BP Regulation and Complications
Angiotensinogen is produced by this organ.
Liver
Hydrochlorothiazide is which class of medication?
Thiazide Diuretic
Explain how gastroenteritis can lead to an episode of orthostatic hypotension.
Increased vomiting/diarrhea leads to fluid loss which prevents adequate venous return upon standing.
How much does BP have to fall to diagnose orthostatic hypotension?
>20 systolic and/or >10 diastolic
What is the equation for EF when given EDV and ESV?
EF = (EDV - ESV) / EDV
List a class of antihypertensive medication that should be avoided in severe renal failure.
ACE inhibitors (↓ ATII, ↓Aldosterone), Potassium sparing diuretics (↑ K+), Other diuretics (↓ECV –> ↓GFR)
This peptide can build up when taking an ACE inhibitor leading to unwanted side effects, such as a cough.
bradykinin
Q1 While trying to tie his tie, Otto passes out. An increase of which type of ANS impulse leads to this effect.
Q2 Name the pathway this nervous impulse takes from the carotid baroreceptor to the SA node.
A1 Parasympathetic
A2 Carotid baroreceptor → Glossopharyngeal nerve (CN IX) → Nucleus Solitaire → Vagus nerve (CN X) → SA Node
This laboratory test can be used to distinguish between dehydration and kidney injury.
Blood urea nitrogen (BUN)
Name a maneuver that can increase afterload in a patient.
Hand grip, squatting
Maximus the gladiator, who’s never gone to the doctors, gets a pre-coloseum health check and is found to have a BP of 155/95 mmHg. Should anti-hypertensive medication be prescribed to him prior to his fight?
No because two high BP measurements are needed to make the diagnosis of hypertension.
Which calcium channel blocker class is primarily used to lower TPR?
Dihydropyridine (Nifedipine)
List two physiological factors that contribute to orthostatic hypotension.
Hypovolemia, Low TPR, Blunted ANS response
What is the purpose of a treadmill exercise stress echocardiogram.
To detect flow limiting coronary artery disease by detecting wall movement abnormalities
Which equation can be used to calculate blood pressure?
BP = CO x TPR
In renal artery stenosis what is the driving mechanism in developing hypertension?
Decreased blood flow leads to an increase in renin release which causes an increase in sodium and water retention. (Bonus: patients do not prevent as volume overloaded)
Q1 Which antihypertensive class can increase the risk for hypoglycemia.
Q2 In patients taking this medication class why is sweating the most predominant symptom of a hypoglycemia episode.
A1 B-Blockers
A2 Sweating is mediated by muscarinic receptors
Identify this cause of syncope from the image below.
Aortic Stenosis
A patient in a hypertensive emergency has developed MAHA. Which laboratory value is commonly elevated in patients with a hemolytic anemia.
Red Cell Distribution Width (RDW)
Chronically increased afterload can lead to this finding on EKG.
Large voltages in the QRS complex
Name this finding that can be seen in chronic hypertension and/or diabetes.
Hyaline arteriosclerosis
A patient is prescribed alsikerin for blood pressure, but it does not improve. Would adding an ARB lower the BP? Yes or no and why.
No, because alsikerin is a renin inhibitor and ARBs block angiotensin II receptor. Without renin, ATII would not be produced and hence an ARB would be ineffective. This combination can also lead to kidney failure.
Orthostatic hypotension can manifest in men taking this class of BPH medication. (Hint: Can also be a less used antihypertensive).
alpha 1 - blockers
A patient is taking a nondihydropyridine CCB, what EKG finding will be seen, and will this result in a widening of the QRS complex.
PR prolongation with no change in the QRS complex.
This equation can explain the increase in pulse pressure in patients with chronic hypertension. (hint compliance is involved)
ΔP = ΔV/C