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Coronary arteries:
Originate inside aorta
Fill during diastole
RCA—Supply Rt atrium and ventricle and AV node and Bundle of His.
LCA—supply the left atrium and ventricle.
Coronary arteries empty into the coronary sinus (venous flow), which empties into the Rt.
Atrium.
HTN—Chapter 32
Increased HR = Increased Oxygen demand
BP = CO x SVR
Systemic Vascular resistance—force opposing the movement of blood within the blood
vessels.
CO = SV X HR (total blood flow through the systemic or pulmonary circulation in one minute)
SV--blood pumped out from Lf. Ventricle each beat (aprox. 70 mL)
Normal CO = 4-8 L/min
1) Regulation:
Decreases HR
Vasodilation—via vagus nerve (Vaso vagal response Dec. HR and dec. BP)
~Maria Vogel’s Chapt 32 HTN—Med/Surg Page2~
c) Vascular Endothelium
d) Kidneys—rennin-angiotensin-aldosterone system.
Stages of HTN:
2) HTN—sustained BP of >140/90
3 + readings
a) Stage I –140-159/90-99
b) Stage II—160-179/100/109
c) Stage III-->180/110
Types of HTN:
a) Primary HTN
95% of case
Cause unknown
b) Secondary HTN
5% of cases
~Maria Vogel’s Chapt 32 HTN—Med/Surg Page3~
can identify cause—usually renal disease, sleep apnea, medications, estrogen and
NSAID, and Coarctation aorta.
3) Pathophysiology—
~ Increased SNS stimulation = Increased HR and Increased CO Increased vascular resistance
and Increased BP.
~ hyperinsulinemia or insulin resistance prevents nitricoxide release—prevents vasodilation.
6) Diagnostics:
a) H and P
b) Kidneys—UA BUN and creatinine signal kidney problems
c) chest x-ray
d) EKG
e) CBC
f) Lipids—cholesterol
g) Blood sugar
~Maria Vogel’s Chapt 32 HTN—Med/Surg Page4~
1. Treatment
3. HTN Crisis: --Not over time It is a severe and abrupt elevation with elevation of > 130
Diastolic.
Causes—Failure to comply, inconsistently taking medications
~ Response to cocaine, crack and LSD
~ Eclampsia.
VASOCONSTRICTION triggers endothelial damage, which leads to MI, Stroke, and
seizures.
Treatment:
Dec. Mean arterial pressure by 10-20% in first 1-2 hours.
MAP = Diastolic and 1/3 of pulse pressure
Pulse Pressure—difference between diastolic and systolic
Medications: Nitroprusside/Hyperstat
Apressoline
Given IV
Rx titrated for effect
Pt should be in intensive care because we don’t have an expected outcome.
Adrenegic Blockers—NORMADINE—Alpha Beta adrenergic blocking properties—produces
peripheral vasodilation, dec. HR which reduces CO, SVR, and BP.
? Add an oral Rx—vasotec (ACE inhibitor)