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MEDICINE > 1 - ACS and Hypertension > Flashcards

1 - ACS and Hypertension Flashcards

1
Q

What are the different stages of hypertension?

A

Stage 1: 140/90 or 135/85 HBPM/ABPM

Stage 2: 160/100 or 150/95 HBPM/ABPM

Severe/Stage 3: Sys>180 or Dia>120

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2
Q

How is hypertension diagnosed?

A

If >140/90 then offer ambulatory BP or home BP to check it is true before treating

If severe treat immediately with no ABPM/HBPM

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3
Q

What is malignant hypertension?

A

Rapid rise in blood pressure to over 200/130, leading to vascular and organ damage

Can causes bilateral retinal haemorrhages, headache, visual disturbances

Needs urgent treatment (BB or CCB)

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4
Q

Hypertension can be primary (90%) or secondary (10%). What are some secondary causes of hypertension?

A
  • Renal disease: renal artery stenosis, polycystic kidneys
  • Cushing’s
  • Phaeochromocytoma
  • Pregnancy
  • Drugs
  • COCP
  • Cocaine
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5
Q

What are some symptoms of hypertension?

A
  • Usually asymptomatic
  • Sweating, headache, palpitations and anxiety if phaeochromocytoma
  • Muscle weakness or tetany in hyperaldosteronism
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6
Q

What are some signs on examination of a patient with hypertension?

A
  • Retinopathy
  • Palpable kidneys/renal bruits
  • Radiofemoral delay in coarctation
  • Signs of Cushing’s
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7
Q

What other tests apart from BP are performed when a patient is newly diagnosed with hypertension?

A
  • Urine dip
  • Bloods
  • Retinopathy
  • ECG
  • ECHO

- Q Risk score

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8
Q

How do you test for end organ damage in hypertension?

A
  • Check for proteinuria or haematuria
  • Check for retinopathy
  • Do ECHO for LV hypertrophy
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9
Q

When should hypertension be pharmacologically managed?

A

Stage 1: if under 80 and end organ damage

Stage 2 and above: everyone should be offered

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10
Q

What are target blood pressures to bear in mind when treating hypertension?

A
  • Low-moderate risk: <140/90

- Diabetic/Previous Stroke: <130/80 (keep below 85)

- Elderly >80: <150/90

Reduce slowly, can be fatal if lower too rapidly!

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11
Q

How is hypertension treated non-pharmacologically?

A
  • Weight loss
  • Stop smoking
  • Reduce alcohol
  • Reduce salt intake
  • Aerobic exercise
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12
Q

How is hypertension treated pharmacologically?

A

ACD rule!

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13
Q

What are some side effects of the following antihypertensive drugs?

  • Thiazides
  • CCBs
  • ACEi
  • ARB
  • BB
A

Thiazides: impotence, hypoK, hypoNa, cannot use in gout

CCB: ankle oedema, flushing, gum hyperplasia

ACEi: cough, hyper K, renal failure, angio-oedma

ARB: vertigo, urticaria, be careful in valve disease

BB: bronchospasm, cold peripheries, impotence

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14
Q

Why should you drop hypertension slowly?

A

Any sudden drops in BP increases stroke risk as cerebral autoregulation is poor

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15
Q

What is the definition of a hypertensive emergency?

A

Increase in BP which if sustained over the next few hours will cause irreversible end organ damage (encephalopathy, LV failure, aortic dissection, unstable angina, renal failure)

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16
Q

What is the difference between a hypertensive emergency and urgency?

A

Emergency - High BP with critical illness (AKI,MI, Encephalopathy). Will cause damage over hours

Urgency - High BP without critical illness at the moment, often accompanied by retinal damage. Will cause damage over days

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17
Q

How is a hypertensive emergency managed?

A

Aim to reduce diastolic BP to 110 in 3-12 hours (if emergency) or 24 hours (if urgency)

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18
Q

How is hypertensive urgency managed?

A

Reduce diastolic gradually to <100 over 48-72 hours using PO drugs

Usually a combination of ACEi and CCB or Nifedipine AND Amlodipine for 3 days and then continue Amlodipine alone

  • Amlodopine
  • Diltiazem
  • Lisinopril
19
Q

What is the classic triad of symptoms for patients with a phaeochromocytoma?

A
  • Episodic headache
  • Sweating
  • Tachycardia

with sustained/paroxysmal hypertension

20
Q

How is phaeochromoctyoma diagnosed?

A

24h urine collection: measure urinary and plasma metanephrines and catecholamines

Can do MRI or CT abdo/pelvis to detect adrenal tumours

21
Q

How is a phaeochromocytoma managed after diagnosis?

