CPR: SYSTEMIC ARTERIAL HYPERTENSION & CAD

1. Cardiovascular disease is a major risk factor for what?

2. T or F. Many patients with hypertension are diagnosed

3. T or F. High BP remains a major contributor of CAFD, CHF, CVD, and ESRD

1. Atherosclerotic cardiovascular disease

2. False. Many patients with hypertension are NOT diagnosed

3. True

1. Nice to know: This is the tendency to promote or cause atherosclerosis; refers to substances or conditions that promote the formation of plaque in the arteries, leading to heart disease, ↑ levels of LDL cholesterol, smoking, ↑ blood pressure, DM, & an unhealthy diet

2. What syndrome does HTN + Dyslipidemia + sugar problems + Obesity make up?

3. These presentations make up what syndrome: Cardiac failure + kidney failure + diabetes

1. Atherogenic

2. Metabolic syndrome

3. Cardiokidneymetabolic (CKM) syndrome

1. Uncontrolled SBP elevation are prone to what?

2. Uncontrolled DPB elevation are prone to what?

3. T or F. Association with other risk factors is multiplicative rather than additive

1. prone to heart failure

2. prone to CAD, acute coronary syndromes, acute MI, heart attack

3. True

Name the 4 atherogenic factors

DHOG

1. Dyslipidemia (abnormal cholesterol; HDL or LDL)

2. Hyperinsulinemia (↑ insulin in your blood than what's considered normal d/t insulin resistance

3. Obesity (↑ obesity = ↑ sugar problem tendency)

4. Glucose intolerance

1. T or F. Most patients have NO symptoms attributable to high BP

2. T or F. CAD is approximately twice as prevalent in hypertensives as in normotensive person of same age

1. True. That’s why many ppl with HTN are not diagnosed

2. True.

Name the 4 factors that contribute to increased risk of CHD:

CARP

1. Coronary arteriolar hypertrophy

2. Accelerated narrowing of epicardial arteries → the classic typical arteries that gets blocked in MI

3. Reduced myocardial vascularity → konti lang ugat sa puso 

4. Perivascular fibrosis → end product of inflammation

1. This pressure refers to ventricular filling & ventricular relaxation

2. This pressure refers ventricular emptying & ventricular contraction period

3. This is the FIRST loudest and audible sound

4. Average pressure throughout cardiac cycle against the walls of the proximal systemic arteries (aorta)

1. DBP (Diastolic)

2. SBP (Systolic)

3. SBP (Systolic)

4. Mean Arterial Pressure (MAP)

1. Formula of MAP

2. In a stroke patient, should we lower BP right away?

3. This is what you call the sum of all forces that oppose blood flow

1. DOC ROB: 1/3 (SBP - DBP) + DBP

   1. Easier formula: (2 x DBP) + SBP / 3

2. No, don’t lower right away. It should be based on MAP

3. Total Peripheral Resistance
   
   Note: Heart has to pump harder all the time → hypertrophy = start of heart failure

1. Arterial pressure is a product of ___and _______

2. Amount of blood pumped by the heart per minute

3. Amount of blood ejected by the heart per contraction

1. Cardiac Output (CO) and Peripheral resistance

2. Cardiac Output

3. Stroke volume

1. What is Cardiac Output based on?

2. What happens if there’s ↓ SV?

3. Vascular function constricts d/t what conditions?

4. Vascular function dilates d/t what conditions

1. Stroke Volume (SV) and Heart Rate (HR)

2. There will be ↓ CO → ↓ BP→ feedback mechanism compensates by ↑ HR; But if body is overwhelmed = cannot increase HR anymore = leading to heart failure (↓ SV + ↓ BP)

