Term
| How are africnas and women unique in hypertension stats? |
|
Definition
| Blacks higher prevalence with low plasma rennin and greater response to diuretics, women pass men post menopause in prevalence |
|
|
Term
| If age < __, main hemodynamic fault is vasoconstriction at the level of the resistance arterioles.. > __, isolated systolic htn. CV risk increases with increasing systolic pressure but inversely related to diastolic pressure. |
|
Definition
|
|
Term
| Is there a genetic component to HTN? If so, what is the gene? |
|
Definition
| Yes, M235T links the angiotensiongen gene |
|
|
Term
| People think the decersed salt excretion in bad kidneys causes primary htn. But 3 things can control htn RAAS, SNS, and insulin resistance. How? |
|
Definition
| RAAS is high due to SNS vascular tone decreasing GFR, SNS induces contractility and hypertrophy, and insulin has pressor and SNS effect as well as Na reabsorption |
|
|
Term
| The molecular mechanism of which HTN syndrome is due to loss of PPPXY signal not attaching to a clarthin coated pit and prolonging sodium channel retention? |
|
Definition
|
|
Term
| What is the main cause of death in patients with HTN? |
|
Definition
|
|
Term
| What is the downstream effect of limiting NaHCO3 with acetzolemide? |
|
Definition
| Limited potency because of Na retention distally and increased K excretion inducing hypokalemia |
|
|
Term
| How long is the maximum effect for net salt loss take with diuretics? |
|
Definition
| 1 week since there are SNS, RAAS, and other counter mechanisms |
|
|
Term
| What are the effects of loop diuretics on calcium, K, and urine tonicity? |
|
Definition
| Increases Ca excretion, distal Na delivery induces hypokalemia, prevents medulla tonicity and thus water retention and can cause volume depletion which can be dangerous if used in conjuction with ACEI or ARB |
|
|
Term
| How does hypokalemia affect insulin? |
|
Definition
| Reduces islet cell insulin secretion inducing hyperglycemia |
|
|
Term
| Since thiazides work in cortical segments meduallry tonicity Is preserved, so what does this water reabsorptin help treat? |
|
Definition
|
|
Term
| Name the molecule with this function - stims NO and prostaglandin formation, ups vasc permeability, inhibits Na and H2O absorb, nociception, decomposed by ACE. |
|
Definition
|
|
Term
| When using aldosterone antags what are two major concerns? |
|
Definition
| Patients with hyperkalemia and renal insufficiency |
|
|
Term
| Angiotensin 2 has two receoptrs with diff effects. Which category is which receptor -1. hypertrophy, thrombosis, fibrosis, vascon, aldosterone release, vasopressin; 2. antiproliferation, antifibrosis, apop, vasodilation. |
|
Definition
|
|
Term
| Describe the kininogen-kallikrein system. |
|
Definition
| Kiniogen is converted to lysl-bradykinin via kallikrein, aminopeptidase converts to bradykinin, ACE converts to inactive peptides |
|
|
Term
| THE main adverse effects of ACEis are hypotension, hyperkalemia, creatinine up, cough, angioedema, so what are contraindications? |
|
Definition
| Hyperkalemia, preggers, hypotension |
|
|
Term
| What are the indications for ARBs? |
|
Definition
| Same as ACEI, watch out for angioedema and hyperkalemia especially |
|
|
Term
| What is biggest contribution to cardiovascular disease other than CHD? |
|
Definition
|
|
Term
| What aree some complications fo LVH? |
|
Definition
| CHF due to sys/diastolic dysfunction, arrtyhmias via a. fib (cause stroke) and PVCs and v. tach |
|
|
Term
| In physiological cardiac hypertrophy increases SV and CO, but what happens to EDV and ESV? |
|
Definition
| Edv increases due to size but ESV remains unchanged because it can pump the blood out because it has both dilation and concentric thickening |
|
|
Term
