spikes

Why is hypertension called the "silent killer"?

Often asymptomatic until severe damage (MI, stroke, renal failure)

What organ is damaged in hypertensive retinopathy?

The eyes (retina)

A BP reading of 150/90 is classified as?

Stage II hypertension (JNC VII)

Which stage represents the heart at rest and filling?

Diastole

What does the QRS wave represent?

Ventricular depolarization

What indicates an AV conduction block?

Prolonged PR, dropped beats, or AV dissociation

What is an increase in heart rate called?

Positive chronotropy

What is torsades de pointes?

Polymorphic ventricular tachycardia due to prolonged QT

What is the most common cause of coronary heart disease (CHD)?

Atherosclerosis of coronary arteries

Angina pectoris occurs due to blockage of which vessels?

Coronary arteries

What triggers stable angina?

Exertion; relieved by rest or nitroglycerin

What is unstable angina?

Chest pain at rest, variable duration, higher MI risk

Classic symptom of MI?

Prolonged chest pain ± radiation, dyspnea, nausea/vomiting

Chest pain while playing pickleball most likely indicates?

Stable angina

What causes myocardial ischemia?

Decreased O₂ supply or increased O₂ demand

How does hypertension increase myocardial oxygen demand?

By increasing afterload (wall stress)

What is the initiating factor in atherosclerosis?

Endothelial injury + LDL oxidation → inflammation

How does increased HDL affect atherosclerosis risk?

Decreases risk

Major risk factors for atherosclerosis?

High LDL/TG, smoking, hypertension, diabetes

Mechanism of statins?

Inhibit HMG-CoA reductase → lower cholesterol

What symptom defines intermittent claudication?

Calf pain with walking, relieved by rest

What is shock?

Circulatory failure with inadequate tissue perfusion

Cause of hypovolemic shock?

Low blood volume; skin is cold/clammy

Types of distributive shock?

Anaphylactic, neurogenic, septic

Which type of shock is histamine release central to?

Anaphylactic shock

What causes neurogenic shock?

Sudden loss of sympathetic tone

What are key features of septic shock?

Vasodilation + myocardial depression, high mortality

What causes cardiogenic shock?

Pump failure, usually a large MI

Examples of obstructive shock?

Massive PE, tamponade, tension pneumothorax

Classic symptoms of left-sided heart failure?

Dyspnea, rales, S3/S4, displaced apical impulse

Classic signs of right-sided heart failure?

JVD, peripheral edema, ascites, hepatomegaly

How does RAAS worsen heart failure?

Increases preload/afterload via Ang II & aldosterone

What is the role of the sympathetic nervous system in early HF?

Increases HR and contractility but worsens remodeling long-term

What is regurgitation?

Backflow through a leaky valve

What is stenosis?

Narrowed valve obstructing forward flow

Common systolic murmurs?

Aortic stenosis, mitral regurgitation

Common diastolic murmurs?

Mitral stenosis, aortic regurgitation

Acute aortic regurgitation presentation?

Dyspnea, pulmonary edema, hypotension

Mitral stenosis symptoms?

Dyspnea, hemoptysis, orthopnea, neurologic issues

Mitral regurgitation symptoms?

Dyspnea, fatigue, palpitations; acute MR → shock/HF

What is erythropoietin (EPO)?

A kidney hormone that increases RBC production

Causes of polycythemia (excess RBCs)?

Hypoxia (altitude), EPO excess, or primary polycythemia

Where does hematopoiesis occur in adults?

Bone marrow

Risk of thrombocytopenia?

Easy bruising, petechiae, mucosal bleeding

What type of reaction is coagulation?

Enzyme cascade (proteolytic amplification)

What does INR assess?

Extrinsic pathway and warfarin effect

Role of vitamin K in clotting?

Carboxylates factors II, VII, IX, X, proteins C/S

Role of protein S?

Cofactor for protein C; inhibits Va and VIIIa

First defense against bacteria?

Neutrophils (innate immunity)

Cells of adaptive immunity?

B and T lymphocytes

What is aplastic anemia?

Pancytopenia due to bone marrow failure

What is homeostasis?

Body maintaining a steady internal state

Blood enters pulmonary circulation from?

Right ventricle → pulmonary artery

Blood exits into the aorta from?

Left ventricle via the aortic valve

What is venous return?

Flow of blood back to the heart (equals CO at steady state)

Pulmonary edema + orthopnea suggest?

Left-sided heart failure

Ascites is more likely due to?

Right-sided heart failure or portal hypertension

A patient prescribed a statin most likely has?

Atherosclerotic disease/dyslipidemia

Long-standing untreated hypertension leads to?

Retinopathy, LVH, CKD, stroke

What happens to renal blood flow during shock?

Decreases (vasoconstriction → ↓ GFR/urine)

Which arrhythmia increases stroke risk and is treated with anticoagulants?

Atrial fibrillation

What is erythropoietin (EPO) and where is it produced?

A peptide hormone from the kidney that stimulates red blood cell production when oxygen delivery falls

What triggers erythropoietin release?

Low hemoglobin or oxygen delivery to the kidney

What is hematopoiesis and where does it occur in adults?

Formation of blood cells in the bone marrow (vertebra, sternum, ribs)

How many blood cells are produced daily by the marrow?

About 100 billion

What are the three formed elements of blood?

Red cells, white cells, and platelets

What is the lifespan of a red blood cell?

About 120 days

What does the presence of a nucleus in a mature RBC indicate?

Disease (normal RBCs extrude nuclei before maturity)

What is polycythemia (erythrocytosis)?

An increase in red blood cells, often secondary to hypoxia or tumors

What is anemia?

Low hemoglobin concentration due to decreased number, size, or abnormal hemoglobin in red cells

What are the three types of anemia classified by cell size?

Microcytic, macrocytic, normocytic

What causes microcytic anemia?

Iron deficiency or thalassemia (low hemoglobin production)

What causes macrocytic anemia?

Vitamin B12/folate deficiency, drugs interfering with DNA synthesis, myelodysplastic syndromes

What causes normocytic anemia?

Acute blood loss, hemolysis, sickle cell disease, hereditary membrane defects

What is aplastic anemia?

Failure of bone marrow leading to pancytopenia

What are granulocytes?

Neutrophils, eosinophils, basophils (contain cytoplasmic granules)

Which WBCs are first line of defense against bacteria?

Neutrophils

Which WBCs respond to parasites and some allergies?

Eosinophils

Which WBCs function in hypersensitivity reactions?

Basophils

Which WBCs become macrophages in tissue?

Monocytes

Which cells mediate adaptive immunity?

Lymphocytes (B and T cells)

What are platelets derived from?

Fragments of megakaryocytes

Do platelets have nuclei?

No

What activates platelets?

Exposure to thrombin, ADP, collagen, thromboxane, serotonin

What is the role of platelet granules?

Release ADP, PF4, and other activators to promote aggregation

What are the three stages of hemostasis?

Primary hemostasis, secondary hemostasis, fibrinolysis

What happens in primary hemostasis?

Vasoconstriction and platelet plug formation

What happens in secondary hemostasis?

Coagulation cascade forms fibrin

What is fibrinolysis?

Breakdown of fibrin clots by plasmin

Which vitamin is essential for synthesis of clotting factors II, VII, IX, X and proteins C & S?

Vitamin K

What drug inhibits vitamin K activity?

Warfarin

What does protein S do?

Cofactor for protein C to inactivate factors Va and VIIIa

What does INR measure?

Extrinsic pathway (PT) to monitor warfarin therapy

What does aPTT measure?

Intrinsic pathway, used to monitor heparin