3. Cold environment, nicotine, caffeine = HTN & Stroke

4. Warmth, hydrotherapy = hypotension = death

1. What are the 4 principle mechanisms

2. T or F. During the exercises there is sympathetic vasoconstriction in non working areas.

3. In exercise, where will there be a modest increase? SBP or DBP

4. How much is O2 consumption of during exercise

1. Intravascular volume, ANS, RAA System, Vascular Mechanism

2. True

3. SBP will have a modest increase. DBP will NOT change

4. 20x

1. This is primary determinant of the extracellular fluid volume

2. This is primary determinant of arterial pressure over the long term

3. What happens when sodium intake exceeds the kidney's capacity to excrete sodium?

4. This is the most modifiable risk factor for HTN

1. Sodium

2. Intravascular volume

3. vascular volume expands & ↑ CO &

4. Sodium

1. In the ANS, what are the 3 components that maintain  cardiovascular homeostasis?

2. What reflex consists of baroreceptors and chemoreceptors?

3. These 3 play an important role in tonic & phasic cardiovascular regulation. What are the 3 endogenous catecholamines?

4. These reflexes modulate blood pressure over short term?

1. Pressure, Volume, Chemoreceptor signals (PVC)

2. Adrenergic reflex

3. Norepinephrine, Epinephrine, Dopamine (NED):These are part of the flight or flight syndrome

4. Adrenergic reflexes

1. This catecholamine is synthesized by adrenal medulla

2. This catecholamine is synthesized by adrenergic neurons

3. Released into the synaptic cleft and to receptor sites on target tissue

4. This catecholamine is released into the circulation upon adrenal stimulation

1. Epinepherine

2. Norepinephirine & Dopamine

3. Norepinephirine & Dopamine

4. Epinepherine

1. This catecholamine is stored in vesicles within the neuron

2. This catecholamine is either metabolized or taken up into the neuron by an active reuptake process

3. Modulates BP on a minute-to-minute basis

1. Norepinephirine & Dopamine

2. Norepinephirine & Dopamine

3. Baroreceptors

1. Where are stretch-sensitive sensory nerve endings located?

2. T or F. Rate of firing of these baroreceptors increases with arterial pressure

3. What is the net effect of stretch-sensitive sensory nerve endings?

4. Primary mechanism for rapid buffering of acute fluctuations of arterial pressure that may occur what conditions?

1. Carotid sinuses & aortic arch

2. True

3. ↓ in sympathetic outflow then results into ↓ in arterial pressure & HR

4. During postural changes, behavioral or psychologic stress, and changes in blood volume

1. Pts c autonomic neuropathy & impaired baroreceptor reflex function may have what description of BP with difficulty-to-control episodic blood pressure spikes

2. T or F. Activity of the baroreflex declines or adapts to sustained increases of arterial pressures

3. What do you call the nerves that supply blood verssels?

1. Extremely labile blood pressures

2. True. Baroreceptors are reset to higher pressures

3. Nervi vasorum

1. This protein is synthesized in the segment of the renal afferent renal arteriole that abuts the glomerulus and a group of sensory cells, macula densa

2. Where is the location of the group of sensory cells, macula densa?

3. Name the 3 primary stimuli for renin secretion.

4. What cells release renin?

1. Renin

2. Loop of Henle

3. Macula densa mechanism, Baroreceptor mechanism, Sympathetic nervous system stimulation of renin-secreting cells (MSB)

4. Juxtaglomerular (JG) cells

1. Nice to know: What is the goal of renin system?

2. This primary trigger of renin senses decreases pressure or stretch within the renal afferent arteriole → → Inc BP

3. This primary renin mechanism trigger senses decrease in NaCl transport in the thick ascending limb of the loop of Henle → conserves NaCl then water follows → Inc BP

4. This primary renin trigger detects stress response in the body by stimulating β-adrenoreceptors receptors in kidney

1. Increase BP, Increase blood volume, & conserve sodium and water. This is the body’s emergency response to LOW BP or LOW volume

2. Baroreceptor mechanism

3. Macula Densa Mechanism

4. Sympathetic Nervous System

1. Where does Angiotensin 1 become Angiotensin 2?

2. T or F. Angiotension is a vasodilator

3. T or F. Most feedback (98%) of the body are NEGATIVE

4. What makes inflammation good?

5. What makes inflammation bad?

1. In the lungs

2. False. Angiotension is a vasoconstrictor

3. True

4. Good if controlled and ends in healing

5. Bad if too much and ends in fibrosis

1. What is the reason lots of drugs are used to counter this RAA system?

2. What are the 3 inhibitors (stoppers) of Renin?

3. This term refers to geometric alterations in the vessel wall WITHOUT changing vessel volume

1. RAA system is the primary main cause of high BP

2. High NaCl, ↑ stretch of renal afferent arteriole, and β1 receptor blockade, modulated by Angiotensin II (feedback)

3. Remodelling

Angiotensin 2 vs Aldosterone:

1. This is a potent mineralocorticoid that increases sodium reabsorption + promotes water retention.

2. This gets released in response to low renal arterial pressure or low concentration of filtered sodium

3. This enhances extracellular matrix and collagen deposition within the myocardium

4. ↑ intracellular calcium & blood vessel wall constriction

5. Stimulates vasopressin release

1. Aldosterone

2. Angiotensin 2

3. Aldosterone

4. Angiotensin 2

5. Angiotensin 2

Angiotensin 2 vs Aldosterone:

1. This causes ↑ sympathetic nervous system activity

2. This may play a role in cardiac hypertrophy and CHF

3. This stimulates cardiac fibrosis and left ventricular hypertrophy

4. This may cause glomerular hyperfiltration and albuminuria

1. Angiotensin 2

2. Aldosterone

3. Aldosterone

4. Aldosterone

1. T or F. Resistance to flow favors inversely with the fourth power of the radius

2. T or F. Small decreases in lumen size significantly increase resistance

3. These 2 types of remodelling ↓ lumen size and ↑ peripheral resistance

4. What are the other factors that contribute to remodelling (3)?

1. True

2. True

3. Hypertrophic and Eutrophic

4. Apoptosis, low-grade inflammation, & vascular fibrosis (ALV)

1. This type of remodelling ↑ cell number, cell size, & deposition of intercellular matrix

2. This type of remodelling has no change in the amount of material in the vessel wall

3. Under lumen diameter, this can accommodate an increase of volume with relatively little change of pressure

4. Under lumen diameter, this system says that a small increment in volume induces a relatively large increment of pressure.

