Week 8:NR283/NR283 Pathophysiology Week 8
What is the other name for malignant hypertension - ANSWER:Hypertensive crisis
What is characteristic in terms of timing of a hypertensive crisis - ANSWER:Things happen fast, relatively
speaking, for whatever reason (e.g. patients runs out of meds, renal artery stenosis, etc.)
What is mortality after a hypertensive crisis - ANSWER:mortality is about 90% after just one year
What kind of damage occurs in in a hypertensive crisis - ANSWER:Organs can't take the pressure,
damage occurs in kidneys first, eyes, brain, vessels may swell and pop, etc.
What is the number one concern in a hypertensive crisis - ANSWER:Stroke
What is common remodeling seen in the heart due to hypertension - ANSWER:Left side of the heart gets
bigger - hypertrophy, not hyperplasia - due to chronic demand for more power/work, and this can
ultimately cause it to fail
What happens to the lumen of the heart after prolonged hypertension - ANSWER:Lumen of the
ventricles gets reduced, less volume for blood to get pushed out, which makes the heart work harder
and hypertrophy
What happens to end diastolic volume in the heart after prolonged hypertension - ANSWER:Lose end
diastolic volume in the left ventricle
Has to compensate for this by jacking heart rate and increased work by myocardium
What happens to blood vessels after prolonged hypertension - ANSWER:become much less compliant,
they get tough, and this makes the heart have to work harder
How do changes in blood vessels due to hypertension affect the ability of blood to perfuse -
ANSWER:make blood work harder in tissues themselves, meaning it's hard to get the blood in and out of
capillaries.
What are the new standards of treatment for hypertension - ANSWER:120/80
What are the four main categories of drugs for hypertension - ANSWER:Calcium channel blockers,
angiotensin converting enzyme inhibitors, beta blockers (beta-adenergic receptors), diuretics
The CV system naturally wants to run backwards, what keeps this from happening - ANSWER:valves are
the only thing keeping blood flowing in the direction it flows
Problems with valves cause problems in two ways, what are they - ANSWER:blood flows backwards
(regurgitates), and/or
blood flow is impeded (stenosis)
Many valve problems also occur as a result of rheumatic fever. What can lead to this -
ANSWER:Streptococcal infections of head/throat can lead to rheumatic fever, usually during childhood.
, Most valve problems are due to what fact - ANSWER:We outlive our valves
Are you more susceptible to rheumatic fever once you've had one bout of it - ANSWER:Yes, bouts of
rheumatic fever was associated with continual damage to CV, encourages more bouts of it
What causes rheumatic fever - ANSWER:Don't really know what causes rheumatic fever, but it may be
hyper-immune response to strep, and/or
direct damage caused by strep on tissues
Immune response theory of rheumatic fever seems most likely, why - ANSWER:Have antibodies
developed against strep reacting also against self (e.g. valve tissues)
How does rheumatic fever damage the CV system - ANSWER:cause damage to valves (and other heart
tissues, endothelium) which causes problems over a long period of time
How long can it take the CV symptoms from rheumatic fever to show up - ANSWER:Years
What, specifically, happens to valves in rheumatic fever - ANSWER:Over time, valves become sclerotic
and calcified, which affects their performance
Why does the left side of the heart seem to be diseased the most? - ANSWER:Likely because of high
pressures
Valve disease can result from non-rheumatic things, like what? - ANSWER:like congenital defects,
infections of the heart, and atherosclerosis
There is a problem with blood getting from the left atrium to the left ventricle during ventricular diastole.
What disease is this, most likely - ANSWER:Mitral stenosis
Are there pressure differences between the left chambers in the heart - ANSWER:In a normal heart there
is no real pressure difference that develops between these two chambers
Why does mitral stenosis generate pressure differences (positive pressure in the atrium) in the left side
of the heart - ANSWER:Because the atria now has to push blood through the smaller mitral valve
How does the atria first respond to mitral stenosis - ANSWER:The atrium, to push blood through the
mitral better, hypertrophies, and usually dilates too.
What kind of hypertrophy involves a thickening of tissue? A thinning and elongation of tissue? -
ANSWER:Thickening of the myocardium is concentric hypertrophy
Thinning/elongation is called eccentric hypertrophy
What happens after the atrium starts to thicken because of mitral stenosis - ANSWER:Pressure backs up
into the pulmonary circulation, all the way to the right ventricle, which hypertrophies too; pulmonary
congestion & hypertension are a result
What is the hallmark sign of mitral stenosis - ANSWER:Dyspnea on exertion is a hallmark of mitral
stenosis.