| Name this myocardial hypertrophy type - AD mutation in beta myosin heavy chain or dystrophin complex (duchennes MD), hypertrophied and non-dilated LV, most common cause of sudden cardiac death in athletes, asymmetrically enlarged septum and cellular disarray, symptoms of dyspnea, angina, fatigue, arrythmias. |
|
Definition
| Familial hypertrophic cardiomyopathy which is tx with beta-blcokers and avoiding athletics |
|
|
Term
| Pathologically hypertrophies cardiac myocytes are just big but dysfunctional. What happens to beta-mysoin heavy chains, troponin 2, l-type ca channels, b1 receptors and apop signaling? |
|
Definition
| Down alpha MHC and up beta MHC drops contractile strength, up troponins make cross-bridge formation more difficult, downs L-type Ca channels and downs SR Ca uptake during relaxtion, downs b1 receptors and cell cAMP levels, and induces apop and fibrosis. |
|
|
Term
| Which of the following are either right, left HF, or low CO - 1. fatigue, reduced exercise; 2. ankle edema, ab pain and swelling, nausea, 3. dyspnea, orthopnea, hemoptysis. |
|
Definition
| 1. low CO, 2. right HF, 3. left HF |
|
|
Term
| Which types of cardiomyopathy result in systolic dysfunction or diastolic? |
|
Definition
| Dilated cardiomyopathy is systolic, hypertrophic and restrictive are diastolic |
|
|
Term
| B-type natrueitc peptide (BNP) causes natruiesis and inhibits RAAS, where is it found and when is it released? |
|
Definition
| Ventricles primarily due to wall stretch and LVEDP, indicates CHF |
|
|
Term
| All positive inotropes (sympathomimetics, phosphodiesterase inhibs) increase mortality except ____________ |
|
Definition
|
|
Term
| Etiologies of what type of cardiomyopathy include alcohol, beriberi, cox B virus myocarditis, chronic cocaine use, chagas disease, doxorubicin tox, preipartum cardiomypoathy. |
|
Definition
|
|
Term
| Which of the following are proven HF therapies to reduce mortality and symptoms - ACEi/ARB, b-blacokers, Aldos antags, nitrates/hydralazine, AICD devices. |
|
Definition
| All; digoxin and diuretics just improve symptoms |
|
|
Term
| Name some venous, arterial, and mixed vasodilators. |
|
Definition
| Nitrates are venous, nitroprusside, Ca antags, a-blockers, ACEi are mixed, minoxidil and hydralazine are arterial |
|
|
Term
| What are 3 possible effects of long term aldos secretion? |
|
Definition
| Edema, arrythmias due to K/Mg excretion, collagen depo and fibrosis in myo and vessels |
|
|
Term
| Calcium channel blockers work on L-type channels cause vasdilation and compensatory sympathic discharge. Adverse effects include cardiac depression, flushing, headaches, constipation. Name all 3 types. |
|
Definition
| Nifedipine, dilitiazem, and verapimil in the order of vessel efficacy. Reverse for cardiac efficacy |
|
|
Term
| B-adrenergic stim is primary stimluls for rennin secretion from JG cells. B-blockers are great for HTN and up prostacyclins and baroreceptor sensitivity. What are the indications for using a selective B1 blocker like metaprolol/atenolol versus propanolol. |
|
Definition
| B1 should be used in airway disease/COPD, depressed/CNS patients because propanolol is non-selective and lipophilic causing bronchospasm and CNS effects; note beta blockers can induce SA/AV nodal blocks |
|
|
Term
| Low dose _________ have little effect on cholesterol and triglycerides. Alpha-Blockers decrease LDL/HDL ratio. Calcium-channel blockers, ACE inhibitors, angiotensin II receptor blockers have little effect on lipid profile. |
|
Definition
|
|
Term
| If taken before pregnancy, most antihypertensives can be continued except ______ and ________. |
|
Definition
| ACEi and ARBs; Methyldopa is most widely used when hypertension is detected during pregnancy. |
|
|
Term
| What is the bodys reaction to arteriolar vasodilators like hydralazine and a1 blokcers like prazosin? |
|
Definition
