Week 3

Secondary Hypertension

Hypertension caused by an underlying condition, such as kidney disease, hormonal disorders, or certain medications.

What are the commonly affected organs due to hypertension?

• Heart

• Brain

• Kidneys

• Eyes

• Blood vessels

.

What are the modifiable risk factors in hypertension management?

• Obesity

• Physical inactivity

• High salt intake

• Excessive alcohol consumption

• Smoking

• Stress

• Sleep apnea

• Diabetes

• High cholesterol levels

What are the blood pressure classification ranges according to ACH?

Normal: systolic BP <120 mm Hg, diastolic BP 80 mm Hg;

Pre-hypertension: systolic BP 120-129 mm Hg, diastolic BP <80 mm Hg;

Stage 1 hypertension: systolic BP 130-139 mm Hg, diastolic BP 80-89 mm Hg;

Stage 2 hypertension: systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg.

How does high sodium intake affect the Renin-Angiotensin-Aldosterone System (RAAS)?

High sodium intake suppresses the release of renin, a hormone secreted by the kidneys, which can lead to an imbalance in the RAAS and contribute to hypertension.

What is fluid retention and how does it relate to high sodium intake?

Fluid retention is an increase in extracellular fluid volume due to high sodium intake, which puts additional strain on the blood vessels and the heart, leading to an increase in blood pressure.

How does high sodium intake affect kidney function?

The pathogenesis of high sodium intake on kidney function involves several mechanisms. Firstly, high sodium intake leads to an increase in extracellular fluid volume, which triggers the release of hormones such as aldosterone and antidiuretic hormone (ADH). These hormones cause the kidneys to retain more water and sodium, leading to an increase in blood volume and blood pressure.

What is vascular resistance and how does high sodium intake affect it?

Vascular resistance is the resistance offered by the blood vessels to blood flow. High sodium intake can increase vascular resistance by reducing the bioavailability of nitric oxide, a potent vasodilator, causing blood vessels to become more constricted and blood pressure to rise.

How does high sodium intake stimulate the sympathetic nervous system?

High sodium intake has been shown to stimulate the sympathetic nervous system, which can increase heart rate, vascular resistance, and renal sodium retention, all of which contribute to elevated blood pressure.

What is the action of ACE inhibitors?

ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to vasodilation, decreased blood volume, and reduced blood pressure.

What are the complications of orthostatic hypotension?

Falls, syncope, and injury.

What is pulmonary stenosis?

Pulmonary stenosis is a congenital heart defect characterized by a narrowing of the pulmonary valve, which obstructs blood flow from the right ventricle to the lungs, causing the right ventricle to work harder and potentially leading to right ventricular hypertrophy.

What is Acute Coronary Syndrome (ACS)?

ACS is a condition associated with acute changes in plaque morphology and thrombosis that can lead to unstable angina and myocardial infarction.

What are some complications of ACS?

Complications of ACS may include heart failure, arrhythmias, cardiogenic shock, rupture of the heart muscle, and sudden cardiac death.

How does chest pain in ACS differ from typical angina?

Chest pain in ACS is usually more severe and lasts longer than typical angina.

What is the cause of ACS?

ACS is caused by plaque rupture with acute thrombus development.

What is the difference between unstable angina and MI?

Unstable angina is when the occlusion is partial, while MI is when the occlusion is complete.

What diagnostic tools are used for ACS?

ECG and biomarkers are used for the diagnosis of ACS.

Is ACS relieved by rest or nitroglycerin?

ACS is not relieved by rest or nitroglycerin.

Patent ductus arteriosus (PDA)

A persistent opening between the aorta and pulmonary artery that normally closes shortly after birth.

Low blood oxygen tension

Conditions that cause low blood oxygen tension may contribute to continued patency of PDA.

Harsh, grinding systolic murmur or thrill

Continued patency of PDA can be identified by a harsh, grinding systolic murmur or thrill.

Pulmonary hypertension

PDA can lead to increased pulmonary blood flow, causing right sided heart failure and pulmonary hypertension if left untreated.

What is atrial septal defect (ASD)?

