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Hypertension (and ECG review)
Terms in this set (17)
What are the cutoffs for different blood pressures?
: >= 160/100
What are the different classifications of hypertension?
(primary; 90%) vs.
These can then be broken into chronic or hypertensive crisis (urgency vs. emergency)
What are 6 etiologic factors in essential htn?
Increased sympathetic tone
2. Genetic abnormalities in Na+ metabolism
Excessive Na+ intake
4. Increased stiffness of aorta and large vessels in young and senior adults
5. Endothelial dysfunction (decreased NO production)
6. Arteriolar wall inflammation
What are the two major types of pathology that htn can cause? (give an example of each)
: hyaline arteriosclerosis (in the eye you can have hypertensive retinopathy and can see AV nicking)
a. Heart: LV hypertrophy and heart failure
b. Kidneys: Hypertensive nephrosclerosis
c. Brain: stroke, multiinfarct dementia, Binzwanger disease (subcortical leukoencephalopathy)
What is the pathogenic process of hyaline arteriosclerosis? (picture)
BP elevation --> hemodynamic stress --> endothelial injury --> increased permeability --> transudation and accumulation of plasma proteins in arteriolar wall -->
Hallmark of benign hypertension
(and seen in normotensive diabetics)
What defines LV hypertrophy?
F >250gm and M>300gm
Increased LV wall >1.5cm
Boxcar nuclei will be present and interstitial fibrosis will be in later stages
What is the renal pathology caused by hypertension called and what can it result in?
Hypertensive (benign) nephrosclerosis
Will see glomerular hyaline arteriosclerosis and atrophy (from lack of blood flow) and in advanced stage will have
small kidneys with granular surface
Clinical features: Proteinuria--> chronic renal failure
What defines hypertensive emergency and what can be seen on fundoscopy?
Sudden rise in BP >180/120 and acute end-organ damage
Moderate retinopathy will show retinal hemorrhages, exudates, and cotton wool spots
Severe retinopathy will have
What are the causes of a hypertensive emergency?
Usually exacerbation of existing htn following removal of short acting antihypertensive drugs
2. Cocaine and amphetamine
What are the types of acute target organ damage that can be seen in the brain, heart, and kidney during a hypertensive emergency?
1. Brain: Stroke (lacunar infarct or hemorrhagic type) and hypertensive encephalopathy
2. Heart: ACS, acute left sided heart failure, and aortic dissection
3. Kidneys: Malignant nephrosclerosis
What is seen in the kidney during a hypertensive emergency and what is the pathogenesis?
Severe hypertension --> vasospasm and ischemia of vascular wall which causes necrosis or proliferation leading to
fibrinoid necrosis or hyperplastic arteriolosclerosis
You can also see microinfarctions and microhemorrhages (
This is all called
Picture of hyperplastic arteriolosclerosis in kidney
What happens in hypertensive encephalopathy? What will be seen on microscopy?
High BP --> dilation of small cerebral arteries and arterioles --> increased permeability --> cerebral edema --> raised intracranial pressure that can lead to coma and death
Arteriolar fibrinoid necrosis and Microhemorrhages
What is hypertensive urgency?
BP >180/120 but no target organ damage with only moderate hypertensive retinopathy (no papilledema)
What is the approach you should take when reading every ECG? (really remember this)
(If irregular look at rhythm strip and multiply by 6)
Rhythm and conduction
(Regular vs irregular; p for QRS and QRS for p; PR interval; QRS wide; ectopics?
(axis deviation; R&S amplitude)
(ST segment, T wave, and Q wave abnormalities?)
What should you think of first if aVR is positive?
Wrong lead placement
List of two more random ECG facts
Wide QRS means it's coming from the ventricles
V1 and V2 should be more negative because the left ventricle is dominant
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