What is the other name for malignant hypertension - ANSWER:Hypertensive crisis
What is characteristic in terms of timing of a hypertensive crisis - ANSWER:Things happen fast, relatively
speaking, for whatever reason (e.g. patients runs out of meds, renal artery stenosis, etc.)
What is mortality after a hypertensive crisis - ANSWER:mortality is about 90% after just one year
What kind of damage occurs in in a hypertensive crisis - ANSWER:Organs can't take the pressure,
damage occurs in kidneys first, eyes, brain, vessels may swell and pop, etc.
What is the number one concern in a hypertensive crisis - ANSWER:Stroke
What is common remodeling seen in the heart due to hypertension - ANSWER:Left side of the heart gets
bigger - hypertrophy, not hyperplasia - due to chronic demand for more power/work, and this can
ultimately cause it to fail
What happens to the lumen of the heart after prolonged hypertension - ANSWER:Lumen of the
ventricles gets reduced, less volume for blood to get pushed out, which makes the heart work harder
and hypertrophy
What happens to end diastolic volume in the heart after prolonged hypertension - ANSWER:Lose end
diastolic volume in the left ventricle
Has to compensate for this by jacking heart rate and increased work by myocardium
What happens to blood vessels after prolonged hypertension - ANSWER:become much less compliant,
they get tough, and this makes the heart have to work harder
How do changes in blood vessels due to hypertension affect the ability of blood to perfuse -
ANSWER:make blood work harder in tissues themselves, meaning it's hard to get the blood in and out of
capillaries.
What are the new standards of treatment for hypertension - ANSWER:120/80
What are the four main categories of drugs for hypertension - ANSWER:Calcium channel blockers,
angiotensin converting enzyme inhibitors, beta blockers (beta-adenergic receptors), diuretics
The CV system naturally wants to run backwards, what keeps this from happening - ANSWER:valves are
the only thing keeping blood flowing in the direction it flows
Problems with valves cause problems in two ways, what are they - ANSWER:blood flows backwards
(regurgitates), and/or
blood flow is impeded (stenosis)
Many valve problems also occur as a result of rheumatic fever. What can lead to this -
ANSWER:Streptococcal infections of head/throat can lead to rheumatic fever, usually during childhood.
, Most valve problems are due to what fact - ANSWER:We outlive our valves
Are you more susceptible to rheumatic fever once you've had one bout of it - ANSWER:Yes, bouts of
rheumatic fever was associated with continual damage to CV, encourages more bouts of it
What causes rheumatic fever - ANSWER:Don't really know what causes rheumatic fever, but it may be
hyper-immune response to strep, and/or
direct damage caused by strep on tissues
Immune response theory of rheumatic fever seems most likely, why - ANSWER:Have antibodies
developed against strep reacting also against self (e.g. valve tissues)
How does rheumatic fever damage the CV system - ANSWER:cause damage to valves (and other heart
tissues, endothelium) which causes problems over a long period of time
How long can it take the CV symptoms from rheumatic fever to show up - ANSWER:Years
What, specifically, happens to valves in rheumatic fever - ANSWER:Over time, valves become sclerotic
and calcified, which affects their performance
Why does the left side of the heart seem to be diseased the most? - ANSWER:Likely because of high
pressures
Valve disease can result from non-rheumatic things, like what? - ANSWER:like congenital defects,
infections of the heart, and atherosclerosis
There is a problem with blood getting from the left atrium to the left ventricle during ventricular diastole.
What disease is this, most likely - ANSWER:Mitral stenosis
Are there pressure differences between the left chambers in the heart - ANSWER:In a normal heart there
is no real pressure difference that develops between these two chambers
Why does mitral stenosis generate pressure differences (positive pressure in the atrium) in the left side
of the heart - ANSWER:Because the atria now has to push blood through the smaller mitral valve
How does the atria first respond to mitral stenosis - ANSWER:The atrium, to push blood through the
mitral better, hypertrophies, and usually dilates too.
What kind of hypertrophy involves a thickening of tissue? A thinning and elongation of tissue? -
ANSWER:Thickening of the myocardium is concentric hypertrophy
Thinning/elongation is called eccentric hypertrophy
What happens after the atrium starts to thicken because of mitral stenosis - ANSWER:Pressure backs up
into the pulmonary circulation, all the way to the right ventricle, which hypertrophies too; pulmonary
congestion & hypertension are a result
What is the hallmark sign of mitral stenosis - ANSWER:Dyspnea on exertion is a hallmark of mitral
stenosis.