An abnormal formation at the opening between the right and left atria, allowing oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium.

What are the consequences of untreated ASD?

Increased blood flow to the lungs, leading to pulmonary hypertension and right heart failure, right ventricular hypertrophy, and reversal to a right-to-left shunt.

Ventricular septal defect (VSD)

A hole in the septum between the right and left ventricles, causing oxygen-rich blood to mix with oxygen-poor blood.

Congenital cardiac anomaly

A heart defect present at birth.

Membranous septum

The thin, fibrous section of the septum between the ventricles.

Pulmonary hypertension

High blood pressure in the arteries of the lungs.

Right ventricular hypertrophy

Enlargement of the right ventricle due to increased workload.

Shunt

Abnormal flow of blood between two areas of the heart.

Ventricular septal defect (VSD)

A hole in the septum between the right and left ventricles of the heart.

Congenital cardiac anomaly

A heart defect present at birth.

What are the common side effects of ACE inhibitors?

The common side effects of ACE inhibitors include a dry cough, dizziness, and hyperkalemia.

What is left-sided heart failure?

Left-sided heart failure is the inability of the left ventricle to pump blood efficiently to the rest of the body, leading to pulmonary congestion and edema.

What are the symptoms of left-sided heart failure?

The symptoms of left-sided heart failure include shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and weakness.

What is right-sided heart failure?

Right-sided heart failure is the failure of the right ventricle to pump blood effectively to the lungs for oxygenation, leading to peripheral edema, ascites, hepatomegaly, and jugular venous distension.

What are the symptoms of right-sided heart failure?

The symptoms of right-sided heart failure include swelling of the ankles, legs, and abdomen, as well as weight gain and general fatigue.

What is Paroxysmal Nocturnal Dyspnea (PND)?

PND is a sudden and severe shortness of breath that occurs during sleep, typically in patients with left-sided heart failure, caused by the accumulation of fluid in the lungs due to the left ventricle's inability to pump blood effectively.

What is reduced cardiac output in heart failure?

Reduced cardiac output is a condition where the heart's pumping function is compromised, leading to a decrease in the amount of blood pumped by the heart per minute.

Why is cardiac output important?

Cardiac output is important for maintaining adequate blood flow and oxygenation to the body's tissues.

What are the pathophysiological mechanisms that contribute to reduced cardiac output in heart failure?

The pathophysiological mechanisms that contribute to reduced cardiac output in heart failure include decreased contractility of the heart muscle, increased preload or afterload, and structural abnormalities in the heart.

What are the symptoms of reduced cardiac output in heart failure?

Symptoms of reduced cardiac output in heart failure include fatigue, weakness, and exercise intolerance.

What is the compensatory response to reduced cardiac output?

The compensatory response to reduced cardiac output is an increase in heart rate, which may further exacerbate the heart's dysfunction.

What are dysrhythmias?

Dysrhythmias are abnormal heart rhythms that can disrupt the normal electrical conduction system of the heart, impairing its ability to pump blood effectively.

Reduced cardiac output

A complication associated with dysrhythmias that decreases the efficiency of the heart's pumping action, leading to reduced blood flow and oxygen delivery to vital organs.

Heart failure

A complication associated with dysrhythmias that occurs when persistent or severe dysrhythmias strain the heart muscle and contribute to the development or worsening of heart failure.

Blood clots and embolism

A complication associated with dysrhythmias, such as atrial fibrillation, that causes blood to pool in the heart chambers, increasing the risk of clot formation and embolism, potentially leading to stroke or other serious complications.

Cardiac arrest and sudden death

A life-threatening complication associated with dysrhythmias, such as ventricular fibrillation or sustained ventricular tachycardia, that causes the heart to stop pumping blood effectively, leading to cardiac arrest and sudden death if not treated promptly.

What is anaphylactic shock?

Anaphylactic shock is a severe and life-threatening allergic reaction that occurs when the immune system overreacts to an allergen.

What are the signs and symptoms of anaphylactic shock?

Signs and symptoms of anaphylactic shock include difficulty breathing, swelling of the face, lips, or tongue, hives or rash, rapid or weak pulse, low blood pressure, dizziness or fainting, nausea, vomiting, or diarrhea, and a feeling of impending doom.

