Cardiovascular Health and Hypertension Quiz

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Questions and Answers

What is the role of nitric oxide in the cardiovascular system?

It acts as a potent vasodilator produced in the endothelium. (correct)

It inhibits the formation of endothelial adhesion molecules.

It acts as a potent vasoconstrictor.

It is synthesized in the liver to increase blood pressure.

Increased synthesis of which substance is associated with essential hypertension?

Bradykinin

Angiotensin II (correct)

Prostacyclin

Nitric oxide

How does a high sodium diet correlate with hypertension?

It reduces peripheral vascular resistance.

It decreases intracellular calcium concentration.

It enhances nitric oxide synthesis.

It is linked to increased stroke prevalence. (correct)

What effect does a deficiency in dietary calcium have on blood pressure?

It increases intracellular calcium concentration. Signup and view all the answers

What complications can arise from endothelial dysfunction?

Increased clot formation and adhesion molecules. Signup and view all the answers

What is the primary nondrug approach for preventing CAD events?

Lifestyle modifications Signup and view all the answers

Which of the following lifestyle changes is recommended for CAD prevention?

Smoking cessation Signup and view all the answers

Which treatment method involves the insertion of a catheter with a balloon to treat blocked coronary arteries?

Percutaneous coronary intervention (PCI) Signup and view all the answers

What type of stroke accounts for 87% of all strokes and is primarily due to thrombus or emboli?

Ischemic stroke Signup and view all the answers

What is the primary pharmacologic therapy option for treating prinzmetal angina?

Calcium channel blockers Signup and view all the answers

What is the presumed cause of a stroke that lasts at least 24 hours?

Vascular origin Signup and view all the answers

What is one potential cause of ischemic stroke related to plaque buildup in arteries?

Cerebral atherosclerosis Signup and view all the answers

Which intervention is recommended for psychological support in patients at risk for CAD?

Screening and treatment for depression Signup and view all the answers

What is the primary characteristic of stable angina episodes?

Pain is associated with exertion or increased myocardial oxygen demand Signup and view all the answers

Which group shows the highest prevalence of angina between the ages of 45-64?

African-American women Signup and view all the answers

What is a common symptom that may accompany ischemic episodes in patients with stable angina?

Diaphoresis Signup and view all the answers

What is a common cause of subdural hematomas?

Trauma Signup and view all the answers

Which symptom is typically associated with hemorrhagic stroke?

Headache Signup and view all the answers

What kind of diagnostic test is most specific for diagnosing stable angina?

Coronary angiography and cardiac catheterization Signup and view all the answers

In older patients, what atypical symptom might indicate stable angina?

Midepigastric discomfort and excessive fatigue Signup and view all the answers

In which patient population should antiphospholipid antibodies be assessed more routinely?

Patients younger than 50 with recurrent thrombotic events Signup and view all the answers

Which imaging technique is best utilized for a definitive diagnosis of a stroke?

Magnetic resonance imaging (MRI) Signup and view all the answers

In women, which symptom is less likely to be a classic presentation of stable angina?

Episodic leg swelling Signup and view all the answers

What is a potential surgical intervention for subarachnoid hemorrhage (SAH)?

Clipping or ablating vascular abnormalities Signup and view all the answers

What is the typical duration of chest pain during stable angina episodes?

5 to 20 minutes Signup and view all the answers

Which test is NOT primarily used in the evaluation of strokes?

Complete blood count (CBC) Signup and view all the answers

What demographic factor significantly increases the risk of stable angina?

A family history of atherosclerotic disease Signup and view all the answers

Which statement about acute ischemic stroke is correct regarding treatment?

Surgical decompression may reduce intracranial pressure Signup and view all the answers

What defines hemorrhagic stroke in contrast to ischemic stroke?

Rupture of a blood vessel Signup and view all the answers

Which of the following is a common cardiovascular risk factor for hypertension?

Increasing age Signup and view all the answers

What is the target blood pressure goal for most patients with hypertension?

140/90 mmHg Signup and view all the answers

Which laboratory test is an indicator of kidney damage in patients with hypertension?

BUN Signup and view all the answers

What is an important non-pharmacologic treatment for managing hypertension?

Maintaining a normal body weight Signup and view all the answers

Which of the following can result from target organ damage due to hypertension?

Heart failure Signup and view all the answers

What dietary modification is recommended for patients with hypertension?

