Hypertension
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Hypertension - Details
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14 questions
| 🇬🇧 | 🇬🇧 |
| When does BP rise to a maximum | Rises to a maximum in systole- the systolic pressure |
| How do you calculate BP and CO | BP = CO * TPR CO = HR * SV |
| When does BP rise to a minimum | Falls to a minimum in diastole- the diastolic pressure |
| What does stroke volume depend on ( what factors ) | Preload → venous return Load → inherent pumping power ( contractility ) Afterload → = pressure against which the heart must pump ( pressure in the aorta ) |
| What are the 2 mechanisms for control of Blood Pressure | Fast acting for immediate pressure changes Baroreceptor reflexes act on heart (CO) and blood vessels (TPR) via autonomics ( Sympathetic and Parasympathetic ) Slow acting long term responses act on RAAS (Renin Angiotensin Aldosterone System) via kidneys to regulate blood volume |
| What is the difference between primary and secondary hypertension | Primary hypertension --> Unknown cause , most common Secondary hypertension --> Defined cause, e.g. renal , endocrine or pregnancy |
| What are the 2 pathophysiology of hypertension in the heart | Muscle hypertrophy - Left ventricle works harder to combat high wall pressure - Due to muscle hypertrophy, there is higher demand of oxygen which could lead to LV ischemia and failure→ pulmonary congestion and oedema Atherosclerosis : - Endothelial damage in coronary arteries by atheroma which leads to loss of elasticity and hardening - Narrowing and reduced oxygen supply - Angina →infarction → heart failure |
| What are the 2 mechanisms of a stroke and TIA can be caused in the brain | Atherosclerotic plaques or thrombi in carotid or cerebral vessels which can embolize and block brain vessels Brain micro-aneurysms can rupture → hemorrhagic stroke |
| What are some causes of secondary hypertension | Renal : renal artery stenosis, glomerulonephritis Endocrine : Cushing syndrome adrenocortical hyperplasia Conn syndrome primary hyperaldosteronism Pheochromocytoma Thyroid dysfunction Mechanical : coarctation of the aorta Pregnancy : pre-eclampsia and hypertension |
| What can happen due to hypertension in the kidneys | Nephrosclerosis damages vessel walls of nephron Reduced blood supply leading to ischaemia Which can lead to atrophy of renal glomeruli and tubules Progressive renal failure |
| How would you diagnose hypertension | BP > 140/90 at clinic BP > 135/85 after ABPM or HBPM Also examine retina by fundoscopy, Femoral pulses and Renal bruit |
| What are some investigations for hypertension | ECG - for left ventricle hypertrophy Echocardiogram Blood --> U/E, cholesterol, glucose and steriods Urine --> Protein, blood Renal ultrasound |
| What is a hypertensive emergency | BP > 200/130 with evidence of organ damage Headache, visual disturbance Papilloedema + retinal haemorrhages Encephalopathy, heart failure, renal failure |
| What are some management strategies for hypertension | If it is secondary then treat the cause If primary then there are 2 ways Non-drugs --> Lifestyle changes Drugs --> Angiotensin blcokers ( ACEi/ARB ) , Calcium channel blockers , Diuretics and beta blockers Annual Review |