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What is the most common of all health problems in adults?
What disease is commonly the silent killer and patients are asymptomatic?
What ethnicity was the patient with hypertension? How old was he?
What diseases did the hypertension patient's parents have?
- father: MI and HTN
- mother: diabetes and HTN
What are the risk factors for the hypertension patient?
- no exercise
- high salt, fat, carb diet
- stressful job
- african american
- genetic susceptibility
- body weight
What was going on with the heart in the patient with HTN?
left ventricle hypertrophy
What two symptoms/states did the HTN patient present with?
- gained 20 pounds
- shortness of breath
What are the systolic and diastolic values that indicate HTN?
- systolic = greater than 140
- diastolic = greater than 90
Which type of HTN has known causes and which one has unknown causes?
- primary: unknown
- secondary: known
What is the most common type of HTN?
What are the four main factors that control BP?
- electrolyte balance
- peripheral autoregulation
- alpha and beta receptors of the CNS and ANS
What electrolytes affect BP?
- natriuretic hormone
Describe what happens in the RAA system in response to a blockage in the renal artery.
- renal artery blockage
- kidneys secrete renin
- renin converted to Ang I in the liver
- Ang I converts to Ang II in the lungs
What does Ang II do?
- increases heart contractility
- increases cardiac output
- increases vasoconstriction
- retains salt and water to increase blood volume
- increases blood pressure
- increases total peripheral resistance
What are some of the known causes of secondary HTN?
- renal artery atherosclerosis
What are some tests done to determine HTN?
- BP times 2 or 3, then avgd
- Chest Xray
- blood test
What did the lab values for the HTN patient look like?
- high BP
- high BMI
- high GGT (liver)
- high lipids, low HDL
- (+) for microalbuminuria
- low ejection fraction
- increased QRS voltage
What drug is questionable for the HTN patient to be taking?
- Pseudoephedrine: causes vasoconstriction and increases heart rate
- this could be a problem
What meds can we use to treat HTN?
How do alpha 1 antagonist HTN meds work?
decrease BP by decreasing constriction by blocking NE from binding to the post synaptic receptor
How do alpha 2 agonists HTN meds work?
inhibit release of NE and epi
How do Ang II receptor inhibitor HTN meds work?
decrease vasoconstriction and aldosterone release
How do ACE inhibitors work for HTN?
prevent conversion of Ang I to Ang II which decreases cardiac output
How do beta blockers work for HTN?
- allow vasodilation
- block epinephrine
How do calcium channel blockers work for HTN?
block calcium channels in the heart which decreases heart rate
What type of blood pressure med was the HTN patient currently taking?
thiazide diuretic (HCTZ)
How do thiazide diuretics work for HTN?
they get rid of unneeded water and salt
How do endothelin antagonists work for treating HTN?
they block endothelin receptors which decreases blood pressure
What three OTC products could the HTN patient use to get his BP down?
What are the symptoms of the CHF patient?
- racing hearbeat
- shortness of breath
- swollen ankles and feet
- weak and tired
- breathing difficulties at night
What major events have happened to the CHF patient in the past?
- coronary artery bypass
What did the parent's of the 69 yr old female CHF patient have?
- father died of heart attack
- mother has had several strokes
What is the most common form of CHF?
left sided heart failure = shortness of breath
Is CHF more common in males than females?
yes, from 40-75
What are some common causes of CHF ?
- viral infections
- valvular heart disease
- systemic HTN
What did the electrolytes look like for the CHF patient?
- sodium: high
- potassium: low
Why were the sodium and potassium abnormal in the CHF patient?
- increased aldosterone
- maybe increased RAA activation
What LFT was high in the CHF patient? And what does this indicate?
- high AST
- indicative of heart damage
What did the CHF patient's arterial blood gases reveal?
- PaCO2: high
- PaO2: low
- due to impaired breathing b/c of pulmonary edema
Why were the CHF patient's renal function tests both high?
decreased renal blood flow and urine output = high BUN and high SCr
Was the patient with CHF's ejection fraction high or low?
low: ventricular dysfunction
What is cor pulmonale?
right sided heart failure due to problems with the lungs
What does left-sided heart failure look like?
heart can't contract so it dilates and fails
What does right-sided heart failure look like?
dilation and failure due to increased resistance to ventricular emptying
Which type of heart failure causes edema and hepatomegaly, JVD, and HJR?
What is diastolic heart failure?
the heart can't relax enough to fill ventricles with blood
What is systolic heart failure?
the heart cannot contract enough to get blood out of the ventricles
Which two catecholamines cause toxicity to myocytes in the heart?
epi and NE
What is bronchiectasis?
- dilation of bronchioles causing risk of infection
- from foreign bodies, CF
What is atelectasis?
- incomplete expansion of the lung or portion of the lung due to mucus plug or pores of Kohn
- alveoli collapse
What does aldosterone do?
- retains salt and water
- contributes to high salt and low potassium
What three things (cytokines and hormone) are elevated in CHF patients?
What drug was the CHF patient allergic to?
What type of heart failure did the CHF patient have?
total: both left and right side heart failure
What is ARDS?
- diffuse alveolar capillary damage
- massive inflammatory response to an injury
What risk factors did the CHF patient have?
- previous heart disease/events
- potential diabetes
What does triamterene do?
reduce potassium excretion which will increase potassium levels
What is dyspnea?
shortness of breath
What is orthopnea?
dyspnea when lying down
What is eupnea?
What is a Kussmaul respiration?
What is Cheyne-Stokes breathing?
alternating periods of deep and shallow breathing
What type of breathing causes hypocapnea?
What causes respiratory alkalosis?
hyperventilation and hypocapnea
What is hypocapnea?
What is hypercapnea?
What causes respiratory acidosis?
hypoventilation or hypercapnea
What drugs are known to cause cough?
What can cause hemoptysis?
- lung cancer
What is polycythemia?
What is the difference b/w hypoxia and hypoxemia?
- hypoxia: decreased oxygen to tissues
- hypoxemia: decreased oxygen in arterial blood
Is hypoxia always caused by hypoxemia?
no, could be low cardiac output or cyanide
What is V/Q ratio?
ventilation to perfusion ratio
What does a low V/Q tell us?
good perfusion or well-perfused but inadequate ventilation
What does a high V/Q tell us?
adequate ventilation but inadequate perfusion
What is FVC?
forced vital capacity
What is FEV1?
forced expiratory volume in one second
What is the difference between acidemia and acidosis?
- acidosis: mixed venous blood
- acidemia: directly from arterial blood
What can measure oxygen saturation once PaO2 has been measured, but not PaCO2 or pH?
In what lung condition does collagen form?
How are the lungs kept dry?
- lymphatic drainage
- capillary hydrostatic and oncotic pressure
What are some common causes of pulmonary edema?
- toxic gases
- injury to pulm capillaries
- plasma protein leakage
- lymphatic obstruction
At what pulmonary capillary wedge pressure does pulmonary edema begin?
What is a Swan-Ganz catheter?
a balloon-tipped catheter used to measure pulmonary capillary wedge pressure by going directly into the pulmonary artery and through the right ventricle
How do we treat pulmonary edema?
- give oxygen
- get rid of toxins/irritants
Which lung is more susceptible to aspiration?
What term describes imperfect expansion of the lungs (collapsed lung)?
What condition of the lungs would you likely see post-op?
How does deep breathing relieve atelectasis?
by opening up the pores of Kohn
persistent abnormal dilation of the bronchi
What is more common, focal, or diffuse bronchiectasis?
What type of bronchiectasis is usually seen after pneumonia and is reversible?