Reduce dietary sodium intake Signup and view all the answers

Which of the following chronic conditions can lower the target blood pressure goal in hypertensive patients?

Diabetes Mellitus Signup and view all the answers

Microalbuminuria is associated with which risk factor for hypertension?

Smoking Signup and view all the answers

What is the clinical significance of the difference between systolic and diastolic blood pressure?

It is known as pulse pressure. Signup and view all the answers

During which part of the cardiac cycle is systolic blood pressure achieved?

During cardiac contraction. Signup and view all the answers

Which component primarily regulates the release of renin?

Afferent arterioles of the kidney. Signup and view all the answers

What effect does angiotensin II have on blood pressure?

It is a strong vasoconstrictor. Signup and view all the answers

What is one of the main roles of baroreceptors in blood pressure regulation?

To maintain homeostasis through sympathetic activity. Signup and view all the answers

Which adrenal response is recognized to be stimulated by angiotensin II?

Increase in aldosterone secretion. Signup and view all the answers

Where do the juxtaglomerular cells primarily obtain their sensory feedback for renin release?

From decreased renal artery pressure and blood flow. Signup and view all the answers

How do catecholamines influence the renin-angiotensin-aldosterone system?

They increase renin release. Signup and view all the answers

What do presynaptic alpha-2 receptors do in adrenergic regulation?

They exert negative feedback on norepinephrine release. Signup and view all the answers

What primarily causes an increase in blood pressure when renal blood flow decreases?

Increased retention of sodium and water. Signup and view all the answers

What role does the vascular endothelium play in blood pressure regulation?

It regulates blood vessel tone. Signup and view all the answers

Which statement is correct regarding the duration of the cardiac cycle?

Diastole lasts for two-thirds of the cardiac cycle. Signup and view all the answers

Study Notes

Cardiovascular Disorders: Coronary Heart Disease

Ischemia is defined as a lack of oxygen and diminished or absent blood flow to the myocardium, stemming from artery narrowing or blockage.

Coronary Heart Disease (CHD)

Coronary heart (artery) disease leads to chest pain, heart attack, and heart failure.
Peripheral arterial disease (PAD) leads to pain, numbness, infection, gangrene, and potential amputation.

Coronary Artery with Atherosclerosis

Atherosclerosis is associated with decreased blood flow and plaque buildup in the coronary arteries.
Coronary arteries are located on the surface of the heart.

Pathophysiology

Myocardial oxygen consumption (MVO2) is primarily determined by heart rate, myocardial contractility, and wall tension.
Conditions like atherosclerosis, coronary spasm, or left ventricular hypertrophy can reduce oxygen supply, potentially leading to ischemia.
Factors like increased oxygen demand and reduced supply due to atherosclerosis can contribute to ischemia.

Thrombosis and Embolism

Thrombosis involves blood clot formation within a blood vessel.
Embolism involves a blood clot, air bubble, or other substance traveling in the bloodstream and lodging in a blood vessel.

Myocardial Ischemia

Myocardial ischemia occurs when coronary blood flow is insufficient to meet the myocardial oxygen demand.
Myocardial ischemia can result from decreased compensation for oxygen demand; from myocardial shifting from aerobic to anaerobic metabolism; and from progressive impairment of metabolic, mechanical, and electrical function.

Atherosclerosis

Atherosclerosis is a common cause of epicardial coronary artery stenosis (narrowing).
Patients with fixed coronary atherosclerotic lesions exceeding 50% can display myocardial ischemia during increased myocardial metabolic demands due to decreased coronary flow reserve (CFR).
90% of fixed atherosclerotic lesions may show limited to no CFR.
Patients with severe atherosclerosis may experience angina at rest.

Stable Angina

Stable angina is characterized by episodic chest pain associated with exertion or increased myocardial oxygen demand.
Pain often described as crushing or squeezing, radiating to the left arm or jaw.
Pain is typically relieved by rest.

Risk Factors for Coronary Heart Disease (CHD)

CHD is more prevalent in women.
Prevalence generally increases with age.
The highest prevalence for ages 45-64 is found in African-American women.
- Highest prevalence for ages 65-74 is found in African-American men.

