Hypertension Overview Quiz

Hypertension

• Primary hypertension is the most common type
• Idiopathic; no direct cause
• Rare in patients under 10
• Three subtypes:
  • Isolated systolic hypertension: High systolic, stable diastolic
  • Isolated diastolic hypertension: High diastolic, stable systolic
  • Combined systolic and diastolic hypertension: Elevated both systolic and diastolic
• Risk factors:
  • Nonmodifiable: Age, family history
  • Modifiable: Diet, sedentary lifestyle, obesity, metabolic syndrome
• End-organ damage in: Heart (failure), kidneys (failure), eyes (microcirculation damage), brain (hemorrhage)

Secondary Hypertension

• Identifiable condition causing hypertension
• Most common in children under 10 with specific conditions
• Associated with: Renal disease, coarctation of the aorta, pregnancy, obesity, sleep apnea

Hypertensive Urgency vs. Emergency

• Hypertensive urgency: Least severe, sudden increase in BP without end-organ damage. Controlled over 24-48 hrs with medication
• Hypertensive emergency: Severe, sudden increase in BP with end-organ damage. Requires ICU care

End-Organ Damage

• Impairment or damage of major organs due to hypertension
• Examples in:
  • Vascular system (endothelial dysfunction, atherosclerosis, arteriosclerotic stenosis, aortic aneurysm)
  • Brain (stroke, hemorrhage)
  • Heart (left ventricular hypertrophy, chronic heart failure, myocardial infarction)
  • Kidneys (albuminuria, proteinuria, chronic renal insufficiency)

Modifiable Risk Factors

• Poor diet high in fat (increases LDL, atherosclerosis)
• Sedentary lifestyle (weakens vasculature, heart)
• Obesity (contributes to hypertension)
• Metabolic syndrome

Blood Pressure Classification

• Normal: <120/<80 mmHg
• Prehypertension: 120-139/80-89 mmHg
• Stage 1 Hypertension: 140-159/90-99 mmHg
• Stage 2 Hypertension: >160/>100 mmHg

Sodium and Hypertension

• RAAS (renin-angiotensin-aldosterone system) initiated with low BP.
• Sodium retention leads to increased water retention, increased blood volume, and increased blood pressure.
• High sodium intake associated with chronic elevation of blood pressure.

ACE Inhibitors

• Inhibit RAAS, reducing blood volume and blood pressure
• Angiotensin I converted to Angiotensin II is prevented. This prevents vasodilation and release of aldosterone

Orthostatic Hypotension Complications

• 20 mmHg drop in blood pressure within 3 minutes.

Hypotension - Causes

• Vasomotor or baroreceptor response issues
• Drug therapy adverse effects
• Arterial stiffness
• Blood volume depletion

Pulmonary Stenosis

• Abnormal fusion of the pulmonary valve cusps.
• Right ventricular hypertrophy occurs

Correlation of LDL and Coronary Artery Disease

• High LDL is not easily broken down and stays in blood for longer
• LDL may damage epithelial cells (inflammation, immune response).
• This leads to endothelial cell and macrophage activity. (Foam cells and thrombus formation).

Stable Angina vs Unstable Angina

• Stable: Predictable chest pain relieved by rest. Usually due to chronic occlusion by atherosclerosis.
• Unstable: Unpredictable, unrelated to exertion. Often due to vasospasm

Complications of Acute Coronary Syndrome

• STEMI (ST-elevation myocardial infarction), identified by ECG.
• NSTEMI (non-ST-elevation myocardial infarction), not clearly shown on an ECG, but can lead to myocardial infarction
• Complications: Heart failure, myocardial infarction, acute kidney failure

Inverted T Waves

• Possible indicator of ischemic myocardial damage.

Rheumatic Heart Disease

• Acute inflammatory disease, typically from beta-hemolytic streptococci.
• Affects connective tissue in joints, heart, and skin.

Congenital Heart Defects

• Atrial Septal Defect (ASD): Opening between atria
• Ventricular Septal Defect (VSD): Opening between ventricles
• Patent Ductus Arteriosus (PDA): Failure of ductus arteriosus closure
• Coarctation of the aorta: Narrowing of the aorta

Left-Sided vs. Right-Sided Heart Failure

• Left-sided: Systemic effects
• Right-sided: Systemic effects

Paroxysmal Nocturnal Dyspnea (PND)

• Difficulty breathing during sleep

Arrhythmias

• Abnormal heart rhythms that interfere with cardiac output
• Possible symptoms: Fatigue, dizziness, lightheadedness

Cardiogenic Shock

• Reduced cardiac output from left ventricular dysfunction

Obstructive Shock

• Reduced cardiac output by physical obstruction.
• Examples: Pulmonary embolus, cardiac tamponade

Distributive Shock (e.g., Anaphylactic Shock)

• Shock with excessive vasodilation and reduced blood pressure.
• Causes: Inflammatory or allergic responses.
• Symptoms: Severe vasodilation, reduced cardiac output.

Sepsis/Septic Shock

• Body's response to severe infection.
• Clotting cascade, complement system, kinin system are triggered.
• Significant vasodilation, hypotension, blood flow maldistribution, cellular hypoxia, edema.