What is the pathophysiology of anaphylactic shock?

The release of histamine and other inflammatory mediators from mast cells and basophils, leading to widespread vasodilation, increased vascular permeability, bronchoconstriction, and systemic hypotension.

What are the risk factors for anaphylactic shock?

Risk factors for anaphylactic shock include a history of allergies or previous anaphylaxis, asthma, and family history of anaphylaxis.

What is the pathogenesis of anaphylactic shock?

An initial sensitization to an allergen followed by a subsequent exposure that triggers a rapid and massive release of inflammatory mediators from mast cells and basophils, causing vasodilation, increased vascular permeability, and bronchoconstriction, leading to hypotension, respiratory distress, and potentially multiorgan dysfunction.

What is sepsis?

Sepsis is a life-threatening condition caused by the body's overwhelming response to an infection.

What is septic shock?

Septic shock is a severe form of sepsis characterized by profound circulatory, cellular, and metabolic abnormalities, including hypotension that is unresponsive to fluid resuscitation, and a high risk of mortality.

Obstructive shock

A type of shock that occurs when a physical obstruction impedes blood flow, leading to reduced cardiac output and tissue hypoperfusion.

Cardiac tamponade

A type of obstructive shock where accumulation of fluid in the pericardial sac compresses the heart, impairing its ability to fill and pump blood.

Tension pneumothorax

A type of obstructive shock where air trapped in the pleural space causes increased intrathoracic pressure, compressing the heart and great vessels, and reducing venous return.

Pulmonary embolism

A type of obstructive shock where a blood clot or other embolus obstructs the pulmonary artery or its branches, reducing blood flow to the lungs and increasing right ventricular afterload.

It can be explained to a patient that high blood pressure increases the risk of (Select all that apply)

Heart Attack- High blood pressure damages arteries that can become blocked and prevent blood flow to the heart muscle.

Stroke — High blood pressure can cause blood vessels that supply blood and oxygen to the brain to become blocked or burst.

Heart failure — The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body.

Kidney disease or failure — High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively.

Vision loss — High blood pressure can strain or damage blood vessels in the eyes.

Sexual dysfunction — High blood pressure can lead to erectile dysfunction in men and may contribute to lower libido in women. Angina — Over time, high blood pressure can lead to heart disease including microvascular disease. Angina, or chest pain, is a common symptom.

Peripheral artery disease (PAD) — Atherosclerosis caused by high blood pressure can lead to narrowed arteries in the legs, arms, stomach and head, causing pain or fatigue.

Hypotension associated with neurogenic and anaphylactic shock is due to _________

peripheral pooling of blood.

Hypertrophy of the right ventricle is a compensatory response to

Pulmonary Stenosis

Angiotensin Converting Enzyme inhibitors (ACE inhibitors) blocks the

ACE blocks the body's production of angiotensin II.

Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of ___________.

Cardiac Tamponade ***Cardiac Tamponade is also known as Beck's Triad.

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding?

Increased LDL levels are associated with an increased risk of coronary artery disease

What are the reasons that make cardiac dysrhythmias significant in cocaine use?

Cardiac dysrhythmias are significant in cocaine use due to a direct toxic effect of cocaine, secondary sensitization of ventricular tissue to catecholamines, and slowed cardiac conduction secondary to local anesthetic effects.

What type of shock is a patient most likely experiencing if they present with fever, hypotension, and lactic acidosis?

Septic Shock.

What is septic shock?

Septic shock is a life-threatening condition that occurs when a severe infection leads to a dangerous drop in blood pressure.

What does Cor Pulmonale refer to?

Cor Pulmonale refers to right-sided heart failure caused by pulmonary hypertension.

What is a patent ductus arteriosus?

A normal channel between the pulmonary artery and the aorta that remains open during intrauterine life and is not an opening or a stricture in the atria.

Which electrolyte restriction is recommended in the management of high blood pressure?

Sodium.

What is stable angina?

Stable angina is a condition that occurs when there is a lack of oxygen in the heart muscle.