Clinical Presentation

Chest pain precipitated by exertion or daily activities, often described as squeezing, crushing, heaviness, or tightness.
Chest discomfort may be characterized tightness, numbness, or burning.
Ischemic symptoms may accompany diaphoresis, nausea, vomiting, and dyspnea.
Women or older patients may show atypical symptoms including epigastric discomfort, exertion intolerance, dyspnea, and excessive fatigue.
Hypoglycemia can sometimes cause symptoms similar to those presented in cardiac patients.

Diagnostic Tests

Medical history evaluation is essential to understand the quality, severity, precipitating factors, location, duration, radiation patterns, and response to treatment (e.g., nitroglycerin) of chest pain.
Assess nonmodifiable risk factors for coronary artery disease (CAD) : age, sex, and family history of premature atherosclerosis in first-degree relatives (male onset before age 55 or female before age 65).
Patients with acute ischemic episodes sometimes experience tachycardia, diaphoresis, shortness of breath, nausea, vomiting, and lightheadedness.

Nonpharmacological Therapy

Risk factor modification is crucial for primary and secondary prevention of CAD events.
Lifestyle modifications include daily physical activity, weight management, dietary therapy (reduced saturated/trans-fatty acids and cholesterol), smoking cessation, and psychological interventions (screening/treatment for depression if appropriate), controlling alcohol intake, avoiding air pollution.
Surgical revascularization options for select patients include coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with or without stent placement.

Percutaneous Transluminal Coronary Angioplasty (PTCA)

PTCA is a treatment for patients with obstructed blood flow through the coronary arteries.
A flexible catheter is inserted into the femoral artery, enabling the catheter to be guided to the site of obstruction with a balloon at its tip, enabling the physician to open up the artery.
X-rays are often used to help guide the physician.

Coronary Artery Bypass Graft (CABG)

Surgical procedures involving the coronary arteries to bypass obstructed segments.
Procedures may involve single, double, triple, or quadruple bypass grafts.

Pharmacologic Therapy (Prinzmetal's Angina)

Nitroglycerin and calcium channel blockers are used to prevent coronary spasms.
Amlodipine is sometimes a preferable choice for certain patients given its longer half-life.

Neurovascular Disorders: Stroke

A stroke is an abrupt onset of focal neurologic deficit lasting at least 24 hours, presumed to have a vascular origin.

Ischemic Stroke

Ischemic strokes (87% of all strokes) are caused by local thrombus formation or emboli that occlude cerebral arteries.
Cerebral atherosclerosis is a common cause of ischemic stroke.
Emboli may originate from intra- or extracranial arteries.

Hemorrhagic Stroke

Hemorrhagic strokes (13% of all strokes) encompass subarachnoid hemorrhage (SAH), intracerebral hemorrhage, and subdural hematomas.
SAH can result from trauma or rupture of an intracranial aneurysm or arteriovenous malformation (AVM).
Intracerebral hemorrhage involves blood vessel rupture within the brain, resulting in hematoma formation.
Subdural hematomas frequently stem from trauma.

Clinical Presentation (Stroke)

Stroke symptoms include unilateral weakness, inability to speak, loss of vision, vertigo, and falling.
Ischemic strokes are generally painless, whereas hemorrhagic strokes may result in headaches.

FAST Stroke Assessment

The FAST acronym helps rapidly assess stroke:
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call emergency services

Stroke Diagnosis

Protein C, protein S, and antithrombin III are best measured during steady states, not during acute stages.
Antiphospholipid antibodies may be useful for diagnosis in younger patients (<50 years) with multiple venous or arterial thrombotic events or livedo reticularis.
Diagnostic tests include CT, MRI, Carotid Doppler, ECG, transthoracic echocardiogram (TTE), transcranial Doppler (TCD).

Nonpharmacological Therapy (Stroke)

Acute ischemic stroke may require surgical decompression to reduce intracranial pressure.
Early rehabilitation by an interprofessional team reduces long-term disability.
Carotid endarterectomy and stenting may reduce stroke recurrence in appropriate patients.

Pharmacologic Therapy (Ischemic Stroke)

Alteplase (t-PA) initiated within 4.5 hours of stroke symptom onset can potentially reduce disability.
Aspirin (160-325 mg/day) administered between 24 and 48 hours post-alteplase may further reduce long-term death and disability.
Cilostazol (used as a first-line agent, but data limitations exist).
Oral anticoagulation for atrial fibrillation or presumed cardiac sources of embolism.
Statins may reduce stroke risk in patients with coronary artery disease and elevated plasma lipids by approximately 30%.
Low-molecular-weight or low-dose subcutaneous unfractionated heparin may prevent deep vein thrombosis, especially in hospitalized patients with diminished mobility due to stroke.