A
  • Surgical resection

- Whilst awaiting surgery hypertension control: combined alpha and beta blockade. Start alpha blocker first (phenoxybenzamine) then add beta blocker when alpha blockade achieved. Never BB first

22
Q

How do you diagnose Cushing’s syndrome as the underlying cause of hypertension?

A
  • Physical appearance
  • Hyperglycaemia
  • Elevated 24h urine cortisol

- Diagnosis: low dose dexamethasone suppression test

  • Need to do adrenal CT
23
Q

When should you suspect primary hyperaldosteronism as the cause of hypertension and how do you diagnose this?

A

Suspect:

  • Low K+ and high/normal Na+
  • FHx of premature hypertension
  • Resistant hypertension

Diagnose:

  • Aldosterone:renin ratio measured in the morning. Will be very high
  • Adrenal CT
24
Q

How does the RAAS system work?

A
25
Q

What are some causes of postural hypotension?

A
  • Hypovolemia
  • Drugs e.g diuretics, nitrates, antipsychotics
  • Autonimic neuropathy
  • Hypopituatirism
26
Q

How do you treat postural hypotension?

A
27
Q

What are some signs of hyperlipidaemia?

A
  • Xanthoma
  • Xanthelasma
  • Corneal arcus
28
Q

What are the causes of the following pulses:

  • Bounding pulse
  • Collapsing waterhammer pulse
  • Slow rising anacrotic pulse
  • Jerky pulse
  • Pulsus paradoxus
A

Bounding: sepsis, CO2 retention, liver failure

Collapsing pulse: aortic regurgitation, AV malformation, PDA

Slow rising: aortic stenosis

Jerky pulse: HCM

Pulsus paradoxus: severe asthma, pericardial constriction, cardiac tamponade

29
Q

What does each part of the JVP wave form represent?

A
30
Q

S1 is the closure of the mitral and tricuspid valve. S2 is closure of the pulmonary and aortic valve. What makes a loud S1, soft S1, loud A2 and loud P2?

A

Loud S1: Mitral stenosis

Soft S1: Mitral regurg

Loud A2: tachycardia, hypertension

Loud P2: pulmonary hypertension

31
Q

When do you hear an opening snap?

A

Mid diastolic murmur of mitral stenosis usually due to calcification

32
Q

What do the following murmurs indicate:

  • Ejection-systolic
  • Pansystolic
  • Early diastolic
  • Mid diastolic
A

Ejection Systolic: (Crescendo-Decresendo) aortic stenosis, pulmonary stenosis

Pansystolic: mitral regurgitation, tricuspid regurgitation

Early diastolic: aortic regurgitation

Mid diastolic: mitral stenosis, rheumatic fever, Carey Coombs

33
Q

Which murmurs radiate and to where?

A

Aortic stenosis: carotids

Mitral regurgitation: axilla

34
Q

Which murmurs can be heard best when leaning forward, left lateral positioned, expiring?

A

- Leaning forward: aortic regurg

- Left lateral: mitral stenosis

- Expiring: left sided murmurs as expiring increases blood follow to left side of heart

35
Q

What are the following signs:

  • De Mussets
  • Corrigan’s
  • Muller’s
  • Quincke’s
  • Traubes’
A

All signs of aortic regurgitation

Lookat Quinke and demussets

36
Q

Why are transoesophageal echos better than transthoracic and what are they used for?

A

Closer to the heart so more sensitive

  • Cardiac emboli
  • Aortic dissections
  • Assessing prosthetic valves
37
Q

What is cardiac catheterisation used for and what are some complications of this procedure?

A
  • Angioplasty
  • Valvuloplasty
  • Intravascular ultrasound or ECHO
38
Q

What is used second line to treat hypertension for an Afro-Carribbean patient?

A

ARB e.g Valsartan

39
Q

Which valve is the most commonly affected in infective endocarditis?

A

Mitral valve

40
Q

What medication do you need to give a patient before PCI?

A

Dual antiplatelet therapy with aspirin and a P2Y12 antagonist(-grel)

PLUS

Unfractionated Heparin

41
Q

What is the difference between a STEMI and an NSTEMI?

A

STEMI is complete occlusion of the coronary artery but NSTEMI is only partial

Both result in tissue necrosis

42
Q

How is hypertensive retinopathy graded?

A

1 - Tortuous arterterues with thick shiny walls

2 - AV nipping where arteries cross veins

3 - Flame haemorraghes and cotton wool spots

4 - Papilloedema

43
Q

How should cocaine induced MI be managed?

A

Benzodiazepine plus GTN

MEDICINE (25 decks)

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