| Reflexive SNS activation, which may calm over time; but a2 blockers like clonidine block SNS at the brainstem |
|
|
Term
| ACE inhibitors, alpha-antagonists, and calcium antagonists can be effective, and have few adverse effects on carbohydrate metabolism. Which is important in which patient pop? |
|
Definition
|
|
Term
| ANCA is the antineutrophil cytoplasmic antigen test that ids neutrophil rupture that releases inflammatory proteolytic enzymes. What does c-ANCA and p-ANCA test for? |
|
Definition
| C-ANCA is seen internally and tests for PR3 (proteinase3) and P-ANCA test myeloperoxidase seen in periphery of cell in IF |
|
|
Term
| Name this type of arteritis - known as pulseless disease, granulomatous thickening of aortic arch and vessels, asian females under 40, histo shows invasion of subcutaneous fat, symptoms of fever, myalgia, skin nodules, ocular probs, weak upper extremeties pulse. |
|
Definition
|
|
Term
| Name this type of arteritis - granulomatous infection of aorta and major branches with predilection for carotid branch called temporal artery, females over 50 and associated with polymyalgia rheumatica, causes unilateral headache and impaired vision with cotton wool exudates. |
|
Definition
| Giant cell temporal arteritis |
|
|
Term
| Name this type of ANCA positive vasculitis- involves upper airways, destroys sinues, inflames orbits, characteristic cavitating pulmonary nodules, no immune complex desposits on IF (pauci-immune). |
|
Definition
|
|
Term
| Name this vasculitis - IgM/IgG or IgG/IgG polymers that precipitate in the cold causing inflammation in vessel, associated with Hep B or C, digital gangrene, on histo of kidney pink pseudothrombi are seen, IF shows IgG corresponding to pseudothrombi in glomer. |
|
Definition
| Cryoglobulinemia vasculitis |
|
|
Term
| What are the most common causes of small vessel vasculitis - allergic purpura due to drug rxn, rheumativ disease, or Henoch-Schonlein purpura? |
|
Definition
|
|
Term
| Name this type of prupura - most common in children, IgA IC mediated, GI bleeding, renal disease, spontaneous remission, palpable purpura on buttocks and thighs. |
|
Definition
|
|
Term
| In diagnosing vasculitis, what tests do you use for IC deposition, necrotizing vascultieis without IC, suggestive systemic inflammation? |
|
Definition
| Rheumatoid factor, cryoglobs, ANA, low complement; ANCA; ESR or CRP |
|
|
Term
| Name this vasculitis - small vessels, hypersensitivity immune response to toxins, leukocytoclasis (PMN nuclear dust fragments), fibrinoid degen, cellular infiltrate of PMNs, hemorrhagic lesions. |
|
Definition
| Leukocytoclastic vasculitis |
|
|
Term
| T or f: retinal abnormalities are associated with stroke. |
|
Definition
|
|
Term
| What was the outcome of the HOPE trial that looked for endpoints of MI, stroke, CVD, nephropathy? |
|
Definition
|
|
Term
| What is the S3 sound indicate? |
|
Definition
| Rapid filling during diastole, non-pathological as an isolated finding in young adults |
|
|
Term
| Which of the following is NOT safe for preggers - nitroprusside, labetalol, nitroglyceine, hydralazine? |
|
Definition
| Nitroprusside, which can induce cyanide toxicity |
|
|
Term
| What are the two most common causes of 2nd HTN? |
|
Definition
| Chonic renal disease, renal vascular disease |
|
|
Term
| Why are ACEi bad for bilateral renal artery stenosis even if they are the cause of HTN? |
|
Definition
| ACEi decrease GFR drastically, underperfusing kidneys |
|
|
Term
| Neseirtide is IV BNP. BNP is released by ventricles from stretch. Amound of BNP is serum correlates to _________, not symptoms. Values of BNP are worthless in patients with __________ ___________ because cleared through kidney only. |
|
Definition
| PCWP, renal insufficiency |
|
|
Term
| What is afflicting a patient with Hypertension, Hypokalemia, Hypernatremia, Alkalosis, Low rennin? |
|
Definition
|
|