Pharmacologic Therapy (Hemorrhagic Stroke)

There are no standard pharmacological treatments for intracerebral hemorrhage.
Nimodipine (60 mg every 4 hours for 21 days) combined with maintenance of intravascular volume and pressor therapy can help reduce the incidence and severity of neurologic deficits due to delayed ischemia in patients with SAH (subarachnoid hemorrhage) stemming from aneurysm rupture.

Cardiovascular Disorder: Hypertension

Hypertension is persistently elevated arterial blood pressure.
It is a significant risk factor for cardiovascular disease.
The Joint National Committee (JNC7) and the American Heart Association (AHA) are pivotal evidence-based guidelines for hypertension management in the United States.

JNC 7 Blood Pressure Classification

Categorizes blood pressure levels in adults (aged ≥18 years) into categories: normal, prehypertension, stage 1 hypertension, and stage 2 hypertension, using systolic blood pressure (SBP) and diastolic blood pressure (DBP) values.

Epidemiology (Hypertension)

Approximately 31% of the population has hypertension.
Before age 45, more men than women may have hypertension.
After age 55, more women than men often have hypertension.
In the United States, more Black individuals may have a higher prevalence of hypertension.
Factors such as obesity, stress, smoking, physical inactivity, dietary sodium consumption, ethnicity, and family history have a role in the development of hypertension and cardiovascular disease risk.

Etiology (Hypertension)

Essential Hypertension: Unknown pathophysiology, but it can be controlled.
Secondary Hypertension: Specific cause of hypertension exists; this must be identified.

Secondary Hypertension causes

Chronic kidney disease, Cushing's syndrome, pheochromocytoma, parathyroid disease, and thyroid disorders.
Medications such as adrenal steroids, amphetamines, decongestants, erythropoietin, and NSAIDs.
Street drugs including cocaine, ephedra, nicotine, ergotamine, and anabolic steroids.
Dietary sources including sodium, ethanol, licorice, and tyramine-containing foods.

Regulation of Blood Pressure

Dependent on peripheral vascular resistance, which is mostly controlled at the level of the arterioles by neural and hormonal inputs .
Cardiac output is also significant and influenced by sodium concentration.
Resistance vessels exhibit autoregulation; increased blood flow triggers vasoconstriction to maintain tissue perfusion. (e.g. Angiotensin II and catecholamines)

Vascular Changes

Functional vasoconstriction may lead to permanent vascular thickening.
Changes in the vascular wall structure can result in increased resistance.

Genetic Factors

Genetic variance in the renin–angiotensin–aldosterone system (RAAS) contributes to racial differences in blood pressure regulation.

Environmental Factors

Stress, obesity, smoking, physical inactivity, and dietary sodium consumption, among other environmental factors contributing to hypertension

Arterial Blood Pressure

Arterial blood pressure is the force exerted on arterial walls.
Two measurements commonly used are systolic and diastolic.
- Systolic blood pressure (SBP): Pressure peak during heart contraction.
- Diastolic blood pressure (DBP): Pressure during heart relaxation/filling.
- The difference between SBP and DBP is the pulse pressure.

Mechanisms of Hypertension

Renin-Angiotensin-Aldosterone System (RAAS)
Neurohormonal regulation; including Central Nervous System (CNS)/Autonomic Nervous System (ANS), and factors such as adrenergic receptors (postsynaptic A1, B1, B2), baroreceptor reflex system, and peripheral autoregulatory components.
Vascular Endothelial Mechanisms, and Electrolytes.

Renin-Angiotensin-Aldosterone System (RAAS)

Stored in Juxtaglomerular cells, located in the afferent arterioles in the kidney.
Release is controlled by intrarenal/extrarenal factors.
Juxtaglomerular cells are baroreceptors that sense decreased renal artery pressure and kidney blood flow.
The signaling pathway starts with renin, which converts angiotensinogen to angiotensin I.
Angiotensin I is converted to angiotensin II by angiotensin-converting enzyme (ACE).
Angiotensin II raises arterial blood pressure.
Angiotensin II increases sodium and water retention, which increases blood volume.