1. Hypertrophic

2. Eutrophic

3. High Degree of Elasticity

4. Semi-rigid vascular system

1. Essential Htn or Secondary Htn. Elevated BP WITH an identifiable cause

2. Essential Htn or Secondary Htn. Elevated BP WITHOUT a cause

3. What is the age onset of Secondary HTN?

4. What is onset of Secondary diastolic HTN?

5. What are the features that indicate secondary HTN?

1. Secondary HTN

2. Essential HTN

3. >20 y/o

4. >50 y/o

5. Hypokalemic paralysis (episodes of muscle weakness), Abdominal bruit (renal artery stenosis), Labile HTN c tachycardia, Family hx of renal disease (HALF)

Secondary HTN:

1. This refers to narrowing of one or both renal arteries & causes activation of RAA system = volume EXPANSION = Htn

2. What factors describe Renal Parenchymal Disease?

3. This adrenal tumor causes an ↑ BP & low potassium

4. This secretes a lot of aldosterone & the body reabsorbs sodium = Htn

1. Renovascular: Renal Artey Stenosis

2. Intracellular volume expansion c sodium retention, Excessive renin secretion, & Sympathetic overactivity (IES)

3. Primary Hyperaldosteronism

4. Hyperaldosteronism

Secondary HTN:

1. This adrenal tumor causes release of catecholamines which would lead to HTN with tachycardia sweating

2. Increased catecholamines & *increase PVR* cause diastolic HTN (DBP elevation)

3. Excessive growth hormone release causes ↑ cardiac output

4.  Increase in CO & decrease in PVR cause systolic HTN (SBP elevation)

1. Pheochiromocytoma

2. Hypothyroidism

3. Cushing’s Syndrome

4. Hyperthyroidism

Secondary HTN:

1. Pt snoring then stops breathing for awhile

2. Steroids, HRT, PPA, alcohol, nicotine

3. *Congenital narrowing of the aorta that increases blood pressure above the constriction and reduces blood flow to the lower body.

4. T or F. You’re giving the pt lots of meds for HTN but still doesn’t get better is an example of Secondary HTN; poor response to generally effective tx.

1. Obstructive sleep apnea

2. Drugs

3. *Coarctation of Aorta

4. True

1. What BP classifies as a HTN emergency

2. What BP classifies as a HTN urgency

3. HTN emergency or urgency. This has acute target organ damage.

4. This HTN disease has applied for chronic uncontrolled hypertension

1. BP >220/140; needs to be brought down immediately

2. BP >180/100; BP lowering is more slowly

3. HTN emergency

4. Hypertensive Cardiovascular Disease

1. What is the most common risk factor for Hypertensive Cardiovascular Disease

2. Normal home readings but elevated BP readings in clinics/offices

3. Most common organ cause of death in HTN patient?

4. Percent risk factor for infarction?

5. T or F. Incidence of stroke rises progressively with increasing BP levels, particularly systolic blood pressure in individuals >65 years

1. Uncontrolled HTN

2. White Coat HTN

3. Heart

4. 85% for infarction. 15% for hemorrhage

5. True

1. Most common etiology of secondary HTN?

2. What is a classic sx of PAD?

3. What is the Ankle-Brachial Index (ABI) of PAD which serves as its diagnostic

4. T or F. ABI score associated with >50% stenosis in at least two major lower limb vessel

1. Kidney: primary renal diseases

2. Intermittent claudication

3. <0.90

4. False. ABI score is associated with >50% stenosis in at least ONE major lower limb vessel

1. T or F. LENGTH of the cuff bladder should encircle at least 80% of the arm circumference

2. What is normal BMI?

3. What is the dietary restriction of sodium and sodium chloride?

4. What meds go against RAA system

1. True

2. 18.5-24.9

3.  <2gm sodium & <6 gm sodium chloride

4. Angiotensin receptor blockers

1. What is the leading cause of death around the world? What is the 2nd leading cause?

2. T or F. CAD may sufficiently decrease blood flow in the myocardium and is usually caused by atherosclerosis

3. This is a deep visceral pressure or squeezing sensation; like theres hollow blocks on chest

1. Leading cause is Ischemic heart disease / CAD. 2nd leading cause is Neoplasm (tumors)

2. True

3. Angina Pectoris

1. Where is the location of the pain in angina pectoris?

2. Where does this pain usually radiate?

3. How long does angina pectoris last?

4. Aside from rest and cessation of triggering event, what are the drugs that dilate blood vessels and that relieves angina pectoris?

1. Substernal (not L or R); sometimes at the back or epigastrium

2. Typically ulnar surface of L arm but also jaw or neck

3. Transient, 2-30 mins. If >30 min = heart attack

4. Nitrates

1. What are the causes of angina pectoris?

1. Exertion, Emotional upset, or other events that ↑ Myocardial O2 demand (tachycardia or HTN)