Neurohormonal Regulation

CNS/ANS control sympathetic activity.
- Pre-synaptic a-receptors (a2) affect NE release
- Pre-synaptic b-receptors affect NE release.
- Adrenergic Receptors (postsynaptic A1, B1, B2)

Baroreceptor Reflex System

A major negative feedback mechanism that controls sympathetic activity.
Located in larger arteries (carotid, aortic).
- Decrease in BP stimulates baroreceptors and triggers vasoconstriction to increase HR and force of contraction.

Peripheral Autoregulatory Components

Maintains blood pressure via pressure-volume adaptation.
Responds to decreased BP by increasing sodium and water reabsorption, thus raising blood volume.
Local arteriolar constriction/vasodilation occurs in response to tissue oxygen demands.

Vascular Endothelial Mechanisms

Vascular endothelium and smooth muscle regulate blood vessel tone and blood pressure via vasoactive substances.
Renal endothelium produces ACE.
Imbalances in vasodilating/vasoconstricting substance levels can contribute to hypertension and other cardiovascular issues (e.g., excess angiotensin II and endothelin-1).
Nitric oxide, a potent vasodilator, is produced by endothelial cells.

Electrolytes

Epidemiological and clinical data indicates elevated sodium intake associated with hypertension.
Conversely, lower sodium intake is linked to a lower prevalence of hypertension.
Calcium levels may correlate with blood pressure.

Clinical Presentation of Hypertension

Patients can physically appear healthy.
Factors such as age, diabetes mellitus, dyslipidemia (elevated LDL), microalbuminuria, family history of premature cardiovascular disease, obesity (high BMI), physical inactivity, and tobacco use may also be present.

Laboratory Tests (Hypertension)

BUN (blood urea nitrogen) serves as a kidney damage indicator.
Fasting lipid panel
Fasting blood glucose
Serum electrolytes
Spot urine albumin-to-creatinine ratio

Clinical Presentation - Target Organ Damage

Stroke, transient ischemic attack, retinopathy, left ventricular hypertrophy (LVH), angina, prior myocardial infarction (MI), prior revascularization, heart failure (HF), chronic kidney disease (CKD), and peripheral arterial disease.

Goal of Therapy (Hypertension)

Reduce morbidity and mortality associated with hypertension.
Achieve a target blood pressure less than 140/90 mmHg, often lower for those with diabetes mellitus or chronic kidney disease.

Non-Pharmacological Treatment (Hypertension)

Maintain normal body weight (BMI 18.5–24.9 kg/m²).
Consume fruits, vegetables, low-fat dairy with reduced saturated and total fat.
Reduce daily dietary sodium intake (ideally to 65 mmol/day).
Regular aerobic physical activity.
Limit alcohol consumption.

Proper Blood Pressure Measurement

No smoking, coffee, or tea 30 minutes prior.
Comfortable seated position, without crossed legs.
Arm placed at heart level, cuff 1 inch above elbow.
No talking.
Two measurements, 5 minutes apart, to obtain average value.

Drug Treatments (Hypertension)

Primary antihypertensive agents (first-line): diuretics, ACE inhibitors, ARBs, and CCBs.
Consideration for patients with additional conditions, such as left ventricular dysfunction or systolic heart failure, post-myocardial infarction, or coronary artery disease.
For chronic kidney disease, ACE inhibitors or ARBS are often beneficial due to their effect on intraglomerular pressure.
For patients with diabetes, the goal BP should be less than 130/80 mmHg; ACEIs or ARBs are commonly chosen in these cases.
Non-selective beta-blockers may mask some signs of hypoglycemia in patients with diabetes..
The use of thiazides for these cases may also be indicated.

Clinical Monitoring (Hypertension)

Evaluate BP response within 2-4 weeks of initiating or modifying therapy.
If stable BP reached, then monitoring frequency is usually every 3-6 months.
Monitor for signs and symptoms of progressive target organ damage, such as chest pain, palpitations, dizziness, dyspnea, orthopnea, HA, sudden changes in vision, one-sided weakness, slurred speech, and loss of balance.

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Description

Test your knowledge on the role of nitric oxide, dietary influences, and prevention strategies related to cardiovascular health and hypertension. This quiz also covers treatment methods for coronary artery disease and the types of strokes, emphasizing the importance of lifestyle changes and pharmacologic therapies.